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Blog: Brain Parasite Influences Rats’ Attraction to Cats  

Sometimes the introduction of a foreign body such as a parasite can cause typical behaviors to go haywire. Patrick House, a neuroscientist at Stanford University in Palo Alto, Calif., studies the behavioral manipulation of fear in rats by the parasite toxoplasma gondii. House found that rats infected with the parasite were curious about, even attracted to, cat odor.

Because taxoplasma gondii can only reproduce in the guts of cats, the parasite is dependent on rats to spread itself from feline to feline. To overcome this obstacle, the parasite leads the rat to do some strange things.

In studies, House observed that both the fear and attraction pathways in the brain of taxo-infected rats “light up” after they smell cat urine.

The researchers believe the parasite hijacks brain circuits in the amygdala, making the rat exhibit attraction when it should show fear, House said.

Many humans carry the taxoplasma gondii parasite, said House. They can get it from eating uncooked meat and unwashed vegetables, or from handling a cat litter box. The parasite can be harmful to developing fetuses, and expectant mothers have been advised to avoid contact with cat litter.  

While the presence of the parasite has been considered harmless, some epidemiological research suggests that the parasite may have an association with schizophrenia and risk-taking behavior, House said.

House presented his research at the Society for Neuroscience annual meeting.

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Blog: The Secret War: Physicians on health care costs  

From my perspective as a patient, it appears that physicians and other health care professionals face a debate much more burdensome than deciding courses of treatment, the rigors and costs of training, and ethical issues like abortion, euthanasia and the role of humanities in medicine.

 

On a daily basis they are faced with literature and incentives from pharmas, and disincentives from HMOs and insurers to refer patients to mental health professionals. They must consider bonuses based on profit, time constraints established by administrators, and staff cuts and overtime for those remaining. These are practical, everyday decisions that affect not only their financial well-being and their jobs, but also the health of those they treat.

  

I wonder how many lay people and politicians are aware of the great effort the AMA and its panels of specialists put in to establish criteria for treatment only to have those criteria curved, carved, and altered by insurance companies, pharmaceutical concerns and HMOs to the point where they are so watered down as to lose their value as standards.

  

How many physicians realize the subconscious effect the lobbying groups and the subsequent payment plans have on physician efforts to develop standards independent of those groups?

Regarding costs, the basic questions become:

Are physicians in general agreement on a standard criterion for care, regardless of cost? Are current practice guidelines (laboriously researched, reviewed and released on consensus) independent of insurers or are the profit-making concerns of insurers and others consciously or unconsciously built into these standards?

As George Dawson, a Minnesota physician, points out, the Agency for Healthcare Research and Quality (AHRQ) guidelines for depression were such a standard; rigorously designed by experts to provide optimal care, yet severely watered down on the path to adoption.

  

“The unrecognized battle here is who is in charge of quality care, physicians or insurance companies?” asks Dawson.

  

The general assumption is, of course, the insurance companies.

  

As more and more physicians enter the debate on health care reform they need to be aware of their own conscious and unconscious motivations – their Pavlovian reaction to cost/benefit.

  

Recently, during a discussion on health care options among physicians, patients and other interested parties, I inquired as to the viability of the president-elect’s promise of health care for all equal to that provided members of Congress.

 

The general reaction was not “What a great idea!” or even “No, that would not be beneficial to the many in terms of providing optimal coverage.”  The most instantaneous reaction was “My God -- the cost!”

  

Is it preconditioned thinking that forces physicians to take such a position?

  

As of March 2008, state and local governments were paying an average of $4.15 for health care benefits per worker per hour and private industry paid $1.92, according to a new study by the U.S. Bureau of Labor Statistics. It’s assumed the cost for Congress is at least in the same range as other government employees.

  

But which is the prime motivator here – cost or treatment?

  

Once again, a standard must be set for care before the cost is put in place and then managed based not on cost, but on a standardized, unified approach to the treatment goal.

  

Surely this is better than “implicit rationing” without a scientific basis. Setting a standard of care for non-elective procedures should be the first step among many in this great unrecognized battle.

Jeff McCallum is a commercial building contractor, a stage four cancer survivor and author of a book of poems for patients and clinicians.

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Posted: Dec 2, 2008 7:15pm | (0) | (0) |
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Blog: The Secret War: Physicians on health care costs  

From my perspective as a patient, it appears that physicians and other health care professionals face a debate much more burdensome than deciding courses of treatment, the rigors and costs of training, and ethical issues like abortion, euthanasia and the role of humanities in medicine.

 

On a daily basis they are faced with literature and incentives from pharmas, and disincentives from HMOs and insurers to refer patients to mental health professionals. They must consider bonuses based on profit, time constraints established by administrators, and staff cuts and overtime for those remaining. These are practical, everyday decisions that affect not only their financial well-being and their jobs, but also the health of those they treat.

  

I wonder how many lay people and politicians are aware of the great effort the AMA and its panels of specialists put in to establish criteria for treatment only to have those criteria curved, carved, and altered by insurance companies, pharmaceutical concerns and HMOs to the point where they are so watered down as to lose their value as standards.

  

How many physicians realize the subconscious effect the lobbying groups and the subsequent payment plans have on physician efforts to develop standards independent of those groups?

Regarding costs, the basic questions become:

Are physicians in general agreement on a standard criterion for care, regardless of cost? Are current practice guidelines (laboriously researched, reviewed and released on consensus) independent of insurers or are the profit-making concerns of insurers and others consciously or unconsciously built into these standards?

As George Dawson, a Minnesota physician, points out, the Agency for Healthcare Research and Quality (AHRQ) guidelines for depression were such a standard; rigorously designed by experts to provide optimal care, yet severely watered down on the path to adoption.

  

“The unrecognized battle here is who is in charge of quality care, physicians or insurance companies?” asks Dawson.

  

The general assumption is, of course, the insurance companies.

  

As more and more physicians enter the debate on health care reform they need to be aware of their own conscious and unconscious motivations – their Pavlovian reaction to cost/benefit.

  

Recently, during a discussion on health care options among physicians, patients and other interested parties, I inquired as to the viability of the president-elect’s promise of health care for all equal to that provided members of Congress.

 

The general reaction was not “What a great idea!” or even “No, that would not be beneficial to the many in terms of providing optimal coverage.”  The most instantaneous reaction was “My God -- the cost!”

  

Is it preconditioned thinking that forces physicians to take such a position?

  

As of March 2008, state and local governments were paying an average of $4.15 for health care benefits per worker per hour and private industry paid $1.92, according to a new study by the U.S. Bureau of Labor Statistics. It’s assumed the cost for Congress is at least in the same range as other government employees.

  

But which is the prime motivator here – cost or treatment?

  

Once again, a standard must be set for care before the cost is put in place and then managed based not on cost, but on a standardized, unified approach to the treatment goal.

  

Surely this is better than “implicit rationing” without a scientific basis. Setting a standard of care for non-elective procedures should be the first step among many in this great unrecognized battle.

Jeff McCallum is a commercial building contractor, a stage four cancer survivor and author of a book of poems for patients and clinicians.

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Blog: Scientists hone in on how viruses might cross from birds to
humans 		 

Human metapneumovirus (HMPV), a common cause of lower respiratory infection in young children, originated in birds and may have been passed to humans about 200 years ago, according to new research published in the current issue of the Journal of General Virology.  

By the age of five, “virtually all children have been exposed to the virus and re-infections appear to be common," said Ron Fouchier of Erasmus Medical Center in Rotterdam, The Netherlands, in a written statement.

HMPV causes cold-like symptoms including runny nose, cough, sore throat and fever in humans. The infection can lead to more serious illnesses such as bronchitis and pneumonia.  

"HMPV was first discovered in 2001, but studies have shown that the virus has been circulating in humans for at least 50 years," said Fouchier. "HMPV is closely related to Avian metapneumovirus C (AMPV-C), which infects birds. Because of the similarity, scientists have suggested that HMPV emerged from a bird virus that crossed the species barrier to infect humans."

Metapneumoviruses have high evolutionary rates like other RNA viruses such as influenza, hepatitis C and SARS. Analyzing genetic information obtained from many different strains of HMPV and AMPV-C circulating in humans and birds, the researchers determined that the AMPV-C virus crossed the species barrier to infect humans as the HMPV about 200 years ago.  

Understanding how the viruses mutate, evolve and cross to humans from other species will help scientists develop better ways to monitor and predict the emergence of new pathogenic viruses.  

Citation:

deGraaf M, Osterhaus AD, Fouchier RA, Holmes EC. Evolutionary dynamics of human and avian metapneumoviruses J Gen Virol. 2008 Dec;89(Pt 12):2933-42.

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Blog: Scientists hone in on how viruses might cross from birds to
humans 		 

Human metapneumovirus (HMPV), a common cause of lower respiratory infection in young children, originated in birds and may have been passed to humans about 200 years ago, according to new research published in the current issue of the Journal of General Virology.  

By the age of five, “virtually all children have been exposed to the virus and re-infections appear to be common," said Ron Fouchier of Erasmus Medical Center in Rotterdam, The Netherlands, in a written statement.

HMPV causes cold-like symptoms including runny nose, cough, sore throat and fever in humans. The infection can lead to more serious illnesses such as bronchitis and pneumonia.  

"HMPV was first discovered in 2001, but studies have shown that the virus has been circulating in humans for at least 50 years," said Fouchier. "HMPV is closely related to Avian metapneumovirus C (AMPV-C), which infects birds. Because of the similarity, scientists have suggested that HMPV emerged from a bird virus that crossed the species barrier to infect humans."

Metapneumoviruses have high evolutionary rates like other RNA viruses such as influenza, hepatitis C and SARS. Analyzing genetic information obtained from many different strains of HMPV and AMPV-C circulating in humans and birds, the researchers determined that the AMPV-C virus crossed the species barrier to infect humans as the HMPV about 200 years ago.  

Understanding how the viruses mutate, evolve and cross to humans from other species will help scientists develop better ways to monitor and predict the emergence of new pathogenic viruses.  

Citation:

deGraaf M, Osterhaus AD, Fouchier RA, Holmes EC. Evolutionary dynamics of human and avian metapneumoviruses J Gen Virol. 2008 Dec;89(Pt 12):2933-42.

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Blog: Stopping HIV/AIDS Locally and Globally  

Local clinic honors World AIDS Day with free HIV tests 

The Family Tree Clinic in St. Paul, Minn., is offering free rapid HIV tests Mon. Dec. 1, in collaboration with World AIDS Day.  

The screening test looks for the presence of HIV antibodies. If antibodies are detected, a Western Blot test is used to confirm the results since general screenings give a false positive about 20 percent of the time.  

Barbara Peterson, a Family Tree clinician, said if an individual’s tests come back positive, the clinic will help the individual line up primary care, social workers, and insurance.  

HIV is a reportable disease, meaning it must be reported to the state health department. But it’s up to the person being tested whether they submit their information anonymously or confidentially. If people testing positive provide their previous partners names, the health department can contact them for recommended screening. 

A slow yet steady increase in reported cases 

Last year, 325 new cases of HIV positive were reported in Minnesota, a 30 percent increase from 2002 and an 81 percent jump from 1997. An estimated 2,500 Minnesotans are believed to be living with HIV disease but do not know they are infected, according to the Minnesota Department of Health’s 2007 HIV/AIDS Surveillance Report.  

More Minnesota HIV/AIDS Facts:

·         A new case of HIV disease is reported in Minnesota every 27 hours.

·         5,950 people were known to be living with HIV disease in Minnesota as of December 31, 2007

·         8,504 cases of HIV disease have been reported in Minnesota since 1982. Of those, 2,912, or 34%, of these people have died.

·         In 2007, 38% of the newly reported cases of HIV resided in Minneapolis, 13% in Saint Paul, 37% in Twin Cities’ suburbs, and 12% in Greater Minnesota. There has been a steady increase in reported Twin Cities’ suburban cases over the past five years.

·          77% of Minnesota’s living cases of HIV are male. Of that total, 72% contracted the virus through male-to-male sex alone or in combination injecting drug use 

 Source: HIV/AIDS Surveillance Report – 2007, Minnesota Department of Health 

 

 

While Minnesota is considered a low risk region, worldwide, an estimated 33 million people living with HIV. 

“Even though we’re in a low risk community, we want it to stay that way,” says Peterson.  

Maneesha Jain, Family Tree’s hotline coordinator, knows some people resist getting tested because they fear the result. What does she tell them? “It’s peace of mind. If you’re wanting to live in reality and take control of your life you can know and make decisions on that. If you know you have it you can monitor your health and the chance of living a high quality of life is much higher. People also need to think about the potential impact on others.” 

Jain said the clinic was able to offer free tests through the generosity of its testing kit supplier, which donated the kits.  

Family Tree Clinic provides birth control and sexual health testing and treatment services and information for men, women and adolescents.  

In Indonesia, proposed surveillance of  people with HIV an ‘act of desperation’ 

A bill in the Papua province of Indonesia to implant a microchip into HIV positive patients who are “sexually aggressive” to monitor their activities has met with strong resistance. The implication for human rights abuses the law could bring is clear. Such a law could also prove counter-productive to screening efforts.  

But the introduction of the bill underscores the desperation surrounding the HIV crisis in Papua. 

A proponent of the draft law, legislator John Manangsang, told the Jakarta Post that the microchips would only be implanted in people living with HIV/AIDS who were sexually aggressive.  

“Aggressive means actively seeking sexual intercourse. This is one way to protect healthy people,” he said.

“Do not misunderstand human rights; if we respect the rights of the people living with HIV/AIDS, then we must also respect the rights of healthy people.”  He said the draft bylaw also “requires everyone to take HIV/AIDS tests so that preventative measures can be taken early on.  

“I am a doctor, saving lives is my profession. If we want to save the only limited number of Papuans, we have to take real action because 47 percent of (the country’s) HIV/AIDS (cases) are in Papua.” 

A virus has been sweeping the world for the past two decades, causing a disease which has killed millions of people and which looks likely to kill millions more. HIV stands for Human Immunodeficiency Virus. After a period of time this virus damages the immune system, and this causes a variety of symptoms known as AIDS. This time period varies, depending on factors such as access to AIDS drugs, and possibly such factors as nutrition, the presence of other medical conditions, and stress. In the absence of treatment, the average time between HIV infection and progression to AIDS is around ten years. – from AVERT, an international AIDS charity

A bold plan for ending HIV/AIDS in Africa? 

If all adults in Africa were tested annually for HIV and every identified infected person received immediate treatment, it “could virtually end the AIDS epidemic in Africa in about a decade," according to a mathematical model published in the Lancet on Nov. 26. 

In the model, people in South Africa and Malawi were voluntarily tested annually and started on a regimen of antiretrovirals if their test results found them to be HIV-positive, even if they showed no symptoms. According to the model, HIV cases decreased by 95 percent within 10 years.  

The model was developed by AIDS treatment experts Reuben Granich, Charlie Gilks, Christopher Dye and colleagues at the World Health Organization. The researchers have faced much criticism from other experts and commentators after the model was published, but said they offered it as a basis for discussion and additional research. Kevin de Cock, HIV/Aids director at the WHO, and one of the authors, defended the model to the Guardian, saying that it “offers hope at a time when other avenues appear to have closed.” 

The strategy would:
  • Reduce the estimated number of AIDS-related deaths between 2008 and 2050 by about 50%, from about 8.7 million to 3.9 million deaths
  • Reduce the prevalence of HIV to less than 1% within 50 years
  • Decrease incidence rates from 20 new cases per 1,000 people annually to one case per 1,000 people annually in about 10 years
  • Include additional steps such as comprehensive sex education and male circumcision

"Although other prevention strategies, alone or in combination, could substantially reduce HIV incidence, our model suggests that only universal voluntary testing and immediate initiation of antiretroviral drugs could reduce transmission to the point at which elimination might be feasible by 2020 for a generalized epidemic, such as that in South Africa," according to the researchers. 

A major investment  

The financial investment to undertake such an endeavor is substantial --  $1.7 billion annually. That’s far out of reach for developing African nations to manage. But from Minnesota to Papua and South Africa, HIV/AIDS is a global health crisis. While prevention and treatment efforts have stabilized the epidemic in some regions, it is not retreating. It will be very expensive to address, but not when you compare its costs to what has already been spent globally on financial bailouts that benefit the wealthiest, most powerful nations and citizens. It’s just a matter of priorities and keeping promises. 

Citation:

Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model The Lancet, Early Online Publication, 26 November 2008doi:10.1016/S0140-6736(08)61697-9

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Blog: Stopping HIV/AIDS Locally and Globally  

Local clinic honors World AIDS Day with free HIV tests 

The Family Tree Clinic in St. Paul, Minn., is offering free rapid HIV tests Mon. Dec. 1, in collaboration with World AIDS Day.  

The screening test looks for the presence of HIV antibodies. If antibodies are detected, a Western Blot test is used to confirm the results since general screenings give a false positive about 20 percent of the time.  

Barbara Peterson, a Family Tree clinician, said if an individual’s tests come back positive, the clinic will help the individual line up primary care, social workers, and insurance.  

HIV is a reportable disease, meaning it must be reported to the state health department. But it’s up to the person being tested whether they submit their information anonymously or confidentially. If people testing positive provide their previous partners' names, the health department can contact them for recommended screening. 

A slow yet steady increase in reported cases 

Last year, 325 new cases of HIV positive were reported in Minnesota, a 30 percent increase from 2002 and an 81 percent jump from 1997. An estimated 2,500 Minnesotans are believed to be living with HIV disease but do not know they are infected, according to the Minnesota Department of Health’s 2007 HIV/AIDS Surveillance Report.  

More Minnesota HIV/AIDS Facts:

·         A new case of HIV disease is reported in Minnesota every 27 hours.

·         5,950 people were known to be living with HIV disease in Minnesota as of December 31, 2007

·         8,504 cases of HIV disease have been reported in Minnesota since 1982. Of those, 2,912, or 34%, of these people have died.

 Source: HIV/AIDS Surveillance Report – 2007, Minnesota Department of Health 

 

 

While Minnesota is considered a low risk region, worldwide, an estimated 33 million people are living with HIV. 

“Even though we’re in a low risk community, we want it to stay that way,” says Peterson.  

Maneesha Jain, Family Tree’s hotline coordinator, knows some people resist getting tested because they fear the result. What does she tell them? “It’s peace of mind. If you’re wanting to live in reality and take control of your life you can know and make decisions on that. If you know you have it you can monitor your health and the chance of living a high quality of life is much higher. People also need to think about the potential impact on others.” 

Jain said the clinic was able to offer free tests through the generosity of its testing kit supplier, which donated the kits.  

Family Tree Clinic provides birth control and sexual health testing and treatment services and information for men, women and adolescents.  

In Indonesia, proposed surveillance of  people with HIV an ‘act of desperation’ 

A bill in the Papua province of Indonesia to implant a microchip into HIV positive patients who are “sexually aggressive” to monitor their activities has met with strong resistance. The implication for human rights abuses the law could bring is clear. Such a law could also prove counter-productive to screening efforts.  

But the introduction of the bill underscores the desperation surrounding the HIV crisis in Papua. 

A proponent of the draft law, legislator John Manangsang, told the Jakarta Post that the microchips would only be implanted in people living with HIV/AIDS who were sexually aggressive.  

“Aggressive means actively seeking sexual intercourse. This is one way to protect healthy people,” he said.

“Do not misunderstand human rights; if we respect the rights of the people living with HIV/AIDS, then we must also respect the rights of healthy people.”  He said the draft bylaw also requires everyone to take HIV/AIDS tests so that preventative measures can be taken early on.  

“I am a doctor, saving lives is my profession. If we want to save the only limited number of Papuans, we have to take real action because 47 percent of (the country’s) HIV/AIDS (cases) are in Papua.” 

A virus has been sweeping the world for the past two decades, causing a disease which has killed millions of people and which looks likely to kill millions more. HIV stands for Human Immunodeficiency Virus. After a period of time this virus damages the immune system, and this causes a variety of symptoms known as AIDS. This time period varies, depending on factors such as access to AIDS drugs, and possibly such factors as nutrition, the presence of other medical conditions, and stress. In the absence of treatment, the average time between HIV infection and progression to AIDS is around ten years. – from AVERT, an international AIDS charity

A bold plan for ending HIV/AIDS in Africa? 

If all adults in Africa were tested annually for HIV and every identified infected person received immediate treatment, it “could virtually end the AIDS epidemic in Africa in about a decade," according to a mathematical model published in the Lancet on Nov. 26. 

In the model, people in South Africa and Malawi were voluntarily tested annually and started on a regimen of antiretrovirals if their test results found them to be HIV-positive, even if they showed no symptoms. According to the model, HIV cases decreased by 95 percent within 10 years.  

The model was developed by AIDS treatment experts Reuben Granich, Charlie Gilks, Christopher Dye and colleagues at the World Health Organization. The researchers have faced much criticism from other experts and commentators after the model was published, but said they offered it as a basis for discussion and additional research. Kevin de Cock, HIV/Aids director at the WHO, and one of the authors, defended the model to the Guardian, saying that it “offers hope at a time when other avenues appear to have closed.” 

The strategy would:
  • Reduce the estimated number of AIDS-related deaths between 2008 and 2050 by about 50%, from about 8.7 million to 3.9 million deaths
  • Reduce the prevalence of HIV to less than 1% within 50 years
  • Decrease incidence rates from 20 new cases per 1,000 people annually to one case per 1,000 people annually in about 10 years
  • Include additional steps such as comprehensive sex education and male circumcision

"Although other prevention strategies, alone or in combination, could substantially reduce HIV incidence, our model suggests that only universal voluntary testing and immediate initiation of antiretroviral drugs could reduce transmission to the point at which elimination might be feasible by 2020 for a generalized epidemic, such as that in South Africa," according to the researchers. 

A major investment  

The financial investment to undertake such an endeavor is substantial --  $1.7 billion annually. That’s far out of reach for developing African nations to manage. But from Minnesota to Papua and South Africa, HIV/AIDS is a global health crisis. While prevention and treatment efforts have stabilized the epidemic in some regions, it is not retreating. It will be very expensive to address, but not when you compare its costs to what has already been spent globally on financial bailouts that benefit the wealthiest, most powerful nations and citizens. It’s just a matter of priorities and keeping promises. 

Citation:

Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model The Lancet, Early Online Publication, 26 November 2008doi:10.1016/S0140-6736(08)61697-9

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Blog: Bees voted most ‘irreplaceable species’ in
the world 		 

For more photos of bees and other insects visit wolfpix's photostream.

Bees were declared the most invaluable species on the planet at an Earthwatch-sponsored debate held last week at the Royal Geographical Society in London.

On November 20, the European Parliament adopted a resolution (485-13 with five abstentions) calling on the European Commission to increase research into the cause of declining bee populations and to take immediate action to reverse the decline throughout the EU and the rest of the world. Sponsors of the resolution warn that the decline in bees poses a threat to food production. The resolution also calls for research to establish whether there is a link between the use of pesticides, including thiamethoxam, imidacloprid, clothianidin and fipronil, on bee mortality.

George McGavin of the Oxford University Museum of Natural History convinced audience members that bees deserved the designtion because they play a crucial role in world agriculture. He noted that one-quarter of a million species of flowering plants depend on bees, and that without bees, the world would lose flowering plants, and many fruit and vegetables.  

Among the major causes of bee declines are habitat loss and fragmentation, increasing use of insecticides, and diseases.

“Bee populations are in freefall,” said McGavin. “A world without bees would be totally catastrophic.”

The other speakers at the “Irreplaceable – The World’s Most Invaluable Species” debate were Ian Redmond OBE, chair of the Ape Alliance representing primates, Kate Jones of the Zoological Society of London, arguing for bats; Professor Lynne Boddy of Cardiff School of Biosciences, representing fungi; and Professor David Thomas of the School of Ocean Sciences, University of Bangor, who was a close second in the debate, with his argument for plankton.

This was the eighth annual debate sponsored by Earthwatch with support from the Mitsubishi Corporation. Previous themes included endangered ecosystems and invasive species. 

Earthwatch, an international environmental charity, currently funds 61 environmental research projects in 31 countries in the areas of sustainable resource management, climate change, oceans and sustainable cultures. 

For more information visit www.earthwatch.org./europe. The debate will be broadcast in Europe Christmas Eve at 8 pm on Radio 4.

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