A county in the U.S. state of California is suing GlaxoSmithKline, the maker of Avandia, a controversial diabetes drug. The lawsuit was spurred by a report on the drug released by the U.S. Senate last week (March 22). That report accused the drug company of withholding information about side effects of serious heart problems, including death. At issue now is whether Avandia should be taken off the market
A U.S. Senate report on the diabetes drug Avandia says both the manufacturer, GlaxoSmithKline, and the U.S. Food and Drug Administration should have warned patients about the dangers of the drug years before they did. The report recommends taking Avandia off the market.
In 2007, Dr. Steven Nissen published a study showing that those taking Avandia had a 43 percent higher risk of having a heart attack and a 64 percent greater chance of dying from a heart attack than those not taking the drug. Weve been warning about this for two and a half years, he said. There really isnt a good reason for physicians to continue to prescribe the drug. Its time to get it off the market.
But doctors still prescribe Avandia to hundreds of thousands of patients worldwide
Dr. Yasser Ousman at Washington Hospital Center prescribes it for some pre-diabetic patients or those in the early stages of diabetes. There are a number of drugs that have been tested in these individuals and Avandia is one of them, and actually, it is quite effective in improving the blood sugar, in normalizing the blood sugar or delaying the occurrence of diabetes in these individuals, Dr. Ousman said.
What bothers me the most is that every month that goes by, more people are harmed by a drug that people simply dont need, Dr. Nissen said. Dr. Nissens report was based on 42 clinical trials that showed a connection between Avandia and heart problems.
I think when you look at the information and the statistics from the initial study, the initial paper by Dr. Nissen in 2007, the increase in the risks of heart attacks is actually small, Dr. Ousman points out. He says that many over the counter drugs - aspirin, ibuprofen, acetaminophen or paracetamol - can be toxic if used improperly.
If you look at the large studies, that were published over the last several years, including a large number of patients comparing Avandia to a placebo or other drugs, there was actually no increase in that risk. That risk was based on smaller studies, Dr. Ousman said.
A study on Avandia funded by GlaxoSmithKline published last year, found no increase in heart attacks. But it found a significant increase in the risk of heart failure where the heart cannot pump enough blood to the organs or muscles. A number of cases resulted in hospitalization or death.
The Food and Drug Administration says it will review Avandia for heart risks and has scheduled a meeting of its advisory panel in July. The agency warns those taking Avandia not to discontinue use without consulting with a doctor.
The dengue virus is spread through the bite of an infected female Aedes egypti mosquito. The disease causes flu-like symptoms, including high fever, muscle aches and sometimes death. Each year, the disease strikes between 50 and 100 million people living in tropical and subtropical regions. There are no effective treatments for dengue, so public health experts focus on prevention to keep the disease under control. Thats what researchers at the University of California Irvine and the British biotech company, Oxitec, have done by creating a new breed of mosquito. We put a gene in, that in the next generation, females wont be able to fly, explains UC-Irvine biologist Anthony James. So when a wild type female mates with a [genetically altered] male, all of her daughters are incapable of flying. Since the female mosquito is the one that spreads the disease, creating female mosquitoes that cant fly is key to controlling dengue. Its only the females that feed on blood and transmit disease, so the males are not part of the transmission dynamics, James says. So if you can reduce the number of females, ultimately the population crashes and you dont have dengue transmission anymore. A safer alternative James says using this new breed of mosquito could be a more benign and, perhaps, more effective alternative to spraying insecticides, a commonly-used strategy to control dengue. Insecticides require people to be able to find where the mosquitoes are. It requires care in their use because insecticides have off-target effects. And, he adds, they are more costly since they require more personnel and materials. This no-fly strategy is still in the testing stage. James and his colleagues are now planning what they call cage tests, where the genetically-modified mosquitoes are placed in huge outdoor cages and their effectiveness in stopping transmission of dengue is assessed. Within a year, James hopes he can begin testing the strategy in places where dengue is prevalent. The research is published in the Proceedings of the National Academy of Sciences.
Researchers at Stanford University in California say acupuncture can be an effective weapon against depression in pregnant women. Depression can pose serious health risks to mother and baby, according to Rachel Manber, a Stanford University psychiatry professor. Depression is associated with suffering, can be associated with suicide or wishing to not live. She adds that depression has been linked to babies who are more difficult to console. Need for safe alternative treatment Psychological counseling is commonly used to treat depression in pregnancy. But many women avoid taking antidepressants while theyre pregnant because of safety concerns. That makes finding an alternative treatment important. Acupuncture has been used to treat other medical conditions during pregnancy, like pain and nausea. Its also used to treat depression in other patients. Manber and her colleagues wanted to find out if the technique could be used to ease depression during pregnancy as well. They recruited pregnant women who suffered from major depressive disorders for a study. We then randomized them to receive eight weeks of treatment with one of three treatments. One of the treatments was the acupuncture that we have tested for depression. The two other groups, who received massage therapy and acupuncture treatments not known to ease depression, were used as controls. Modern success for an ancient practice After eight weeks, the women were tested to see if their symptoms of depression remained. What we found is that women who received the acupuncture for depression had a greater reduction in symptom severity and a greater proportion of women have responded to treatment than the control groups, Manber says. Researchers found acupuncture to be about as effective as the current treatment approaches, counseling and drugs. We that found 63 percent of the women who received the acupuncture for depression ended up responding to treatment, which is really at the high end of response rates for treatment for depression in outpatients. Manber says the results must be independently replicated, and scientists need to better understand the mechanisms of how acupuncture therapy works. This study is published in the March issue of Obstetrics and Gynecology.
LASIK eye surgery is used to correct peoples vision and end their need for glasses or contact lenses. The U.S. Food and Drug Administration approved the procedure 15 years ago. But now, a former government regulator is publicly expressing concerns about the procedures safety.
A review of LASIK studies worldwide shows that 95 percent of those who have had LASIK surgery are happy with the results
With LASIK, doctors use a laser to permanently change the shape of the cornea to improve vision. The U.S. military considers Lasik so safe, the procedure is often performed on troops about to be deployed
But some people who have undergone LASIK are left with permanently damaged vision. They see double, or have problems seeing at night or see starbursts or halos around lights. Some people have lost their jobs and can no longer perform basic functions, such as driving due to bad outcomes from LASIK.
Abby Ellin is one of the people not satisfied with the outcome of her LASIK procedure. I was not a success because I had dry eyes and halos and everything else. That is not a success, she explained
Now, the man who headed the office responsible for reviewing the data on LASIK at the Food and Drug Administration says those side effects were not taken seriously enough. Morris Waxler is no longer with the agency
Its right there in the record, the agencies and the refractive surgeons, said Waxler. People know these problems occur and there doesnt seem to be a plan to handle some of the more difficult problems that are created.
Waxler says the agency should have provided better oversight and employed tougher standards for dealing with adverse effects of LASIK. The agency is now investigating patient reports of LASIK injuries and is working on a study of post-LASIK problems
In addition, the agency requires the makers of machinery used in LASIK to meet certain standards before the agency will approve any new lasers used in this surgery
In the meantime, Morris Waxler has advice for those thinking about having LASIK.
Read everything you can. Theres no urgency to do it. So make sure you understand the worst that can happen to your eyes and you can live with the worst, added Waxler
Dr. Penny Asbell, a doctor who performs the procedure, says people should be aware that not everyone is a good candidate for the surgery
Sometimes I think instead of asking how many LASIK procedures you have done, you should actually ask the doctor, how many have you turned away, noted Dr. Asbell
The Food and Drug Administration does not regulate the practice of medicine in the U.S. It regulates the lasers used in the procedure.
The World Health Organization reports a joint North-South Korean Health Project is making impressive gains. The project that was launched four years ago, aims at improving health conditions for millions of North Koreans, especially women and children.
The World Health Organizations top humanitarian official, Eric Laroche, has just returned from a four-day visit to North Korea. He says what he saw indicates the project is improving health services in the country.
I was really impressed by the effectiveness of the program that has been set up. You know I have been working for 30 years in this field and in the field. And, you do not always get that high rate of return for investment, said Laroche
The World Health Organization reports South Korea is providing $36 million for the health project that began in 2006.
Laroche says the project is delivering essential, quality health services to mothers, newborns and children. He says this is being done through the so-called Integrated Management for Childhood Illness program, which has been very successful in other developing countries.
It is an extremely cost-effective measure that gets a lot of high rate of return in terms of incidence of disease, in terms of reduction of mortality and so on, said Laroche. Along with that there were strategies to reduce also maternal health, to reduce ill-health of mothers, to reduce maternal mortality with emergency obstetric care.
The project also is working to upgrade infrastructure. Hospitals are being rehabilitated and provided with modern surgical and medical equipment.
Laroche says a survey of health facilities that have been upgraded show a number of impressive results.
He says the number of operations performed has increased by eight percent and post-operation infection rates have fallen by more than 42 percent. He says the number of deaths during operations has fallen by more than 73 percent and post-operation deaths have gone down by more than 50 percent.
He says more than 6,000 health professionals have been trained and equipped in emergency obstetric care, essential newborn care and integrated management of childhood illnesses.
North Korea has 220 counties. Laroche says the World Health Organization is allowed to go freely to 210 of these counties. He says the joint North-South Korean health project has been implemented in 80 of these counties and hopes to reach the rest in the coming years.
President Barack Obama is urging Congress to vote in the next few weeks on his proposal to reform the U.S. health care system. The president is indicating that he is ready to try to pass the plan with no Republican Party support.
After about a year of debate, President Obama says lawmakers owe the American people a final vote on health care reform. So that is our proposal. This is where we have ended up. It is an approach that has been debated and changed and I believe improved over the last year. It incorporates the best ideas from Democrats and Republicans, he said.
The president is rejecting Republicans demands that he start over on the issue, and has asked leaders in both houses of Congress to schedule a vote in the next few weeks. For us to start over now could simply lead to delay that could last for another decade or even more. The American people and the U.S. economy just cannot wait that long, he said.
With no Republican support for the bill, Senate Democrats will need to use a legislative procedure called reconciliation, which would require almost unanimous Democratic support.
The top Senate Republican, Minority Leader Mitch McConnell, warns against passing the plan, even with the presidents addition of several Republican ideas. Now I appreciate, we all do, the presidents call for a bipartisan approach. But where we are headed, through the use of reconciliation, means that the only thing that will be bipartisan about this proposal will be the opposition to it, he said.
McConnell says most Americans oppose the presidents plan, and passing it will have political consequences for Democrats in Novembers congressional elections. So I would say to my Democratic friends, you ignore the overwhelming desires of the American people at your own peril, he said.
The president says he is not concerned about the political implications of the issue. He says Americans are questioning their elected officials ability to govern. At stake right now is not just our ability to solve this problem, but our ability to solve any problem. The American people want to know if it is still possible for Washington to look out for their interests and their future, he said.
Mr. Obama is promising an all-out push to build public support for the plan. He will visit the states of Pennsylvania and Missouri next week as part of the campaign.
Travelers in the United States will now be able to help reduce health problems - including malaria, tuberculosis and HIV/AIDS - around the world with a simple $2 donation when they purchase plane tickets, rent a car or book a hotel room. U.N. Secretary-General Ban Ki-moon launched the unique initiative on Thursday.
With a simple click on a computer mouse travelers will now be able to contribute $2 to the MASSIVEGOOD campaign to save lives.
Mr. Ban said the individual contributions may be small, but the thinking behind it is big. Through this partnership between U.N. agencies and the travel business, ordinary people will have the opportunity to do massive good for global health, he said.
All contributions will go to the U.N.-funded UNITAID, which purchases medicines for people living with HIV/AIDS, tuberculosis and malaria. Those three diseases kill nearly 4.5 million people each year
With only five years to go until the Millennium Development Goals target date of 2015, the health-related goals are lagging most. Among them are improving maternal health, reducing child mortality and combating HIV/AIDS, malaria and tuberculosis
Former U.S. President Bill Clinton helped Mr. Ban launch the MASSIVEGOOD program. The U.N. Special Envoy for Haiti said he thinks the initiative will catch on around the world and save millions of lives.
And this is basically an institutionalized version of what we saw happen after the Haiti earthquake, where people were texting in $10 or $5 in Canada, in the automatic systems. These systems, I predict, will empower ordinary people to change the future of the world in ways that we can only begin to imagine, he said.
The initiative is the brain child of former French Foreign Minister Philippe Douste-Blazy, who heads UNITAID. It builds on a similar program started in France in 2006, that instituted a microtax on airplane tickets. That idea spread to 16 countries and raised more than $1 billion
Traveler contributions to the MASSIVEGOOD campaign are voluntary. Thursdays launch in the U.S. will soon be followed in Europe and elsewhere.
Researchers have moved a step closer toward fully restoring the eyesight of people with a rare genetic disorder. A new study shows the treatment is safe and effective, and could pave the way for helping cure more common causes of blindness
Lebers congenital amaurosis is an extremely rare condition that causes blindness in approximately 4,000 people in the United States.
Approximately five to seven babies are born each year with the progressive inherited disorder, according to Jean Bennett, a professor of ophthalmology at the University of Pennsylvania in Philadelphia. Its probably one of the most severe forms of retinal degeneration, most severe because it affects infants, and its usually the parents who first notice that their children arent seeing the way most normal children do at approximately six weeks of age, Bennett said.
LCA is caused by a single defective gene. This defect prevents normal function of the retina, the light-sensitive layer of cells at the back of the eye. This results in severely impaired vision from a very young age and there are currently no effective treatments available
A recent study done on animals has shown that tests on both eyes are safe and effective and improve vision. This clears the hurdle for trials in humans to receive treatments in both eyes.
In a groundbreaking clinical trial last year, researchers repaired the gene and injected it into the retinas of the single eye of 12 people, where it started to produce healthy cells. Bennett says the patients experienced a dramatic improvement in their eyesight in the single eye, particularly among younger patients whose vision had not deteriorated to near blindness. It now allows them to be able to read books and sit in the front of a classroom and see what a teacher is writing on a blackboard and to riding their bike around the neighborhood by themselves, whereas before they enrolled in the study, they were learning braille. They sat in the back of a classroom looking at computer monitors which magnified the teachers image and they were dependent upon canes or holding on to people to walk around, Bennett said.
Bennett, one of the researchers, says the study participants have been clamoring to have their other eye treated with the gene therapy. But before researchers did that, they wanted to make sure the treatment was safe.
Now researchers are waiting for the green light to treat the second eye of Lebers congenital amaurosis patients, to significantly restore their sight in both eyes
Bennett says a similar strategy could someday be used to treat age-related macular degeneration, which is responsible for vision loss in more than 14 million older adults worldwide each year. The disease is the result of damage to the macula, a part of the retina in the eye, which results in central vision loss.
Scientists have identified several gene candidates involved in the disease.
Although there are currently no gene therapy trials under way to treat macular degeneration, Bennett says her study shows that using a virus to repair defective genes involved in the disease is safe. If a strategy is developed to deliver a corrective gene to the eyes of patients with AMD, it may be possible to correct the defect in the second eye of the person at a later time point, she said.
An article on gene therapy by the University of Pennsylvanias Jean Bennett and colleagues is published this week in the journal Science Translational Medicine.
A new study has found that teenagers who are exposed to second-hand tobacco smoke are more likely to have changes to their blood vessels that could lead to heart disease later in life.
Researcher Katariina Kallio of the University of Turku in Finland says her study on teenagers extends previous research, which found cardiovascular damage in grown-ups who breathed in other peoples smoke.
We know previously that in adults there is that kind of association, but we didnt know that in adolescents, she said in a telephone interview. So somehow it was a surprise that there is already in adolescents these kinds of changes.
Significant changes
Changes include thicker walls in the youngsters blood vessels. American Heart Association spokesman Dr. Donald LaVan explains why that change in the arteries is significant.
The blood vessel wall, when it becomes thickened and the lining is disturbed, is more sensitive to the effects of cholesterol deposition. So therefore, these kids are at higher risk for the development of plaque in their arteries as time goes by.
Plaque inside the artery can restrict blood flow, and makes blood clots more likely. Blood clots can block an artery and cause a heart attack.
In their study, the researchers tested blood for cotinine, a chemical which is produced when nicotine is metabolized, so they got an objective measure of how much smoke the teenagers were exposed to. They also did ultrasound and other tests to measure blood vessel function and the thickness of the artery wall.
Dr. Kallio agrees with Dr. LaVan that the results support the recommendation that kids be kept away from tobacco smoke.
Undoing the damage
Exposure to tobacco smoke is a risk factor for cardiac disease already in adolescents, and thats why this study supports that children and adolescents need smoke-free environments, said Kallio.
Although there is some evidence that artery damage caused by second-hand smoke in adults may be reversible, LaVan says its unclear whether thats also true for adolescents
We think that they may be. We do know that people who are taken out of high tobacco smoke environments have a definite drop in developing coronary artery disease. Theres been studies that show that in adults, that when theyre taken away, it is a prevention.
The study was published in the journal Circulation: Cardiovascular Quality and Outcomes, which is published by the American Heart Association.
While the health care reform debate in the United States has been dominated on lowering the cost of health insurance, other health care activists and experts are working behind the scenes to lower barriers to quality health care for African-Americans and Hispanics. One well-respected figure says the key is bringing more minorities into the profession.
Numerous studies indicate African-Americans and Hispanics receive a poorer quality of health care than non-Hispanic whites, even when they have the same levels of income and health insurance coverage. Researchers say the reasons for this disparity include stereotyping of patients by health care providers, and a severe shortage of minority health care professionals.
Dr. Louis Sullivan says minority health care professionals fill a key role in serving ethnic communities. There are studies that have shown that African American physicians and Hispanic American physicians are three to five times more likely to establish their practices in African American or Hispanic American communities, he said
Sullivan, who once served as secretary of the U.S. Department of Health and Human Services, says minority physicians see a higher percentage of patients with either no insurance, or covered by Medicaid, the government insurance program for low-income Americans.
He says these factors improve the chances for providing quality health care, because of the shared identity between doctor and patient.
What happens with the health outcome, depends upon good communication, the trust and credibility between the health professional and the individual seeking care, and an understanding of the patients culture, value system, so that one can develop, hopefully, a strong relationship or interaction between the health professional and the individual, Dr. Sullivan explained. Otherwise what we see resulting are a lack of compliance, people not returning for appointments, not filling prescriptions, not doing a number of things they should be doing as part of the health exchange
Consideration of a minority patients language, customs and beliefs by virtue of their heritage is a concept known as cultural competency. Sullivan, who also served as dean of the historically African-American Morehouse College School of Medicine, says medical schools are beginning to incorporate this concept in educating and training the next generation of health care professionals, regardless of their race.
It will be decades before our health care system truly mirrors the makeup of our general population, Dr. Sullivan said. So yes, we want all of our physicians, white, African American, Latino, what have you, to be culturally competent.
Dr. Sullivan says there will be a chronic shortage of doctors in the country as a whole, as more medical schools transform from training and education, into medical research.
The U.S. Census Bureau estimates that by the year 2080, one in five Americans will be over age 65. For some time, experts have warned that health care needs of the elderly will be enormous in the years ahead. A study out this week raises concern for older patients who leave a hospital after surviving a critical illness.
American hospitals are doing a better job of keeping elderly patients alive while theyre in intensive care. Reports indicate theres a decrease in the risk of in-hospital deaths.
But a study of elderly patients discharged from a hospitals intensive care unit (ICU) shows that almost 40 percent did not survive beyond the research period of three years.
Dr. Hannah Wunsch of Columbia University College of Physicians and Surgeons says for some patients, the survival rate was even less.
A lot of these patients are at the highest risk of death and re-hospitalization and problems in the six months following discharge from the hospital, said Dr. Wunsch.
Dr. Wunsch and colleagues studied the survival rate of 35,000 intensive care patients discharged from U.S. hospitals. They were randomly chosen from data of the U.S. governments medical assistance program for the elderly, called Medicare
The intensive care patients were then compared to elderly patients assigned to other hospital units or in the general Medicare population
Patients transferred from the ICU to skilled nursing facilities, and who needed a ventilator to breathe, faced the highest risk.
More than one million elderly are survivors of intensive care in the United States. Dr. Wunsch says these grim statistics raise serious questions about future treatment of the critically ill
We really need to pay a lot of attention to those patients when they leave the hospital and not just leave them with the idea that they are going to continue their lives as before, added Dr. Wunsch.
The study was published in the Journal of the American Medical Association.
March 8 marks International Womens Day. Hundreds of events are held throughout the world to inspire women and celebrate their achievements. The United Nations says the theme of this years celebration is Equal rights, equal opportunities: Progress for all.
Four years ago on International Womens Day, the Afghan government unveiled a plan for accelerating the improvement of womens status in the country.
Today, almost one-fourth of the Afghan parliament is female. President Hamid Karzai also has selected three women as members of his new Cabinet.
And while the Afghan government expects more than 3.2 million girls to enroll in school this year, the countrys acting Public Health Minister Suraya Dalil says improvements are needed to ensure their future wellbeing.
On average, an Afghan woman will get pregnant six times during her reproductive years. Dalil says officials are working to educate people on contraception, but only 15 percent of couples use one sort of family planning. Dalil says this contributes to a harsh statistic.
Every 30 minutes one woman in Afghanistan dies from causes related to pregnancy and childbirth. So that is [a] really alarming figure, she noted.
Many women around the country lack access to hospitals like the ones in the capital, Kabul. So it is up to the government to bring the medical care to them.
One of the strategies to address maternal mortality is to increase skilled birth attendants, she added. That means midwives, nurses and physicians to assist deliveries.
Skilled birthing attendants are present at 25 to 30 percent of births in Afghanistan. Dalil says the government hopes to expand its midwife training programs and install these professionals in local communities.
Also this year, the Afghan government, along with its international partners, is launching a new mortality study. Dalil participated in the last study in 2002, which she says uncovered some shocking results.
It found that in Badakhshan the maternal mortality issue was 6,500 [deaths] per 100,000 live births and that is the highest ever documented in human history, she explained.
Dalil says she hopes the new study will highlight improvements that can lead to lasting achievements for womens health. But she stresses that the Afghan government needs a combination of international and public support for health advancements before the overall well-being of women in the country can show real progress.
The World Health Organization calls tobacco the leading cause of preventable death in the world. In December, the WHO launched a campaign against cigarette smoking in Africa, saying a rapidly growing population is creating “larger and more accessible markets” on the continent for tobacco companies.
While the risks of cancer and heart disease are generally well-known, smoking has many other effects on the body.
The act of lighting a cigarette and taking a puff is simple enough, but it triggers complex physical changes within the body. And Dr. Ana Navas-Acien says those changes begin within seconds of inhaling
“The respiratory airway is very effective in absorbing tobacco and all the tobacco components. Tobacco has thousands of components, including many toxicants and many carcinogens. And so these components go immediately to the blood stream, to the respiratory tract,” she says.
Carcinogens are substances that can lead to the development of cancer, a well-known risk of smoking. But Navas-Acien, professor of preventive medicine at Johns Hopkins University, says cancer can be a long-term consequence of tobacco smoking. There are much quicker unhealthy effects, such as nicotine addiction.
“The most addictive component in tobacco is nicotine. And so nicotine reaches the brain in less than a second. So it’s like a peak of nicotine and that immediate response to nicotine is where the addictive power of tobacco is,” she says.
The brain actually has receptors for nicotine – structures that receive and bind to specific substances.
“So, it’s going to target these receptors that are in the brain cells. And actually the number of receptors is very small in people who do not smoke. But in people who start smoking, the number of receptors for tobacco increases. And the younger people start smoking the higher the number of receptors. That means the more addictive you are going to be,” the doctor says.
Heart, veins, arteries
While the body craves nicotine once addiction sets in, damage is being done to the cardiovascular system.
“The cardiovascular disease effects can be quite short term. There can be changes in the platelets that are very important particles in the blood that form clots. For example if we have a wound then we need these platelets to aggregate so that there is a clot and we don’t bleed. However, if we don’t have a wound and if we smoke then the platelets aggregate – that’s going to potentially contribute to the forming of (a) thrombosis and heart attacks, says Navas-Acien.
A blood clot in the wrong place can stop the flow of blood to the heart, triggering a heart attack.
Cigarette smoke also reduces lung function, even if inhaled as second-hand smoke.
“We have some very good evidence from workers in bars in Scotland. And their lung function was measured when smoking was allowed in the restaurants. And then Scotland passed a smoke-free legislation, so it was not possible to smoke in restaurants any longer and in bars any longer. When their lung function was measured a year later their lung function had improved quite substantially,” she says.
The Johns Hopkins doctor conducted a similar study in Accra, Ghana, measuring the effect of smoking in public places. People who worked in those environments, whether smokers or not, had higher levels of cigarette chemicals in their bodies. Another study was done in Nigeria, but those results are pending.
Looking older
The physical changes taking place inside the body can’t readily be seen without the aid of medical equipment. But there are telltale signs on the outside.
She says, “The skin is going to age more rapidly. For instance, if we take some twins, one who smokes and the other one doesn’t, and they do everything exactly the same, the skin of the person who smokes is going to have more wrinkles and is going to look much older. Maybe like even 10 years older.”
Then there are the yellow teeth and fingernails and discolored gums. Navas-Acien says smoking is also very bad for dental health.
She admits quitting is not easy, whether it’s done by sheer willpower or with the help of medication. It may take numerous attempts to break the nicotine addiction, but the Johns Hopkins professor says it’s worth it.
About 30 years into the HIV/AIDS epidemic, a new strategy is being launched to better respond to the needs of women and children.
The research agenda -- called Asking the Right Questions – includes 20 specific recommendations to expand and improve care and treatment. The announcement coincides with Monday’s International Women’s Day and is a joint effort by the International AIDS Society (IAS), U.N. agencies, researchers and civil society.
IAS Executive Director Robin Gorna says, “We’re nearly three decades into the epidemic and we have the depressing news that AIDS is now the leading cause of death of women of reproductive age across the globe,” she says.
It wasn’t always that way
“Three decades ago, very few women were infected with HIV. It was a minority issue. But sadly, as HIV has taken its increasing toll on women, the pace of research and the response really hasn’t kept up,” she says.
While “excellent treatments” are available, she says, which can prolong life, many have “not been properly researched on women’s bodies.”
As a result, the full effects of those treatments on women are not known.
“Now that more and more women are accessing treatment, what we still don’t know is how we can best get women into care and how we can make sure that care is integrated,” she says.
That includes, she says, ensuring HIV positive pregnant women get the best health care, while at the same time providing the necessary drugs to prevent HIV transmission to their babies.
What happened along the way
“There are very good reasons for not including women in early research. Doctors and pharmaceutical companies are always very worried about how drugs might affect the growing fetus. And of course we have the terrible history of Thalidomide, where women unintentionally took drugs, which led to side effects in their babies,” she says.
This side effects included severe deformities, including missing limbs. The drug was sold between 1957 and 1961, before being pulled from the market.
“No one ever wants that to happen again. What that means is as an extreme caution,” she says. “Women of reproductive age are not included in clinical trials.”
In the event women of child bearing age are included, they must drop out of clinical trials if they become pregnant.
“For example, one of the drugs that is now used as first-line therapy throughout the world – one of the best drugs we have in combination (therapy) to combat AIDS – is recommended not to be used in women of reproductive age. And yet they are in many countries the majority of people with HIV,” she says.
Kids need special care
“One of the other things we’re looking at is the effect on children. Now in the rich world…we’ve basically eradicated transmission of HIV from pregnant women to their babies. And that’s brilliant news. Sadly, in many of the poorer countries of the world, the opposite is true. And hundreds of thousands of babies are born with HIV every year,” Gorna says.
The head of the International AIDS Society calls it “tragic” that drugs are not available in the “correct formulation” in the developing world.
“We have the drugs, but they need to be mini pills or syrups or a range of other innovative delivery mechanisms. And quite simply, there isn’t any economic rationale for many companies to make those products in that style,” she says.
The IAS, U.N. and other groups are calling on the pharmaceutical industry to increase its research and development of pediatric AIDS drugs “to make sure that these children, who are being born with HIV, can stay alive,” she says.
The IAS, UNICEF and others have set a goal of no more children being born HIV positive by 2015. Gorna says it’s possible, but it will take money and political will.
Universal access
Gorna is in London for a Tuesday meeting on universal access to HIV care, treatment and prevention. In 2005, at the G8 summit in Gleneagles, Scotland, leaders set a goal to provide such access by 2010.
“In 2005, the U.K. led the charge for the G8 and then the whole world at the U.N. to commit to this ambitious goal…. It’s sad, but truly the fact, that we’re about a third of the way there,” she says.
The London meeting, Gorna says, “Is to try very hard to reignite the energy and the passion to achieve that goal of universal access to HIV treatment, prevention and care. We estimate there are about 10 million people who need HIV treatment today and are simply not able to access it.”
Gorna says Canada is hosting both the G8 and G20 summits this year, but so far has not included HIV/AIDS on the summits’ agendas.
African leaders and HIV positive Africans are expected to address Tuesday’s gathering in London about the problems they face.
“My suspicion is that what they’re going to say we need more money. We need to make sure that this remarkable momentum over the last five years does not slow down, that the funding is not flatlined. And that we don’t get into an unhealthy competition with other diseases or with climate change,’ she says.
She says the need for universal access is no less great today than it was in 2005.