Gates Foundation looks to fight malaria
Wed, 17 Oct 2007 20:42:17 GMTBy DONNA GORDON BLANKINSHIP, Associated Press Writer
SEATTLE - Bill and Melinda Gates appealed to more than 300 malaria scientists and policy makers at a forum Wednesday to take the risky step of seeking to eradicate the disease worldwide instead of just keeping it under control.
A goal of anything short of eradication would be unethical and a bad business decision, despite unsuccessful efforts to stamp out the disease in the 1950s and 1960s, Melinda Gates said.
"It's a long-term goal; it won't come soon," she said, "but to aspire to anything less is just far too timid a goal for the age we're in. It's a waste of the world's talent and it's a waste of the world's intelligence, and it's wrong and unfair to the people who are suffering from this disease."
She said the world wasn't ready for a long fight against malaria 50 years ago, and when drugs and pesticides started failing, enthusiasm faded and funding almost disappeared. Malaria was eliminated from the United States and other developed countries at that time.
She is co-chairwoman of the Bill & Melinda Gates Foundation, which has committed $860 million to malaria programs and another $650 million to support the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Bill Gates promised the foundation's enthusiasm for the cause would never lag. He said many others would contribute money and commitment as long as those attending the organization's first malaria forum keep showing the world they can achieve their goals.
"If you show the world that we can end this disease, you will unleash the energy and the caring the commitment we need to meet that goal," he said. "We're not done and we will not stop working until malaria is eradicated."
Malaria kills more than a million people each year, most of them children. Deaths doubled in Africa over the past 20 years as malaria grew resistant to existing drugs and insecticides. New efforts to control the spread of the disease and develop new medicine and vaccines are starting to show results, according to a UNICEF report issued Tuesday.
Millions of insecticide-treated bed nets are being distributed throughout sub-Saharan Africa. The newest treatment for the disease is reaching community health clinics in some countries. Four new vaccines are being prepared for large scale testing on humans as early as 2008.
After the Gates' presentation, conference participants said eradication should be possible as long as people and groups like the Gates Foundation continue to provide support.
"Funding for malaria is gaining momentum. Some years back you couldn't even get money for research. If that momentum grows over time, and people get the money to do more work, we will transform control to eradication," said Seth Owusu-Agyei, an epidemiologist with the Kintampo Health Research Centre in Kintampo, Ghana.
Owusu-Agyei led a team that recently completed a successful small trial of a new malaria vaccine for children developed by GlaxoSmithKline. Study results were released Wednesday in a paper published online in The Lancet.
The vaccine was found to be safe for infants and 35 percent effective in preventing new infections over a six-month period in infants. The same vaccine was found to be 45 percent effective among children age one to four.
Cooperation among those fighting the disease and developing vaccines, medications and insect control is key to achieving eradication, said Christian Loucq, director of the Malaria Vaccine Initiative,.
"The big risk is if you don't reach soon, fatigue will come," Loucq said.
He and other emphasized the need for more money and coordination of efforts. He said the $107 million cost of a single one large-scale trial of a new vaccine, or phase three trial, shows the need for planning by organizations and governments.
Margaret Chan, director general of the World Health Organization, urged scientists and policy makers not be territorial in their work or waste time debating whether eradication is possible because, "as we are talking here, children are dying."
The World Health Organization pledges to do whatever it can to bring about an end to malaria, Chan said.
"We have to make it work in the interest of humanity," she said. "I dare you to come along with us."
New cervical cancer test more accurate
Wed, 17 Oct 2007 21:02:27 GMTBy STEPHANIE NANO, Associated Press Writer
NEW YORK - A relatively new screening test was about twice as accurate as the traditional Pap smear at spotting cervical cancer, according to the first rigorous study of the test in North America. The new test could replace the 50-year-old Pap in a matter of years, experts say. And there's a bonus for women: They won't need a screening test as often.
The HPV test, which looks for the virus that causes cervical cancer, correctly spotted 95 percent of the cancers. The Pap test, which checks for abnormal cells under a microscope, only found 55 percent, according to researchers at McGill University in Montreal, who published their findings in Thursday's New England Journal of Medicine.
"We've had the Pap test for over 50 years and it's high time it be replaced by technology that's more robust," said Eduardo Franco, director of McGill's division of cancer epidemiology, who led the study.
Franco said some feared the HPV test would result in more false alarms, causing anxiety and requiring more follow-up testing. In the study, there were only slightly more false positives for the HPV tests than the Pap smears .
HPV, or human papilloma virus, is a common sexually transmitted disease. Infections are mostly in young women and most go away on their own. The HPV test looks for the high-risk viruses that can cause cervical cancer if the infection persists. Like the Pap, it uses cells scraped from the cervix, the lower part of the uterus.
Because the Pap test misses about half of the cases, doctors use frequent testing to catch the slow developing cancer at its earliest, most treatable stages.
The HPV test has been available in the U.S. since 2000 and was first used for inconclusive Pap tests. Now women over 30 can get a HPV test — but only along with a Pap — and wait three years to be tested again if both tests are negative.
More recently, scientists have been studying whether the HPV test can be used alone and whether it can prolong the intervals between exams. Debbie Saslow, director of breast and gynecologic cancer for the American Cancer Society, said evidence from a number of studies supports using the HPV test in place of a Pap.
"Overall, I don't think there's any doubt that HPV testing has a lot of advantages over the Pap test," she said.
Saslow said there are still issues to be resolved, and federal approval needed, but "it's definitely coming." She said experts expect that to happen sometime in the next decade.
A Swedish study also in the journal compared Pap with HPV testing to Pap alone in 12,527 women in their 30s. They found the combo test detected precancerous lesions or cancer earlier than the Pap test alone.
The Canadian study, which was government-funded, included 10,154 women ages 30 to 69 in Montreal and St. John's, Newfoundland. The women got both tests. Still to be determined is the best way to start using the HPV test by itself and what follow-up action to take after positive results, the researchers said.
The HPV test is more expensive: In the U.S., Medicare pays about $50 for the HPV test and $15 to $28 for a Pap test.
Some of the researchers have received fees or grants from drug makers including Merck Frosst Canada Ltd., a subsidiary of Merck & Co., which makes a cervical cancer vaccine. One has stock in Digene Corp., which developed the only approved HPV test.
Franco emphasized that girls who have been vaccinated against HPV will still need to be screened because the vaccine only protects against some of the cancer-causing strains.
Dr. Carolyn D. Runowicz, who wrote a journal editorial, noted that the two studies used a different kind of Pap test, not the liquid-based technology used in the U.S, which may be more sensitive The results of a British study that used liquid Pap are due to be presented in November.
"We're not ready for prime time. We're moving in that direction. But we're not there yet," said Runowicz, a former president of the American Cancer Society.
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On the Net:
New England Journal: http://nejm.org
Report Kids overlooked in flu pandemic
Wed, 17 Oct 2007 20:50:42 GMTWASHINGTON - Children would likely be both prime spreaders and targets of a flu pandemic, but they're being overlooked in the nation's preparations for the next super-flu, pediatricians and public health advocates reported Wednesday.
The report urges the government to improve planned child protections, including how to care for youngsters if a pandemic closes schools.
"Right now, we are behind the curve in finding ways to limit the spread of a pandemic in children even though they are among the most at risk," said Dr. John Bradley of the American Academy of Pediatrics, which co-authored the report with the Trust for America's Health.
Concern is rising that the Asian bird flu known as H5N1 could trigger the next worldwide influenza epidemic if it mutates to become more easily spread person-to-person.
Children have long seemed particularly vulnerable to H5N1, possibly because they are more likely to touch or play with the diseased birds who spread it. Wednesday's report says nearly 46 percent of bird flu deaths since 2003 were among people 19 or younger.
Bird flu aside, germ-ridden youngsters already spur regular flu's spread through communities every winter, and experts have long called for better pediatric pandemic preparations.
Among gaps cited Wednesday:
_A stockpile of anti-flu medications contains only enough pediatric doses for 100,000 children; child vaccine doses are still under study.
_No protective face masks come in child sizes, although it's also not clear that children would tolerate wearing one.
_There are no plans for how to feed the 30 million children who rely on the school lunch program, if schools close.
Parents use religion to avoid vaccines
Wed, 17 Oct 2007 20:57:05 GMTBy STEVE LeBLANC, Associated Press Writer
BOSTON - Sabrina Rahim doesn't practice any particular faith, but she had no problem signing a letter declaring that because of her deeply held religious beliefs, her 4-year-old son should be exempt from the vaccinations required to enter preschool.
She is among a small but growing number of parents around the country who are claiming religious exemptions to avoid vaccinating their children when the real reason may be skepticism of the shots or concern they can cause other illnesses. Some of these parents say they are being forced to lie because of the way the vaccination laws are written in their states.
"It's misleading," Rahim admitted, but she said she fears that earlier vaccinations may be to blame for her son's autism. "I find it very troubling, but for my son's safety, I feel this is the only option we have."
An Associated Press examination of states' vaccination records and data from the Centers for Disease Control and Prevention found that many states are seeing increases in the rate of religious exemptions claimed for kindergartners.
"Do I think that religious exemptions have become the default? Absolutely," said Dr. Paul Offit, head of infectious diseases at Children's Hospital in Philadelphia and one of the harshest critics of the anti-vaccine movement. He said the resistance to vaccines is "an irrational, fear-based decision."
The number of exemptions is extremely small in percentage terms and represents just a few thousand of the 3.7 million children entering kindergarten in 2005, the most recent figure available.
But public health officials say it takes only a few people to cause an outbreak that can put large numbers of lives at risk.
"When you choose not to get a vaccine, you're not just making a choice for yourself, you're making a choice for the person sitting next to you," said Dr. Lance Rodewald, director of the CDC's Immunization Services Division.
All states have some requirement that youngsters be immunized against such childhood diseases as measles, mumps, chickenpox, diphtheria and whooping cough.
Twenty-eight states, including Florida, Massachusetts and New York, allow parents to opt out for medical or religious reasons only. Twenty other states, among them California, Pennsylvania, Texas and Ohio, also allow parents to cite personal or philosophical reasons. Mississippi and West Virginia allow exemptions for medical reasons only.
From 2003 to 2007, religious exemptions for kindergartners increased, in some cases doubled or tripled, in 20 of the 28 states that allow only medical or religious exemptions, the AP found. Religious exemptions decreased in three of these states — Nebraska, Wyoming, South Carolina — and were unchanged in five others.
The rate of exemption requests is also increasing.
For example, in Massachusetts, the rate of those seeking exemptions has more than doubled in the past decade — from 0.24 percent, or 210, in 1996 to 0.60 percent, or 474, in 2006.
In Florida, 1,249 children claimed religious exemptions in 2006, almost double the 661 who did so just four years earlier. That was an increase of 0.3 to 0.6 percent of the student population. Georgia, New Hampshire and Alabama saw their rates double in the past four years.
The numbers from the various states cannot be added up with accuracy. Some states used a sampling of students to gauge levels of vaccinations. Others surveyed all or nearly all students.
Fifteen of the 20 states that allow both religious and philosophical exemptions have seen increases in both, according to the AP's findings.
While some parents — Christian Scientists and certain fundamentalists, for example — have genuine religious objections to medicine, it is clear that others are simply distrustful of shots.
Some parents say they are not convinced vaccinations help. Others fear the vaccinations themselves may make their children sick and even cause autism.
Even though government-funded studies have found no link between vaccines and autism, loosely organized groups of parents and even popular cultural figures such as radio host Don Imus have voiced concerns. Most of the furor on Internet message boards and Web sites has been about a mercury-based preservative once used in vaccines that some believe contributes to neurological disorders.
Unvaccinated children can spread diseases to others who have not gotten their shots or those for whom vaccinations provided less-than-complete protection.
In 1991, a religious group in Philadelphia that chose not to immunize its children touched off an outbreak of measles that claimed at least eight lives and sickened more than 700 people, mostly children.
And in 2005, an Indiana girl who had not been immunized picked up the measles virus at an orphanage in Romania and unknowingly brought it back to a church group. Within a month, the number of people infected had grown to 31 in what health officials said was the nation's worst outbreak of the disease in a decade.
Rachel Magni, a 35-year-old stay-at-home mother in Newton, Mass., said she is afraid vaccines could harm her children and "overwhelm their bodies." Even though she attends a Protestant church that allows vaccinations, Magni pursued a religious exemption so her 4-year-old daughter and 1-year-old son, who have never been vaccinated, could attend preschool.
"I felt that the risk of the vaccine was worse than the risk of the actual disease," she said.
Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center, one of the leading vaccine skeptic groups, said she discourages parents from pursuing religious exemptions unless they are genuine. Instead, Fisher said, parents should work to change the laws in their states.
"We counsel that if you do not live in a state that has a philosophical exemption, you still have to obey the law," she said.
Even so, Fisher said, she empathizes with parents tempted to claim the religious exemption: "If a parent has a child who has had a deterioration after vaccination and the doctor says that's just a coincidence, you have to keep vaccinating this child, what is the parent left with?"
Offit said he knows of no state that enforces any penalty for parents who falsely claim a religious exemption.
"I think that wouldn't be worth it because that's just such an emotional issue for people. Our country was founded on the notion of religious freedom," he said.
In 2002, four Arkansas families challenged the state's policy allowing religious exemptions only if a parent could prove membership in a recognized religion prohibiting vaccination. The court struck down the policy and the state began allowing both religious and philosophical exemptions.
Religious and medical exemptions, which had been climbing, plummeted, while the number of philosophical exemptions spiked.
In the first year alone, more parents applied for philosophical exemptions than religious and medical exemptions combined. From 2001 to 2004, the total number of students seeking exemptions in Arkansas more than doubled, from 529 to 1,145.
Dr. Janet Levitan, a pediatrician in Brookline, Mass., said she counsels patients who worry that vaccines could harm their children to pursue a religious exemption if that is their only option.
"I tell them if you don't want to vaccinate for philosophical reasons and the state doesn't allow that, then say it's for religious reasons," she said. "It says you have to state that vaccination conflicts with your religious belief. It doesn't say you have to actually have that religious belief. So just state it."
Society adds pressure to be obese report
Wed, 17 Oct 2007 16:16:47 GMTLONDON - Individuals cannot take all the blame if they are obese -- modern society adds pressure to put on weight, a report said Wednesday.
The study by British government think-tank Foresight called for greater help to counter the &;'obesogenic' environment&; by designing towns and cities to promote walking and cycling and encouraging people to buy healthier food.
But it could take 30 years to tackle the problem, it said. Obesity rates have more than doubled in Britain in the last 25 years -- in 2004, nearly a quarter of men and women in England were obese.
&;There is compelling evidence that humans are predisposed to put on weight by their biology,&; the report said.
&;Although personal responsibility plays a crucial part in weight gain, human biology is being overwhelmed by the effects of today's 'obesogenic' environment, with its abundance of energy-dense food, motorised transport and sedentary lifestyles.
&;As a result, the people of the UK are inexorably becoming heavier simply by living in the Britain of today.&;
Some experts said the report confirmed what the government had known for years and accused it of failing to act.
Peter Hollins, chief executive of the British Heart Foundation , said it was &;hardly a wake-up call&;.
&;Reports like this, which should have had alarm bells ringing... long ago, have been met only by repeated pushes of the government's snooze button,&; he said.
Britain on Monday launched a campaign for greater participation in sports at school to combat the looming obesity crisis, which Health Secretary Alan Johnson was was potentially on the scale of climate change.
Government-commissioned research suggested half of all Britons will be obese in 25 years if current trends are not halted; furthermore, 86 percent of men will be overweight in 15 years and 70 percent of women in 20, it suggested.
