WHO claims Polio stopped in Somalia
Tue, 25 Mar 2008 22:14:31 GMTBy MARIA CHENG, AP Medical Writer
LONDON - The World Health Organization claims polio transmission has been stopped in Somalia, leaving only a dozen other countries with the deadly disease.
But given the lack of detailed medical data from Somalia, the absence of a centralized government and continued violence across the country, officials admitted the virus could very easily pop up again.
"Polio could absolutely return to Somalia," said Dr. Bruce Aylward, director of WHO's polio department. "Based on our surveillance, we're pretty confident, but we could still be surprised."
Polio mostly strikes children under five, and is spread when unvaccinated people come into contact with the feces of those with the virus, often through water. It usually attacks the nervous system, causing paralysis, muscular atrophy, deformation and sometimes death.
WHO said Somalia has not reported a case in exactly a year. Last year, the country identified eight cases. Aylward said that WHO has a network of about 100 local Somalis across the country who regularly report any suspected polio cases.
About 10,000 Somali health workers and volunteers were involved in efforts during the past decade to vaccinate nearly every child under the age of five, Aylward said.
Somalia has been ravaged by violence and anarchy since warlords overthrew dictator Mohamed Siad Barre in 1991 and then turned on one another. The current government — formed with U.N. help in 2004 — has struggled to assert any real control.
At most, polio paralyzes one out of every 200 children it infects, leading other health officials to suspect that cases might be missed in Somalia.
"I would be very surprised if there were any reliable data at all," said Dr. Donald A. Henderson, who led WHO's smallpox eradication effort in the 1970s. "We can be optimistic, but I think we should also be very cautious."
Henderson also said that without a strong health system in Somalia, reporting polio cases would be extremely difficult.
"If you're the mother of a 10-month-old baby who's suddenly paralyzed, where do you go for this to be reported if there's no health facility?" he asked.
Somalia was declared polio-free in 2002 but the disease was detected again in 2005. Aylward said the country had succeeded this time because of strengthened vaccination campaign strategies, and that the polio strategy could be used to combat other health problems in war-torn areas.
So far in 2008 there have been 191 cases globally, compared with 61 at the same time last year. But only a fraction of the cases have been type 1 polio, which WHO says is the most dangerous and fastest spreading type.
When WHO and partners began their anti-polio campaign in 1988, the worldwide case count was more than 350,000 annually. The disease's incidence has since been slashed by more than 99 percent and remains endemic in four countries: Afghanistan, India, Nigeria and Pakistan.
Polio cases were also detected last year in Angola, Cameroon, Chad, Congo, Myanmar, Nepal, Niger and Sudan.
The health body has missed goals of eradicating the disease globally by 2000 and 2005, and critics have wondered whether the goal is logistically possible.
No new target date for eradication has been set, and the campaign has cost over $4 billion. To continue fighting polio until 2010, WHO estimates that another $525 million is needed.
Penalty for pharmacists refusal upheld
Tue, 25 Mar 2008 22:14:46 GMTBy ROBERT IMRIE, Associated Press Writer
WAUSAU, Wis. - A state appeals court upheld sanctions Tuesday against a pharmacist who refused to dispense birth control pills to a woman and wouldn't transfer her prescription elsewhere.
The 3rd District Court of Appeals ruled that the punishment the state Pharmacy Examining Board handed down against pharmacist Neil Noesen did not violate his state constitutional rights, specifically his "right of conscience" to religiously oppose birth control.
"Noesen abandoned even the steps necessary to perform in a minimally competent manner under any standard of care," the three-judge panel said. The decision upheld a ruling by Barron County Circuit Judge James Babler.
Planned Parenthood of Wisconsin praised the ruling as important for women's access to reproductive health care. Several states have been wrestling with the issue of pharmacists who refuse on religious grounds to dispense birth control or "morning-after" pills.
Noessen's attorney Paul Linton said that he was disappointed but that no decision had been made on whether to appeal.
The ruling "can curtail the religious rights of pharmacists and perhaps other health care professionals," Linton said.
According to court records, Noesen was working as a substitute pharmacist at a Menomonie Kmart in 2002 when a University of Wisconsin-Stout student sought to refill her birth control prescription.
Noesen testified he advised the woman of his objection to the use of contraception and refused to fill the prescription or tell her how or where she could get it refilled.
The woman was able to get the prescription filled two days later but missed the first dose of the medication, court records said. She filed a complaint with the state Department of Regulation and Licensing.
Noesen, 34, of St. Paul, Minn., told regulators that he is a devout Roman Catholic and refused to refill the prescription or release it to another pharmacy because he didn't want to commit a sin by "impairing the fertility of a human being."
The Pharmacy Examining Board ruled in 2005 that Noesen failed to carry out his professional responsibility to get the woman's prescription to someone else if he wouldn't fill it himself.
The board reprimanded Noesen and ordered him to attend ethics classes. He was allowed to keep his license as long as he informs all future employers in writing that he won't dispense birth control pills and outlines steps he will take to make sure a patient has access to medication.
The board also found Noesen liable for the cost of the proceedings against him — about $20,000 — but the appeals court ordered the board to reconsider that decision.
Larry Dupuis, legal director for the American Civil Liberties Union of Wisconsin, which like Planned Parenthood participated in the appeal, said the ruling struck the proper balance between patients' and pharmacists' rights.
A pharmacy should accommodate its pharmacists' religious beliefs but it can't leave "a patient high and dry," Dupuis said.
Noesen said the discipline "critically devastated" his business as a traveling pharmacist because some pharmacies refused to hire him and he lost his liability insurance, court records said.
There was no telephone listing for Noesen in St. Paul. Linton said he had not talked to Noesen in several months and didn't know whether he still lived in St. Paul.
Weighing costs in choosing cancer care
Tue, 25 Mar 2008 22:00:39 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - You've just been diagnosed with cancer, and the doctor is discussing treatment options. Should the cost be a deciding factor? Chemotherapy costs are rising so dramatically that later this year, oncologists will get their first guidelines on how to have a straight talk with patients about the affordability of treatment choices, a topic too often sidestepped.
"These are awkward discussions," says Dr. Allen Lichter of the American Society of Clinical Oncology, which is writing the guidelines. "At least we can bring this out in the open."
It's a particular issue for patients whose cancer can't be cured but who are seeking both the longest possible survival and the best quality of life — and may be acutely aware that gaining precious months could mean bankrupting their families.
The prices can be staggering. Consider: There are two equally effective options to battle metastatic colon cancer, the kind spreading through the body — but one costs $60,000 more than the other, says Dr. Leonard Saltz of Memorial Sloan-Kettering Cancer Center.
What's the difference? The cheaper one, irinotecan, causes hair loss that makes it impossible for people trying to keep a job to hide their cancer treatment, he explains. The pricier oxaliplatin can cause nerve damage in hands and feet that might make it a worse option for, say, a musician or computer worker.
Saltz offers a tougher example: A drug for pancreatic cancer — an especially deadly cancer with few treatment options — can cost $4,000 a month. Yet while Tarceva has offered some people remarkable help, research suggests that extra survival on average is a few weeks.
"Is it a good investment, a high-risk investment, or buying a lottery ticket?" is how Saltz puts these choices.
Drug prices are a growing issue for every disease, especially for people who are uninsured. But cancer sticker shock is hitting hard now, as a list of more advanced biotech drugs have made treatment rounds costing $100,000, or even more, no longer a rarity. Also, patients are living longer, good news but meaning they need treatment for longer periods. The cost of cancer care is rising 15 percent a year, Lichter notes.
Make no mistake: Some of these newer drugs have greatly helped some patients — Gleevec, for example, has revolutionized care for a type of leukemia — and the prices reflect manufacturers' years of research and development investment.
Also, drug companies do donate a certain amount of medication to prescription-assistance programs that provide them for free to patients who otherwise couldn't pay. Since 2005, nearly 5 million people — cancer patients and people with other diseases — have been matched to such programs through the drug industry's "Partnership for Prescription Assistance."
But few patients get a Gleevec-style home run, and there's very little research that directly compares competing treatments to guide cancer patients on which might offer the best shot at survival for the money.
"As long as a therapy provides a benefit, it will tend to be offered to patients. Whether it's a small benefit or a moderate benefit, it may be offered with the same level of enthusiasm," says Dr. Neal J. Meropol of Philadelphia's Fox Chase Cancer Center, who is leading the panel writing ASCO's new guideline on how to weigh treatment costs.
The idea: treat cost essentially as another side effect to weigh in choosing a therapy. Meropol has watched patients do those calculations on their own, like the colon cancer patient who asked to switch from oral chemo to cheaper but more laborious intravenous chemo, or the woman who refused a pricey anti-nausea drug that would make her chemo more bearable.
Even if doctors want to discuss cost, they may not know it — it's not included in treatment standards. At a meeting of the standard-setting National Comprehensive Care Network earlier this month, Sloan-Kettering's Saltz and other doctors urged adding chemo prices to those treatment guidelines.
"If there's a need to spend it, let's talk about it. If we can do it just as well less expensively, I think doctors should know that and be able to make a decision," Saltz says.
Even the well-insured are feeling the bite as patients are having to shoulder a higher portion of the bill.
When Medicare began its Part D prescription coverage, retiree Helen Geiger of Whiting, N.J., paid for a premium plan and put it to good use when she was diagnosed with multiple myeloma, a blood cancer. She said the plan listed the cost of her dose of Thalomid at $5,500 a month but her copay was $60 a month.
In renewing the prescription plan last year, the 71-year-old Geiger didn't notice that Thalomid coverage had been changed. It now was classified a specialty drug, costing a $1,051 monthly copay that she couldn't afford. She went several months without the anti-cancer pills, as her doctors at Philadelphia's Fox Chase Cancer Center and her family appealed to the insurer and then scoured charities in hopes of finding her free or cheaper drug.
"You don't need this kind of stress when you're sick," says Geiger, who finally stumbled onto a prescription assistance program that provided her free medicine.
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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On the Net:
Prescription assistance programs: http://www.pparx.org
Fla. teen dies during breast surgery
Wed, 26 Mar 2008 01:43:51 GMTBOCA RATON, Fla. - A South Florida teenager who was captain of her high school cheerleading squad and had plans to become a doctor died after corrective breast surgery, a family attorney said Tuesday.
Stephanie Kuleba, 18, died Saturday, about 24 hours after her surgery. Kuleba was rushed to Delray Medical Center about two hours into the procedure to correct asymmetrical breasts and inverted areola, family attorney Roberto Stanziale said.
"This was something that was believed to be a routine procedure," said Stanziale who added it was too early to determine if any legal action would be taken. "There was never any indication that she was not going to walk out of that surgical suite. It's obviously devastating."
A message left after-hours at the clinic where Kuleba's surgery was performed was not immediately returned and a telephone listing for the Kuleba family was not available.
Grieving friends turned Kuleba's parking space at a Boca Raton high school into a makeshift memorial with flowers, candles and a teddy bear. Friends called Kuleba "Sunshine" because of her blonde hair and smile.
"I have chills right now just thinking about it," Ashley Gutknecht, 18, told the South Florida Sun-Sentinel. "It doesn't seem real."
