CRACKDOWN ON ANTIBIOTICS IN HOSPITAL

Pharmacists have been asked to cut down the Royal Devon amp; Exeter Hospital's use of antibiotics.

The RD &E believes tackling overuse of antibiotics will contribute towards the recovery of patients as well as reduce the risk of infection.

A research project funded by the European Commission in 2005 concluded that antibiotic and infection control measures have a significant impact on levels of the hospital superbug MRSA, which is resistant to most types of antibiotic.

Out of around 300 European hospitals studied, those with the highest MRSA prevalence also had the greatest levels of antibiotic use.

Now, as part of a pilot scheme, clinical pharmacists are studying antibiotic prescriptions for two wards at the RD &E.

The wards specialise in illnesses which are usually treated with antibiotics and the two clinical pharmacists will ensure the right type of antibiotics are being used and the right course is being prescribed.

One of the clinical pharmacists will work with doctors to monitor prescriptions and advice on alternatives. The other will audit the data to update guidelines and training for the future.

The pilot is one of a series of infection control measures being taken by the hospital. An RD &E spokeswoman said: "Overuse of antibiotics increases the potential for infections to become resistant to the antibiotics.

"If antibiotics are used for any longer than the absolute optimum time, it can then compromise the health and well-being of a patient.

"The range of infection control measures being taken at the RD &E reflects trust-wide responsibility with the support and co-operation of patients and visitors."

There are a number of bacteria in people's bowels which cause no harm, but overuse of antibiotics can kill them, allowing small amounts of Clostridium difficile present there to reproduce in large numbers. This can cause diarrhoea, cramps, loss of appetite, fever and nausea.

The hospital's efforts to reduce infection also involves a team working across the hospital trust examining the use of intravenous medication.

Over the year, senior vascular access nurse specialist Vicky Shawyer, and vascular nurse specialists Helen Williamson and Barbara Hector, will assess IV access - fluid or medicine going directly into a vein - ensuring patients are assessed and given the appropriate IV device for their healthcare needs. They will carry out audit work to ensure the risk of infection is reduced.

Both this work and that carried out by the clinical pharmacists has been partly funded by the South West Strategic Health Authority.

Other initiatives being introduced at the hospital with the SHA include more patient handling aids to allow them to be regularly washed.

Source:www.thisisexeter.co.uk

Possible Target For Prevention And Treatment Of Pneumonia Identified

Researchers at Children's Hospital of Pittsburgh of UPMC have identified a key protein target that may be a crucial factor in the development of a vaccine to prevent and new therapies to treat pneumonia, the leading killer of children worldwide.Research led by Jay K. Kolls, MD, chief of the Division of Pediatric Pulmonary Medicine, Allergy and Immunology at Children's, identified for the first time the importance of a protein known as interleukin 22 (IL-22) in the immune response to a strain of bacterial pneumonia. In the laboratory, the researchers were able to effectively treat mice with pneumonia by using purified IL-22.

"Currently there is no vaccine that covers all kinds of pneumonia and antibiotic treatment is sometimes limited by antibiotic resistance. As acute respiratory infections are the no. 1 killer of children in the world, progress in the development of novel vaccines or new, more effective treatments is critical," said Dr. Kolls, the Neils K. Jerne Professor of Pediatrics and Immunology at the University of Pittsburgh School of Medicine. "Our results raise the possibility of developing new protein-based therapies using IL-22 to limit or prevent pneumonia."

Pneumonia causes almost one in five deaths in children under age 5 worldwide -- more than 2 million children each year, according to the World Health Organization. It kills more children than any other disease -- more than AIDS and malaria combined.

IL-22 and interleukin 17A (IL-17A) are produced by a recently discovered lineage of cells known as T Helper Type 17 (Th17). Children's researchers found evidence that the Th17 cell lineage and its cytokines IL-22 and IL-17A have evolved to promote host defense against certain infections in the lung caused by extracellular pathogens.

This is an important discovery because the Children's research team proposes that by stimulating the Th17 arm of the immune system, they can more efficiently treat bacterial pneumonia. Furthermore, the researchers propose that Th17 is a less critical pathway for intracellular bacteria such as those that cause listeria and tuberculosis -- thus raising the potential to target this pathway in diseases of chronic inflammation such as rheumatoid arthritis or inflammatory bowel disease without increasing susceptibility to these intracellaulr pathogens.

Dr. Kolls' laboratory investigates mechanisms of lung host defenses in normal and immunocompromised hosts as well as lung immunology in disease such as cystic fibrosis and asthma. Additional research interests of Dr. Kolls include gene therapy, lung immunology, lung host defenses, tumor necrosis factor, pneumocytis carinii pneumonia, ethanol, gene expression, polymerase chain reaction and molecular biology.

Results of the study are published in the February online issue of Nature Medicine.

Source:www.sciencedaily.com

Scientists identify key protein target for pneumonia treatment

London, Feb 12 (ANI): A team of researchers at Childrens Hospital of Pittsburgh have discovered a protein, known as interleukin 22 (IL-22) that may play a critical role in the development of new therapies to treat pneumonia in children.

The study led by Dr Jay K. Kolls, chief of the Division of Pediatric Pulmonary Medicine, Allergy and Immunology at Childrens was conducted using a mice model and could successfully treat the mice with pneumonia by using purified IL-22.

Currently there is no vaccine that covers all kinds of pneumonia and antibiotic treatment is sometimes limited by antibiotic resistance, Nature quoted Dr. Kolls, as saying.

As acute respiratory infections are the no. 1 killer of children in the world, progress in the development of novel vaccines or new, more effective treatments is critical, he added.

IL-22 is generated by a lineage of cells known as T Helper Type 17 (Th17) that defends the host against the infections.

Our results raise the possibility of developing new protein-based therapies using IL-22 to limit or prevent pneumonia, said he said.

Source:www.thaindian.com

Return of the Plague

Like no other disease, plague evokes terror. One of the most lethal illnesses in human history, it killed probably a third of Europe's population in the 14th century. It may also have been one of the first agents of biological warfare: It's said that in the 1340s, invading Mongols catapulted their plague dead over the city wall into Kaffa in the Crimea.Yet the plague is not just a disease of the distant past. While cases tapered off in the mid-20th century, the World Health Organization (WHO) now classifies plague as "re-emerging." No one is predicting another pandemic like the Black Death that devastated Europe. The WHO now records at most only a few thousand cases worldwide per year; and, if detected early, the disease can be treated effectively with antibiotics. But since the early 1990s, plague has returned to places — including India, Zambia, Mozambique, Algeria and parts of China — that had not seen it in many years or even decades. Its global footprint has also shifted, according to a paper published last month in the journal PLoS Medicine. In the 1970s, most plague cases were in Asia; today, more than 90% are in Africa. The conundrum for epidemiologists: Why is human plague reappearing now, even though nearby animal populations have likely harbored the culprit Yersinia pestis bacteria all along?

Plague lives in many rodent species, and is most often transferred to humans by the animals' fleas. Scientists know which regions of the world harbor infected animals, but they are only just beginning to understand the dynamics of plague infection. Its spread depends not just on Yersinia pestis but also on interactions among rodents and, crucially, on contact between humans and wildlife. Madagascar is a good example. For decades, plague was restricted to the highlands, according to a 2004 paper by researchers in Madagascar, Senegal and France. But it showed up on the coast in 1991, when the Asian shrew somehow picked up infected fleas. The plague's earlier comeback in the inland capital, Antananarivo, arose as city sprawl and shoddy housing put residents in closer contact with black rats. In 1998, inland villages reported cases, too, perhaps caused by rats displaced through deforestation.

Even in the antibiotic age, then, containing plague requires monitoring more than human cases, says Nils Christian Stenseth, head of the Center for Ecological and Evolutionary Synthesis in Oslo, and lead author of the PLoS Medicine paper. Working with nearly 50 years of animal, human and bacteriological statistics from the former Soviet Union, his team found that human plague in Kazakhstan occurs only when the local gerbil population reaches a certain threshold in winter. Warmer winters mean more gerbils. That, says Stenseth, suggests plague's "re-emergence might have a climate component."

If so, global warming may exacerbate the threat — an unsettling thought, given the viciousness of the disease. "The plague bacillus is probably the most pathogenic infectious agent on the planet right now, and we still don't know why it's so virulent," says Elisabeth Carniel, a plague expert at the Institut Pasteur in Paris. It may no longer make history, but plague hasn't lost its terrifying power.
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There's nothing wrong with letting drug reps schmooze with doctors.

What's the matter with Americans? They think there is something incestuous about the connection between drug companies and doctors.

Politicians tell them that the drugmakers wine and dine physicians while pushing the latest antibiotic or statin. Utterly corrupted, doctors impose those medications on patients, whether or not the drugs are better than cheaper alternatives.

A pending U.S. Senate bill would require drug companies to report gifts to doctors of more than $25; the House is investigating marketing practices. New York State's legislature plans to hold hearings this year on the relationship between doctors and drug companies. One congressional critic has even compared the drug industry with the tobacco industry, and Senator John McCain has called drugmakers the "bad guys."

What drugs are these legislators taking? Drug company reps offer overworked doctors useful, lifesaving information in an efficient manner. The drug companies are of course motivated by profit, but economists have known since Adam Smith that the profit motive is the best way to induce someone to do something useful. (Disclosure: I consult for the drug industry from time to time, most recently for Pfizer (nyse: PFE - news - people ).)

Marketing and research are both information activities; they work together to get effective drugs to patients. The two activities are not in competition for resources. The denouncers of drug companies don't understand this. One of the senators sponsoring the bill suggests that "the millions of dollars these companies spend on marketing … could be put into research." In fact, drug companies would not switch money from marketing to research. If they cannot market drugs in the best way, they will reduce spending on research. What's the point of inventing a new drug if doctors and patients don't know about it?

Academic physicians think that doctors should obtain information by reading medical journals. Practicing doctors do not have time to comb through the International Journal of Medical Sciences or the Annals of Internal Medicine. A meal with a pharmaceutical salesperson is a time-efficient way for a busy doctor to learn about new drugs, or perhaps a better therapeutic alternative, or a drug with easier dosing or fewer side effects than the old drug. Physicians interact with more than one drug rep, so they have competing sources of information.

Another argument made by supporters of the Senate bill is that promotion leads physicians "to prescribe the expensive new drugs that are being marketed to them when a more affordable generic would do," in the words of one senator. There are three things wrong with this argument. First, manufacturers of generics do not promote those drugs, so it might be difficult for the physician to learn about generics at all. Second, new drugs lead to better health outcomes. They keep people out of the hospital. A 2007 study by business professor Frank Lichtenberg of Columbia University estimated that a prescription for a new drug (5 years from FDA approval) costs an average $18 more than an older one (15 years on the market) but reduces other medical costs, including hospital and office visits, by $129. Finally, by leading consumers to purchase newer drugs, marketing increases investment in innovation and thus makes research more likely.

A widely cited 2000 article in the Journal of the American Medical Association summarized 29 published studies critiquing the interaction between doctors and drug reps. Notable feature of these articles, as quoted in the summary paper: "No study used patient outcome measures." That is, in all of the medical literature on drug sales, there was no evidence of harm to patients caused by doctors and drug reps breaking bread. These articles were written by physicians who by their oaths put patient welfare at the top of the list, but they were critical of the industry based on analyses that totally ignore this measure.

A recent report shows that the life expectancy of Americans is at its highest level ever and will continue to increase. It is truly amazing that this society keeps coming up with ways to demonize and penalize an industry that has provided us with so many benefits.

Source:www.forbes.com

Gene Chips Used to Distinguish Ventilator-associated Pneumonia from Underlying Critical Illness

Critically ill patients who need a ventilator to breathe face a high risk of pneumonia. The lung infection, however, is exceedingly difficult to diagnose because a patient's underlying condition often skews laboratory test results and masks pneumonia's symptoms – a reality that can delay appropriate antibiotic treatment.

Using gene chip technology, scientists at Washington University School of Medicine in St. Louis demonstrate for the first time they can distinguish pneumonia associated with ventilator use from other serious illnesses. The research, published Feb. 13 in the journal Public Library of Science One, suggests that the method may lead to early, more accurate detection and treatment of ventilator-associated pneumonia.

The team analyzed patterns of expression in more than 8,000 genes as patients on mechanical ventilators developed and recovered from pneumonia. They found changes in the activity of 85 genes could pinpoint early activation of the immune system in response to pneumonia, typically several days before clinical signs of the infection developed. By adding computational tools to their genomic analysis, the researchers also showed they could objectively monitor patients' recovery by graphing changes over time, creating a tool they called the "riboleukogram."

"This is an important step toward the development of a specific molecular test for diagnosing infection – in particular pneumonia – and predicting patients' recovery," says J. Perren Cobb, M.D., director of Washington University's Center for Critical Illness and Health Engineering and an intensivist at Barnes-Jewish Hospital. "If we could determine which patients are destined to develop pneumonia based on early changes in the activity of genes that regulate immune response, we could give them antibiotics sooner, with the hope that we might be able to prevent or curtail the infection."

As one of the more common and deadly hospital-acquired infections, ventilator-associated pneumonia has recently become a target for both quality improvement and patient safety efforts. Up to 30 percent of patients on a ventilator develop pneumonia, statistics show, increasing length of stay and the risk of death while adding thousands of dollars to each patient's hospital bill. The breathing tube is inserted into patients' lungs, bypassing the body's natural protective mechanisms that normally filter out harmful bacteria. The air that is pumped through the tube also must be humidified, which creates a breeding ground for microorganisms.

Scientists have tried unsuccessfully for years to identify a single marker or a suite of markers that could diagnose infection in ICUs. While both fever and an elevated white blood cell count often indicate an infection in healthy individuals, the same symptoms are widespread in ICU patients, where they are linked to a range of underlying conditions, including trauma, shock, organ failure and surgical complications. Diagnosis of infection is even more complicated in patients on a ventilator because they are sedated and the breathing tube prevents them from talking.

The current study took Cobb and his Washington University colleagues from the laboratory bench to patients' bedsides as they refined their method to diagnose pneumonia. Initially, they used the gene chip technology in mice to identify 219 genes whose patterns of expression could distinguish pneumonia from widespread inflammation, another common condition in intensive care units that involves systemic activation of the immune system. The patterns of gene expression in mice also could differentiate between gram-negative bacteria (Pseudomonas), a common type responsible for ventilator-associated pneumonia, and gram-positive bacteria (Streptococcus), which is a frequent cause of pneumonia in a community setting.

The researchers then moved to the ICU to determine whether the activity of the equivalent human genes could differentiate between pneumonia and inflammation in patients breathing with the assistance of ventilators. They narrowed their focus to 11 of 20 patients who developed pneumonia more than two days after having a breathing tube inserted. These patients had blood samples drawn at 48-hour intervals to determine whether changes in gene expression could monitor patients' response to treatment and their recovery. Most of the patients developed pneumonia within three to six days of being on a ventilator. None of them died.

The researchers used microarray analysis to study gene expression patterns in infection-fighting white blood cells contained in the blood samples. They found alterations in the activity of 85 genes some 24 to 72 hours before diagnosis of pneumonia by the physician attending in the ICU.

"This suggests that we could start patients on antibiotics earlier, say at the first change in these genomic vital signs, and we likely could significantly improve their ability to recover from pneumonia," Cobb says.

Many of the genes identified by the research team regulate specialized immune cells known as neutrophils. These cells dramatically increase in number as bacteria invade the body. "We found genes that control neutrophil activation were turned on, and that is consistent with someone developing a bacterial infection," Cobb explains. "We did not find neutrophil genes being activated in patients who did not have infection, even though they had fevers and high white blood cell counts."

Other genes of interest regulated messenger proteins called chemokines, which send signals recruiting immune cells to fight off infection.

The scientists confirmed the ability of their genomic analysis to diagnose infection and monitor recovery in a second small group of seven patients on mechanical ventilators, two of whom developed pneumonia. As the patients healed, alterations in the expression of the 85 genes diminished, indicating that they had returned to a healthy state.

"Dr. Cobb's work represents an important step forward in developing an objective way to diagnose ventilator associated-pneumonia in intensive care units and predict patients' recovery," says Sarah Dunsmore, Ph.D., who oversees sepsis grants at the National Institute of General Medical Sciences, which partially funded the study. "This innovative approach has the potential to benefit patients, through earlier diagnosis and treatment, and to help hospitals better control outbreaks of pneumonia in patients on ventilator support."

Cobb says he and his team now plan to evaluate the clinical usefulness of the genetic analysis in a larger, independent group of patients with ventilator-associated pneumonia.

Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

Source:www.newswise.com

In the Pink for Valentine's Day

According to the information on the back of my shampoo bottle, 15 percent of women send themselves flowers on Valentine's Day. I find that hard to believe. As far as I know, none of my friends have ever done that, and I think I would have run across at least one person sending themselves flowers by now, if almost one out of every seven women did. This is not to say that I can't understand why some women would want to send themselves flowers. Valentine's Day can magnify insecurities about being loved and feeling attractive. Fortunately, there are a few quick fixes that can still make a difference in the appearance of your skin in time for the big day.

A few simple steps can improve the appearance of your skin even at the last minute. Avoid overdrying with soap or toners. Instead, use a gentle, hydrating cleanser, such as Cerave. Or exfoliate with a mildly abrasive scrub like Dove Gentle Exfoliating Daily Facial Cleanser. Always use a moisturizer, especially if you are going to apply makeup. Hydrated skin looks and feels smoother, and make-up is easy to apply evenly and smoothly on moisturized skin. If you plan ahead and give yourself some time, there's even more you can do.

Botox is well known as a quick, reliable way to smooth lines on the forehead and around the eyes. But did you know that it can improve your smile? Botox can be used to lift the corners of the mouth that turn down with age, turning an unintentional frown into a content, happy expression. It can also be used to make an asymmetric smile even, to smooth "smoker's" lines around the mouth, and to prevent the upper lip from riding up and showing too much gum line with smiling. Botox can also lift the tip of the nose and smooth a wrinkled chin. Botox in the lower face must be administered with care by a physician who is familiar with these applications to avoid interfering with normal expressions, but in the right hands it is a home run.

Light-based procedures continue to evolve, and many provide significant improvement with little down time. If you're still committed to waxing or plucking to remove dark facial hair, consider laser hair removal. Multiple treatments are required for the best results, but hair is usually noticeably thinner after each session. Nd:YAG lasers, such as the LaserGenesis, can improve facial redness and skin texture. Many patients see improvement after one or two treatments, although optimal results are seen after a series of 4 to 6 treatments. Broad-spectrum light sources, such as the Titan, can help to firm sagging skin under the chin and on the neck. Improvement continues for three to six months after treatment, but may be noticeable soon after the first treatment. You can leave the doctor's office and go right back to work, or play, immediately after any of these procedures.

Even when you can put your best face forward, Valentine's Day can be challenging, and this, unfortunately, can be reflected in your skin. Conditions such as acne, rosacea, psoriasis and eczema are known to become worse in some people when they are under stress. If you suffer from one of these problems, make sure to be consistent with your treatment regimen to minimize the effects of stress around any important social event. Don't worry too much, however, about tasting chocolates from your valentine. Conventional wisdom holds that chocolate is bad for your skin. In fact, recent studies of diet and its effects on the skin have implicated consistently increased dairy intake with acne flare-ups. One study showed that restricting high glycemic foods (such as those containing sugar and white flour) is associated with improving acne. There is no evidence, however, that occasional consumption of sweets makes acne consistently worse. And for most of us, indulging in a bit of chocolate will just make Valentine's Day a little sweeter.

Source:www.washingtonpost.com

Constant struggle to conquer bacteria

Dr. Ian Friedland was sitting at his Mountain View office on a rainy October afternoon when the telephone rang with some long-awaited news: The Food and Drug Administration had just approved doripenem, the powerful antibiotic he had labored over since 2004.

"Shortly after the drug was approved," the 50-year-old Johnson & Johnson researcher said, "we began to hear stories about it being used successfully in patients." It was the kind of outcome that pharmaceutical scientists spend their lives trying to attain.

It is also the kind of story that has become frighteningly rare.

Since the early 1990s, drug companies that had built their businesses on early antibiotic research have been leaving the field. As a consequence, there has been a steady decline in the number of new antibiotics approved by the FDA - even as the existing ones are losing ground to a surge of drug-resistant bacterial strains such as Staphylococcus aureus.

In the five-year period from 1983 through 1987, the FDA approved 16 new antibiotics. During a similar five-year span that ended last year, only five made the cut.

At the same time, the overall level of antibiotic drug research has dropped. In 2006, a survey by the Infectious Diseases Society of America counted only 13 potential new antibiotics in mid- to large-scale clinical trials - a stage of drug development that requires years to complete and offers no guarantee of success.

Medical researchers describe the supply of new drugs under development as "the pipeline." The pipeline for new antibiotics is running dry.

Intravenous doripenem, approved on Oct. 12, is the only important antibiotic licensed since 2005. Distantly related to penicillin, it will be used at first to treat severe and life-threatening abdominal infections in hospitalized patients.

The reasons for the decline in antibiotic research and development are complex, but drug company economics are at the core of it. Drugs that treat chronic conditions such as heart disease, arthritis and diabetes must be taken for a lifetime. A good antibiotic can clear an infection in a week to 10 days.

With the cost of developing new drugs ranging between $110 million and $800 million, cautious investors are putting their money into research that promises the biggest payout.

But scientists also acknowledge that the bugs themselves are proving more difficult to fight. Most antibiotics are derived from toxins created by bacteria to use as weapons against competing bugs. Much of drug development in the second half of the 20th century relied on finding molds that produced these natural toxins, and then tinkering with them to make them easier to manufacture.

More recent efforts focus on the deliberate design of new drugs. Scientists probe disease-causing organisms for weaknesses, and create molecules to attack those weak points. The approach has worked for AIDS drugs, but has yet to hit gold in the effort to find new antibiotics.

Dr. Jack Edwards, chief of infectious diseases at Harbor-UCLA Medical Center, said it was "quite easy" in the 1970s to make new antibiotics such as cephalosporins - a penicillin-like family of drugs that includes well-known products such as Keflex. "It's clear now that it is not so easy to make a new antibiotic," he said.

The struggle to find new antibiotics to replace the old has been going on since the start of the antibiotic revolution.

Scottish researcher Alexander Fleming discovered penicillin in 1928 when a spot of mold contaminated a petri dish of Staphylococcus aureus and produced a distinctive ring where the bacteria would not grow.

It took another 15 years before British and American scientists came up with a practical way to make penicillin on a commercial scale. Yet almost as soon as penicillin went into common use in the 1940s, a new variety of staph appeared that the antibiotic could not treat.

Hospitals eventually set up special wards to isolate the growing number of patients with penicillin-resistant staph. A new antibiotic, methicillin, came out in 1960, but within a year some staph germs had developed a defense against that drug, too.

Alarmed by the need to keep ahead of rapidly mutating bacterial strains, researchers since then have developed four successive generations of cephalosporins - the first came out in 1964.

These drugs repeatedly raised hopes that the resistance problem could be tamed, but even as scientists developed new generations of cephalosporins, bacteria methodically evolved ways to sidestep each one.

When bacteria began to resist the fourth - and final - generation of cephalosporins, researchers came up with carbapenems, yet another promising family distantly related to penicillin. Carbapenems are, like thoroughbreds, powerful, expensive and potentially dangerous.

Doripenem, the new Johnson & Johnson antibiotic, is the latest carbapenem.

While germs such as methicillin-resistant Staphylococcus aureus, or MRSA, have been grabbing headlines of late, there are other bugs such as Acinetobacter, Klebsiella and Pseudomonas that are evolving resistance to most existing antibiotics at an alarming pace. Those three, classified as Gram-negative, carry microscopic pumps that drive antibiotics out of their system. They have proved particularly adept at dodging new drugs, and researchers have been largely stumped in their efforts to come up with substitutes.

Lawmakers in Washington have repeatedly offered bills containing packages of incentives to encourage drug companies to develop new antibiotics more rapidly, but specialists such as UCLA's Edwards acknowledge that is a hard sell in Congress.

"There is a general dissatisfaction with the pharmaceuticals industry, based in part on the concept that their profit margins are too large," he said. "But we need to keep industry interested in making new antibiotics."

The latest effort to spur on the drug companies occurred last year, but by the time a large FDA reauthorization bill reached President Bush's desk for signature on Sept. 27, key incentives - such as allowing antibiotic makers to stave off generic competition when they find new uses for their drugs - had been stripped out.

"There are no provisions in the bill that will directly lead to stimulation of antibiotic development," said UCLA infectious disease specialist Dr. Brad Spellberg.

With few incentives to keep big drug companies from bowing out, entrepreneurs such as John and Mike Flavin are trying to fill the gap.

John is president and Mike chief executive of Advanced Life Sciences, a Chicago-area startup that is carrying out late-stage clinical trials of cethromycin. The antibiotic was initially developed, and later dropped, by nearby Abbott Laboratories. The Flavin brothers acquired rights and continued to test it because it shows promise as a pneumonia drug and a treatment for inhaled anthrax.

They have raised $71 million through stock offerings to take the drug through final clinical trials.

"As entrepreneurs, the business case we saw was this lack of a pipeline," said John Flavin. "This product would address a growing need in the face of no real competition. That puts us in the right place, at the right time."

This month, as a result of provisions in the new FDA law signed by the president in September, federal regulators convened a meeting with infectious disease doctors and drugmakers to clarify just what kind of proof is required in clinical trials to win approval of drugs to treat pneumonia. A meeting will be held in April to turn those discussions into formal recommendations.

Looming over those talks is the unfortunate history of Ketek - and the question of how to balance speedy approval against the risk of serious side effects.

When Paris-based Sanofi-Aventis won FDA approval for Ketek as a treatment for respiratory illnesses in April 2004, there was talk of a blockbuster drug. More than 28 million prescriptions have been sold worldwide.

But in January 2006, an alert team of North Carolina physicians published online a startling discovery that has put a cloud over Ketek, Sanofi-Aventis and the FDA. Three patients treated at the same hospital had come down with serious liver problems within days of taking Ketek. A 51-year-old woman required a liver transplant, a 26-year-old man died, and a 46-year-old man became ill with jaundice until he stopped taking the pills.

"When you see three cases, same county, same hospital, you start to connect the dots," said Charlotte, N.C., liver specialist Dr. John Hanson, who co-authored an account of the three cases in the journal Annals of Internal Medicine.

By the end of that year, 53 cases of liver toxicity nationwide had been traced to Ketek, including 12 cases of acute liver failure, resulting in four deaths. A congressional investigation revealed that the drug was approved by the FDA despite the discovery that one doctor had fabricated data in a clinical trial. In February, under pressure from Congress, the FDA imposed a "black box" warning on the label of the drug, and dropped its approval for the two conditions for which it was most often prescribed: bronchitis and sinus infection.

Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, acknowledged that antibiotic resistance is a serious problem, but warned that boosting financial incentives for drug companies to make new drugs could yield nothing more than other me-too products with problematic side effects. "I'm tired of all these lures to an industry making so much money today that they can't even see straight," he said.

Although doctors are frustrated by the slow pace of drug development, the biggest challenge may not be lawmakers or drugmakers, but the bugs themselves.

Among the most troubling forms of antibiotic resistance was one of the first encountered in the early days of penicillin. The penicillin molecule features a ring of carbon, called beta-lactam, which hobbles the ability of new bacteria to form cell membranes. But penicillin-resistant strains of bacteria quickly emerged equipped with enzymes called beta-lactamases, which can knock out those carbon rings.

UC Berkeley biochemistry Professor Hiroshi Nikaido, who has studied resistance mechanisms for 40 years, noted that some of the most difficult-to-treat classes of bacteria carry genes to make some form of beta-lactamase. "It must have been there for a long, long time, performing functions that nobody really understands," he said.

Bacteria have shown an extraordinary ability to develop new forms of the enzyme. At least 532 different types of beta-lactamases have been identified, according to Johns Hopkins University epidemiologist Dr. John Bartlett, who reported his findings last year in the journal Clinical Infectious Diseases.

Bacteria containing gangs of these enzymes - known as extended-spectrum beta-lactamases - are a growing threat, particularly in pneumonia-causing bugs such as Klebsiella and Pseudomonas. Bartlett said Pseudomonas aeruginosa seems to have a greater ability than most bacteria to develop resistance to "virtually any antibiotic." Some lab tests from hospitalized patients, he said, have already turned up resistance "to all available FDA-approved antibiotics."

It's a step toward what some researchers have labeled "the post-antibiotic era."

Martin Mackay, president for Global Research and Development at Pfizer Inc., the world's largest pharmaceutical firm, remembers as a young bacteriologist in the 1970s the optimism surrounding new antibiotics. "A lot of companies thought we'd cured infectious diseases," he said.

The years since have been a sobering reminder of the power of bacterial evolution. Mackay said neither he nor his company have given up, but instead have a new respect for the challenges ahead.

"I doubt there will ever be a time we really crack this resistance problem," he said. "I think this is going to be a constant war."

Source:www.sfgate.com

Top geneticist wins Japan Prize

Professor of Medical Genetics Victor A. McKusick, from the School of Medicine, will receive the coveted Japan Prize in medical genetics and genomics in an April 23 ceremony. In addition to the presentation, the Prize includes 50 million yen ($470,000). Held in Tokyo, the 24-year-old Japan Prize recognizes living individuals who have made significant advancements in science and technology.

McKusick, 86, began his education at Tufts University, where he spent three years before enrolling in the Hopkins School of Medicine in 1943 without even completing his bachelor's degree. Since then, McKusick has remained at Hopkins, doing residency in internal medicine and training as a cardiologist. His professional interests later turned to genetics.

His accomplishments in the field involve being the first to describe Marfan syndrome's cluster of characteristics, working to identify genes leading to different physical conditions and publishing what is now known as Online Mendelian Inheritance in Man, a catalog of diseases and their genetic factors.

Other accolades which McKusick has received include the 2001 National Medal of Science and the 1997 Albert Lasker Award for Achievement in Medical Science. At Hopkins, he served 1985 as the William Osler Professor of Medicine, chairman of the Department of Medicine and physician-in-chief at Hopkins Hospital before retiring last month.Professor of Medical Genetics Victor A. McKusick, from the School of Medicine, will receive the coveted Japan Prize in medical genetics and genomics in an April 23 ceremony. In addition to the presentation, the Prize includes 50 million yen ($470,000). Held in Tokyo, the 24-year-old Japan Prize recognizes living individuals who have made significant advancements in science and technology.

McKusick, 86, began his education at Tufts University, where he spent three years before enrolling in the Hopkins School of Medicine in 1943 without even completing his bachelor's degree. Since then, McKusick has remained at Hopkins, doing residency in internal medicine and training as a cardiologist. His professional interests later turned to genetics.

His accomplishments in the field involve being the first to describe Marfan syndrome's cluster of characteristics, working to identify genes leading to different physical conditions and publishing what is now known as Online Mendelian Inheritance in Man, a catalog of diseases and their genetic factors.

Other accolades which McKusick has received include the 2001 National Medal of Science and the 1997 Albert Lasker Award for Achievement in Medical Science. At Hopkins, he served 1985 as the William Osler Professor of Medicine, chairman of the Department of Medicine and physician-in-chief at Hopkins Hospital before retiring last month.



Hopkins Hospital goes rubber free

The Hopkins Hospital has achieved a major goal in the medical field by becoming "latex safe." Latex gloves will no longer be used in the hospital, and use of most latex in other products will cease.

The pervasive problems with latex in medicine have grown in recent years, with about 6 percent of the public and nearly 15 percent of healthcare workers having a latex allergy. Frequent contact with the natural rubber proteins found in latex has been shown to increase the chances of developing an allergy.

The allergic reactions to latex include decreased blood pressure, irregular heartbeat, swelling in the extremities and airway constriction. In severe cases, the anaphylactic shock resulting from a latex allergy can result in death. The new gloves that Hopkins will use are composed of the synthetic materials neoprene and polyisoprene. Nonsterile gloves made from these substances cost about the same as nonsterile latex gloves, while sterile neoprene and polyisoprene cost 30 to 50 percent more than the latex ones

Hopkins, where the first rubber surgical gloves in the United States were introduced in 1894, is the first major medical institution to be deemed "latex safe."



Poultry workers have high risk of E. coli infection

A new study by Lance B. Price and his colleagues at the Bloomberg School of Public Health reports that poultry workers have 32 times greater odds of carrying an antibiotic-resistant strain of E. coli bacteria. Those studied were workers in the poultry industry and members of the community on the Eastern Shore of Maryland and Virginia.

Stool samples from the 49 participants were tested for various antibiotics, and the results showed that the 16 poultry workers were 32 times more likely than the 33 community members to carry a strain of E. coli that is resistant to the common antibiotic gentamicin. Of the 16 antimicrobials used in feeds produced for food animals, gentamicin is the most common. The findings of Price's study corroborate similar studies done in Europe.

Price is a member of the research faculty at the Hopkins School of Medicine's Division of Infectious Diseases in addition to acting as a scientific adviser to the School of Public Health's Center for a Livable Future, which provided the majority of the funding for this research. Complete results of the study are available in December's Environmental Health Perspectives.



High school gym helps control weight later on

Researchers at the School of Public Health recently reported in the findings of a study showing that teens who have physical education at school are less likely to be overweight adults. Each day of physical education corresponds to a 5-percent decrease in the odds of being overweight.

The research team looked at 3,345 students in grades eight through 12 who were surveyed as part of the Longitudinal Study of Adolescent Health. This survey asked the teens about their physical education and extracurricular physical activity.

The Hopkins researchers measured the participants' height and weight five years after the initial survey. Teens participating in wheel-related activities, like rollerblading or biking, outside of school at least four times a week had the most decreased likelihood of being overweight later in life. The results of the study, written by Robert Wm. Blum, David Menschik, Saifuddin Ahmed and Miriam H. Alexander, are published in the January issue of Archives of Pediatric and Adolescent Medicine.

Source:media.www.jhunewsletter.com

New Report Underscores Need for Congressional Action to Limit Antibiotic Use in Animal Agriculture

A new report by the Pew
Commission on Industrial Farm Animal Production (http://www.pcifap.org) documents
the perils of antibiotic use in factory farms and the many strains of
antibiotic-resistant E-Coli, Salmonella, Camphylobacter,
methicillin-resistant Staphylococcus aureus (MRSA), and other bacteria that
these facilities cause.



The report release comes a few days after Tyson Foods and the U.S.
Department of Agriculture (USDA) agreed on a new label for their chickens
raised without antibiotics: "Chicken raised without antibiotics that impact
antibiotic resistance in humans." Tyson announced in June, 2007, that it
would stop feeding antibiotics important in human medicine to their
chickens, a move that advocated hailed as "a great step forward." But no
other large meat producers have followed suit.



"The added voice of the Pew Commissioners to that of the American
Medical Association and the Infectious Diseases Society of America shows
the need to stop factory farms from squandering the effectiveness of our
antibiotic supply," said Richard Wood, Steering Committee Chair of the Keep
Antibiotics Working coalition. "But lasting change will only come when the
U.S. government decides to act. We hope that the Pew report will help spark
that step."



The heavy use of antibiotics in industrialized livestock operations can
select for resistant bacteria, such as MRSA. The Union of Concerned
Scientists estimates that 70% of all the antibiotics and related drugs used
in the United States are used as feed additives for chicken, hogs, and beef
cattle. The new report details the many links between farm antibiotic use
and the spread of resistant infections in humans.



Despite a long awareness of the link between farm antibiotic use and
resistance in humans, the United States still allows the routine and
unnecessary use of critically important drugs in farm animals for growth
promotion. The United States also fails to adequately monitor antimicrobial
resistance in farm animals. Even the recent media coverage on MRSA being
found in Canadian and European livestock has not prompted the US to check
its own livestock to ensure food safety.



Proposed federal legislation would phase out the use of antibiotics
that are important in human medicine as animal feed additives within two
years. The Preservation of Antibiotics for Medical Treatment Act is
sponsored by Senate Health Committee Chairman Edward Kennedy (D-MA) and
Senators Olympia Snowe (R-ME), Susan Collins (R-ME), Sherrod Brown (D-OH)
and Jack Reed (D-RI) in the Senate (S. 549) and Rep. Louise Slaughter
(D-NY), the only microbiologist in Congress, and 34 other House members in
the U.S. House of Representatives (H.R. 962).



The Keep Antibiotics Working Coalition has recently highlighted a
half-dozen scientific studies that clearly demonstrate the escalating
health threat:

-- Clinical Infectious Diseases published a study this month showing
that patients in a Dutch hospital who were exposed to pigs or veal calves
(mostly farmers) had 3-fold increase in risk for MRSA infections.

-- The U.S. Centers for Disease Control and Prevention's Emerging
Infectious Diseases published a study in December linking a new strain of
methicillin-resistant Staphylococcus aureus (MRSA) once found only in pigs
to more than 20 percent of all human MRSA infections in the Netherlands

-- Veterinary Microbiology published a study in October that found MRSA
prevalent in Canadian pig farms and pig farmers, pointing to animal
agriculture as a source of the deadly bacteria.

-- Applied and Environmental Microbiology published a study in August
that linked the routine use of the antibiotic tetracycline, popular in
swine production, to the presence of antibiotics resistance genes in
groundwater.

-- Journal of Food Protection published a study in August by USDA
researchers showing that feeding chickens the antibiotic tylosin to promote
growth -- not to treat disease -- greatly increases the number of
erythromycin-resistant Campylobacter on chicken carcasses.

-- Emerging Infectious Diseases published a study in 2006 documenting
U.S. veterinarians as carriers of MRSA. In a 2005 survey of attendees at an
international veterinary convention in Baltimore, MD, who were tested for
MRSA found that of the 27 who tested positive, 23 were from the United
States.


Source:www.prnewswire.com

Fight to curtail antibiotics in animal feed

Consumer advocates have been campaigning for years to curb the use of antibiotics in agriculture, citing studies that show that 70 percent of all U.S. antibiotics are administered in low doses - not to treat disease, but to promote the growth of pigs, sheep, chicken and cattle.

Low doses of antibiotics in animal feeds have been shown to boost the speed of food-to-muscle conversion by 5 percent, and can prevent the spread of disease in the tight quarters of modern factory farms.

But as early as 1963, British researchers tied the emergence of drug-resistant strains of salmonella in humans to antibiotics fed to cattle. Among the drugs routinely found in animal feed are erythromycin, penicillin and streptomycin. Critics warn that the use of antibiotics in feed at low dosages helps to breed resistant bacteria in the gut of farm animals - threatening the future of these drugs for use in animals or humans.

Major antibiotic classes such as tetracyclines and the Cipro-like fluoroquinolones have already been compromised, according to Keep Antibiotics Working, a coalition backed by environmental groups and the American Medical Association.

The stakes are high. The Union of Concerned Scientists calculated in 2001 that U.S. farm interests were using 24.6 million pounds of anti-microbials - almost 40 percent higher than industry estimates.

Ron Phillips, vice president of the Animal Health Institute, a Washington trade group for agricultural drugmakers, maintains that growth promotion accounts for only 4.5 percent of antibiotic consumption in agriculture. The rest are used to prevent, treat or control the spread of disease. "Antibiotics," he says, "are a net positive for both animal health and human health."

After antibiotics were banned from animal feed in Europe beginning in 1995, Phillips said, farmers there found they had to use more antibiotics to care for illnesses that cropped up in their livestock.

Keep Antibiotics Working nevertheless is pushing for a federal ban on antibiotics in feed. Introduced by Sens. Edward Kennedy, D-Mass, and Olympia Snow, R-Maine, the "Preservation of Antibiotics for Medical Treatment Act" would phase out in two years antibiotics deemed "important in human medicine."

In response to pressure from consumer groups, McDonald's declared four years ago its intention to phase out the purchase of meats from chicken and livestock fed the drugs to promote growth. The Food and Drug Administration in 2005 banned the use of a Cipro-like drug, Baytril, to treat bacterial infections in poultry, after drug-resistant strains of Campylobacter - a common food-poisoning organism - were found in chicken. Cases of Cipro-resistant Campylobacter were also rising in humans.

The FDA is considering an application for approval of the antibiotic cefquinome, a proposed veterinary drug that is similar to the human drug cefepime. In the fall of 2006, an FDA advisory committee recommended against approval.

"It was surprising what the committee did, because it was stacked with veterinarians and animal science people," said Stephen Roach, director of public health programs for Keep Antibiotics Working.

"The USDA is very reluctant to say that antibiotic use causes a problem, and the FDA has traditionally been in the middle. But I feel that in the last several years, they have been more accommodating to industry," said Roach.

Source:www.sfgate.com

Vaccine News You Need

Louis Pasteur, a pioneer in vaccine science, wrote that "chance favors only the prepared." Vaccines are some of modern medicine's greatest tools for putting chance on your side, yet a recent CDC report found that only about 2 percent of American adults are adequately vaccinated.

Vaccines provide either active or passive protection against disease. Active vaccines, for instance against chickenpox, deliver an altered (inactivated) chickenpox virus, allowing your immune system to develop antibodies, which rapidly multiply to protect you if you're infected. Passive vaccines, such as one of the rabies vaccines, provide short-term protection with pre-formed antibodies and are sometimes used in pregnant women, travelers, immune compromised patients and those already exposed to disease.

Today children receive hepatitis, measles/mumps/rubella, tetanus/diphtheria, polio, meningitis and chicken pox vaccines. Of these, only tetanus/diphtheria requires a booster (every 10 years). The new tetanus/diphtheria vaccine also vaccinates against whooping cough. This resurging infection in adults can cause cough severe enough to crack ribs or induce vomiting, and may last months. If you did not receive this set of shots you can get them now, and if you did but don't want to wait for your tetanus/diphtheria booster to receive the whooping cough vaccine, it's OK to get the combined tetanus/diphtheria/whooping cough vaccine before it's time for your booster shot. Also, as you age and your immune system weakens, chicken pox can "re-present" as the painful and long-lasting shingles rash. Getting revaccinated for chicken pox at age 60 can significantly reduce your chance of getting shingles.

If you're tired of being revaccinated for the mutating flu virus each season, there's good news: Scientists recently developed a vaccine against part of the virus that doesn't change with seasonal mutations and is present in bird flus. So, sometime in the near future, a lifelong vaccine for both seasonal and pandemic flu may be available.

While you may know about flu vaccine, you may not know there's also a vaccine that reduces your risk of pneumonia. The CDC recommends pneumonia vaccine for those older than 65, or those 19 to 64 with chronic heart or lung conditions, alcoholism, diabetes or other conditions that make them predisposed to infection.

The human papilloma virus (HPV) vaccine (which protects against cervical cancer) is currently FDA recommended for only girls and women ages 9 to 26. However, scientists are beginning to understand the role of HPV in other diseases, such as mouth and throat cancers, which means the vaccine may soon be offered to other segments of the female population and to men, as well. (This vaccine is available to women older than 26, but insurance may not cover it.)

Most vaccines are safe, with occasional low-grade fevers or local site reactions. Two 2007 studies in the New England Journal of Medicine found no link between vaccines and autism, and the 2006 World Health Organization Global Advisory Committee on Vaccine Safety found "no evidence of toxicity in infants, children or adults exposed to thimerosal (containing ethyl mercury) in vaccines." Ask your doctor if it's safe to receive certain vaccines if you've had Guillain Barré syndrome, antibiotic allergies, egg allergies or you or your family had previous vaccine allergies. You shouldn't have live vaccines if you're pregnant or immune suppressed.

Research is being conducted on vaccines for high blood pressure, rheumatoid arthritis, Alzheimer's and nicotine addiction, as well as on vaccines which not only prevent, but also treat cancer. And as delivery systems move from needles to patches and nasal powders, prevention (and even cure) may come without the sting.

Dr. Nayer Khazeni specializes in internal medicine and pulmonary/critical care, teaches and conducts research at Stanford University Medical Center.

Source:www.sfgate.com

Antibiotics responsibility

Antibiotic resistance seems to be all over the news lately - from drug resistant tuberculosis to methicillin-resistant Staph. aureus, also known as MRSA. Antibiotic resistance is not new, and, unfortunately, it is not limited to a couple of high-profile, rare occurrences. A great majority, if not all, bacteria that make us sick have developed ways to resist antibiotics. We don't have to sit back and watch our important medicines fail. Rather, we all can do something about this serious health threat.

We can no longer afford to take antibiotics for granted. These amazing drugs are designed to treat bacterial infections, some of which can be deadly without treatment. Since antibiotics are so important, we must appreciate them and use them correctly.

Knowledge is essential. Since taking antibiotics unnecessarily encourages resistant germs to multiply, it's essential to know when antibiotics work and how to use them wisely. Too often we have the notion that, when ill, an antibiotic will improve our symptoms regardless of the cause. However, antibiotics only cure bacterial infections and do not work for viral infections. The illnesses we get this time of year - coughs, colds and flu - are usually viral. Antibiotics simply will not help.

Communication's key. It's important to see your health care provider if concerned about an illness. But it's equally important to ask questions. Sometimes we need antibiotic treatment. Sometimes other medicines are best. Communicate with your health care provider to find the right medicine to treat your illness. Antibiotics aren't always the answer.

Antibiotic resistance is a serious concern that affects everyone. The good news is awareness is growing. Do not be a bystander. Get involved, talk with your health care providers and learn what you can do to prevent antibiotic resistant infections. It's each of our responsibility to keep antibiotics working.

Source:/theflume.com

First checkup for area's clinics

After years of work, lots of fanfare and a plentiful dose of disagreement, a collaboration by employers, health insurers, unions and medical providers around Puget Sound has produced a first-of-its-kind, comprehensive comparison of the medical care performed at 14 different clinic systems in the Puget Sound area.

The "Community Checkup" report, released Thursday, uses billing records for 1.6 million patients to compare the care that is being delivered to the region's health-care consumers to national standards. It covers 21 different areas, including diabetes, heart disease, cancer screening and low back pain, and rates clinics against regional averages.

"The goal here is to shine a light on our health-care delivery system, in a way that everyone can see how health care is being provided, and from there, how to make much better choices," said King County Executive Ron Sims, who helped start the coalition, called the Puget Sound Health Alliance.

But it's not yet clear just how useful such ratings will be to the "consumers" of health care — who are sometimes patients but are more often businesses and government agencies that purchase health coverage for workers.

For now, businesses and insurers are barred from using the data to change employee benefit plans, negotiate new contracts or choose clinics to be included in "preferred provider" networks. The medical community wanted to have time to see the report before contracts or insurer networks were affected, said Diane Giese, spokeswoman for the Alliance.

And whether individual patients will use the information to make changes is still a question mark.

Long, costly process

Producing the report, along with related health-quality work, was a long, costly process — three years and $3.5 million.

The alliance began in late 2004 at the urging of a King County task force. The goal was to develop a system to improve quality — which, Sims believed, would lead to cost containment — align incentives among employers, insurers, doctors and patients, and to agree on clinical guidelines and measures to be used in a report.

The alliance now includes 160 organizations, including Boeing, Starbucks and Washington Mutual, and more than 50 people. Its board includes representatives from medical providers, health insurers, large businesses, King County, the city of Seattle, and union-employer trusts. "Consumer representatives" also were included on specific committees.

The report compares 14 clinic systems that volunteered to have their scores published, and rates 81 individual clinics of six or more doctors. In all, it covers roughly 65 to 70 percent of insured patients in the five-county region, said Margaret Stanley, the alliance's executive director.

The analysts hired by the alliance, using patient billing records, calculated how often patients received the recommended care based on national standards.

The report shows success in some cases. For example, more than 90 percent of children seen for a common cold were not given an unnecessary antibiotic — better than the top performing states measured in a national report.

But in other cases, such as colon cancer screening, Puget Sound-area clinics are far behind the best-performing states. And even in Puget Sound, the average of all clinics is significantly lower than the top-performing clinic system.

The survey shows that "everyone has room to improve," said Dr. David Fleming, director of Public Health — Seattle & King County, who chairs the alliance's board.

Improving care

The directors of several clinics included in the report said they expected patients to use the report's ratings to help improve their own personal care.

"This gets patients involved in the quality process," said Dr. David Dreis, medical director of clinical outcomes at Virginia Mason Medical Center.

And for the clinics and medical providers, it provides a unique, public measurement.

"You can't improve what you don't measure," said Dr. Peter McGough, chief medical officer of University of Washington Medicine Neighborhood Clinics.

Some UW doctors were "stunned" to find they were below par on care for diabetics and breast-cancer screenings, and have quickly worked to significantly improve care, McGough said.

Doctors' "first instinct is [to ask] 'How am I doing compared to others?" said Lloyd David, CEO and executive director of The Polyclinic and a board member of the alliance.

But Dr. Warren Fein, medical director for Swedish Physicians, a 12-clinic network of primary-care clinics, questioned whether the burden for improving care should fall primarily on doctor and patients.

In some cases, he said, insurance plans control the levels of care. For example, patients might skip colon-cancer screenings because their insurance doesn't cover them adequately.

Does the alliance have a "strategy for improvement?" Fein asked. "I'm hopeful, but I haven't heard anything along those lines. "

Source:seattletimes.nwsource.com

Emergence of New Bacteria Strain Affecting Gay Men

A recently published study in the journal Annals of Internal Medicine reports that a new, multi drug-resistant strain of the bacteria Methicillin-Resistant Staphylococcus aureus (MRSA) is being spread rapidly among gay men in San Francisco and Boston.

The new strain is spread easily through anal intercourse as well as casual skin-to-skin contact and contact with contaminated surfaces. Researchers noted that the strain “has the potential for rapid, nationwide dissemination” if microbiology laboratories are not able to identify the strain and doctors did not prescribe the correct antibiotic therapy.

The study was based on outpatient records in San Francisco and Boston and nine medical centers in San Francisco. According to researchers at UCSF, San Francisco has the largest gay population in the country. Gay men in San Francisco were found to be 13 times more likely to be infected than other people in the city. The study also found that 1 in 588 residents is infected with the new strain, correlating to 1 in 3,800 people in San Francisco.

There are measures to effectively stop skin-to-skin transmission of the strain, such as hand washing with soap and water especially after sexual activities, researchers say.

The New York Times reports that MRSA infections can cause unusually severe abscesses and skin ulcers, necrotizing faciitis through invasion of the skin (hence the name “flesh eating bacteria”), pneumonia, heart damage, and can produce widespread infection through the blood. In 2005, nearly 19,000 people died from MRSA infections, according to The Centers for Disease Control and Prevention.

One of the authors of the study, Dr. Henry F. Chambers, professor of medicine and clinical researcher at UCSF, says the new strain is closely related to earlier ones and is also more difficult to treat because of its resistance to methicillin, clindamycin, tetracycline, mupirocin, and the many other antibiotics used to treat earlier strains.

Project A.W.A.R.E. (Alliance Working for Antibiotic Resistance Education), a pharmacy community service project on campus, has received many questions about MRSA at their outreach events such as health fairs. Anh T. Nguyen, a project coordinator for Project A.W.A.R.E. says that, “It is important that we educate health care providers, patients, and consumers about the appropriate use of antibiotics. Simple things like never sharing or using leftover antibiotics, never using or prescribing antibiotics for the cold or flu, finishing an antibiotic prescription, and even washing your hands (especially in the case for MRSA) can help tremendously in decreasing the spread of antibiotic resistance and disease.”

Source:www.ucsf.edu

Parenting Imperfect: Germs winning in household cold war

This weekend made it official. We have entered the season of snot.

We have not yet hit the heart of the season, which is when all four humans in the house are on medication for some kind of acute illness.

By the time you read this, however, the situation on the ground may have changed.

It started, as it so frequently does, with a cold. The Diva caught if first, then promptly gave it to her brother. Toys they won't share; germs they will.

In him, it lingered, filling his head with vile and disgusting bacteria that made him into a crabby, cranky toddler who needed to have his nose wiped every few seconds, which made him even crabbier.

When the stuff oozing out of his head became a color rarely found in nature, we hauled him to the pediatrician, who promptly started him on antibiotics prescription No. 1.

The Diva emerged unscathed, which is a surprise since she spent most of her toddler winters on an endless cycle of meds whose colors and tastes left much to be desired. In her opinion, at least.

Various helpful people suggested ways to make her take her medicine. Everything from mixing it with chocolate pudding to dipping her thumb in it so that she'd suck it off was suggested. None worked.

Eventually, the Hub and I hit on a solution. On its surface, it will seem cruel, but those who've had kids who won't take medicines will understand.

Two adults had to be involved. One would man (or woman, depending) the syringe full of liquid antibiotic while the other would straddle the girl and pin down her arms and legs. The person with the dropper would pinch her cheeks into a fish face and administer the medicine, drop by silly drop, lest she choke. Big fun.

We were always waiting for a concerned neighbor to call the cops on us, given all of the screaming and crying (and wrestling and swearing) everything from ibuprofen to amoxicillin required. I always felt compelled to close the blinds, if only to spare concerned passersby the sight of us sitting on our firstborn.

Thankfully, she seems to have grown out of the constant illnesses and everyone is spared the trauma of medicating her.

As in so many things, the Dude is the exact opposite. All we have to do to get him to take his medicine is show it to him.

Which is good, because just as the Dude was finishing up his most recent round of antibiotics, the Diva spent a night tossing and turning. Restlessness, of course, requires waking us up, too. She kept complaining that her cheek hurt; we kept hustling her back to bed in the hopes that she'd just sleep off whatever was bugging her.

She did appear better in the morning. She seemed her usual healthy self, except she'd occasionally complain about her cheek or ear, then go back to chasing her brother.

We took her to the pediatrician anyway, who described her ear as red and angry and infected. Additionally, that said ear might pop and leak all kinds of disgusting stuff onto the Diva's pillow during the night.

Rather than be upset by the prospect of her head exploding, the Diva was more upset the next morning when it hadn't happened. She wanted to see what it would look like.

She's only marginally better about taking her meds than she was when she was a 3-year-old. We don't have to hold her down anymore _ not that I think we could at this point _ but there is still a certain amount of bribery and cajoling involved.

While his sister waited for her ear to pop, the Dude got better. Then, of course, he caught another cold, which led to another sinus infection, which led to more crabbiness and drugs. I just keep reminding myself that immune systems work best when they are tested every now and again.

The biggest problem, however, is that the boy isn't careful with his germs. He's not the best at washing his hands after he touches his nose. He has no problem with sneezing directly in your face. We're working on teaching him some manners _ but there is only so much one can expect from a 21/2-year-old, whose understanding of infectious diseases is nebulous at best.

The end result is that the germs tend to travel up the chain, moving seamlessly from the knee-biters to the grown-ups. It's a wonder that the nasty bugs hadn't started their migration before now. Usually we've had a few rounds of household-wide drugs by the time Valentine's Day rolls around.

There's still hope for the snot season of 2008. When I woke up this morning and it felt like someone had stuck a cactus up my nose, I realized that we were back on track. The Hub _ our last best hope for good health _ remains standing. Wish us luck.

I would knock wood if I could only reach my desk from under this gigantic mound of tissues. So far, nothing in my head has exploded, but it might only be a matter of time.

Source:www.thedailystar.com

Breeding an Epidemic Antibiotics and Meat

Antibiotics and Meat

Nowadays, it's so simple and inexpensive to take an oral dose of tetracycline or amoxicillin to fight off an infection that most of us take antibiotics for granted. The time may be rapidly approaching, however, when we'll have to learn what it's like to do without these drugs . . . in large part because of the way American agribusiness raises meat!
ANTIBIOTICS

To understand this bizarre connection, we'll need to review the nature of antibiotics themselves. Antibiotics are chemicals derived from the toxins one microorganism generates to fight off the assault of another.

Though we know that the Chinese used moldy bean curd to treat carbuncles and boils several millennia ago, it wasn't until 1928 that Sir Alexander Fleming discovered that a mold, penicillin, actually killed competing bacteria. When penicillin was synthesized in useful, therapeutic concentrations in 1941, many infectious diseases that had been practically uncontrollable finally became treatable. Between 1943 and 1960, the annual production of penicillin soared—from 29 pounds to 860,000 pounds—and the fatality rates associated with various diseases plummeted.

Truly, the description "wonder drugs" aptly reflected the early success of antibiotics in treating disease. For the first time, doctors had medicine that actually attacked the cause of bacterial disease. However, not long after antibiotics began to see widespread use, scientists discovered an alarming trend. Some bacteria were developing resistance to antibiotics . . . they were effectively selecting for a stronger strain of microorganism! And these resistant bacteria could run rampant when a constant barrage of wonder drugs wiped out their nonresistant competitors.

It was another decade, though, before the full effects of bacterial resistance to antibiotics were felt. In 1968, Shigella dysenteriae (a virulent strain of dysentery) broke out in Guatemala and spread throughout Central America over the course of three years. Doctors assumed that they were dealing with amoebic dysentery when the four antibiotics of choice—streptomycin, tetracycline, chloramphenicol, and sulfonamide—had no effect. By the time the real cause, resistant bacteria, was discovered, tens of thousands had died.
HOW BACTERIA BECOME RESISTANT

Part of the reason that it took so long to recognize the significance and extent of bacterial resistance to antibiotics is that no one anticipated the means by which resistance is passed from one cell to another. If resistant strains developed only through the reproduction of strong survivors and chromosomal mutation—as was initially assumed—it would take a long time for large cultures of resistant bacteria to develop.

Unfortunately, as Japanese researchers discovered in the late 1950s and early 1960s, bacteria have a much more efficient means of transmitting resistance. Dr. Tsutomo Watanabe found that, in the case of some microbes, drug resistance could be passed from one bacterium to another in the form of R (resistance) plasmids, pieces of DNA not directly linked to or affecting the chromosome. These plasmids, which can number up to 2,000 per cell, are directly transferred from cell to cell, through a connection called a pilus, without otherwise affecting the donor or recipient. Thus, instead of facing the extended process of mutation (a probability of less than 1 in 10,000,000) and natural selection, resistance DNA can be passed from one group of cells to another in a matter of minutes. What's more, the bacteria involved need not be of the same species; for example, Escherichia coli (a prevalent intestinal bacterium) readily becomes resistant and transfers that resistance to salmonella or Shigella dysenteriae.
CONCERN SPREADS

In the December 1967 issue of Scientific American, Dr. Watanabe wrote, "Unless we put a halt to the prodigal use of antibiotics and synthetic drugs, we may soon be forced back into a pre-antibiotic era." It was an outcry that few heeded at the time. But by 1982, the Lancet reported that 90% of Staphylococcus aureus bacteria (which infect surgical incisions) were resistant to penicillin and that 35% of E. coli were resistant to ampicillin.

Though doctors and scientists don't agree about the severity of the problem, many physicians are now exercising restraint in prescribing antibiotics. For example, the use of antibiotics for cold and flu viruses, against which they are entirely ineffective, has practically ended. Doctors have recognized that antibiotics are a depletable resource that needs to be saved for really serious health problems. Meanwhile, new (and much more expensive) antibiotics are under development to replace those that have become ineffective. But trying to keep up with the expanding inventory of resistant bacteria is a constant battle.
ANTIBIOTICS AND LIVESTOCK

Unfortunately, even if all physicians exercised thorough restraint in the use of antibiotics, there would still be a tremendous influx of these substances into the environment. Nearly half the volume of antibiotics produced in the U. S. each year—about 15,000,000 pounds, worth almost $250,000,000—is fed to animals. Penicillin, tetracycline, and other such medications are routinely mixed into the feed of the majority of livestock in this country . . . not mainly to stave off disease but, instead, in efforts to increase growth rates.

In 1949, Dr. Thomas Jukes—who then worked for Lederle Laboratories, the company that discovered chlortetracycline (Aureomycin)found that feeding the wastes from the production of chlortetracycline to baby chickens increased their growth rate by 10 to 20%. Continued research showed that the effect was at least as pronounced on piglets and calves. Companies such as American Cyanamid (the parent of Lederle and the largest producer of veterinary tetracycline) claim that giving doses of antibiotics well below those that would be used to treat disease (a procedure called subtherapeutic administration) can return $3.00 in improved feed-conversion efficiency for every dollar invested.

Dr. Jukes' discovery did much to make a whole new sort of farming possible. Antibiotics have made it more practical to confine animals where they can be fed controlled doses of commercial feeds, rather than allowing them to range. And, because of the medicinal properties of the antibiotics, animals can be kept in such crowded conditions without serious outbreaks of disease. Antibiotic-supplemented rations have made possible the modern-day feedlot . . . an efficient method of raising fowl, pigs, or cattle that has done much to make the small, low-intensity family farm uneconomic.

At the same time, the volume of antibiotics and their by-product, resistant bacteria, has burgeoned. According to an Office of Technology Assessment report in 1979, 99% of all poultry, 70% of beef cattle and veal, and 90% of swine receive routine subtherapeutic doses of antibiotics. It's now nearly impossible to find livestock that don't have significant populations of resistant bacteria, whether or not they've actually been fed antibiotics. The resistant strains quickly pass from one animal to another in confinement and have even been reported to mysteriously travel several hundred yards between pens.
THE ANIMAL-HUMAN LINK

Those groups opposed to, and those in favor of, subtherapeutic use of antibiotics in livestock spent most of the 1960s and '70s arguing about whether resistant bacteria developed in animal populations could be transferred to and infect humans. Today it's fairly clear that this does happen, but there's still much argument about how widespread the problem is.

Most bacteria present in cattle, for example, don't seem to do well in humans . . . each species has its own set of microorganisms well adapted to their particular environment. An exception, however, is the genus Salmonella, with its ten common species. In England, a rash of 305 cases of Salmonella typhimurium in the '60s and early '70s—an outbreak that resulted in the deaths of two adults and a child—led that country to ban subtherapeutic use of antibiotics. In 1976, there was a Salmonella heidelberg outbreak in Connecticut. The bacteria were found in calves, then in the farmer who kept the calves, then in his pregnant daughter, then in his daughter's baby three days after birth, and finally in other babies kept in the same hospital nursery. At the time, it wasn't possible to prove the existence of a direct path for the salmonella from the calves to the babies in the nursery, but the circumstantial evidence was very strong.

The most heralded example of salmonella transfer from livestock to humans—the one that seems finally to have proven the link to most scientists' satisfaction—occurred two years ago but has only recently received much publicity. A Minnesota couple became seriously ill after taking penicillin for a cold and were found to be infected by a resistant strain of Salmonella newport. A Centers for Disease Control researcher, Dr. Scott Holmberg, was brought in and used a new technique called genetic fingerprinting to track the salmonella to hamburger, back through a supermarket, and finally to a South Dakota farm where a herd of cattle was being fed subtherapeutic doses of chlortetracycline.

Dr. Holmberg eventually traced the same strain of Salmonella newport to 18 other peo ple in four states. Eleven had been hospitalized, and one had died. Most of the infected people had handled the meat from the farm before it was cooked. Salmonella are killed by heat—as yet, there's little evidence that eating cooked meat from livestock raised on antibiotics is in itself unhealthy—but the bacteria are so virulent that they were able to enter the bodies of the people who had prepared or otherwise come in contact with the raw meat. What's more, 12 of the 18 had been taking penicillin or other antibiotics for cold symptoms.

After 25 years of effort, the mechanisms that had long been suspected were established: Antibiotics fed to animals had created a resistant strain of bacteria for which the fatality rate in humans was 21 times higher than for non resistant strains . . . and antibiotics taken directly by the people had cleared the way for the disease-causing microorganisms.
THE OVERRIDING CONCERN

As alarming as it is that diseases made resistant by antibiotics can be transferred from animals to people, that threat to human health may be small compared with the possibility—indeed, the likelihood—that antibiotics are gradually becoming ineffective treatments for many diseases as resistance is transferred from one type of bacteria to another.

When England banned subtherapeutic use of antibiotics, the decision was based in part on a study showing that while 30% of Salmonella typhimurium were resistant in 1963, fully 73% had become resistant by 1979. A more alarming fact is that even if animals are fed only one antibiotic, their bacterial cultures may develop resistance to a variety of other antibiotics at the same time. Today in the U.S. approximately 25% of the salmonella infections in humans are resistant to drugs.

It may be that the overprescribing of antibiotics for people bears a similar responsibility for the development of resistant strains of bacteria, but the fact remains that the use of antibiotics in animals certainly adds to the problem. Though most of the bacteria that inhabit a cow's intestinal tract are different from those that live in humans, there's no distinguishable difference between the carriers of resistance: the R plasmids. Even though E. coli from cattle may be expelled by humans within a day, these able carriers of resistance can work numerous transfers during their stay. The routes of travel are mind-boggling, and the bacteria's persistence is remarkable. Some of us may bear a bigger burden of R plasmids than others, but it's safe to say that nearly all of us have some . . . and that the number is increasing.
REGULATORY STONEWALL

North American countries stand practically alone among developed nations in allowing the indiscriminate use of antibiotics in animals. Czechoslovakia, Denmark, England, the Netherlands, Norway, Sweden, and West Germany all require veterinary prescriptions for animal antibiotics. In the U.S., however, the director of the FDA's Center for Veterinary Medicine, Lester M. Crawford, has been unsuccessfully pursuing a ban on subtherapeutic use of antibiotics since 1977. It seems that each year since 1979 the House of Representatives Appropriations Committee has written a clause into the FDA budget which specifically prohibited the agency from restricting antibiotic use in animals until further research was completed!

The last of the research work requested, a study of food poisoning in Seattle from poultry that was fed antibiotics, was finished early this year. There now seems to be little question that routinely feeding antibiotics to animals presents a threat to human health. The remaining question is, What exerts more pressure in Congress—corporate pharmaceutical and farming interests, or a cry of public outrage? Let Representative Jamie Whitten, Chairman, House Appropriations Committee, 2362 Rayburn H.O.B., Washington, DC 20515, know what you think.

As of July 1, 1985, the FDA had taken no direct action to restrict the subtherapeutic use of antibiotics in livestock. However, two bills have been introduced in Congress. H.R. 616 would prohibit the use of antibiotics that increase the resistance of pathogenic bacteria. H.R. 2379 would restrict the importation of meat from antibiotic-treated animals.

Source:www.motherearthnews.com

Research Using Thermo Fisher Scientific RNA-Interference Technology Unveils Potential New Targets for HIV Drugs

Thermo Fisher Scientific Inc., the world leader in serving science, announced today that its RNA-interference (RNAi) technology has enabled a groundbreaking study at Harvard Medical School in Boston, which identified human proteins required for growth of the human immunodeficiency virus (HIV). This research points to potential new targets for treating HIV infection, which causes acquired immune deficiency syndrome (AIDS).

In the study, Harvard Medical School researchers used the Thermo Scientific Dharmacon(R) siGENOME(R) siRNA Library to "silence" more than 21,000 human genes, blocking the proteins they produce. With the help of Harvard's ICCB-Longwood High Throughput Screening Facility, the researchers identified 273 proteins required for HIV reproduction. Only 36 were previously known to be important to HIV.

"This study clearly demonstrates the power of genome-wide RNAi screening in identifying novel drug targets," said Ian Jardine, vice president of global research and development for Thermo Fisher Scientific. "The Harvard Medical School findings dramatically expand the number of potential targets for fighting HIV. It is an exciting discovery that holds promise for new treatments, and we are thrilled that our genome-wide siRNA library enabled this work."

Current HIV therapies target the virus itself, but HIV often mutates to build resistance against those drugs. Drugs targeting host proteins may be significantly less vulnerable to resistance caused by the virus' ability to mutate.

The research team was led by Harvard Medical School (HMS) professor Dr. Stephen J. Elledge and Dr. Judy Lieberman, HMS professor of pediatrics as well as an investigator at the Immune Disease Institute and director of the HMS Division of AIDS. The team also included Dr. Abraham L. Brass, postdoctoral researcher, working with Derek Dykxhoorn and Nan Yan, molecular virologists in Dr. Lieberman's group. Brass used the Dharmacon siGENOME siRNA Library for discovering weaknesses in pathogens such as HIV.

"HIV only expresses a few proteins, so it depends greatly on our cellular machinery during its lifecycle," said Brass. "Every time the virus relies on one of our proteins, it gives us the potential to disrupt that interaction and hurt HIV, which is very exciting. We also now have the ability to combine technology like siRNA screening with advanced robotics, giving us an incredibly powerful tool to go after devastating diseases such as HIV and cancer."

Dr. Caroline Shamu, director of the ICCB-Longwood Screening Facility, added, "Whole-genome siRNA (short-interfering RNA) screening is playing an increasingly important role in advancing genomic and proteomic research. Because it allows us to investigate the entire human genome, screening thousands of samples simultaneously, it dramatically accelerates the pace of biomedical discovery." Shamu's facility hosts the Dharmacon siGENOME siRNA Library and oversees screening conducted by researchers from Harvard Medical School and its affiliates.

The siGENOME siRNA Library is a collection of more than 21,000 siRNAs targeting every gene in the human genome. Each siRNA silences or disrupts the gene's ability to produce a specific protein. The siGENOME siRNA Library is currently used by many of the world's leading research institutions to accelerate the identification of genes important to human health.

Harvard Medical School is a member of the RNAi Global Initiative, founded by the Dharmacon products team and several leading research institutions around the world. In addition to Thermo Fisher Scientific, there are now 26 member institutions, all using the siGENOME siRNA Library and collaborating on research into cancer, diabetes, infectious diseases and other human health problems.

A paper written by the researchers details their findings and has been published online by Science magazine. It will appear in the magazine's print publication on Feb. 8. Other members of the HMS team who contributed to the paper include Alan Engelman, Yair Benita and Ramnik J. Xavier.

About the Genome-wide RNAi Global Initiative

The Genome-Wide RNAi Global Initiative is an alliance of leading international biomedical researchers, established to increase and accelerate the utility of human genome-wide siRNA libraries. The RNAi Global Initiative provides a forum for member institutions to share research protocols, establish experimental standards and develop mechanisms for exchanging and comparing screening data. Membership is open to not-for-profit biomedical research institutions across North America, Europe and Asia. The RNAi Global Initiative is being coordinated under the auspices of the RNA Technologies product team within Thermo Fisher Scientific. Its members include the Campbell Family Institute for Breast Cancer Research at Princess Margaret Hospital and Samuel Lunenfeld Research Institute at Mount Sinai Hospital, both with The University of Toronto; Cancer Research UK (CRUK) at the London Research Institute and the Institute of Cancer Research (ICR); The German Cancer Research Center (DKFZ); Eppley Cancer Center at the University of Nebraska Medical Center; Netherlands Cancer Institute (NKI); The Division of Pathway Medicine at the University of Edinburgh Medical School; the University of Texas Southwestern Medical Center; Yale University; the University of Texas M. D. Anderson Cancer Center; the Cambridge Institute for Medical Research and MRC Cancer Cell Unit; Fox Chase Cancer Center; Harvard Medical School; Stanford University School of Medicine; British Columbia Cancer Research Centre; Trinity College, Dublin; the Vrije University Medical Center; Weizmann Institute of Science; University of Dundee School of Medicine; the Institute Pasteur Korea; and the Institute of Molecular and Cell Biology, a member of A*Star Biomedical Sciences Institutes in Singapore; The Institute of Molecular Biology and Tumor Research - Philipps-University Marburg; University of Chicago; The Salk Institute for Biological Studies; The United States Air Force; University of Manchester; The Center for Genomic Regulation (CRG).

Source:www.foxbusiness.com

Generics medicine law enforcement dismal

SOME people addicted to conspiracy theories are beginning to ask: Did the pharmaceutical lobby insert the generics issue as an apple of discord in the House of Representatives’ Cheaper Medicines Bill?

The issue made the doctors and their Philippine Medical Association so mad that they threatened to go on strike—though they called it a “holiday.”

An amendment to the existing, two-decade old Generics Drug Act—the enforcement of which the Department of Health describes as “dismal”—is preventing the bicameral conference committee of the Philippine Congress from coming up with the unified version of the Cheaper Medicines Act (or if the Senate title is retained, the Quality, Affordable Medicines Act).

President Gloria Arroyo wants to sign it into law as soon as she gets it.

The generics provision is sponsored by Iloilo Congressman Dr. Ferjenel Biron. He is being accused by detractors supporting the pharmaceutical lobby of sponsoring the amendment because he was the top honcho of a leading generic medicine manufacturing company.

The Biron provision would amend the existing Generics Act of 1988 and the Pharmacy Law to require doctors to write only the generic names of drugs in the prescriptions they give their patients.

First in Asia

The Philippines is the first country in Asia to enact a Generics Drug Act. It was the government’s first legislative move to provide greater access to safe and affordable medicine. The Generic Drug Act of 1986 allows the production of unbranded drugs, using the same active ingredients and processes as the ones used in branded drugs, thus bypassing the patent system.

The law makes essential medicines, such as antibiotics, available at lower prices. A provision of the law requires pharmacies and physicians to support lower-priced, unbranded or generic drugs to solve the problem of millions of poor Filipinos unable to buy expensive branded medicines.

After two decades, the consensus among health sector people—and the public—is that the implementation of the landmark Generics Act has been a great disappointment.

Defective law

“Enforcement has not been all that good. In fact, it’s somewhat dismal,” says Health Undersecretary Alexa-nder Padilla. He also says the law itself is defective, because he sees it as bearing the mark of the strong pharmaceutical lobby that insists on the right of doctors to continue prescribing branded medicines.

“While the law compels doctors to issue generic prescriptions,” says Padilla, “it also allows them to continue prescribing the branded equivalent of their choice, the net effect of which has been to nullify generics altogether, “ Padilla explained.

Dr. Eduardo Banzon, a health economist, agrees with Padilla that the Generics Law has suffered from weak enforcement. While consumers are now familiar with the generic names of several popular over-the-counter branded medicine such as Tylenol (paracetamol) and Ponstan (mefenamic acid), he says that most people still do not ask for the generic equivalents. “How we’ve implemented the law hasn’t empowered consumers enough,” he says. “We need to push for it more.”

But can a new Cheaper Medicines Bill really lower the prices of medicine?

The Philippine Medical Association (PMA), the national organization of medical practitioners in all areas of specialization—is at the forefront of the menacing hospital strike threat to fight the Biron provision.

PMA president Dr. Jose Sabili said that the Cheaper Medicine Act is a positive development. But compelling doctors to write only the generic name of medicine they prescribe will put the health and safety of consumers at risk.

The doctors only want to remove Iloilo Congressman Biron’s provision. The passage of the Cheaper Medicines Law is okay by them.

Sabili explains, “The patient-doctor relationship is based on trust. The medicines that we prescribe to our patients are based on careful study of their illness and medical history. Our paramount concern is their safety and we cannot compromise this at all cost.”

In other words, even if a generic medicine is exactly the same as the branded one that comes from the foreign pharma company that they trust, the doctor must not be forced to prescribe the generic.

Sabili contended that this provision “violates the doctors’ rights to protect their patients” and take care of their health.

The Cheaper Medicines Bill has been lauded as a breakthrough that will lead to the lowering of the price of medicines and encourage local drug manufacturers and distributors to market quality and affordable drugs.

Most expensive medicines

The Philippines has the most expensive medicines in Asia, the prices here next only to those in Japan. According to the Philippine International Trading Corporation, the cost of medicine in the country is higher by 40 percent to 180 percent than other Asian countries.

As a result three out of five Filipinos get sick without being able to see a doctor at all. In 2005, Filipinos spending for medicines dropped by 2.2 percent while prices of medicines went up by 10 percent, according to the PITC.

For many Filipinos, buying drugs accounts for as much as 45 percent of the total health expenditures. Such a pattern is not seen in the US where drug expenditure accounts for a much lower 10 percent of health expenditures.

Citing an Asean survey, the PITC says the retail prices of medicine in Indonesia, Malaysia and Thailand are 40 percent to 70 percent lower than in the Philippines. Five out of every nine medicines in the Philippines cost more than in Malaysia or Indonesia. Some, like one brand of antibiotic, cost more in the Philippines than in the United Kingdom or Canada.

Former PITC President Roberto Pagdanganan says generics they are as efficacious and safe as branded medicines. A 2003 study showed that the utilization of generic medicine in Poland was 86 percent; United Kingdom, 60.06 percent; United States, 85.6 percent; Germany, 67.97 percent and Canada, 77.4.

In the Philippines today generics only account for 10 percent to 20 percent of medicine sales.

Under our Generics Law, doctors are required to write the generic name of a drug on the prescription. The branded medicine that they prefer must be written inside a parenthesis.

“People feel that ‘cheap’ generic medication is not going to do them any good so either they buy the expensive stuff or don’t bother to take medication at all,” Pagdanganan pointed out. Based on his experience with the PITC, he said it is not poor quality that makes generic medication cheap, but the add-on costs like marketing.

The PTIC, together with the Department of Health and the Bureau of Food and Drugs, are at the forefront of the government’s thrust to provide Filipinos with affordable medicine. “In order to do that we need to be able to provide them with more products and more venues or stores, as well as an educational campaign that corrects their wrong assumption about ‘cheap’ medication,” he said.

But the pharma companies keep publishing adds subtly suggesting that people must be careful with generic drugs because, who knows, these might be fake or in other ways unsafe?

Generik Botika Inc., a very young and versatile organization addressing the issue of the common people’s lack of access to good medicines, said in a statement: “There are only very few players from manufacturing to distribution in this 120 billion peso industry, where the multinational companies (MNC’s), corner as much as 70 percent of the total market.

The pharmaceutical business grows by no less than 10 percent every year either by price increase or volume. This very lucrative business has been out of sight from local entrepreneurs because of the many myths that haunts the mind of prospecting investors.”

The local price of the leading mefenamic acid product is P21.82 compared to P2.61 in India and P1.38 in Pakistan. (Mefenamic acid under the brand name Ponstan costs P20.98 here, but only P2.80 in India and P1.46 in Pakistan). A 5-mg anti-hypertensive pill costs P44.75 in the Philippines. In South Korea, the same brand costs only P22.25, while in India and Thailand, the pill costs only P5.15 and P29.85, respectively. (an anti-hypertensive pill under the brand name Norvasc costs P44.75 here, but only P6 in India). The top anti-asthma drug sells for P406.75 while India and Thailand sells it for only P83.88 and P230.54, respectively. While a drug against respiratory tract infection costs P17.75 while it only costs in P.51 in India and P4.63 in Thailand.

The Philippine College of Physicians (PCP) echoes the PMA’s concerns. In a statement, PCP said that disallowing doctors to write a brand name will not make medicines cheaper but will rather put their profession at risk because of unqualified and uncontrolled substitution at the pharmacy level. “We urge legislators to recognize that the therapeutic equivalence, palatability and safety differ among the various brands of prescribed drugs,” the statement said.

Source:www.manilatimes.net