“Human resistance to antibiotics could bring ‘the end of modern medicine as we know it’,” according to The Daily Telegraph. The newspaper says that we are facing an antibiotic crisis that could make routine operations impossible and a scratched knee potentially fatal. Similarly, the Daily Mail’s headline stated that a sore throat could soon become fatal.
The alarming headlines follow a new report by the World Health Organization (WHO , which set out ways to fight the growing problem of antimicrobial resistance (AMR . AMR occurs when infectious organisms, such as bacteria and viruses, adapt to treatments and become resistant to them. The publication specifically addressed the long-known problem of antibiotic resistance, where increasing use of antibiotics can lead to the formation of “superbugs” that resist many of the antibiotic types we currently have. It outlined a variety of measures that are vital for ensuring we can still fight infections in the future and described how other major infectious diseases, such as tuberculosis, HIV, malaria and influenza, could one day become resistant to today’s treatment options.
However, despite the future danger posed by antimicrobial resistance, the situation is not irretrievable. As Dr Margaret Chan, director general of WHO, said: “much can be done. This includes prescribing antibiotics appropriately and only when needed, following treatment correctly, restricting the use of antibiotics in food production to therapeutic purposes and tackling the problem of substandard and counterfeit medicines.” The report also highlighted successful cases where antimicrobial resistance has been tackled, demonstrating that we can safeguard the effectiveness of important antimicrobial medicines with dedicated, rational efforts.
Where has the news come from?
WHO has just published a new report (“The evolving threat of antimicrobial resistance - Options for action” that sets out a global strategy for fighting antibiotic resistance. It explores how over past decades, bacteria that cause common infections have gradually developed resistance to each new antibiotic developed, and how AMR has evolved to become a worldwide health threat. In particular, the report highlights that there is currently a lack of new antibiotics in development and outlines some of the measures needed to prevent a potential global crisis in healthcare.
This is not the first time WHO has set out such a strategy. In the 2001, WHO published its “Global strategy for containment of antimicrobial resistance”, which laid out a comprehensive list of recommendations for combating AMR. The current report looks at the experiences over the past decade of implementing some of these recommendations, the progress made, and what else should be done to tackle AMR.
What is antimicrobial resistance?
Antimicrobial resistance (AMR occurs when microorganisms, such as bacteria, viruses, fungi or other microbes, develop resistance to the drug that is being used to treat them. This means that the treatment no longer effectively kills or inactivates the microorganism. The term “antimicrobial” is used to describe all drugs that treat infections caused by microorganisms. Antibiotics are effective against bacteria only, antivirals against viruses only, and antifungals against fungi.
The case of penicillin illustrates the AMR phenomenon well. When penicillin was first introduced in the 1940s, it revolutionised medicine and was effective against a wide range of staphylococcal and streptococcal bacteria. It was also able to treat infections that had previously been fatal for many people, including throat infections, pneumonia and wound infections. However, with increasing use of antibiotics over the decades, bacteria began to adapt and develop changes in their DNA that meant they were resistant to the actions of the once-powerful antibiotic. These bacteria would survive and proliferate, which meant their protective genes would then be passed on to other strains of bacteria. As a result, new and stronger antibiotics had to be created to combat the resistant bacteria.
AMR is driven by many factors, including overuse of antimicrobials for human and animal health and in food production, which can allow microbes to adapt to antimicrobials they are exposed to. Poor infection-control measures, which fail to prevent the spread of infections, also contribute. In particular, the WHO publication reports what it describes as the five most important areas for the control of AMR, as recognised in its 2001 strategy:
- surveillance of antimicrobial use
- rational use in humans
- rational use in animals
- infection prevention and control
- innovations in practice and new antimicrobials
How big is the problem?
As the report describes, AMR makes it difficult and more expensive to treat many common infections, causing delays in effective treatment or, in the worst cases, an inability to provide effective treatment at all. Many patients around the world suffer harm because infections from bacteria, viruses, fungi or other organisms can no longer be treated with the common medicines that would once have treated them effectively.
The report presents some startling facts on major infectious diseases worldwide:
- Malaria: malaria is caused by parasites that are transmitted into the blood stream by a bite from an infected mosquito. Resistance to antimalarial medicines has been documented for all classes of the drug, which presents a major threat to malaria control. The report describes that a change in national antimalarial treatment policy is recommended when the overall treatment failure rate exceeds 10%. Changes in policy have been necessary in many countries due to the emergence of chloroquine resistance. This means that alternative forms of combination therapy have to be used as first-line treatment.
- Tuberculosis: in 2010, an estimated 290,000 new multidrug-resistant tuberculosis (TB cases were detected among the TB cases notified worldwide, and about one-third of these patients may die annually. Inaccuracies in diagnosis also impede appropriate treatment.
- HIV: resistance rates to anti-HIV drug regimens ranging from 10% to 20% have been reported in Europe and the USA. Second-line treatments are generally effective in patients when the first-line therapy has failed, but can only be started promptly if viral monitoring is routinely available.
- Common bacterial infections: various bacteria can cause infections within the chest, skin and urinary tract bloodstream, for example, and the inability to fight these infections appears to a growing problem in healthcare. Estimates from Europe are that there are 25,000 excess deaths each year due to resistant bacterial hospital infections, and approximately 2.5 million avoidable days in hospital caused by AMR. In addition, the economic burden from additional patient illness and death is estimated to be at least ˆ1.5 billion each year in healthcare costs and productivity losses.
What can be done about AMR?
The five key areas that the report highlights could tackle the problem of AMR are as follows:
Surveillance of antimicrobial use
Tracking antimicrobial use (in particular antibiotic use and looking at the emergence and spread of resistant strains of bacteria is a key tactic in the fight against AMR. This can provide information, insights and tools needed to guide policy and measure how successful changes in prescribing may be. This can happen both locally and globally.
AMR is a global problem but, at present, there appears to be wide variation in the way regions and countries approach AMR surveillance. This means there is a long way to go before it can be carried out worldwide.
Rational use in humans
Antimicrobials can obviously be important or even lifesaving in appropriate situations, but it is just as important to prevent unnecessary use of antimicrobials, which can lead to resistance. Putting this into practice worldwide is said to be difficult, but rationalising antimicrobial use has had a demonstrable impact on AMR in some cases.
Rational use in animals
Antibiotics are said to be used in greater quantities in food production than in the treatment of disease in human patients. Also, some of the same antibiotics or classes are used in animals and in human medicine. This carries the risk of the emergence and spread of resistant bacteria, including those capable of causing infections in both animals and people.
The problems associated with the use of antibiotics in animal husbandry, including in livestock, poultry and fish farming, are reportedly growing worldwide without clear evidence of the need for or benefit from it. There are said to be major differences in the amounts of antimicrobials used per kilogram of meat produced in high-income countries, and actions need to be taken by national and international authorities to control this.
Infection prevention and control in healthcare facilities
The hospital environment favours the emergence and spread of resistant bacteria. The report highlights the importance of infection-control measures to prevent the spread of microbes in general, regardless of whether they are resistant to antimicrobials. Many facilities and countries are reported to have progressed well since 2001, implementing many recommendations on infection control and prevention, although gaps and challenges still remain.
Innovations
Lastly, the report describes how innovative strategies and technologies are needed to address the lack of new antimicrobials being produced. As the report says, while antimicrobials are the mainstay of treatment for infections, diagnostics and vaccines play important complementary roles by promoting rational use of such medicines and preventing infections that would require antimicrobial treatment. So far, new products coming on to the market have not kept pace with the increasing needs for improvements in antimicrobial treatment. However, current challenges to new research developments can be both scientific and financial.
Can these strategies really stop AMR?
While AMR poses a significant threat to health in the future, the situation does not appear to be irretrievable. The WHO report and an accompanying press release highlight some examples of success stories over the past years:
- In Thailand, the "Antibiotic Smart Use" programme is reported to have reduced both the prescribing of antibiotics by prescribers and the demand for them by patients. It demonstrated an 18–46% decrease in antibiotic use, while 97% of targeted patients were reported to have recovered or improved regardless of whether they had taken antibiotics.
- A pharmacy programme in Vietnam reportedly consisted of inspection of prescription-only drugs, education on pharmacy treatment guidelines and group meetings of pharmacy staff. These measures were reported to give significant reduction in antibiotic dispensing for acute respiratory infections.
- In Norway, the introduction of effective vaccines in farmed salmon and trout, together with improved fish health management, was reported to have reduced the annual use of antimicrobials in farmed fish by 98% between 1987 and 2004.
- In 2010, the University of Zambia School of Medicine was reported to have revised its undergraduate medical curriculum. AMR and rational use of medicines were made key new topics to ensure that graduates who enter clinical practice have the right skills and attitudes to be both effective practitioners and take a role in fighting AMR.
How can I do my part?
There are times when antibiotics are necessary or even vital. However, as patients and consumers, it is important to remember that antibiotics or other antimicrobials are not always needed to treat our illnesses, and we should not expect them in every situation.
For example, the common cold is caused by a virus, which means it does not respond to antibiotics. However, people may expect to be given antibiotics by their doctor when they are affected, even though they offer no direct benefit and could raise the risk of bacteria becoming resistant. Furthermore many common viral and bacterial infections such as coughs, throat and ear infections and stomach upsets, are “self-limiting” in healthy people, which means they will generally get better with no treatment at all.
If, on the other hand, you are prescribed an antimicrobial, it is important to take the full course as directed. Taking only a partial course of an antimicrobial may not kill the organism but may expose it to a low dose of a drug which can then contribute to resistance.
Links To The Headlines
Health chief warns: age of safe medicine is ending. The Independent, March 16 2012
Human resistance to antibiotics could bring "the end of modern medicine as we know it", WHO claim. The Daily Telegraph, March 16 2012
Why a sore throat could soon be fatal: Bugs are becoming more resistant to antibiotics, warn health chiefs. Daily Mail, March 16 2012
Links To Science
WHO: The evolving threat of antimicrobial resistance - Options for action. March 16 2012
President Obama speaks at a rally in Largo, Md., on Thursday. Photo by Chip Somodevilla/Getty Images.
After months of dipping their toes in the re-election waters, President Obama and Vice President Joe Biden have jumped full-on into the general election expanse.
The president confronted his GOP critics Thursday in a speech on energy policy at Prince George's Community College in Largo, Md., just outside the Washington beltway.
"A lot of the folks who are running for a certain office who shall go unnamed, they've been talking down new sources of energy," Mr. Obama told a crowd of students. "They dismiss wind power. They dismiss solar power. They make jokes about biofuels. They were against raising fuel standards. I guess they like gas-guzzlers," he said.
"If some of these folks were around when Columbus set sail -- they must have been founding members of the Flat Earth Society," the president said. "They would not have believed that the world was round."
Former House Speaker Newt Gingrich responded while campaigning in Illinois, describing the president's remarks as "utter intellectual nonsense" and contending Mr. Obama belongs to "the Flat Earth Sierra Club Society."
"Ask the president why is Saudi oil good and American oil bad? Why is Saudi drilling good and American drilling bad?" Gingrich said.
Biden traveled to the battleground state of Ohio and took aim at Gingrich and the other GOP contenders for their opposition to the federal bailout of the auto industry.
"Mitt Romney, Rick Santorum, and Newt Gingrich -- these guys have a fundamentally different economic philosophy than we do," Biden said. "We're about promoting the private sector, they're about protecting the privileged sector. We are for a fair shot and a fair shake. They're about no rules, no risks, and no accountability."
The Obama campaign also highlighted the decision to rescue the auto industry in a 17-minute video released Thursday titled "The Road We've Traveled."
Watch it
here or below.
The video, narrated by actor Tom Hanks, includes testimonials from the president, first lady Michelle Obama, the vice president, former President Bill Clinton, Chicago Mayor and former White House chief of staff Rahm Emanuel and others. It frames the dire economic picture the president faced when elected in 2008 and touches on actions he took regarding the stimulus, health care reform and the killing of Osama bin Laden.
The only specific mention of any of the president's GOP rivals comes during the defense of the action on the auto industry. "A lot of conventional wisdom wanted to do what Mitt Romney did -- let it go, it can't be saved, why put good money after bad," Emanuel says in the video as an image of Romney's Wall Street Journal editorial, "Let Detroit Go Bankrupt," is showed on the screen.
MESSAGING ONLINE
Discussion about the Obama campaign's video began Thursday's NewsHour segment with the
Daily Download, which examined the race online.
Ray Suarez (
@raysuareznews talked with Howard Kurtz and Lauren Ashburn about how the campaign used the film to collect supporter data. They also talked about the #stoprush movement and the difficulties of controlling campaign messages when Facebook groups spring up opposing the candidate.
Watch
here or below.
2012 LINE ITEMS
"With minimal campaign organization and less funds than his rivals, Santorum has boosted his campaign with the votes of a network of evangelical Christians, anti-abortion rights activists and home-schooling parents who are resisting" Romney, Bloomberg reports in a
story headlined "Santorum Relies on Prayers, Donated Buses to Get Vote Out."
Former Pennsylvania Sen. Arlen Specter's new book is not all that helpful to Santorum, Politico's Manu Raju
reports.
USA Today's Judy Keen
tees up Illinois as the next big primary test for Romney and Santorum.
Emanuel questioned Romney's convictions Thursday, saying the GOP candidate "doesn't have the fortitude, the strength or the character in my view to stand up to Rush Limbaugh,"
reports Fran Spielman of the Chicago Sun-Times. Emanuel's criticism was in reference to derogatory remarks made by Limbaugh about a Georgetown University law student who testified before Congress in support of the administration's birth control policy.
Romney
defended Fox News Thursday from criticism by Santorum that the cable network was favoring the former Massachusetts governor in its coverage of the GOP race.
The pro-Santorum Red White and Blue Fund announced $310,000 worth of television ads in Illinois, saying it "has now become a two-person race and this new ad in Illinois demonstrates the difference between Mitt Romney -- a supporter of bailouts and government spending sprees -- and Rick Santorum who is a conservative who wants to cut spending and create jobs." Stuart Roy, an adviser to the group, said in a statement, "Every state where we have been on the air with a threshold amount to drive home our message about Rick Santorum as a consistent conservative we have either split the delegates or won the state outright. Illinois is an important state to continue our momentum."
Watch the ad
here or below.
Romney released a radio ad in Puerto Rico called "Oportunidad."
Listen.
Reuters
writes that "more than two dozen veterans of the Bush administration have flocked to Romney's campaign."
Santorum
did well among young voters in Tuesday's Southern primaries.
The GOP presidential debate scheduled for Monday in Portland, Ore.,
was officially canceled Thursday after Romney and Santorum both declined to appear.
The Democratic National Committee keeps up the Romney-is-against-women drumbeat in another web video out Friday.
Watch.
TOP TWEETS
Awesome picture leading El Vocero, where Romney penned open letter to Puerto Rick GOP voters:
twitpic.com/8x02xk
March 16, 2012
US/Mexico border fence in Nogales
twitpic.com/8wqaov
March 15, 2012
Meet the Twitterati, the 19 most popular people on Twitter
huff.to/yGu0fn
March 16, 2012
OUTSIDE THE LINES
Fifteen-term Democratic Rep. Gary Ackerman
announced Thursday that he will not seek re-election to his New York congressional seat. It's another decision influenced by redistricting, as New York loses two House seats thanks to population decline.
Sen. Richard Lugar, R-Ind.,
is appealing an election board's 2-to-1 decision ruling him ineligible to vote in his own primary next month. Lugar has been fighting off residency problems in Indiana as he faces a tough challenge from the right.
House Budget Committee chairman Paul Ryan, R-Wis.,
released a video Thursday previewing his federal budget blueprint set to be unveiled next week.
A group of conservative organizations, including Let Freedom Ring, FreedomWorks, 60 Plus Association and some Tea Party groups, wrote a letter to House Republicans urging them not to "settle" during budget negotiations" "We therefore write to suggest a compelling point of contrast: present a budget that balances in ten years or less and does not raise taxes on the American people. As members of the conservative movement, we believe that no budget that fails to meet these two standards can reasonably call itself conservative.".
Senate Democrats
are pushing for a vote to renew the Violence Against Women Act and daring Republicans to vote against it, reports Laurie Kellman of the Associated Press.
Here's the
transcript from Gwen Ifill's chat over at Washington Week on Thursday.
Judy Woodruff
writes about hopeful steps for people with disabilities.
Former Illinois Gov. Rod Blagojevich
entered prison Thursday to begin serving a 14-year sentence for corruption, including trying to sell President Obama's U.S. Senate seat.
Rock the Vote
writes up the South by Southwest panel Christina moderated over the weekend.
ON THE TRAIL
All events are listed in Eastern Time.
President Obama attends a pair of fundraisers in Chicago at 1:20 p.m. and 2:35 p.m. and then travels to Atlanta for three campaign events at 6:35 p.m., 8:25 p.m. and 9:20 p.m.
Mitt Romney meets with voters in Rosemont, Ill., at 8:25 a.m., then travels to Puerto Rico, where he holds a rally in Old San Juan at 7 p.m.
Rick Santorum holds a rally in Osage Beach, Mo., at 11:30 a.m. and a pair of events in Arlington Heights, Ill., at 3 p.m. and 8 p.m.
Newt Gingrich campaigns in Louisiana, attending a meet and greet in New Orleans at 3 p.m., visiting the New Orleans Zoo at 4:30 p.m. and holding a rally in Covington at 8 p.m.
Texas Rep. Ron Paul has no public campaign events scheduled.
All future events can be found on our
Political Calendar:
For more political coverage, visit our
politics page.
Sign up here to receive the Morning Line in your inbox every morning.
Questions or comments? Email Christina Bellantoni at cbellantoni-at-newshour-dot-org.
Follow the politics team
on Twitter:
@cbellantoni,
@burlij,
@elizsummers and
@suddinengel.
Watch Video |
Listen to the Audio
JUDY WOODRUFF: A short time ago, a U.S. government official identified the U.S. soldier accused of killing Afghan civilians as Army Staff Sgt. Robert Bales.
And on that, we turn the analysis of Shields and Brooks. That is syndicated columnist Mark Shields and New York Times columnist David Brooks.
Welcome, gentlemen.
This is the first time we have the name.
We knew 38-year-old staff sergeant. He is being blown tonight from Kuwait to Fort Leavenworth, Kan.
David, this terrible incident, the killing of all these civilians by -- and he is the suspect alleged to have done this -- how does it change what the U.S. is trying to do in Afghanistan?
DAVID BROOKS: Well, I'm not sure it will have a long-term effect.
There have been tragedies before. There have been drone killings. There have been a lot of civilian killings over the years. And, as Ryan Crocker said, generally, we have been through them.
I think what is different now is the circumstances surrounding this and the Quran burnings, which is that we're much closer to the exits. We're certainly leaving by 2014. A lot of people now think we should leave by 2013. And so that idea that the exits are so close creates this momentum where people think, let's get out of here.
And what you have is a lot of Afghan capital is leaving the country, waiting for what is going to happen next. You have got an Afghan -- the educated class leaving the country and applying for asylum abroad, citizenship abroad. You get the Taliban knowing we don't have much longer to wait. So they are much more suspicious about negotiations.
So what happens is, when you begin the withdrawal process, you get this spiral. And so managing the withdrawal -- we're all agreeing we're going to withdrawal -- becomes much, much more difficult for the U.S.
JUDY WOODRUFF: So, Mark, is it all about just managing the withdrawal and getting out faster?
MARK SHIELDS: No, I think it's more than that, Judy.
I think, first of all, there's an iron rule of history here. And that is that armies of occupation throughout human history are unpopular. Just think of the French, who were indispensable to the American Revolution, had stuck around for six months. Americans would have been stoning them in the streets. That's just -- that's human nature.
I think that is the first reality. Now this war is 10 years old. Secondly, nobody can define what the mission is now. Managing the exit, I mean, is this for the more expenditure of blood and treasure and Americans risking death, and worse?
And I guess that -- I think that is where it is. And I think that is the reality. It's got a political implication now. This week, we saw Newt Gingrich say it wasn't -- Afghans -- was not doable, Afghanistan was not doable, Rick Santorum saying that we ought to double the resources -- I'm not sure what resources mean -- or begin to pull out or accelerate the pullout.
And it really appears to be more of a political problem than a strategic international problem.
JUDY WOODRUFF: But. . .
DAVID BROOKS: I have to say, I disagree with that. I think we know what the mission is.
The military is very clear about this and the president has been very clear about this, is that we are trying to create an Afghan army that can defend the country, so it doesn't descend back into civil war, so it doesn't descend back into a pre-9/11 circumstance.
And the people in the military, who are not particularly political, think that is quite doable. And they are little disturbed by the talk of the early withdrawal, because they think they can do that and we can get out. The Afghan army has -- is the one sole institution in that country which sort of functions. It's not perfect by any means. A lot of the troops are illiterate, among other things.
But it does sort of function and there are a lot of them. And so there is some expectation that you will be able to create an army so you won't have a long civil war, as you had after the Soviet pullout, after -- in previous pullouts.
JUDY WOODRUFF: So you don't see that as. . .
MARK SHIELDS: No, I stand second to nobody in my admiration of the military, but there is a pattern of American generals. they are always reluctant to go into a war and they are always to leave it. That is the pattern. And that is what we're seeing now, because this is a failed mission.
Let's be very blunt about it. We are not going to leave Afghanistan as a functioning, operating society. Karzai is a disaster. If you can remember -- those who remember South Vietnam, this is the parallel, this is the bookend to that. We are propping up a corrupt regime that doesn't have the respect and commitment of its own people and it has no commitment and respect of its people. That is the reality. He is the mayor of Kabul at best. And that. . .
JUDY WOODRUFF: So when the ambassador, Ryan Crocker, tells Jeff, as he did a few minutes ago in that interview, that considering the circumstances,
Hamid Karzai is doing what he has to do. . .
MARK SHIELDS: He is, what, playing to the gallery by insulting Leon Panetta and condemning the United States and chastising us and telling us what our strategy ought to be there? I just -- I don't see that he is a particularly either admirable or reliable ally.
DAVID BROOKS: I agree with that. I don't have much -- Ryan Crocker has to say he has a lot of room for Hamid Karzai.
I don't think too many people -- certainly, the U.S. military doesn't. They see him as corrupt, or at least his brother as corrupt. They see a lot of corruption rife through Afghanistan. There's no question about that.
But what we want is just stability so we won't have the Taliban coming in kicking girls out of school. You won't have just a long civil war, which will be a breeding round for Taliban, which will then bleed over into Pakistan. That's what we want.
And so can we get some basic level of stability? Well, I think the generals, maybe they're too yahoo about this, but I do think they think it's possible. And we have handed over large parts of Afghanistan to Afghan control. They're running it without really U.S. troops. We're busy in the south and other regions. So there is some just basic stability. That is all we want.
JUDY WOODRUFF: Mark, you mentioned the political -- the implications in the election this year. Do you see any? Do you see this having an effect one way or another?
DAVID BROOKS: Newt Gingrich said what he said for a reason. People are exhausted by this.
And if you ask them, should we stay in Afghanistan, no, we should spend our money here. That's what people will tell you. On the other hand, I'm not sure it will be a huge campaign issue, because the fiercest opposition to being there is in the Democratic Party. And they're not going to go against the president.
JUDY WOODRUFF: Ron Paul.
DAVID BROOKS: And Ron Paul.
JUDY WOODRUFF: And Ron Paul.
DAVID BROOKS: And Ron Paul, exactly.
MARK SHIELDS: I think it's beyond partisanship now, I think, the American fatigue with Afghanistan and the lack of enthusiasm for the United States continuing to fight and die there.
Stability is a -- that is not exactly unconditional surrender. We want to leave stability in our wake. That just doesn't -- I don't think it's a rallying cry. I don't think it's a defining mission that Americans are going to support at this point.
JUDY WOODRUFF: Okay.
The campaign, David, where does it stand? Mitt Romney, we thought he had a shot in Mississippi and Alabama.
Rick Santorum won. Newt Gingrich is still in the race. Where is it? Where are we?
DAVID BROOKS: From one quagmire to another.
The good news is we are nearly halfway done the campaign, not quite. It will go on. And it's just -- I don't think Romney is not going to get the nomination. I think he will get the nomination, because if you look at the delegate math, A., he is way ahead, B., he is likely to stay way ahead.
Will he get enough delegates to clearly give him the nomination? That, I'm not sure of, but I think he will be close. And I say that because what has happened in campaign after campaign or in state after state is purely the battle of demographics, upscale voters, middle-class voters going for Romney, especially urban voters, downscale and rural voters going for Santorum.
Henry Olsen of the American Enterprise Institute points out that in every place where there is a Major League baseball park, Romney carries that place. In every place where there is a AA minor league team, Santorum carries that place.
It's been purely demographic. And if you count the demographics going forward to all these other states, the Californias and even Illinois, there are just more Romney people. So you would expect him to finally get the nomination, after an incredibly brutal and terrible slog.
JUDY WOODRUFF: So is it inevitable?
MARK SHIELDS: I don't think inevitable.
JUDY WOODRUFF: Or almost.
MARK SHIELDS: A week is a lifetime in politics, and five months an eternity.
I still would bet on Mitt Romney. We are moving -- now, David is right -- we are moving into territory now, Delaware, Maryland, New York, Connecticut, Wisconsin, Illinois, that are better Romney states than they are Santorum states.
What Santorum has achieved is rather remarkable, outspent, outgunned, without any establishment endorsement, written off, just ignored in all those early debates. And contrary to all of the prevailing conventional wisdom about American politics in 2012, he got 49 percent of white working women who work outside of the home voting for him. It's just -- it's an achievement.
JUDY WOODRUFF: Despite all the controversy.
MARK SHIELDS: And he has got the passion. Romney has got the deep pockets. Romney has got the organization. He has got the enthusiasm. That's really. . .
DAVID BROOKS: I must say, I think Romney has a much, much, much better chance in the fall.
It's hard not to be impressed by what Santorum is doing. He's being outspent 15-1 in some places.
MARK SHIELDS: That's right.
JUDY WOODRUFF: Well, what reward does he get then? He just keeps fighting and. . .
MARK SHIELDS: Well, if he could get Gingrich out of the race, he could finally get Romney one-on-one. But Gingrich -- what are the chances of getting Gingrich out?
A man who says -- and on the record -- that "I define my job as saving Western civilization" is not somebody who probably is going to be talked out a race.
JUDY WOODRUFF: I hate to remind you of this, but
on this program last week, you said, if Newt Gingrich doesn't win Alabama and Mississippi, he's going to have to get out.
MARK SHIELDS: Yes, he is going to have to get out.
JUDY WOODRUFF: It's now a week later, Mark.
MARK SHIELDS: That just shows you how limited logic is.
(LAUGHTER
MARK SHIELDS: No. But, I mean, it just -- he really -- now he is saying, "I want to go to Tampa and be a player."
There is a hell of a reason to make phone calls and go door-to-door.
DAVID BROOKS: Right. He thinks he can deny Romney the delegates. And it's possible he can.
MARK SHIELDS: Yeah.
DAVID BROOKS: One of the interesting parlor games, I guess, if Gingrich doesn't get out is, what would happen if he did get out?
Some of the polls show the Gingrich voters are kind of split between Romney and Santorum. It's not necessarily they will all go to Santorum. I think most of the polling suggests the majority would go to Santorum.
JUDY WOODRUFF: But, for now, you see this thing going on?
MARK SHIELDS: It would have been the difference in Ohio and Michigan.
DAVID BROOKS: That's right. It could -- literally, we're not halfway through.
JUDY WOODRUFF: The last thing I want to ask you about is this column, op-ed piece in The New York Times by this former -- now former trader at Goldman Sachs, just blistering,
about the culture of Goldman Sachs, saying it's all about the money.
We knew it was about the money, but he's saying putting the company ahead of the customer.
MARK SHIELDS: Well, Judy. . .
JUDY WOODRUFF: Is this a surprise? What does it tell us?
MARK SHIELDS: This wasn't a column written about the Salvation Army that takes care of homeless and poor people or a column written about the Little Sisters of the Poor who take care of the indigent and dying.
This was a column written
about Goldman Sachs. And people are ready to believe about Goldman Sachs. Understand this in American polling. When you ask favorable of institutions, big corporations rate higher, big pharmaceutical companies, health insurance companies, the Congress of the United States rates higher in favorability than does Wall Street and financial institutions.
And this is a group conspicuous for its arrogance and for total self-absolution of its own responsibility in any way for the financial crisis in this country and the suffering that followed in its wake. And to be very blunt about it, this is a company that created a financial instrument and sold it to its customers solely because a hedge fund customer, larger customer, wanted to bet against it. And they made millions on that.
So are people ready to believe it? Yes, they are ready to believe it.
JUDY WOODRUFF: So, stating the obvious, in 20 seconds. . .
DAVID BROOKS: Well, yeah.
I mean, I thought the guy who wrote it was a bit narcissistic, talking about what a great guy he was. It was three-quarters about him. Nonetheless, the decline in manners and ethos, where people at firms like that talk about their own clients as if they're to be their cows to be milked, I do think that is true. And that is what needs to be addressed.
JUDY WOODRUFF: Well, we thank you both, David Brooks, Mark Shields.
MARK SHIELDS: Thank you.
"The lesson drawn from the outbreak is that even a most carefully supervised milk supply is open to the danger of grave infection from carrier or unrecognized cases of disease," wrote biology professor C.E.A. Winslow. "The only real safeguard against such catastrophes lies in pasteurization, carried out by the holding system and preferably in the final packages."
Professor Winslow made those recommendations 100 years ago, in the Journal of Infectious Diseases, about the 1911 Boston staphylococci or streptococci outbreak that killed 48 people. It was originally caused by drinking contaminated raw milk and spread because it was "communicable by contact," especially among people in the same household.
Winslow's 39-page article, titled "An outbreak of tonsillitis or septic sore throat in Eastern Massachusetts and its relation to an infected milk supply," records the details of one of the most significant public health events in U.S. history.
Winslow says the outbreak was first recognized at a medical meeting in Boston on May 11, 1911 when physicians attending realized they each had been treating at least 20 to 30, and in some cases as many as 60 and 70 patients, for "tonsillitis of a peculiar and characteristic type" within the last week.
Severe headaches, acute abdominal pains and high temperatures of 103 to 105 degrees were the common symptoms. "It was commonly called tonsillitis, but differed from ordinary tonsillitis in some respects, and was held by many physicians to be a new and peculiar pathological condition," Winslow wrote.
At the meeting, the physicians reported something else. Most of the families with illnesses were customers of a single milk supplier -- Dearfoot Farms.
Winslow says many of the doctors were "loath to believe" that Dearfoot Farms "could possibly be involved." The company had been supplying Boston and its suburbs with milk for 28 years, and "had been universally regarded as a pioneer in the work of dairy inspection and in the marketing of clean milk..."
In 1911, tonsillitis was not a "reportable" illness - doctors did not have to report it to health authorities. Wilson's investigation depended on the medical community volunteering information, and that's how he discovered that some areas with illnesses were not directly supplied by Deerfoot. He eventually collected more than 1,400 records directly from physicians.
"The disease was not ordinary follicular tonsillitis, but more nearly what the English recognize as septic sore throat," Winslow wrote. "In early stages there was merely a diffuse redness over the tonsils and adjoining regions, but follicular patches often appear later and in many cases a membrane simulating that of diphtheria."
Winslow said the disease was "severe," and "occasionally fatal among the old and the weak." He said there were actually two epidemics -- one centered in and around Boston, Brookline and Cambridge, and another in the area around Marlboro, 25 miles inland.
In his interviews with physicians in Boston, Winslow identified 1,043 outbreak-related cases, with the illnesses peaking on May 14 and "practically ceasing" after May 22. In 56 percent of the affected households, there was only a single case.
Two-thirds of the deaths were among people older than 55, and one-third of those were over 75. Adults suffered more than children; only 15 percent of the cases were under age 16. Females were infected at twice the rate of males.
Winslow discovered that the distribution of the epidemic "exactly coincided" with Deerfoot's two main milk delivery routes. His study of customer lists found that about one in four on the routes were infected.
In the Marlboro area, Winslow collected 392 case records from physicians. He learned that the outbreak there had not exploded suddenly, but that the inland illnesses had been spread out over April and May. Because there was no known case in that area involving direct exposure to the milk, Winslow suspected a "carrier case" had touched off the infections.
At a time when a microscope might have been a laboratory's only powerful tool, Winslow had to rely on guesswork. "All these symptoms point to streptococcus as the probable cause of infection, but there is as yet no definite information as to the bacteriology of the outbreak," he said.
"Throat cultures examined at the Boston Board of Health Laboratory and elsewhere showed no constant organism but Professor Theobald Smith, of the Harvard Medical School, has four cultures isolated from internal organs in the more severe cases, all of which are streptococci of apparently the same type," Winslow added.
Winslow also addressed rumors at the time that New York and Washington D.C. both experienced similar outbreaks, but found nothing more than the usual number of cases.
Newspaper reports greatly exaggerated the number of septic sore throat in other areas of Massachusetts. Worcester was said to have 2,000 cases, but Winslow's doctor survey turned up nothing unusual.
He did find an "interesting community outbreak" in Wellesley that included about 30 cases at a Roman Catholic academy. The school had its own dairy, and also raised most of its own food. The investigation pointed to "a local infection of some food supply within the institution, perhaps an unrecognized carrier case."
The 48 deaths included 17 males and 31 females. The victims lived in Boston (19 ; Brookline (6 and Cambridge (23 .
"Probability pointed to one of the two more universal vehicles, water or milk, and since the water supplies of the three communities are distinct, more particularly to milk supply," Winslow wrote.
Deerfoot Farms had two milk supplies, Southboro and Northboro, with a cream supply common to both. It was milk from Southboro that corresponded to the spread of the bacteria.
"On the whole, the general correspondence between Southboro milk and tonsillitis appears too close to be accidental," Winslow noted.
For Boston and Cambridge, 85 percent of the cases were on the Deerfoot Farms delivery list, and another 8 percent were believed by physicians to have consumed the milk.
Outbreaks early in the last century, like the one in Boston, eventually brought an end to the widespread distribution of raw milk, and most milk was pasteurized from then on to prevent the spread of disease and death.
In 1920, Winslow defined public health as "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals."
His influence continues today with the C.E.A. Winslow Award, the highest award of professional achievement for public health professionals in Connecticut.
New research has found that “eating white rice could raise your risk of type 2 diabetes” according to the Daily Mail.
The starch-rich staple can potentially release high amounts of sugar into the blood when digested, and so researchers have previously speculated that it may contribute towards type 2 diabetes, a condition where the body finds it difficult to regulate blood sugar.
In this new research, scientists examined the issue by pulling together data from four previous studies that had examined over 350,000 participants. Across the four studies 4% of participants developed diabetes, and greater rice intake was associated with higher risk of developing type 2 diabetes. This link was evident when researchers separately analysed two of the studies conducted in Asian participants who ate four portions of white rice a day on average, but no such link was found in the two studies in Western populations.
Although the review has found an association, it cannot prove that white rice itself directly causes type 2 diabetes, as there are many other factors that could affect the risk of developing the condition (such as physical activity, alcohol and obesity . The four individual varied in the factors they accounted for.
Eating a healthy balanced diet and taking regular exercise are the best ways of reducing type 2 diabetes risk. Where white rice is concerned, perhaps this study is best considered as supporting the idea of ‘everything in moderation’.
Where did the story come from?
The study was carried out by researchers from Harvard School of Public Health, Harvard Medical School and the Brigham and Women’s Hospital. It was funded by US National Heart, Lung, and Blood Institute and published in the peer-reviewed British Medical Journal (BMJ .
Generally the news reflected the research findings but did not make it apparent that the research looked at both Asian and Western populations or that it did not find consistent results across the two groups.
What kind of research was this?
This was a systematic review and analysis of previous studies on the relationship between rice intake and the development of diabetes. It only used the results from prospective studies, meaning those that looked at rice intake in people without diabetes and then followed them over time to see if they developed the condition.
This confirms that the participants’ rice intake preceded their development of diabetes. The review featured a statistical pooling of results (meta-analysis that allowed the researchers to analyse the subjects of all previous studies as a single group.
A systematic review gathers together all relevant high-quality studies on a subject. It is the best way to determine what existing evidence indicates about a particular question.
When combining such studies in a systematic review, the authors need to take into consideration differences between the underlying studies when interpreting their findings and deciding whether to pool the studies. In this case, for example, the studies may have:
- used different methods for assessing dietary intake
- included different populations
- followed participants for a variable length of time
- examined outcomes differently
Although the ideal way to look at the effect of rice intake on diabetes risk would be conducting randomised controlled trials. However, this would be unlikely to be feasible, particularly in this case as people would have to stick with the allocated diet for long periods in order to look at an outcome such as diabetes development. Therefore, prospective cohort studies are the best way of looking at whether this type of exposure (in this case rice intake is associated with a particular outcome (in this case, development of diabetes .
The main limitation with cohort studies such as the ones pooled in this review is that they may not have adjusted for all relevant factors that could be associated with intake of rice and with risk of diabetes. These include other dietary factors such as alcohol intake, physical activity and being overweight or obese. Also, studies assessing food intake can be particularly prone to some inaccuracy. Participants usually have to estimate their typical dietary intake, which can be hard to recall and variable over time.
What did the research involve?
The researchers looked at Medline and Embase electronic databases to identify all prospective cohort studies that related to rice intake and type 2 diabetes. They excluded studies where participants reported they had diabetes at the start of the study.
For studies that reported rice intake as servings a week or day, the researchers converted this to grams a day by assuming that each serving was equivalent to 158g of cooked rice. To convert raw rice intake to cooked rice intake they multiplied raw intake levels by 2.5, to account for the typical increase in weight while cooking. The researchers used standard methods to pool the results from the studies and calculated risk of development of type 2 diabetes in relation to an individual’s rice intake.
What were the basic results?
Four prospective cohort studies met inclusion criteria. They included a total of 352,384 participants, all of whom reported being free of diabetes at the start of the study.
Two studies were performed in Asian populations (in China and Japan and the other two studies in Western populations (the US and Australia . Follow-up in these studies ranged between 4 and 22 years. All studies had assessed dietary intake using food frequency questionnaires. Average rice intake levels varied considerably across studies. For example, the average intake in the Chinese study was four servings (625g of cooked rice a day, compared to the US study where 98% of participants consumed less than five servings a week.
Studies varied in the potential confounders that they took into account, such as other dietary intake, weight, alcohol and physical activity.
Of the 352,384 participants, 13,284 developed type 2 diabetes, or 4% of the group. Overall, the pooled results from all studies found that:
- the highest levels of white rice intake were associated with 27% increased risk of developing diabetes compared to the lowest levels (relative risk 1.27, 95% confidence interval [CI] 1.04 to 1.54
- each extra daily serving of rice increased risk of diabetes by 11% (relative risk 1.11, 95% CI 1.08 to 1.14
- there was significant heterogeneity when pooling these four studies, which meant that their individual results varied significantly
When the researchers separately analysed the two Asian studies and the two Western studies, they found that Asian subjects with a high rice intake had a 55% greater risk of developing diabetes compared to Asian subjects with a low intake (relative risk [RR] 1.55, 95% CI 1.20 to 2.01 . However, there was no significant association between rice intake and diabetes risk in Western people (RR 1.12, 95% CI 0.94 to 1.33 .
How did the researchers interpret the results?
The researchers concluded that, ‘higher consumption of white rice is associated with a significantly increased risk of type 2 diabetes, especially in Asian [Chinese and Japanese] populations’.
Conclusion
Rice is a hugely important staple food for many nations around the world, and also many communities in the UK. However, rice, and particularly white rice, can tend to have a high starch content and therefore may cause rapid increases in blood sugar. Given this property for raising blood sugar, the authors of this review investigated how rice intake might be associated with a person’s risk of developing type 2 diabetes, a chronic condition where the body has difficulty regulating their blood sugar.
To investigate the issue this research has examined the association between white rice consumption and the risk of developing diabetes in both Asian and Western populations. Though overall across the four studies there was an increased risk of diabetes with higher white rice consumption, notably the results differed between studies and were not consistent across the two study populations, with no association between rice intake and diabetes in Western populations.
Separate analyses of the two Asian studies found that those who consumed the highest white rice intake had increased risk of developing diabetes than those who consumed the lowest. As the researchers say, rice is consumed heavily in Asia but relatively infrequently in the West, and the substantial difference in regional rice intake levels may contribute to the inconsistency of results from existing studies.
It is also important to note that there was a low rate of development of diabetes across the studies: only 4% of the entire studied population developed diabetes. The 55% increased risk for Asian populations is a ‘relative risk increase’ in people who had high rice consumption compared to those with low rice consumption, reflecting how the risk varied between the two groups rather than suggesting that 55 out of 100 people got diabetes.
The review does not provide absolute figures of the percentage of people with high intake who developed diabetes and the percentage of people with low intake. For example, if Asian people with the lowest rice consumption had a risk of developing diabetes of 3%, these results would suggest that the risk in the highest consumption group was about 4.7% (approximately a 55% increase on 3% .
Furthermore, it is not possible to conclude from this study that white rice consumption itself directly causes type 2 diabetes. There are many other potential confounders that could affect risk of someone getting diabetes, and the four studies varied in the factors they adjusted for (for example, age, sex, family history of diabetes, other dietary factors, physical activity, alcohol, and being overweight or obese . Other limitations to this study include the inherent inaccuracies in recall that are often involved when people estimate their dietary intake on a food frequency questionnaire.
Lastly, there should be no conclusion from this study that it is better to eat brown rice than white or that it is better to eat non-rice carbohydrates; this has not been studied.
Eating a healthy balanced diet and taking regular exercise are the best ways of reducing diabetes risk. Where white rice is concerned, perhaps this study best supports the idea of ‘everything in moderation’.
Analysis by Bazian
Links To The Headlines
White rice raises T2 diabetes risk, claim academics. The Daily Telegraph, March 16 2012
Eating white rice 'could raise your risk of type 2 diabetes'. Daily Mail, March 16 2012
White rice 'could cause diabetes': Researchers look at reports on 350000 people. Daily Mail, March 16 2012
Diabetes warning on white rice. Daily Express, March 16 2012
Links To Science
Hu EA, Pan A, Malik V, Sun Q. White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 2012; 344
The world is entering an era where injuries as common as a child's scratched knee could kill, where patients entering hospital gamble with their lives and where routine operations such as a hip replacement become too dangerous to carry out, the head of the World Health Organisation (WHO has warned.
There is a global crisis in antibiotics caused by rapidly evolving resistance among microbes responsible for common infections that threaten to turn them into untreatable diseases, said Margaret Chan, director general of the WHO.
Addressing a meeting of infectious disease experts in Copenhagen, she said that every antibiotic ever developed was at risk of becoming useless.
"A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child's scratched knee could once again kill."
Traffic fumes, weather and dirty air from northern England and France add up to worst air pollution since 2008's more stringent monitoring
Air pollution in London hit record levels on Thursday due to a combination of traffic fumes, relatively still weather and an influx of dirty air from the north of England and northern France. Poor conditions are affecting a swath of the country as far north as Leeds and York.
Official monitoring stations in the capital show that particles, nitrogen dioxide, sulphur dioxide and other pollutants have reached levels not recorded since stringent new measurements were introduced in 2008. Pollution levels in London are even higher than last Easter,
when the government was forced to issue a smog alert. The record high will worry officials preparing for the arrival of the world's best athletes and hundreds of thousands of spectators for the Olympics in four months time.
Health advice from the Department for Environment, Food and Rural Affairs (Defra says that adults and children with lung problems, adults with heart problems and all older people should not take any "strenuous physical activity" while pollution is at the recorded levels. The general population is advised to reduce exercise too.
Recirculated dirty air from Europe and the north of England is partly to blame, along with a lack of wind, said
Gary Fuller, senior lecturer in air quality measurement at King's College London. "Still conditions mean that the pollution from the cars and lorries on the roads today is simply not blowing away. On top of this, the air over England today was in northern France yesterday and in northern England on Tuesday where it picked up a lot of air pollution from coal burning industries, domestic heating and traffic."
He added that poor air quality was affecting as far north as Leeds and York, and his forecasts suggested the high levels of pollution would continue into tomorrow.
The Met Office said that winds would be light on Friday morning but would be picking up by lunchtime with gusty winds of 25mph, followed by further winds on Saturday which should bring pollution levels down.
Simon Birkett, director of the
Clean Air in London campaign, said: "The failure by the mayor to warn Londoners about five smog episodes in a row proves he is desperate to avoid the air pollution issue ahead of the mayoral election.
"It's clear the mayor, who would rather suppress pollution in front of official air quality monitoring stations than save lives, is more concerned about getting re-elected than he is about those he represents. This may be the biggest public health fraud for a generation."
This month,
a report suggested that the 2012 Olympics would have no significant impact on air quality in London. Changes to road management during the Games are likely to have "broadly neutral impact on air quality", Transport for London said.
Since December 2008, air quality stations in London have been monitoring smaller particles called PM2.5s, which are able to enter the bloodstream more easily and cause more respiratory damage than larger particles, such as PM10s. Fuller said the levels on Thursday were the highest since the new regime was introduced.
A Defra spokeswoman said: "We want to keep improving air quality and reduce the impact it can have on human health and the environment. Our air quality has improved significantly in recent decades and is now generally very good, and almost all of the UK meets EU air quality limits for all pollutants.
"There are some limited areas where air pollution remains an issue, but that's being dealt with by the air quality plans, which set out all the important work being done at national, regional and local levels to make sure we meet EU limits as soon as we can."
Last month, the environment secretary, Caroline Spelman,
was criticised by an influential group of MPs for rejecting their recommendations to cut pollution on the grounds that it was too costly. Poor air quality has been linked to nearly one in five deaths a year in London. The capital's poor air quality, caused largely by traffic, has seen the UK facing ?300m in fines for breaching EU targets. The government has
successfully lobbied Europe to push back the deadline for meeting the targets.
• This article was amended on 16 March 2012. The original referred to nitrous oxide instead of nitrogen dioxide. This has been corrected.
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Domestic and multinational drugmakers in China have strongly criticised government plans for a wider roll-out of a piloted competitive tendering system for medicines procurement which has been shown to cut the prices of essential drugs by at least 30%.
The plans were announced at the annual National People's Congress in Beijing, where national leaders said the tendering system would be rolled-out further to support an increase in state health insurance coverage and moves to make health care more affordable.
Although the tendering scheme was piloted in five Chinese provinces, it is generally referred to as the "Anhui model" because in Anhui, the country's fourth-poorest province, it has been shown to reduce prices of essential drugs by an average of 53% below their officially-set maximum retail prices, with some price levels being slashed as much as 90%.
"The tendering system that we have implemented for basic drugs has proved to be effective and able to guarantee the drugs' safety, reasonable price and timely supply. Our next step is to further improve on these plans," Bloomberg reports Sun Zhigang, deputy director of the National Development and Reform Commission and head of the health care reform bureau at the State Council, as saying.
Currently, the tendering system covers 307 essential drugs but Ministers want to increase this to around 800 products, and also to cover the procurement of more expensive drugs used in hospitals in the treatment of diseases such as cancer. Research-based drugmakers say that doing so would force them to compete on price with generics makers, but supporters of the proposal point out that most such drugs are expensive imports.
While some observers feel that drugmakers will benefit as the government continues to add more products to the essential drugs list and extend state health insurance coverage to more and more of China's 1.3 billion population, others believe that manufacturers are being used as scapegoats and sector leaders are unhappy at the implications for their industry of a wider roll-out of the Anhui model. Several domestic firms have warned that their profits are likely to be cut as a result of the widening of the competitive tendering model, with some saying that they have already had to take a loss in order to sell their drugs to the authorities in Anhui.
The healthcare reform "is basically about tendering to compete on prices," but what needs to be prioritised is "guaranteeing quality first, rather than focusing on just prices, or this will be very unfair to China's drugmakers," Bloomberg quotes Guo Guangchang, chairman and co-founder of Fosun International, which controls the major drug maker Shanghai Fosun Pharmaceutical Co, as saying.
Last year, IMS Health forecast that drug spending in China will increase at the fastest rate globally during 2010-1015, with annual growth averaging 19%-22% and reaching as much as $125 billion by the end of the period.
What will they do? The Supreme Court (more or less that gave us Bush v Gore in 2000 will later this month hear arguments by states challenging the Affordable Care Act, a.k.a. health care reform. The heart of the legal challenge raised by conservative state attorneys general is whether the individual mandate is constitutional. What happens if the Supremes say no? Does the entire law fall, or just the mandate?
Cancer Research, explains that dietary cadmium - a heavy metal long identified as a carcinogen which leaches into crops from fertilizers and when rainfall or sewage sludge deposit it onto farmland - can potentially increase a woman's risk for breast cancer, writes Christine Kearney for
Medical News Today. Associate professor Agneta Akesson, from the
Karolinska Institute in Sweden said in a recent press release: “Because of a high accumulation in agricultural crops, the main sources of dietary cadmium are bread and other cereals, potatoes, root crops and vegetables. In general, these foods are also considered healthy.” The 12-year study found that among 55,987 post-menopausal women, the one-third with the highest cadmium intakes were 21 percent more likely to develop breast cancer than the one-third with the lowest intakes. Among obese women, the study found no increase in breast cancer rates with higher cadmium exposures. The finding comes just three months after the Institute of Medicine (
IOM , a prestigious body of independent biomedical researchers, concluded that a host of other factors — most within a woman’s power to control, such as obesity and hormone-replacement medication — were the most important sources of breast cancer risk. The IOM had called it “biologically plausible” that estrogen-like pollutants promote breast cancers, but noted that evidence that they contribute significantly was inconclusive. By contrast, studies in human populations strongly point to fattening foods, hormone-replacement drugs, alcohol and cigarettes as having roles in boosting a woman’s breast cancer risk. A woman’s lifetime exposure to estrogen powerfully influences her risk. In animals and in laboratory tests, cadmium has been shown to exert estrogen-like effects more powerfully than other environmental pollutants, and so suspicion has fallen on the heavy metal as a possible promoter of breast cancer. “Cadmium is receiving a lot of attention these days because of its estrogenic properties,” Rudolph Rull, a research scientist at the Cancer Prevention Institute of California in Berkeley, told Melissa Healy of the
Los Angeles Times. Both estrogen receptor-positive and negative tumors had the same risk increase at roughly 23 percent. Akesson said that women who consumed higher amounts of whole grain and vegetables had a lower risk of breast cancer compared to women exposed to dietary cadmium through other foods. “It’s possible that this healthy diet to some extent can counteract the negative effect of cadmium, but our findings need to be confirmed with further studies,” said Akesson. “It is, however, important that the exposure to cadmium from all food is low.”
announced a new graphic anti-smoking ad campaign today featuring personal descriptions and photographs of people who have suffered effects from smoking. The campaign, called "Tips from Former Smokers", will include promotional materials that shows up-close, voyeuristic looks at victims of disease. The new anti-tobacco campaign will last for 12-weeks and will feature prime-time television spots in which people describe how their lives were changed by smoking. The CDC campaign will cost $54 million, a number in which the U.S. tobacco industry spends in an average two days of promotional efforts. "We estimate that this campaign will help about 50,000 smokers to quit smoking," CDC Director Thomas R. Frieden told The
New York Times. "And that will translate not only into thousands who will not die from smoking, but it will pay for itself in a few years in reduced health costs." The diseases suffered by the 14 people in the ad campaign include lung, head and neck cancer, Buerger's disease, asthma, heart attack and stroke. “I think all too often smokers think, ‘I’ll just die a few years early.’ And that’s true. But there’s often a lot of pain and disability that goes with that. The smokers who volunteered to come forward and be in these ads show that reality,” Frieden told the
Washington Post. About 8 million Americans have smoking-related illnesses, and as many as 443,000 Americans die every year from smoking-related causes. The U.S. surgeon general warned last week that one in four high school seniors is a regular cigarette smoker. The surgeon general also said that about 80 percent of those who smoke during high school will continue to smoke as adults. The new campaign comes just two weeks after a federal judge struck down the Obama administration's plan to put graphic images covering half of the front and back of each cigarette pack to warn smokers of the danger.
Getty illustration by Zigy Kaluzny
In the classroom, it starts simply -- sometimes with a struggle to sound out simple words; sometimes with trouble telling time, memorizing the times tables or learning left from right.
It often ends simply, too: with a troubling statistic.
One in five of the American students identified as having a learning disability
will walk away from their education. That's compared to a dropout rate of 8 percent in the general population.
Just as startling: Close to half of the secondary students currently identified as learning disabled are more than three grade levels behind in essential academic skills. And it's widespread. Roughly 2.4 million students -- that's more than the entire population of Houston, Texas -- are known to struggle with it.
"Race, culture economic status -- LD doesn't discriminate. It's real and affects people of all ages," said Dr. Sheldon H. Horowitz of the
National Center for Learning Disabilities, referring to learning disabilities by a common nickname, LD.
In the days ahead on the PBS NewsHour broadcast, health correspondent Betty Ann Bowser will take viewers into a public school in Boston for a better understanding of how this commonly misunderstood set of disorders is playing into the U.S. dropout crisis. Online, we'll explore the crossroads of learning disabilities and art, and we'll profile two young men who, despite academic struggles, achieved stunning success.
But first, a 101. Contrary to popular belief, autism isn't a learning disability. Neither is attention deficit hyperactivity disorder (ADHD , mental illness, or intellectual disability. Here to walk us through the top misconceptions about learning disabilities and to define exactly what they are -- and aren't -- is Dr. Horowitz.
Misconception 1: The Term 'learning disabilities' is interchangeable with other disorders.
"Learning disabilities (LD , are not one thing, but rather the name for a category that encompasses a variety of specific disorders that create real obstacles for success in school, on the job, and in life. It's an umbrella term that points to weaknesses in such areas as reading, writing, spelling, math, and other kinds of skills, and is presumed to result from faulty or inefficient ways that information is processed in the brain. By definition, individuals with a learning disability do not struggle because of low intelligence, poor teaching, lack of motivation or other such factors. Their underachievement is unexpected and unexplained, which is why the term is often misunderstood.
"It's important to note that the term is also often confused with a number of other disorders, so let's set the record straight. Learning disabilities do not include problems that are primarily due to visual, hearing, or motor disabilities -- even though students with those types of disorders can also have LD. It doesn't include intellectual disabilities (formerly called "mental retardation" , emotional disturbance, or autism spectrum disorders, although children who fall within these diagnostic categories can also have learning disabilities. LD is not caused by cultural, environmental, or economic factors. And LD is not synonymous with ADHD, even though they often co-occur and share lots of the same features. They both require specialized, structured and carefully targeted instruction and support. But here's the big difference: ADHD can be treated with medicine; LD cannot.
Misconception 2: Learning disabilities are easily diagnosed.
"There is no quick and easy way to know whether a child has LD. There's no blood test or X-ray that can be done as part of a child's annual physical. And even our most sophisticated brain scanning technologies and genetic studies can't (yet predict LD. What we do know is that learning disabilities run in families, and that a family history of academic difficulties could be an indication of risk. Determining whether a child has LD is a process that unfolds over time and must include information from multiple sources. Parents need to provide their impressions and family history information. Educators need to offer detailed information about the child's progress and how well they respond to instruction. Specialists need to document performance on assessments designed to tap academic skill and the ways that the child processes information. And other factors such as attention, behavior, and medical history need to be considered.
Are there some early signs of LD to look for? Sure. In the area of reading, for example, watch for slow or limited vocabulary, difficulty rhyming, trouble mapping the sounds of letters to their corresponding shapes -- these might all be early warning signs of dyslexia, a specific learning disability in reading."
Misconception 3: Learning disabilities usually correspond with a low IQ.
"If a person's intellectual capacity is below normal, their problems learning are not said to stem from a learning disability. Again, these are processing disorders that occur for reasons other than diminished cognitive ability. They're not due to poor vision, poor hearing, they're not caused by environmental or cultural factors. They aren't caused by 'dysteachia' or a lack of opportunity to learn, and are not a result of a less than optimal home environment. Children with LD have the mental machinery to do well, but because of the unique ways that their brains are organized to receive, process, store, retrieve and communicate information, they struggle to accomplish tasks that are necessary to success in school and in life.
"The other thing I must stress is LD is absolutely not about laziness or a lack of motivation. These are real disorders -- with impacts that are felt every day and in so many ways. Imagine how you would feel if every time you read something new you needed extra time to sound out each word, re-read each sentence more than once to retain its meaning, and struggle to remember details and take notes. Now imagine the stress of the school day, worrying about whether you will be called upon to read aloud or write on the board, in effect being asked to put your LD on display. And the same goes for the workplace. The key is to help those with LD to circumvent the challenges of their learning disabilities so they can share what they know in ways that demonstrate strength, leveling the playing field so their difficulties don't define who they are and what they can accomplish.
Misconception 4: More students seem to be diagnosed with learning disabilities in today's society.
"If you look at all of the nation's students who receive special education services and the 13 different educationally handicapping conditions listed in the Individuals with Disabilities Education Act, almost half -- 41 percent -- have a learning disability. The numbers of school-age students in each category have changed over time, with some categories growing and others shrinking in number, but most experts agree that somewhere between 4 and 6 percent of the population has a learning disability. Within the LD category, the vast majority of children will have significant difficulties in the area of reading. But remember, not everyone in society who struggles in areas of reading, writing, spelling and math will have LD.
"And a word about 'learning differences' or 'preferences.' Do you know someone who is terrific at remembering names and phone numbers but who doesn't like to write things down? How about someone who is not a huge talker but who never forgets a face, is great with directions and likes things to be detailed and well-organized. Or how about someone who is hands-on, preferring to dive in and experiment without relying on printed instructions or verbal feedback. Most people have some of these characteristics, and some have strong preferences about how they organize their lives. While these styles or preferences can help us orchestrate activities of daily living, they don't get in the way of our doing things in other ways. That's where LD is different. People with LD are 'wired' to do things differently, and their struggles are not due to preferences or differences but rather real brain-based disorders. This does not mean that LD is a prescription for frustration or failure. Quite the opposite. But it would be unfair and inaccurate to presume that they can push past their differences if they just tried harder or tried to be more flexible in their approach to learning."
Misconception 5: Learning Disabilities fade with time.
"Learning disabilities do not go away -- they're with you for life. That doesn't mean someone with a learning disability can't achieve or even be wildly successful. They just need to find ways to circumvent or accommodate for the areas in which they don't do well. The more individuals know about themselves and how to get the help they need, the more they'll be able to succeed. A person who is diabetic can still be a world-class athlete, but they need to figure out how to balance the management of their medical condition with their training and completion needs. People who have learning disabilities can be (and are Pulitzer Prize-winning poets, state governors and members of Congress, actors, economists, engineers, physicians,... anything at all. They just need to understand their specific LD-related challenges, find ways to work around these pockets of weakness, and follow their dreams.
"The sooner people learn to talk about their LD and how to be effective self-advocates, the better. There's some really interesting longitudinal data that shows success attributes among children with LD. Studies tell us that even more important than early recognition of LD, overall intelligence or how many years of special education help they received, the thing that had the biggest impact over time was how well they could articulate their learning disability to others. Starting in elementary and middle school, students should become really good at explaining their learning disability to teachers. By the time they're in high school, they should know the rights and protections they have and be able to share the details of their IEPs or 504 plans -- documents that specify the services and supports they are entitled to receive."
For more information about all of these topics, as well as free parent guides and checklists, visit
www.LD.org.
Category: Health News
Created: 3/16/2012 8:05:00 AM
Last Editorial Review: 3/16/2012
A claim for restitution filed by Pennsylvania's attorney general caused a last-minute delay in the sentencing of
Merck & Co. (MRK for its violation of a federal drug law in connection with its marketing of former painkiller Vioxx.
At a hearing Friday in federal court in Boston, U.S. District Judge Patti Saris delayed Merck's sentencing until April 19 to allow for more time to consider the Pennsylvania claim. Merck was originally scheduled to be sentenced Friday.
Merck, of Whitehouse Station, N.J., agreed in November to pay $950 million and plead guilty to a misdemeanor charge of marketing a misbranded drug, to resolve government allegations that the company illegally promoted Vioxx and deceived the government about the drug's safety.
The government alleged Merck promoted Vioxx for treatment of rheumatoid arthritis before that use was approved by regulators. A portion of the $950 million settlement also was to resolve parallel civil allegations that Merck made false and misleading statements about Vioxx's safety, causing government health programs to pay for the drug's use. Merck denied the civil allegations.
Merck had withdrawn Vioxx from the market in 2004 after a study showed it increased the risk of heart attacks and other cardiovascular events.
The proposed November settlement was to resolve claims by the U.S.
Justice Department, more than 40 states and the District of Columbia.
But last week, the Commonwealth of Pennsylvania filed a so-called victim impact statement with the court. Pennsylvania's attorney general office argued that Judge Saris shouldn't impose a sentence unless Pennsylvania obtains restitution for
Medicaid payments allegedly resulting from Merck's criminal misconduct, according to a court document filed by the U.S. Justice Department.
Pennsylvania is continuing to pursue Vioxx-related claims against Merck in proceedings coordinated by a federal judge in Louisiana, according to the Justice Department.
The Justice Department argued that Pennsylvania therefore has a forum to pursue its claims, and it shouldn't hold up the sentencing in Boston.
Merck also urged Judge Saris to decline Pennsylvania's application for restitution because it would delay distribution of the settlement money to participating states.
In a written statement Friday, Merck said: "Through a last minute request the Commonwealth of Pennsylvania has attempted to derail an agreement already reached in good faith with the federal government, 44 other states, and the District of Columbia. There is no legal foundation for the Commonwealth's claim in this court and Merck will vigorously oppose it."
The Justice Department said Pennsylvania was allocated $4.5 million for alleged Medicaid losses under the $950 million settlement. States had the choice of either accepting their allocations or initiating or continuing litigation against Merck.
Category: Health News
Created: 3/15/2012 8:05:00 AM
Last Editorial Review: 3/15/2012
Category: Health News
Created: 3/15/2012 10:06:00 AM
Last Editorial Review: 3/15/2012
Category: Health News
Created: 3/16/2012 10:05:00 AM
Last Editorial Review: 3/16/2012
On Friday afternoon at Duke University, Peyton Manning got one step closer (or perhaps quite a few steps closer to his ultimate destination. Manning welcomed all the key players from the Denver Broncos front office, including VP of Operations John Elway, head coach John Fox and general manager Brian Xanders, to a workout in which he threw about 65 passes in a controlled indoor environment.
After the workout, Elway (perhaps the most social media-friendly football exec this side of Jim Irsay posted an update for fans on his Twitter account:
Duke coach David Cutcliffe, who was Manning's offensive coordinator at Tennessee, had nothing but good to say about his longtime friend's development.
"It's incredible how much progress he's made in throwing the football,"
Cutcliffe told the Tennessean newspaper. "He's gotten his arm strength back and his accuracy is there. I'm not an NFL coach, of course, but I think I know what it takes to complete passes in the NFL, and it's clear that Peyton can make all those throws. From what I've seen, he's right on target for [a return to the NFL in 2012]. Everybody knows what a hard worker he is, and he's dedicated himself to getting ready for the season."
Since the workout was private, the NFL Network turned to expert analyst Mike Mayock to get a sense of what teams look to see in these types of auditions.
"If I'm the Denver Broncos and I'm going to put a significant financial investment into Peyton Manning, what I'd want to see is pretty much what I usually see at the college workouts for the top-level college players," Mayock said on Friday. "At a pro day you're going to see 60-70 throws — three-step, five, five with a hitch, seven, seven with a hitch and play-action. We all know Peyton has made all of those throws in his heyday, but the important thing to me is that when we got to throws 55-70 — in other words, when he's had a pretty good workout, I want to see if he still has the same arm strength that he did in the first 20 throws.
"Can he throw an 18-yard comeback far hash on the 65th throw? Can he throw a go route 60 yards on the 70th throw? I've talked to some people that have seen him throw the football live and everybody has been highly impressed with what he's been able to do. My only question is, does he have the arm strength, the muscle strength and the ability to drive it when he's tired? If he had all of those things, I'd feel pretty comfortable."
So far, so good. Mayock also opined that if the Broncos do win the rights to Manning's services, that should not be the end of their offseason acquisitions.
"If I get Peyton Manning and it's a healthy Peyton Manning, I'm thinking Super Bowl," he said. "From my perspective, the first thing I would do is I would try to make Mike Wallace from the Pittsburgh Steelers a very wealthy young man. He's a restricted free agent so I would have to give up my first-round pick, but my first-round pick is only No. 25. I would be happy to give up No. 25 and then I would get after Mike Wallace, try to put together a deal with him.
"After that, remember that [tight end] Dallas Clark — Peyton's old teammate — is out there as a free agent; it wouldn't cost me anything. I would be trying to augment my offensive firepower because Peyton is used to dealing with an average defense; Denver's defense is fine. I'd be really just getting everybody I could get on the offensive side of the ball and say, 'OK Peyton, it's up to you to win a Super Bowl. Let's go.'"
However, the derby is not yet done. Manning will also work out for the Tennessee Titans before this comes to a close, and
we now know that the San Francisco 49ers are very much in the picture -- head coach Jim Harbaugh and offensive coordinator Greg Roman watched Manning throw at Duke on Tuesday, and all in attendance were impressed.
Category: Health News
Created: 3/15/2012 6:06:00 PM
Last Editorial Review: 3/16/2012
Category: Health News
Created: 3/15/2012 11:01:00 AM
Last Editorial Review: 3/15/2012
Menopause, the journal of the
North American Menopause Society, women really do suffer memory problems when going through menopause. Millions of women going through menopause have complained about forgetfulness or described having "brain fog" in their late 40s and 50s. In a new study, researchers gave women various cognitive tests to validate their experiences and provide some clues to what is happening in the brain as menopause hit. “The most important thing to realize is that there really are some cognitive changes that occur during this phase in a woman’s life,” Dr.
Miriam Weber, a neuropsychologist at the
University of Rochester Medical Center who led the study, said in a recent statement. “If a woman approaching menopause feels she is having memory problems, no one should brush it off or attribute it to a jam-packed schedule. She can find comfort in knowing that there are new research findings that support her experience. She can view her experience as normal.” The researchers studied 75 women from age 40 to 60 who were approaching or beginning menopause. The women underwent various cognitive tests that looked at several skills, including their abilities to learn and retain new information. They were asked about menopause symptoms related to depression, anxiety, hot flashes, and sleep difficulties. The team also checked their blood levels of the hormones estradiol and follicle-stimulating hormone. The researchers found that the women's complaints were linked to some types of memory deficits, but not others. According to the study, those women who had memory complaints were more likely to do poorly in tests designed to measure "working memory", which is the ability to take in new information and manipulate it in their heads. Tasks in working memory include things like being able to calculate the amount of a tip, adding up a series of numbers, or adjusting an itinerary on the fly. The team also found that women's reports of memory difficulties were associated with a lessened ability to keep focus on a challenging task like doing taxes or driving in a long road trip. The women in the study were more highly educated and on average of higher intelligence than the general population, according to Weber. The study said that anywhere from one-third to two-thirds of women during menopause report forgetfulness and other difficulties. “If you speak with middle-aged women, many will say, yes, we’ve known this. We’ve experienced this,” Weber said in a press release. “But it hasn’t been investigated thoroughly in the scientific literature. “Science is finally catching up to the reality that women don’t suddenly go from their reproductive prime to becoming infertile. There is this whole transition period that lasts years. It’s more complicated than people have realized.”
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