“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, 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 bloodstream 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 help?
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
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
Ever been tempted by a ‘sea change’ or ‘tree change’? Now might be your time!
The Rural Health Professionals Program (RHPP is a Federal Government initiative, funded by Health Workforce Australia (HWA , which aims to recruit and retain primary health care nursing and allied health professionals into rural, regional and remote areas of Australia.
RDN and the program
NSW Rural Doctors Network (RDN works in conjunction with HWA to deliver the program in country NSW. RDN acts like a recruitment agency, linking job applicants with suitable job opportunities; however, the service is at NO COST to the employer or the applicant.
RDN’s nursing and allied health recruitment team assists eligible applicants with:
Who’s eligible?
Nurses – includes all levels such as Practice Nurses, Nurse Practitioners, RNs and ENs.
Allied Health – includes OTs, Physios, Dentists, Podiatrists, Speech Pathologists, Dietitians, A&TSI Health Workers, Psychologists, Social Workers and more.
What positions are eligible?
The positions must have a predominant primary health care element (more than 50% , such as:
Which locations apply?
RA2-5 locations (according to Australian Standard Geographical Classification – Remoteness Areas (RA 2-5 . In NSW, these locations tend to be any areas outside of the metropolitan strip of Newcastle, Sydney, Wollongong and Tweed Heads (with a few exceptions . For more information, visit http://www.health.gov.au/internet/otd/Publishing.nsf/Content/RA-intro
Rewarding careers and improved lifestyles
Health professionals enjoy a variety and breadth of experience in rural practice that their urban peers miss out on. They also appreciate the sense of belonging that only rural communities can provide, the lack of traffic and travel time to reach work, collaboration with other health professionals for better patient outcomes, a more relaxed pace of life, improved family relationships, enhanced social opportunities, financial benefits, and more.
When Dietitian Melissa Pellow was on placement in Sydney, the traffic used to drive her crazy, taking her more than an hour to reach work. She’s now practising as an exercise physiologist and dietitian in Dubbo and has plenty of spare time up her sleeve to play netball, touch football and tennis. She and her partner are also in the process of buying a three-bedroom house for under $200,000.
Melissa’s dual qualifications are highly valued by rural communities where there are shortages of allied health professionals. She said, “It has a much more diverse patient base than the city, including Aboriginal health.” She’s also a big fan of the multi-disciplinary practice where she works. “We often see people with multiple health issues and it’s an advantage to bring in other professionals to help them,” she said. “It’s much more holistic care.”
GP Registrar Dr Zahraa Sadeq and her husband Dr Hayder Ridha, an ear, nose and throat specialist, also chose to settle in Dubbo where they value the sense of community that rural practice offers.
Originally from Iraq, Zahraa lived in Ireland before coming to Australia in 2005. After a stint in Darwin, she and Hayder moved to Dubbo where they are raising their three young boys. The fact that work is nearby and traffic snarls are non-existent is particularly important for Zahraa so she can be on time to pick up her youngest from day care. It also helps that everything is so close when Saturday sport is happening for her older boys.
The cost of living is another factor. “We can afford a house on big land with a pool–and a far better quality of life than in a big city,” she says. “The kids love it.”
Zahraa is also appreciating the variety of medicine she is experiencing in general practice in a rural centre as well as the sense of community with patients. “One of the beauties of being a rural GP is that sense of connection you develop with different generations of the same family,” she said. “You get to know the grandparents, mum, dad and the kids.”
While the thought of a move can seem overwhelming, good preparation is the key. If you have someone on your side like RDN to assist you, as well as some financial support, this can make all the difference.
Employer assistance
Employers in rural areas often struggle with their recruitment. This program enables rural employers to access a broader pool of applicants and provides a helping hand to manage the recruitment process.
RDN has a growing pool of UK-qualified applicants who are eager to get a start in Australia, many of whom already have registration but just need visa sponsorship. The process of sponsoring applicants is straightforward with RDN’s experience; we’ll help to increase the likelihood of finding the right person to fill your vacancy. At NO COST to you!
About NSW RDN
NSW Rural Doctors Network (RDN is a not for profit, non government organisation that develops and administers services and programs to improve the recruitment and retention of General Practitioners (GPs , nurses and allied health professionals throughout country NSW. RDN is the appointed body for implementing the RHPP in NSW, in conjunction with HWA, to improve access to primary health care professionals for those living in rural and remote areas.
Start your sea or tree change today!
Contact RDN’s Nursing and Allied Health Recruitment team to get you started. Phone: 02 4924 8000 Email: nah@nswrdn.com.au Web: www.nswrdn.com.au
Growing and supporting an allied health and nursing workforce for rural Australia
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.
WHO warned during a conference of infectious disease experts on Friday. According to
NewsCore reports, WHO Director-General Margaret Chan told those attending the meeting, which was held in Copenhagen, Denmark, that even ailments as simple as a scratched knee or a sore throat could someday become fatal. Furthermore,
Daily Mail reporter Mario Ledwith writes that Chan believes that the Earth was quickly approaching what she referred to as the "post-antibiotic era." As these disease-causing microbes become more and more resistant to the drugs meant to treat the conditions they cause, those injuries and illnesses will become increasingly harder to treat, thus making some "remedies more expensive, and some conditions… untreatable," Ledwith added. If this so-called post-antibiotic era does, in fact, happen, Chan said that it would result in the "end to modern medicine as we know it." This "post-antibiotic era" would "include many of the breakthrough drugs developed to treat tuberculosis, malaria, bacterial infections and HIV/AIDS, as well as simple treatments for cuts," says Hannah Furness of
The Telegraph. Any medicines that would replace existing treatments would not only become more costly, but would also take longer in order to have similar affects as today's antibiotics. "Some sophisticated interventions, like hip replacements, organ transplants, cancer chemotherapy and care of pre-term infants, would become far more difficult or even too dangerous to undertake," Chan said, according to Ledwith. "Antimicrobial resistance is on the rise in Europe, and elsewhere in the world. Replacement treatments are more costly, more toxic, need much longer durations of treatment and may require treatment in intensive care units." Chan's warning comes following the release of a WHO book on the topic. According to Furness, that book, which is entitled '
The Evolving Threat of Antimicrobial Resistance- Options for Action,' claims that "a crisis has been building up over the decades, so that today many common and life-threatening infections are becoming difficult or even impossible to treat, sometimes turning a common infection into a life-threatening one." The Daily Mail reports that while many countries have already introduced policies attempting to prevent the overuse of antibiotics, that the UN's public health group is seeking worldwide implementation of such measures. The UK paper says that the European Union has acknowledged that they are aware of the problem and have developed a five-year plan to slow down antibiotic use, while medical experts in developing nations are also attempting to find ways to stop the substances from being prescribed too often.
A young Dr. Charles Armstrong, fresh from fighting the world influenza epidemic that came with the Great War, was ordered by U.S. Surgeon General Rupert Blue to his home state of Ohio on July 1, 1919 to provide assistance to the state health officer.
Armstrong, just 33, returned home from war just six weeks before a county club banquet was held for more than 200 people near Canton, Ohio. Fourteen of those attending the banquet became stricken by botulism poisoning and seven of those victims died.
The coincidence of Armstrong's assignment to help out in Ohio meant he who would go on to worldwide recognition as virologist with his 1934 discovery of the virus he named lymphocytic choriomeningitis (LCM .
For the California olive industry, this meant the botulism outbreak of 1919 was going to be thoroughly and definitely tied around its neck. With a total of 19 botulism deaths in three states -- that were conclusively linked to canned California olives -- made the outbreak one of the deadliest outbreaks in the U.S.
The California olive industry owed it existence to those first olive trees planted in the mission orchards at San Diego, San Jose, Santa Clara and others before the American Revolution. For 20 years, it had been commercially viable, but the 1919 botulism outbreak was an unmitigated disaster. California olives did not recover for more than a decade.
Other U.S. states -- where those mission olive trees would never grow -- were the market for California canned ripe olives and now botulism in a can from California made for a pretty sensational story.
To make matters worse, California olive growers were not helped by the fact that, after 1919, the botulism outbreaks linked to olives did not really end until 1924.
The 1919 outbreak left dead in three states: Ohio (7 , Montana (5 , and Michigan (7 .
It is Ohio that always gets the most attention, however, because of the Armstrong's investigation and the unusual circumstances he found at the country club. He found that at the country club event attended, which was attended by more than 200 people, the botulism was all contained to people who sat at one table, the chef and two waiters.
"The guests who became ill were all members of a party given by Mrs. I.W.G., of Sebring, Ohio, and had been served at a separate table which shall hereafter be designed as the Sebring table," Armstrong wrote. "The two waiters who attended this table and the chef were also affected."
Armstrong reported the banquet menu included: cantaloupe, turkey, turkey stuffing, tomatoes and mayonnaise, crackers, scalloped corn and pimentos, browned potatoes, green olives, celery and pickles, rolls, butter, ice cream cake, water and coffee.
But he found the Sebring table did not get the green olives, celery, and pickles. Instead, Mrs. I.W.G. provided ripe olives, chocolate candy, Newport creams and candied almonds.
In the Dec. 19, 1919 edition of Public Health Reports, Armstrong includes the seating chart for the Sebring table that also includes the location of the three plates of ripe olives. Five of those in proximity to the olive servings died including Mrs. I.W.G.
Botulism also killed the chef and a waiter.
By the time his investigation got underway, six of the cases "had terminated fatally," according to Armstrong. While no illnesses occurred among those at other tables, Armstrong interviewed 15 of those guests and he also conducted a full blown epidemiological study to exclude all the items on the menu.
Of the 14 people who were ill, all ate olives. "When the dead are considered, it is found in a general way that those who died first who ate the most olives," Armstrong said.
Among those who were recovering, he said those who ate the least suffered were less severe cases. Those who survived reported the olives did not taste right. Asked to describe it, they said things like the olives "bit the tongue" and "stuck to the tongue" or just said they were "not fit to eat."
Armstrong found the ripe olives came from a vacuum-sealed jar and concluded, "something had occurred to destroy the vacuum in the jar, for, in opening it, the lid is said to have come off easily without having been punctured and without the use of instruments." The lid was discarded, but the recovered glass jar "was not cracked or defective in any way."
One of the waiters did not think the olives tasted right, and near the end of the banquet, he took them to the chef to get another opinion. The chef ate two, unwashed, and was among those who died. One of the two waiters for the Sebring table and a guest, both of whom survived credited the amount of whiskey they drank that evening as possibility saving their lives.
Pushing on, the investigation found the source of the contaminated olives to be the Ehmann Olive Company, formed in 1898 by Mrs. Freda Ehmann. She started California's commercial olive industry and credited with establishing the modern California ripe olive industry.
She arrived in California as a widow in the 1890's when olive planting was peaking. She lost her first investment in a ranch called Olive Hill Grove and then turned her attention to perfecting a recipe for pickled olives and selling it to grocers.
By 1900, Ehmann Olive Company was running 90 vats at a large processing plant in Oroville, CA.
Dr. Judith Taylor, who wrote the book "The Olive in California," interviewed Freda Ehmann's grand-daughter who said her grandmother never could come to terms about the company's role in the 1919 outbreak.
USDA's Bureau of Chemistry did a study of Ehmann's glass and metal containers in 1920, finding both could look normal but still contain pathogenic organisms, including Clostridium botulinus.
California canned foods have been the source of about 40 deaths in other states, according to the California Department of Public Health. The California State Board of Health responded to the 1919 outbreak with emergency regulation of olive production on Aug. 7, 1920, requiring sanitation through the processing facility and mandating a thermal process.
Heat treatment for olives after cans or jars are sealed to sterilize contents completely was required. Immersion in water at 240 degrees Fahrenheit for 40 minutes was the rule.
California canned olives continued to poison people in some scattered cases.
The emergency regulations under the California Pure Foods Act and limited staff to enforce them were not enough.
California responded with the Cannery Inspection Act of 1925. Both the State Board of Health and the National Canners' Association supported it, which by then even favored federal inspection.
California's Food and Drug Branch today inspects 200 licensed canners where regulated products are packed. It's primary goal remains preventing foodborne botulism. Tests for retort operators to determine qualifications to operate sterilization equipment are critical.
Dr. Armstrong continued to serve in the uniformed U.S. Public Health Service until 1950, ending up as Chief of the Division of Infectious Disease. In Warm Springs, GA, a sculpture of his likeness is found in the Polio Hall of Fame. He is recognized for being the first to adapt and transmit the human strain of poliovirus to small rodents from monkeys, a key step in the development of vaccines.
As for Mrs. I.W.G., her death by Botulism was probably known to her friends and neighbors in Sebring at the time, but she remains known 87 years later only by those initials assigned to her by Dr. Armstrong.
A multinational research team led by scientists at
Duke-NUS Graduate Medical School has identified the reason why some patients fail to respond to some of the most successful cancer drugs.
Tyrosine kinase inhibitor drugs (TKI work effectively in most patients to fight certain blood cell cancers, such as chronic myelogenous leukemia (CML , and non-small-cell lung cancers (NSCLC with mutations in the EGFR gene.
These precisely targeted drugs shut down molecular pathways that keep these cancers flourishing and include TKIs for treating CML, and the form of NSCLC with EGFR genetic mutations.
Now the team at Duke-NUS Graduate Medical School in Singapore, working with the
Genome Institute of Singapore (GIS ,
Singapore General Hospital, and the
National Cancer Centre Singapore, has discovered that there is a common variation in the BIM gene in people of East Asian descent that contributes to some patients' failure to benefit from these tyrosine kinase inhibitor drugs.
"Because we could determine in cells how the BIM gene variant caused TKI resistance, we were able to devise a strategy to overcome it," said
S. Tiong Ong, MBBCh, senior author of the study and associate professor in the Cancer and Stem Cell Biology Signature Research Programme at Duke-NUS and Division of Medical Oncology, Department of Medicine, at Duke University Medical Center.
"A novel class of drugs called the BH3-mimetics provided the answer," Ong said. "When the BH3 drugs were added to the TKI therapy in experiments conducted on cancer cells with the BIM gene variant, we were able to overcome the resistance conferred by the gene. Our next step will be to bring this to clinical trials with patients."
Said Yijun Ruan, PhD, a co-senior author of this study and associate director for Genome Technology and Biology at GIS: "We used a genome-wide sequencing approach to specifically look for structural changes in the DNA of patient samples. This helped in the discovery of the East Asian BIM gene variant. What's more gratifying is that this collaboration validates the use of basic genomic technology to make clinically important discoveries."
The study was published online in
Nature Medicine on March 18.
If the drug combination does override TKI resistance in people, this will be good news for those with the BIM gene variant, which occurs in about 15 percent of the typical East Asian population. By contrast, no people of European or African ancestry were found to have this gene variant.
"While it's interesting to learn about this ethnic difference for the mutation, the greater significance of the finding is that the same principle may apply for other populations," said
Patrick Casey, PhD, senior vice dean for research at Duke-NUS and James B. Duke Professor of Pharmacology and Cancer Biology.
"There may well be other, yet to be discovered gene variations that account for drug resistance in different world populations. These findings underscore the importance of learning all we can about cancer pathways, mutations, and treatments that work for different types of individuals. This is how we can personalize cancer treatment and, ultimately, control cancer."
"We estimate that about 14,000 newly diagnosed East Asian CML and EGFR non-small-cell lung cancer patients per year will carry the gene variant," Ong said. "Notably, EGFR NSCLC is much more common in East Asia, and accounts for about 50 percent of all non-small-cell lung cancers in East Asia, compared to only 10 percent in the West."
The researchers found that drug resistance occurred because of impaired production of BH3-containing forms of the BIM protein. They confirmed that restoring BIM gene function with the BH3 drugs worked to overcome TKI resistance in both types of cancer.
"BH3-mimetic drugs are already being studied in clinical trials in combination with chemotherapy, and we are hopeful that BH3 drugs in combination with TKIs can actually overcome this form of TKI resistance in patients with CML and EGFR non-small-cell lung cancer," Ong said. "We are working closely with GIS and the commercialization arm of the Agency for Science, Technology & Research (A*STAR , to develop a clinical test for the BIM gene variant, so that we can take our discovery quickly to the patient."
The major contributors to the study include additional researchers and teams from the Duke-NUS Graduate Medical School, Genome Institute of Singapore (Dr. Yijun Ruan and Dr. Axel Hillmer , Singapore General Hospital (Dr. Charles Chuah , and National Cancer Centre Singapore (Dr. Darren Wan-Teck Lim .
In addition, the investigators also received important contributions from Akita University Graduate School of Medicine, Japan (Dr. Naoto Takahashi , the Cancer Science Institute of Singapore (Dr. Ross Soo , the National University Cancer Institute of Singapore (Drs. Liang Piu Koh and Tan Min Chin , the Yong Loo Lin School of Medicine, National University of Singapore (Dr. Seet Ju Ee , the University of Bonn, Germany (Dr. Markus Nothen , the University of Malaya (Dr. Veera Nadarajan , and the University of Tokyo, Japan (Dr. Hiroyuki Mano .
The study was supported by grants from the National Medical Research Council (NMRC of Singapore; Biomedical Research Council (BMRC of A*STAR, Singapore; Genome Institute of Singapore; Singapore General Hospital; and two NMRC Clinician Scientist Awards to Dr. Ong and Dr Chuah.
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 studies 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 .
The news generally 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
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
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 secret to staying slim may be all in your genes,” the Daily Mail has today reported, adding that scientists have uncovered a “greedy gene that makes you eat more even when you are full”.
Before any dieters lose hope and reach for the nearest biscuit, it’s important to note that this news is based on research looking at a mutant gene in mice, not humans. The study examined the impact of a mutated gene called BDNF and the role it plays in telling the body it is full. Normally, various organs and tissues will use hormones to tell the brain that no more food is needed, causing the brain to suppress appetite. However, when mice carried a mutant version of the BDNF hormone it appeared this fullness mechanism was blocked, which meant they carried on eating and gaining weight. Male mice carrying the mutation became nearly twice as heavy as their non-mutant counterparts, while females were 2.7 times heavier.
This study may provide a springboard for further research into the role of genetics in the development of obesity. However, this study was carried out in mice and the findings cannot be assumed to apply to humans, whose bodies may react differently to any similar mutation. It’s also not clear how many humans actually carry similar mutations, so it should not be assumed that all obesity is down to genetics.
Where did the story come from?
The study was carried out by researchers from Georgetown University Medical Center and the University of Colorado in the US. It was funded by the US National Institutes of Health and the American Diabetes Association.
The study was published in the peer-reviewed scientific journal Nature Medicine.
Generally, this research was covered well in the media, with the BBC and the Daily Mail emphasising that the study was carried out in mice, not humans. The Mail pointed out that even if the research leads to treatments for obesity, it will be years before they would be made available.
What kind of research was this?
This was animal study that examined the role of a gene called “brain-derived neurotrophic factor” (BDNF in the development of obesity. The researchers say mutations of this gene have been shown to cause overeating and obesity in humans, and the researchers wanted to investigate how the gene influences energy balance.
The researchers say that energy balance is controlled by several organs that send signals to the brain when certain chemicals (such as the hormones leptin and insulin are present in sufficient amounts. These signals cause several brain regions to react and control appetite and energy expenditure. The BDNF protein (which is generated using the BDNF gene in our DNA is involved in regulating how signals are transmitted through the brain. Mutations within the BDNF gene can lead to a different form of BDNF protein being produced, potentially causing different effects compared with a typical form of BDNF.
Animal studies are often used to conduct early, experimental research and to examine specific interventions or processes before research can be carried out in humans.
What did the research involve?
The researchers took two groups of mice, one with a mutated version of the BDNF gene and the other with a normal version of the gene. They then monitored the eating habits of the mice, measuring the amount of food consumed as well as bodyweight and the development of obesity.
In order to uncover the mechanism by which BDNF mutations affect obesity, the researchers also studied the role of certain chemicals including the “hunger hormone” leptin and its ability to activate the hypothalamus and suppress eating behaviours. The hypothalamus is normally activated by leptin, although once activated the hormone serves to suppress the appetite. The researchers looked at the role of leptin in mice with and without the mutation, injecting them with leptin three times over a day. They then measured changes in eating habits throughout the day.
This animal study can provide information on the probable role of BDNF mutations on the development of obesity, but it cannot be assumed that the results apply to humans.
What were the basic results?
The researchers found that by five-to-six weeks of age, mice with mutated copies of the BDNF gene developed severe obesity and had a higher body weight than mice that did not have a mutated version of the gene.
By 16 weeks of age, female mice with the mutation were 171% heavier than their non-BDNF mutation counterparts, and male mice were 90% heavier. The researchers further found that the development of obesity was due to eating more food, not to reduced activity levels. They found that the mice carrying a mutated version of BDNF ate 69%-80% more food than their counterparts.
When examining the role of leptin in the regulation of eating in mutant mice, the researchers found that the chemical did not activate the hypothalamus and inhibit eating as it does in mice who do not have a mutated version of BDNF. They found that the mice that did not carry a mutated version of BDNF reduced the amount of food they ate by 26% after being injected with leptin. The mice with the mutated form of BDNF, however, showed no changes in the amount of food they consumed after having leptin injections.
How did the researchers interpret the results?
The researchers concluded that mutations of the BDNF gene caused obesity due to overeating. They further concluded that, in mice carrying this mutation, leptin’s ability to activate the hypothalamus and regulate food consumption was impaired.
Conclusion
The number of obese people in the UK has been rising in recent years and this is likely to continue. Obesity is linked to several health problems, including diabetes and heart disease.
This study shows that BDNF mutations can cause obesity in mice and suggests a possible mechanism through which it might work. However, while it may lead to further investigations into the role of this gene in human obesity, the results cannot be directly applied to people. Firstly, the biological mechanisms and processes involved may not apply to the human body, and even if they did, human hunger and eating is unlikely to be solely influenced by a single mutation, with factors such as willpower and environment also involved. It is also not clear how many people carry the gene and whether it is found in a high proportion of obese people.
The researchers say that understanding the way in which communication circuits in the brain have an effect on energy balance and eating habits could lead to new strategies for addressing or treating obesity. However, the current study is at a very early stage, and is unlikely to lead to such strategies in the near future.
Several factors can contribute to the development of obesity in humans, including high food intake, low activity levels, genetics and socioeconomic factors. While research into the genetic factors that contribute to obesity is informative and may lead to the development of treatment options, there are strategies available now to treat obesity, such as exercising more and eating a healthy balanced diet high in fruit and vegetables and lower in sugars and saturated fats.
Analysis by Bazian
Links To The Headlines
Obesity gene's role revealed in mice study. BBC News, March 18 2012
‘Greedy gene’ that makes you eat more even when you are full is uncovered by scientists. Daily Mail, March 18 2012
Links To Science
Liao GY, Ji An J, Gharami K et al. Dendritically targeted Bdnf mRNA is essential for energy balance and response to leptin. Nature Medicine, Published online 2012
Visual source:
Newseum
Ben Adler wants liberals not too get to cocky about Mitt Romney's curtsies to the right:
Many liberals, and increasingly even mainstream journalists, are becoming convinced that Republican candidates—including likely nominee Mitt Romney—are doing irreparable damage to their general election prospects. [...]Paul Krugman decries the lies about health coverage reform:
“Although running to the right is part of Republican primary politics, some are starting to worry,” writes ABC’s Alicia Tejada. “With Santorum’s surge, Romney has been forced to move to the right, too, taking positions his supporters admit may make it harder to win the votes independents in the fall if he is the nominee.”
But is it true? [...] eight months is a very long time in politics. No one should think that a minor kerfuffle such as Limbaughgate would determine the 2012 election.
Each new report from the Congressional Budget Office is touted as proof that the true cost of Obamacare is exploding, even when — as was the case with the latest report — the document says on its very first page that projected costs have actually fallen slightly. Nor are we talking about random pundits making these false claims. We are, instead, talking about people like the chairman of the House Republican Policy Committee, who issued a completely fraudulent press release after the latest budget office report.Michael Gerson says the teleprompter that Rick Santorum hates isn't the problem he thinks it is:
Because the truth does not, sad to say, always prevail, there is a real chance that these lies will succeed in killing health reform before it really gets started. And that would be an immense tragedy for America, because this health reform is coming just in time.
On this issue, Santorum cannot be accused of hypocrisy. His Super Tuesday victory speech, delivered in Steubenville, Ohio, did not make use of a teleprompter -- or any other form of rhetorical discipline. It was a 20-minute ramble of lame jokes, patriotic platitudes and half-developed campaign themes. On the evidence of these remarks, Santorum's guiding philosophy is "free enterprise" and "free people" held together by free association. He vaguely honored Ronald Reagan for saying inspiring words, without bothering to contribute any of his own. He praised the "greatest generation" without crafting a single phrase that captured their accomplishments.David Ignatius describes what he has seen in a sample of the thousands of documents taken from Osama bin Laden's compound after the raid that killed him:
But the al-Qaeda leader turns immediately to a bitter reflection on mistakes made by his followers — especially their killing of Muslims in Iraq and elsewhere. The result, he said, “would lead us to winning several battles while losing the war at the end.” Bin Laden ruminated on the “extremely great damage” caused by these overzealous jihadists. [...]Newsday:
The brooding bin Laden advised his followers to back off on these self-defeating attacks in Muslim nations and instead begin “targeting American interests in non-Islamic countries first, such as South Korea.” At another point, he stressed: “The focus must be on actions that contribute to the intent of bleeding the American enemy.”
A burst of bipartisanship, a behavior too rarely seen these days in Congress, led the Senate last week to pass an eminently sensible transportation bill. That was in sharp contrast to the House of Representatives, which had proposed, but failed to pass, an ugly, anti-mass transit bill. The House must now put aside ideology and pass the Senate version. The current stopgap legislation expires soon, which will further endanger our already-crumbling national infrastructure.David Roberts decries the idiocy of cutting the nation's lead poisoning prevention program by 90 percent as an "empty gesture toward 'fiscal responsibility' to please a decadent elite." Pity the kids whose lives are messed up as a result.
On Feb. 29, a Philadelphia jury sentenced Derrick White to death for murder — in part because his lawyers provided the kind of ineffective counsel that has drawn harsh criticism for decades in the city.Joel Bleifuss writes that in the case of
Barely 20 when arrested in 2010, Mr. White received a death sentence after his lawyers failed to take the most rudimentary steps for capital cases. They did not enter as evidence records about his background or hire a death penalty expert to help prepare the case. The closing argument about whether he deserved death or life without parole was rambling and all but pointless, lasting 15 minutes.
Although Pennsylvania has carried out only three executions since 1976, its system is no less barbaric for that fact. Two hundred and five inmates are on death row. The White case underscores the state’s continuing failure to meet constitutional standards in capital cases. It is well past time for the state to stop its machinery of death.
Kiobel v. Royal Dutch Petroleum
the Supreme Court is likely to rule in June that, under international law, corporations are not people and cannot be held liable for complicity human rights abuse:
So, as withRobert Fisk doesn't buy the widespread media explanation for Sgt. Robert Bales's massacre:
Citizens United
, the lines are drawn. On one side, a pack of lawyered-up marauders claim their rights as persons one day and deny their culpability the next. On the other side, living beings seek relief from the jackals that gorge upon the fruits of human labor and gobble up the riches of the earth.
"Apparently deranged", "probably deranged", journalists announced, a soldier who "might have suffered some kind of breakdown" (The Guardian , a "rogue US soldier" (Financial Times whose "rampage" (The New York Times was "doubtless [sic] perpetrated in an act of madness" (Le Figaro . Really? Are we supposed to believe this stuff? Surely, if he was entirely deranged, our staff sergeant would have killed 16 of his fellow Americans. He would have slaughtered his mates and then set fire to their bodies. But, no, he didn't kill Americans. He chose to kill Afghans. There was a choice involved. So why did he kill Afghans? We learned yesterday that the soldier had recently seen one of his mates with his legs blown off. But so what?Zoe Williams says she's mellowed on some feminist issues and become more hardline on others:
There is no way we will ever reach an agenda on which all of us agree, in equal measure, with everything. I have seen larger, more vivid, more optimistic feminist gatherings in the past six months than in the rest of my life put together, but not one of them has reached its end without a load of time being wasted on one of these classic faultlines: someone frozen out for admitting she likes Debbie Does Dallas; someone else saying: "What do I care about some middle-income woman's childcare arrangements when rape is being used as an act of war in the Congo?"
The women's movement has a problem with ideological purism: in its discourse, it demands not only that we all adhere to a central set of truths, but also that we agree on their priority. This is impossible.
“Babies fed on demand do better at school,” reported The Guardian. The newspaper said that those who “are fed when they are hungry achieve higher test scores” but that the experience takes its toll on their mothers.
The news is based on what is thought to be the first large-scale study to look at how infant feeding schedules relate to academic achievement later in childhood. Examining how more than 10,000 children were fed at the age of four weeks, the researchers then compared their performances in IQ scores tests at the age of eight and in school tests up to the age of 14. The researchers were specifically interested in whether feeding babies at set times led to different developmental outcomes compared with feeding on demand. They found that babies fed on demand did better academically later in childhood than schedule-fed babies. However, mothers who fed on demand were more likely to feel that they were not getting enough sleep and felt less confident than mothers who scheduled feeds.
This research suggests that infant feeding patterns are linked to later academic performance, but it does not prove that one causes the other. Although there did appear to be some relationship between the two factors, other considerations such as maternal attitudes and background may explain both. For example, a mother’s attitudes could lie behind both the choice to follow a particular feeding pattern and the way she motivates her child at school. As the researchers themselves have said, these results should be approached cautiously and more research will be required to confirm the findings.
Where did the story come from?
The study was carried out by researchers from the University of Essex and the University of Oxford and was funded by the UK’s Economic and Social Research Council.
The study was published in the peer-reviewed European Journal of Public Health.
This research was covered appropriately in the media, with both The Guardian and the Daily Mail emphasising that the association between feeding patterns and IQ were statistically significant, but may not necessarily have any practical significance in everyday life.
What kind of research was this?
This prospective cohort study examined the association between babies’ feeding schedules and their cognitive development and academic attainment throughout childhood. The study also examined the association between schedule feeding and the mother’s wellbeing. The research included children who were both breastfed and bottle-fed.
This study was “prospective”, which means that the research used initial assessments to establish the babies’ feeding patterns and then monitored how the children’s development progressed in the years that followed. A prospective cohort study is a useful way to examine the relationship between different factors (variables , as it allows researchers to be fairly confident that their measurements are accurate. Collecting information on the babies’ feeding patterns during infancy, as opposed to asking parents to recall them years later, improves the likelihood that this data was accurately estimated.
However, while this study can describe the relationship between these factors, it cannot determine whether feeding patterns directly caused differences in child academic performance. The study authors have themselves urged caution when interpreting the results, as they demonstrate a potential relationship between a mother’s approach to feeding and her child’s level of subsequent educational attainment, but not that one can cause the other.
What did the research involve?
The researchers analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC , a large ongoing cohort study of children born during the 1990s in and around Bristol in the UK. In all, 14,541 mothers were enrolled in the study while pregnant and they were interviewed repeatedly during their pregnancy and after their child was born. For the current study, the researchers used data collected during these interviews, as well as school attainment test data.
When the babies included in this study were four weeks old, their mothers were asked whether or not they fed their baby on a regular schedule. Based on their responses, the children were classified as being one of the following:
- schedule fed
- attempted schedule fed
- demand fed
Researchers then collected data for several outcomes:
- Maternal wellbeing, which was measured when the child was between the ages of eight weeks and two years, nine months old (33 months . Measures included sleep sufficiency, maternal confidence, maternal enjoyment and postnatal depression.
- Child cognitive development was measured using IQ scores when the children were eight years old.
- Academic attainment was measured using the Standard Attainment Test (SATs given to them at school at ages 5, 7, 11 and 14 years.
The researchers analysed the data while controlling for several variables that may account for, or confound, the relationship between schedule feeding and the outcomes of interest. These variables included the child’s sex, breastfeeding factors (including duration of exclusive breastfeeding , parenting style, maternal health and sociodemographic factors.
What were the basic results?
The researchers found that at four weeks after birth, 7.1% of the mothers reported that they fed to a regular schedule, 23% reported that they tried to feed to schedule and 69.8% reported that they fed on demand.
Mothers who fed to schedule were generally younger and more likely to be single, live in social housing and to be less educated than mothers who fed on demand. They were also likely to report poor health before and during pregnancy. When the children were older, mothers who fed to schedule were more likely to report smacking or shouting at their children and less likely to read to them.
The researchers found that babies who were fed to schedule:
- had lower SATs scores than demand-fed children at ages 5, 7, 11 and 14 (p
<0.001 at all ages - scored 4.3 points lower on IQ tests at age eight (95% CI -5.9 to -2.6, p
<0.001
The researchers then assessed the relationship between feeding pattern and maternal wellbeing. They found that compared with mothers who fed on demand, schedule-feeding mothers:
- were significantly more likely to report getting enough sleep at eight weeks (Odds Ratio [OR] 1.55, 95% CI 1.31 to 1.84, p>0.001
- were significantly more likely to report getting enough sleep at eight months (OR 1.62, 95% CI 1.34 to 1.95, p
<0.001 - were significantly less likely to report feeling “sometimes exhausted” at eight weeks (OR 0.52, 95% CI 0.42 to 0.64, p
<0.001 - reported higher levels of maternal confidence and enjoyment at both eight weeks and 33 months (p
<0.001 for all measures and time periods - had no significant difference in terms of postnatal depression at eight weeks or at 8, 21 or 33 months
How did the researchers interpret the results?
The researchers concluded that feeding infants at regular intervals is associated with better maternal wellbeing but poorer child cognitive development and academic performance.
Conclusion
This large cohort study indicates that infant feeding patterns may be associated with both children’s subsequent academic performance and the wellbeing of their mothers. The researchers emphasised, however, that while the results are statistically significant, they may not reflect “a causal relationship”. In other words, even though there was a statistical link between the two factors, this does not prove that the way the children were fed caused them to develop differently or perform differently at school.
There is a range of possible explanations that could explain the relationships seen, as the researchers have highlighted. First, they said that the results surrounding maternal wellbeing may reflect a “reverse causality”: that instead of regulated feeding patterns improving a mother’s wellbeing, it may be that mothers who get more sleep and feel more confident are more likely to be able to establish a regular feeding schedule.
The study made statistical adjustments to account for the influence of several different factors, including the children’s social and demographic background. However, other factors such as maternal characteristics may influence the relationship between feeding patterns and academic performance. For example, maternal characteristics could govern both a child’s feeding patterns and development, rather than these factors being directly related to each other.
The researchers say that this is the first large-scale cohort study examining the relationship between feeding to a schedule and academic performance later in childhood. They say that additional research will be needed to confirm the results as well as to examine the mechanisms behind the relationship.
It is also important to remember that this study measured schedule feeding only once, when the infants were four weeks old. It is possible that feeding patterns changed after this time and that children who were classified as schedule fed for this study later became fed on demand. Given this limitation, this study is unable to address the impact of such potential misclassification. The study also failed to look at related factors, such as how long it was until the child was weaned onto solid food.
In summary, the study did find a relationship between schedule feeding and academic outcomes later in childhood, but the evidence is not strong enough to influence recommendations on feeding strategies.
Analysis by Bazian
Links To The Headlines
Babies fed on demand 'do better at school'. The Guardian, March 19 2012
Babies fed on demand do better at school... but it's not so good for exhausted and grumpy mothers. Dail Mail, March 19 2012
Links To Science
Iacovou M and Sevilla A. Infant feeding: the effects of scheduled vs. on-demand feeding on mothers’ wellbeing and children’s cognitive development. March 19 2012
"Whocouldanode?" that Apple would do something like pay a de minimus dividend and begin a modest buyback program? Indeed, initial reactions for the stock seemed to be 'sell the news' but of course, it wouldn't be a day ending in 'y' if Apple didn't close green and sure enough, with seconds to spare, Apple managed to close over $600 for the first time. BofA, not so much. After pinging $10 (a healthy double of recent lows , chatter of a secondary began the process of 'normalizing' its recent behavior (the stock is still up 17% post JPM-divi/Stress test news, a whopping 10% better than any of its peers in that 4 day period . The leak in financials dragged on the S&P which limped back lower to close almost perfectly at its VWAP as NYSE trading volumes (after almost record-breaking high levels on Friday OPEX hedge removal day dropped back to near their lows . Credit outperformed equities today but its a very 'technical' day for credit in general with the CDS/index rolls tomorrow (meaning the major credit indices will move to new maturities and new components though HYG staggered notably early in the day. USD and Treasury weakness were the headlines of the day (aside from AAPL of course - which apparently has a great new screen which of course helped commodities rally with high-beta Silver the best on the day +1.2% from Friday and WTI breaking $108 as Gold limped higher (tortoise-like over $1660 at the end. VIX rose once again and the term structure flattened a little but once again post-OPEX and futures roll, there are some more difficult apples-to-camels comparisons there.
HYG (green dropped rather notably in the late morning (around the time of the European close but staged a magnificent comeback as stocks limped higher overall. Whether this was overnight hedged into the credit roll that was snatched up by ETF arbs or just another algo save is unclear. We would expect anyone who needed to hedge to use HYG more than HY today heading into the roll. HY and IG stayed in sync as we suspect reracking off stocks and very light flows into the roll left them dangling near their intrinsic values.
Financials lost their loving feeling as BofA slid over 6% off its intraday highs. We noted in an earlier tweet that BofA has huge amounts of TLGP debt due in the next few months (which are on the books at exceptionally low costs of capital . We note they got a smallish 5Y deal off today at T+275bps so unless they are planning on another juicy DVA spread play, earnings will take a notable hit in Q2-3 from significantly higher debt costs. Of course, post JPM, BofA remains the huge outperformer so why not use this dislocation to raise a secondary... seems unlikely though that they could issue bonds today and not disclose some kind of secondary is coming but then again- MF Global...
Silver was the big winner on the day as Copper and Oil rekindled their synchronicity and Gold underperformed USD's weakness on the day managing only +0.25% from Friday's close.
Treasuries managed a decent overnight rally but as activity picked up this morning so Treasury yields popped higher again - up 7-8bps from Friday's close with the 2s10s30s (or the hump-shape/butterflies that twist seemingly pressured down coming unwound en masse as 2Y outperformed and 7Y underperformed.
We can't help but feel like a lot of short-squeeze / hedge ammunition has been taken from the market post-OPEX (volumes were crazy on Friday, VIX has been leaking higher again, and credit protection buyers won't enter heavy until after the roll now as the Greek CDS auction went off without a hitch (as we said it would - and did during LEH and all those crisis hedges set for MAR expiration at the start of the year died out of the money.
NYSE Volume is 25% below Q1 2011 levels on average. The volume traded on Friday was exception all by any measure and yet today we fall back to our old patterns of low volume limp higher.
Today was also the highest average trade size for the ES (S&P 500 e-mini futures contract since July 1st 2011 - dramatically higher than recent average levels.
Charts: Bloomberg
The big news to come out of the annual winter meeting of the AFL-CIO Executive Council was the endorsement of President Obama. That endorsement comes from the labor federation's General Board; the Executive Council, a subset of the General Board and the governing body of the AFL-CIO, has adopted a series of policy statements that comment broadly—and, for the AFL-CIO, definitively, standing not just as quick responses to events but as considered statements of policy—on important issues of the day from overturning Citizens United to supporting comprehensive immigration reform and women's reproductive health care.
Broad statements on
Fixing What is Wrong with Our Economy and
Organizing and Growth sketch out a vision for the economy and for unions. To "fix what is wrong with our economy,"
What we need now is an economic program as serious and far-reaching as the problem President Obama has correctly diagnosed. We must start by shifting the focus of U.S. economic policy from one of maximizing the competitiveness and profitability of corporations that happen to maintain headquarters somewhere on U.S. territory to one of maximizing the competitiveness and prosperity of the human beings who live and work in America.The AFL-CIO proposes massive "productive public investment" in education, energy, transportation, manufacturing, infrastructure and more, all paid for by letting the Bush tax cuts expire and imposing new or increased taxes on capital gains, financial speculation and income greater than $1 million. Related, we have to rein in the financial sector and expand and support manufacturing. Additionally, "it is essential that we tackle the problems of wage stagnation and economic inequality," by increasing and indexing the minimum wage and reforming labor law, among other things.
Organizing workers is, of course, the mission of the union movement, and it's a mission that's under attack from Republicans and corporations across the board. The statement on "Organizing and Growth" affirms the need to fight for union and non-union workers at every level, legislatively and in on-the-ground campaigns:
Nothing is more central to our work than mobilizing and organizing on the side of workers seeking to form unions and build power by engaging in collective bargaining. We must trumpet this call as part of our legislative and policy agendas at federal and state legislative bodies. We must work to expand collective bargaining rights and reform labor laws to ensure that all workers who want to form unions and bargain collectively have a fair opportunity to do so.Anti-worker forces certainly aren't standing still and waiting, and their assault requires unions and workers to be creative and tireless in the fight for rights in the workplace, decent wages, and a voice in the economy and in governance. That is the big-picture struggle; see below the fold for what the AFL-CIO Executive Council had to say about some of the components of that fight.At the same time, as we execute our ambitious legislative and policy agendas, we cannot overlook the overarching imperative of standing with workers seeking to join our movement now. We must re-dedicate and recommit ourselves to supporting workers’ campaigns, because we cannot wait for politicians to fulfill promises or for favorable legislation to be enacted. Standing still and waiting are not acceptable.
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Did you know that the average conventional dairy farmer today earns only about $1.50 for each gallon of milk he sells to the general pasteurized market, while the average raw milk dairy farmer typically fetches between $4 and $8, or more, per gallon on the health-conscious... |
Heroic mental health nurse Robert Fenwick has been posthumously awarded one of Australia’s highest bravery awards, the Star of Courage.
Mr Fenwick, 62, was working at the Bloomfield Hospital in Orange, New South Wales, when he was stabbed in the chest with a steak knife, receiving multiple lacerations to his body, while protecting a female colleague from a psychiatric patient on January 5, 2011.
Governor General Quentin Bryce awarded Mr Fenwick the Star of Courage, the nation’s second highest bravery decoration, which recognises “acts of conspicuous courage in circumstances of great peril”.
Patient Brett French, who helped Mr Fenwick struggle with the offender, has also been awarded a bravery medal.
Mr Fenwick and nurse Emily Pritchard were attending Mr French when the offender lunged at Ms Pritchard armed with a steak knife in each hand, almost severing her finger.
Mr Fenwick then placed himself between the offender and Ms Pritchard, receiving multiple injuries, according to the Bravery Council Honours List.
“Despite his injuries, Mr Fenwick, and his patient, who came to assist, forced the offender outside,” it states.
“Mr Fenwick grabbed a broom and defended himself with it. The offender backed off and security staff apprehended him.”
Mr Fenwick, a veteran nurse, died the following morning at Westmead Hospital.
Meanwhile, a Melbourne nurse has received a commendation for brave conduct for coming to the assistance of a man being chased by a man wielding a large stick.
District nurse Lynn Brooks was driving along Brunswick Road in Brunswick, Victoria, when she saw the two men run onto the road and stopped her vehicle.
“The first man looked petrified and had a large amount of blood over his body from stab wounds to his head, neck, hands and leg,” the list states.
“As the man pleaded for help, Ms Brooks wound down her window, leaned back and managed to open her rear door.”
Ms Brooks yelled at the man to climb in, drove for 50 metres and then called 000; later returning to the scene after the police and an ambulance arrived.
