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Miniature lab can diagnose disease in the field



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Test Tells Viral And Bacterial Infections Apart: Scientific American Podcast

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Antibiotics don’t work against viruses. But doctors sometimes give antibiotics to patients who have what turns out to be a viral infection. Which adds to the growing problem of antibiotic resistance. Tests to tell a bacterial infection from a viral one take one to two days and don’t always return a clear prognosis. So researchers in Israel have developed a rapid test – using a CSI tool.

The chemical Luminol is used at crime scenes because it fluoresces in the presence of blood. When we get an infection, white blood cells called phagocytes leap into action. In the process, they consume oxygen and produce what are called Reactive Oxygen Species, or ROS. Luminol makes the ROS glow.

But bacterial and viral infections produce different ROS’s and so have different types of glows. By evaluating the infections of 69 patients, the researchers were able to create different Luminol signatures for bacterial versus viral infections. In blind tests, the scientists achieved 89 percent accuracy. The research was published in the journal Analytical Chemistry. [Daria Prilutsky et al, Differentiation between Viral and Bacterial Acute Infections Using Chemiluminescent Signatures of Circulating Phagocytes]

The scientists hope to fine-tune the test to make it more accurate. Which could help doctors make better diagnoses—and reduce the use of unnecessary antibiotics.

—Cynthia Graber

[The above text is a transcript of this podcast]

Vaccines. Time for Society to Say Enough is Enough | Risk: Reason and Reality | Big Think

Vaccination-w-01

What does society do when one person’s behavior puts the greater community at risk? That’s a no-brainer, right? We make them stop. We pass laws, or impose economic rules, or find other way to discourage individual behaviors that threaten the greater common good. You don’t get to drive drunk. You don’t get to smoke in public places. You don’t even get to leave your house if you catch some particularly infectious disease.

Then what should we do about people who decline vaccination for themselves or their children, and put the greater public at risk by fueling the resurgence of nearly eradicated diseases? Isn’t this the same thing, one person’s perception of risk producing behaviors that put others at risk? Of course it is. Isn’t it time for society to say that in the greater public interest, we need to regulate the risk created by the fear of vaccines? Yes. It is.

The evidence is overwhelming that declining vaccination rates are contributing to outbreaks of disease. Take just one example, measles. The WHO reports outbreaks in many countries where vaccination rates have gone down: As of June – France (12,699 cases in 2011, more than in all of 2010 already, including six deaths), Spain (2,261), Italy (1,500), Germany (1,193, one death), Switzerland (580), Romania, Belgium, Denmark, and Turkey. There have already been 550 measles cases in England and Wales this year compared with 33 all of last year. 

The U.S. has seen 156 cases as of mid-June, compared to a total of 56 cases per year from 2001-2008. The CDC has an emergency health advisory out for measles, a disease officially declared eradicated in the United States in 2000.

Small numbers, you say? True, but consider their cost (beyond the suffering of the patients). Measles is ferociously infectious, and potentially deadly to the young or old or people with weakened immune systems, so it requires an intense response from the medical and public health communities. Consider just one small outbreak: When a woman from Switzerland who had not been vaccinated for measles visited Tucson and became symptomatic, she went in to a local hospital for medical attention and three months later at least 14 people, including seven kids, had gotten measles. Seven of the victims caught the disease while visiting health care facilities. Four people had to be hospitalized. The outbreak cost two local hospitals a total of nearly $800,000, and the state and local health departments tens of thousands more, to track down the cases, quarantine and treat the sick, and notify the thousands of people who might have been exposed.

Fueling the spread? None of the victims had been vaccinated, and, remarkably, 25% of the workers in the health care facilities where the patients were treated had no immunity to measles (either they had not been vaccinated or the antibodies from an earlier vaccination could no longer be detected in their blood stream.) One health care worker got the disease, and gave it to two other people. 

That’s just one example of the growing threat to public health caused by people worried that vaccines will cause autism and other harms, despite overwhelming evidence to the contrary. In many places, particularly in affluent, liberal, educated communities (Boulder, San Diego), unvaccinated people are catching diseases that vaccines can prevent, like measles, whooping cough, and meningitis. In 2010 as California suffered its worst whooping cough outbreak in more than 60 years (more than 9,000 cases, 10 infant deaths), Marin County, one of the richest and most educated areas in California, had one of the lowest rates of vaccination statewide and the second highest rate of whopping cough. A 2008 study in Michigan found that areas with “exemption clusters” of parents who didn’t vaccinate their kids were three times more likely to have outbreaks of whooping cough than where vaccination rates matched the state average.

And this is a risk to far more people than just those who have opted out of vaccination. People are getting sick who have been vaccinated but the vaccine either doesn’t work or has weakened. (Of the 156 measles victims in the U.S. as of June, nearly one in five of them had been vaccinated but the vaccine didn’t work, or had weakened.)  Infants too young to be vaccinated are getting sick, and some of them are dying, when exposed to diseases in communities where ‘herd immunity’ has fallen too low to keep the spread of the disease in check. Unvaccinated people are getting sick and visiting doctor’s offices or hospitals seeking treatment, raising the risk to anyone sharing those facilities, costing the health care system millions of dollars in avoidable expense, and costing local and state government (that’s taxpayer money, yours and mine) millions more as they try to chase down each outbreak and bring it under control, to protect the public’s health. Your health, and mine. (A recent economic analysis found that “…vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs.

It is time to act in the face of this threat. This is not to deny the feelings of those who fear vaccines, or denigrate those fears as irrational, as many in the health care and vaccine communities too readily do. In fact, this is to recognize and respect the honest and powerfully deep roots of those fears, and the fact that no amount of communication or dialogue or reasoning can make people really worried about vaccines, stop worrying. Risk perception is ultimately subjective, a combination of the facts and how those facts feel. Sometimes our fears just don’t match the facts, and the gap between our feelings and the evidence, what I call “The Perception Gap”, produces real risks all by itself, risks which need to be managed the same way society tries to manage myriad other threats to public health from which we can’t protect ourselves as individuals.

There are many potential solutions, each fraught with pros and cons and details that require study and careful thought and open democratic discussion.

   —   Perhaps it should be harder to opt out of vaccination. (Twenty-one states allow parents to decline vaccination of their children simply for “philosophical” reasons. 48 allow a religious exemption but few demand documentation from parents to support claims that their faith precludes vaccination.)

   —   Perhaps there should be higher health care/insurance costs for unvaccinated people.

   —   Or we could do it in a positive way, with reduced health care/insurance costs for people who do get vaccinated, ‘healthy behavior’ discounts paid for by what society saves by avoiding the spread of disease.

   —   There could be restrictions on the community/social facilities unvaccinated people can use, or limits on the social activities in which they can participate, like lengthy school trips for kids, etc.

   —   Here’s an idea; vaccination, including boosters, should be required of anyone who wants to work in health care.

This is not about creating more government to intrude further into our lives. There is already too much of that. This is about calling on government to do what it’s there for in the first place, to protect us from the actions of others when we can’t protect ourselves as individuals. We do this in countless ways already. It is appropriate, and urgent, that we act to protect ourselves from those whose choices about vaccines are putting the rest of us at risk, and do the same thing society always does whenever one person’s behavior endangers the greater community. We make them stop.

 

Vaccines. Time for Society to Say Enough is Enough | Risk: Reason and Reality | Big Think

Vaccination-w-01

What does society do when one person’s behavior puts the greater community at risk? That’s a no-brainer, right? We make them stop. We pass laws, or impose economic rules, or find other way to discourage individual behaviors that threaten the greater common good. You don’t get to drive drunk. You don’t get to smoke in public places. You don’t even get to leave your house if you catch some particularly infectious disease.

Then what should we do about people who decline vaccination for themselves or their children, and put the greater public at risk by fueling the resurgence of nearly eradicated diseases? Isn’t this the same thing, one person’s perception of risk producing behaviors that put others at risk? Of course it is. Isn’t it time for society to say that in the greater public interest, we need to regulate the risk created by the fear of vaccines? Yes. It is.

The evidence is overwhelming that declining vaccination rates are contributing to outbreaks of disease. Take just one example, measles. The WHO reports outbreaks in many countries where vaccination rates have gone down: As of June – France (12,699 cases in 2011, more than in all of 2010 already, including six deaths), Spain (2,261), Italy (1,500), Germany (1,193, one death), Switzerland (580), Romania, Belgium, Denmark, and Turkey. There have already been 550 measles cases in England and Wales this year compared with 33 all of last year. 

The U.S. has seen 156 cases as of mid-June, compared to a total of 56 cases per year from 2001-2008. The CDC has an emergency health advisory out for measles, a disease officially declared eradicated in the United States in 2000.

Small numbers, you say? True, but consider their cost (beyond the suffering of the patients). Measles is ferociously infectious, and potentially deadly to the young or old or people with weakened immune systems, so it requires an intense response from the medical and public health communities. Consider just one small outbreak: When a woman from Switzerland who had not been vaccinated for measles visited Tucson and became symptomatic, she went in to a local hospital for medical attention and three months later at least 14 people, including seven kids, had gotten measles. Seven of the victims caught the disease while visiting health care facilities. Four people had to be hospitalized. The outbreak cost two local hospitals a total of nearly $800,000, and the state and local health departments tens of thousands more, to track down the cases, quarantine and treat the sick, and notify the thousands of people who might have been exposed.

Fueling the spread? None of the victims had been vaccinated, and, remarkably, 25% of the workers in the health care facilities where the patients were treated had no immunity to measles (either they had not been vaccinated or the antibodies from an earlier vaccination could no longer be detected in their blood stream.) One health care worker got the disease, and gave it to two other people. 

That’s just one example of the growing threat to public health caused by people worried that vaccines will cause autism and other harms, despite overwhelming evidence to the contrary. In many places, particularly in affluent, liberal, educated communities (Boulder, San Diego), unvaccinated people are catching diseases that vaccines can prevent, like measles, whooping cough, and meningitis. In 2010 as California suffered its worst whooping cough outbreak in more than 60 years (more than 9,000 cases, 10 infant deaths), Marin County, one of the richest and most educated areas in California, had one of the lowest rates of vaccination statewide and the second highest rate of whopping cough. A 2008 study in Michigan found that areas with “exemption clusters” of parents who didn’t vaccinate their kids were three times more likely to have outbreaks of whooping cough than where vaccination rates matched the state average.

And this is a risk to far more people than just those who have opted out of vaccination. People are getting sick who have been vaccinated but the vaccine either doesn’t work or has weakened. (Of the 156 measles victims in the U.S. as of June, nearly one in five of them had been vaccinated but the vaccine didn’t work, or had weakened.)  Infants too young to be vaccinated are getting sick, and some of them are dying, when exposed to diseases in communities where ‘herd immunity’ has fallen too low to keep the spread of the disease in check. Unvaccinated people are getting sick and visiting doctor’s offices or hospitals seeking treatment, raising the risk to anyone sharing those facilities, costing the health care system millions of dollars in avoidable expense, and costing local and state government (that’s taxpayer money, yours and mine) millions more as they try to chase down each outbreak and bring it under control, to protect the public’s health. Your health, and mine. (A recent economic analysis found that “…vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs.

It is time to act in the face of this threat. This is not to deny the feelings of those who fear vaccines, or denigrate those fears as irrational, as many in the health care and vaccine communities too readily do. In fact, this is to recognize and respect the honest and powerfully deep roots of those fears, and the fact that no amount of communication or dialogue or reasoning can make people really worried about vaccines, stop worrying. Risk perception is ultimately subjective, a combination of the facts and how those facts feel. Sometimes our fears just don’t match the facts, and the gap between our feelings and the evidence, what I call “The Perception Gap”, produces real risks all by itself, risks which need to be managed the same way society tries to manage myriad other threats to public health from which we can’t protect ourselves as individuals.

There are many potential solutions, each fraught with pros and cons and details that require study and careful thought and open democratic discussion.

   —   Perhaps it should be harder to opt out of vaccination. (Twenty-one states allow parents to decline vaccination of their children simply for “philosophical” reasons. 48 allow a religious exemption but few demand documentation from parents to support claims that their faith precludes vaccination.)

   —   Perhaps there should be higher health care/insurance costs for unvaccinated people.

   —   Or we could do it in a positive way, with reduced health care/insurance costs for people who do get vaccinated, ‘healthy behavior’ discounts paid for by what society saves by avoiding the spread of disease.

   —   There could be restrictions on the community/social facilities unvaccinated people can use, or limits on the social activities in which they can participate, like lengthy school trips for kids, etc.

   —   Here’s an idea; vaccination, including boosters, should be required of anyone who wants to work in health care.

This is not about creating more government to intrude further into our lives. There is already too much of that. This is about calling on government to do what it’s there for in the first place, to protect us from the actions of others when we can’t protect ourselves as individuals. We do this in countless ways already. It is appropriate, and urgent, that we act to protect ourselves from those whose choices about vaccines are putting the rest of us at risk, and do the same thing society always does whenever one person’s behavior endangers the greater community. We make them stop.

 

Medical Innovations in Humanitarian Situations: The Book (free pdf)

medicalinnovations

Medical Innovations in Humanitarian Situations explores how the particular style of humanitarian action practiced by Doctors Without Borders/Médecins Sans Frontières (MSF) has stayed in line with the standards in scientifically advanced countries while also leading to significant improvements in the medical care delivered to people in crisis.

Through a series of case studies, the authors reflect on how medical aid workers dealt with the incongruity of practicing conventional evidence-based medicine in contexts that require unconventional approaches.

Medical Innovations in Humanitarian Situations: The Book (free pdf)

medicalinnovations

Medical Innovations in Humanitarian Situations explores how the particular style of humanitarian action practiced by Doctors Without Borders/Médecins Sans Frontières (MSF) has stayed in line with the standards in scientifically advanced countries while also leading to significant improvements in the medical care delivered to people in crisis.

Through a series of case studies, the authors reflect on how medical aid workers dealt with the incongruity of practicing conventional evidence-based medicine in contexts that require unconventional approaches.

Gilead License Expands Access, But Several Countries Left Out | Doctors Without Borders

Press Release

Gilead License Expands Access, But Several Countries Left Out

Excluded Countries Should be Ready to Issue Compulsory Licences to Access Needed Drugs

July 12, 2011–>

Take Action

Tweet this:
.@JNJStories, Abbott, Merck, follow Gilead’s first steps into the Patent Pool to make #AIDS drugs affordable. http://bit.ly/or7GNz

Follow @MSF_USA for updates.

Patent Pool Explained

GENEVA/NEW YORK, July 12, 2011 – An agreement announced today by pharmaceutical company Gilead to licence several HIV/AIDS drugs to the Medicines Patent Pool could improve access to medicines for patients, but it excludes several countries with many people living with HIV, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

“This agreement is an improvement over what other big pharma companies are doing to ensure access to their patented AIDS medicines in developing countries,” said Michelle Childs, policy and advocacy director at MSF’s Campaign for Access to Essential Medicines. “But some caution is needed, because in several key areas Gilead is not going beyond the status quo. More needs to be done to fulfil the vision of the Patent Pool to provide a solution to all people living with HIV. So this licence should not become the template for future agreements,” she said.

On the positive side, the licence covers two promising drugs in the pipeline (cobicistat and elvitegravir), one pipeline combination, and the crucial drug tenofovir. This could help ensure that new treatment options are available in developing countries at the same time as in rich countries.

The licence also allows for new fixed-dose combinations and child-friendly medicines to be developed. Critically, the licence is the first of its kind to explicitly incorporate the potential use of public health safeguards: it allows medicines to be exported to countries excluded from the agreement when their governments choose to override the patent with a compulsory licence. It also allows producers to exit the agreement for any one of the drugs if Gilead loses a patent because of a legal challenge. The agreement has also been made public, which sets an important precedent for transparency.

On the negative side, the agreement falls significantly short of what is needed to fully meet the public health needs for HIV/AIDS: it limits price-busting competition by confining manufacturing to one country (India) and includes narrow supply options for active pharmaceutical ingredients needed to make the drugs.

Most critically, people living with HIV in certain middle-income countries are excluded. This contrasts sharply with the first Pool license granted by the US National Institutes of Health, which covers all developing countries. If voluntary measures like the Patent Pool are unable to ensure people access to the medicines they need, countries that are left out will need to aggressively pursue non-voluntary paths like compulsory licences, MSF said.

Several of the countries that are excluded under the Gilead licences are among the first in which MSF provided HIV/AIDS treatment ten years ago.

“We handed over many treatment programs in Latin America and Asia to local authorities in the confidence that they would be able to provide people with the treatment they needed to stay alive,” said Dr Tido von Schoen-Angerer, executive director of MSF’s Access Campaign. “If people in middle-income countries are left out of such deals, their governments still need to pursue compulsory licences to overcome patent barriers.”

The initial idea of the Patent Pool was to allow access for all people in developing countries. Any producer meeting the right standards should be able to make use of licenses to produce and sell. But in this agreement, manufacturers in Thailand and Brazil, which have capacity to produce, have been left out.

This agreement builds on existing contracts made in 2006 between Gilead and generic producers of tenofovir (TDF), a backbone of improved first-line HIV/AIDS treatment. The new deal will allow these producers to make new drugs coming from Gilead, but has not overcome the issue of supply to countries facing patent barriers, such as China.

“Companies currently negotiating with the Pool should agree to licenses that more fully meet public health needs,” said Childs. “We expect all companies, including Johnson and Johnson, Abbott, and Merck, to also put their patents in the Pool, just as we hope that countries that don’t benefit from this agreement will use all means, including compulsory licenses, to increase access to HIV medicines for their people.”

 

Tags:

Access to Medicines,

HIV/AIDS

Gilead License Expands Access, But Several Countries Left Out | Doctors Without Borders

Press Release

Gilead License Expands Access, But Several Countries Left Out

Excluded Countries Should be Ready to Issue Compulsory Licences to Access Needed Drugs

July 12, 2011–>

Take Action

Tweet this:
.@JNJStories, Abbott, Merck, follow Gilead’s first steps into the Patent Pool to make #AIDS drugs affordable. http://bit.ly/or7GNz

Follow @MSF_USA for updates.

Patent Pool Explained

GENEVA/NEW YORK, July 12, 2011 – An agreement announced today by pharmaceutical company Gilead to licence several HIV/AIDS drugs to the Medicines Patent Pool could improve access to medicines for patients, but it excludes several countries with many people living with HIV, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

“This agreement is an improvement over what other big pharma companies are doing to ensure access to their patented AIDS medicines in developing countries,” said Michelle Childs, policy and advocacy director at MSF’s Campaign for Access to Essential Medicines. “But some caution is needed, because in several key areas Gilead is not going beyond the status quo. More needs to be done to fulfil the vision of the Patent Pool to provide a solution to all people living with HIV. So this licence should not become the template for future agreements,” she said.

On the positive side, the licence covers two promising drugs in the pipeline (cobicistat and elvitegravir), one pipeline combination, and the crucial drug tenofovir. This could help ensure that new treatment options are available in developing countries at the same time as in rich countries.

The licence also allows for new fixed-dose combinations and child-friendly medicines to be developed. Critically, the licence is the first of its kind to explicitly incorporate the potential use of public health safeguards: it allows medicines to be exported to countries excluded from the agreement when their governments choose to override the patent with a compulsory licence. It also allows producers to exit the agreement for any one of the drugs if Gilead loses a patent because of a legal challenge. The agreement has also been made public, which sets an important precedent for transparency.

On the negative side, the agreement falls significantly short of what is needed to fully meet the public health needs for HIV/AIDS: it limits price-busting competition by confining manufacturing to one country (India) and includes narrow supply options for active pharmaceutical ingredients needed to make the drugs.

Most critically, people living with HIV in certain middle-income countries are excluded. This contrasts sharply with the first Pool license granted by the US National Institutes of Health, which covers all developing countries. If voluntary measures like the Patent Pool are unable to ensure people access to the medicines they need, countries that are left out will need to aggressively pursue non-voluntary paths like compulsory licences, MSF said.

Several of the countries that are excluded under the Gilead licences are among the first in which MSF provided HIV/AIDS treatment ten years ago.

“We handed over many treatment programs in Latin America and Asia to local authorities in the confidence that they would be able to provide people with the treatment they needed to stay alive,” said Dr Tido von Schoen-Angerer, executive director of MSF’s Access Campaign. “If people in middle-income countries are left out of such deals, their governments still need to pursue compulsory licences to overcome patent barriers.”

The initial idea of the Patent Pool was to allow access for all people in developing countries. Any producer meeting the right standards should be able to make use of licenses to produce and sell. But in this agreement, manufacturers in Thailand and Brazil, which have capacity to produce, have been left out.

This agreement builds on existing contracts made in 2006 between Gilead and generic producers of tenofovir (TDF), a backbone of improved first-line HIV/AIDS treatment. The new deal will allow these producers to make new drugs coming from Gilead, but has not overcome the issue of supply to countries facing patent barriers, such as China.

“Companies currently negotiating with the Pool should agree to licenses that more fully meet public health needs,” said Childs. “We expect all companies, including Johnson and Johnson, Abbott, and Merck, to also put their patents in the Pool, just as we hope that countries that don’t benefit from this agreement will use all means, including compulsory licenses, to increase access to HIV medicines for their people.”

 

Tags:

Access to Medicines,

HIV/AIDS

Scientists Discover That Antimicrobial Wipes and Soaps May Be Making You (and Society) Sick

A few weeks ago as I was walking out of a Harris Teeter grocery store in Raleigh, North Carolina, I saw a man face a moment of crisis. You could see it in the acrobatic contortions of his face. He had pulled a cart out of the area where carts congregate, only to find that its handle was sticky with an unidentifiable substance. He paused and looked at the handle, as if to imagine the nature of the offense. Gum? Meat juice? Chewed marshmallows? So many vulgar possibilities. Forlorn, he reached for an antibiotic wipe conveniently placed by the door. He scrubbed his hands VERY diligently and then pushed the cart back for someone else to rediscover [1].

Read the rest at scientificamerican.com

Scientists Discover That Antimicrobial Wipes and Soaps May Be Making You (and Society) Sick

A few weeks ago as I was walking out of a Harris Teeter grocery store in Raleigh, North Carolina, I saw a man face a moment of crisis. You could see it in the acrobatic contortions of his face. He had pulled a cart out of the area where carts congregate, only to find that its handle was sticky with an unidentifiable substance. He paused and looked at the handle, as if to imagine the nature of the offense. Gum? Meat juice? Chewed marshmallows? So many vulgar possibilities. Forlorn, he reached for an antibiotic wipe conveniently placed by the door. He scrubbed his hands VERY diligently and then pushed the cart back for someone else to rediscover [1].

Read the rest at scientificamerican.com