2011-12-04 ~ It's all about health

Minggu, 04 Desember 2011

Once-conjoined toddlers leave hospital

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Lisandra Sanatis looks at her twin daughter, Teresa Tapia, as daughter Maria Tapia looks on Children’s Hospital of Richmond at Virginia Commonwealth University in Richmond, Va., Thursday Dec. 1, 2011. The conjoined twins were separated during an operation at the hospital Nov. 8, 2011. The twins are expected to be released from the hospital Friday and are expected to go back home to the Dominican Republic before Christmas. (AP Photo/Steve Helber)

Maria Tapia, and TeresaTapia play in a playroom at Children’s Hospital of Richmond at Virginia Commonwealth University in Richmond, Va., Thursday Dec. 1, 2011. The conjoined twins were separated during an operation at the hospital Nov. 8, 2011. The twins are expected to be released from the hospital Friday and are expected to go back home to the Dominican Republic before Christmas. (AP Photo/Steve Helber)

Lisandra Sanatis holds her daughter, Teresa Tapia, in their room at Children’s Hospital of Richmond at Virginia Commonwealth University in Richmond, Va., Thursday Dec. 1, 2011. Sanatis' conjoined twin daughters were separated during an operation at the hospital Nov. 8, 2011. The twins are expected to be released from the hospital Friday and are expected to go back home to the Dominican Republic before Christmas. (AP Photo/Steve Helber)

RICHMOND, Virginia (AP) — Two formerly conjoined toddlers from the Dominican Republic have left a Richmond hospital after recovering from separation surgery, and doctors predict they'll be ready to go home by Christmas.

Maria and Teresa Tapia left Children's Hospital of Richmond at Virginia Commonwealth University on Friday. At a news conference before their departure, the girls clapped and waved and one kissed the lead doctor on their surgical team, Dr. David Lanning.

"I thank God and everyone who made this possible," the girls' mother, Lisandra Sanatis, said through a translator.

The 20-month-old twins were attached at the lower chest and underwent complicated, nearly daylong surgery on Nov. 7. In a series of procedures, the surgical team divided the twins' liver, pancreas and other shared organ systems and reconstructed their abdominal walls.

While they're getting accustomed to exploring their surroundings separately, they still stay near each other and hold hands when they walk.

Lanning said Friday that both children have been recovering well, and doctors don't expect them to require any long-term medical treatment, except possible minor surgery to construct belly buttons.

"Overall, I don't think we could have asked for a better outcome," he said at Friday's news conference.

They'll lead healthy, long lives, with the ability to "be together but make independent decisions."

Maria, the smaller of the two, weighs about 19 pounds, and Teresa weighs about 26 pounds. Lanning expects the disparity in their weight, caused by the configuration of their small intestines and blood flow from the liver, to gradually even out.

Maria's pancreas is slow to produce digestive enzymes, but she is taking replacement enzymes, and doctors are monitoring her colon function. Teresa is undergoing treatment on the incision where the girls were separated, Lanning said.

Doctors, nurses, volunteers and others who cared for them gave the girls and their mother and aunt a warm send-off from the hospital Friday afternoon. Lanning pushed a new double stroller to the van that took the family to a nearby residence for patients and their families.

The girls will stay in Richmond for follow-up medical visits and outpatient therapy to continue working on walking and other motor skills now that they're no longer attached. Lanning said they're on track to return to their native country by Christmas.

After being in Richmond for several months now, Sanatis said she and her daughters have grown fond of everyone they've met. But they're more than ready to go home and reunite with the twins' father and three other siblings.

The twins have become celebrities in the Dominican Republic, with supporters including the country's first lady, Margarita Cedeno de Fernandez, who visited Richmond on the day of the surgery.

The World Pediatric Project, a nonprofit surgical-care provider for children in Central America and the Caribbean, sponsored the toddlers' medical care, along with the family's stay in the United States. Lanning has been a surgical volunteer with the group for several years.

About a half-dozen separation surgeries are done in the U.S. annually, and maybe double that number worldwide.

Conjoined twins account for between 1 in 50,000 and 1 in 100,000 live births worldwide. The condition is three times more likely to occur among females than males. A third of conjoined twins are attached at the lower chest, as in the case of the Tapia twins.

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Online:

Children's Hospital of Richmond at VCU: http://www.childrenshosp-richmond.org/CMS/index.php

World Pediatric Project: http://www.worldpediatricproject.org/

___

Zinie Chen Sampson can be reached on Twitter at http://www.twitter.com/zinie

Associated Press

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Apple juice can pose a health risk _ from calories

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FILE - In this Sept. 15, 2011 photo, an apple and a pitcher of apple juice are posed together in Moreland Hills, Ohio. Despite the government's consideration of new arsenic limits on the juice, the real danger, nutrition experts say, is to waistlines and teeth. Apple juice and other juice-based beverages have relatively few natural nutrients, many calories and more sugar, in many cases, than a can of soda. (AP Photo/Amy Sancetta)

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It's true — apple juice can pose a risk to your health. But not necessarily from the trace amounts of arsenic that people are arguing about.

Despite the government's consideration of new limits on arsenic, nutrition experts say apple juice's real danger is to waistlines and children's teeth. Apple juice has few natural nutrients, lots of calories and, in some cases, more sugar than soda has. It trains a child to like very sweet things, displaces better beverages and foods, and adds to the obesity problem, its critics say.

"It's like sugar water," said Judith Stern, a nutrition professor at the University of California, Davis, who has consulted for candy makers as well as for Weight Watchers. "I won't let my 3-year-old grandson drink apple juice."

Many juices are fortified with vitamins, so they're not just empty calories. But that doesn't appease some nutritionists.

"If it wasn't healthy in the first place, adding vitamins doesn't make it into a health food," and if it causes weight gain, it's not a healthy choice, said Karen Ansel, a registered dietitian in New York and spokeswoman for the American Dietetic Association.

The American Academy of Pediatrics says juice can be part of a healthy diet, but its policy is blunt: "Fruit juice offers no nutritional benefit for infants younger than 6 months" and no benefits over whole fruit for older kids.

Kids under 12 consume 28 percent of all juice and juice drinks, according to the academy. Nationwide, apple juice is second only to orange juice in popularity. Americans slurp 267 ounces of apple juice on average each year, according to the Food Institute's Almanac of Juice Products and the Juice Products Association, a trade group. Lots more is consumed as an ingredient in juice drinks and various foods.

Only 17 percent of the apple juice sold in the U.S. is produced here. The rest comes from other countries, mostly China, Argentina, Chile and Brazil, the association says.

Television's Dr. Mehmet Oz made that a key point a few months ago when he raised an alarm — some say a false alarm — over arsenic in apple juice, based on tests his show commissioned by a private lab. The Food and Drug Administration said that its own tests disagreed and that apple juice is safe.

However, on Wednesday, after Consumer Reports did its own tests on several juice brands and called along with other consumer groups for stricter standards, the FDA said it will examine whether its restrictions on the amount of arsenic allowed in apple juice are stringent enough.

Some forms of arsenic, such as the type found in pesticides, can be toxic and may pose a cancer risk if consumed at high levels or over a long period.

All juice sold in the United States must be safe and meet U.S. standards, said Pat Faison, technical director for the juice association. As for making good nutrition choices, "a lot of the information that people need about fruit juices is on the label," she said.

So what's on those labels?

Carbohydrates, mostly sugars, in a much higher concentration than in milk. Juice has a small amount of protein and minerals and lacks the fiber in whole fruit, the pediatrics academy notes.

Drinking juice delivers a lot of calories quickly so you don't realize how much you've consumed, whereas you would have to eat a lot of apples to get the same amount, and "you would feel much, much more full from the apples," Ansel said.

"Whole fruits are much better for you," said Dr. Frank Greer, a University of Wisconsin, Madison, professor and former head of the pediatrics academy's nutrition committee.

He noted that the WIC program — the U.S. Department of Agriculture's nutrition program for Women, Infants and Children — revised its rules in 2005 to replace juice with baby food fruits and vegetables for children over 6 months. More than half of all infants born in the U.S. are eligible for WIC, and the government "really cut back severely on the ability of mothers to get fruit juices" through the program, Greer said.

If you or your family drinks juice, here is some advice from nutrition experts:

—Choose a juice fortified with calcium and vitamin D-3.

—Give children only pasteurized juice — that's the only type safe from germs that can cause serious disease.

—Don't give juice before 6 months of age, and never put it in bottles or covered cups that allow babies and children to consume it throughout the day, which can cause tooth decay. For the same reason, don't give infants juice at bedtime.

—Limit juice to 4 to 6 ounces per day for children ages 1 to 6, and 8 to 12 ounces for those ages 7 to 18.

—Encourage kids to eat fruit.

—Don't be swayed by healthy-sounding label claims. "No sugar added" doesn't mean it isn't full of naturally occurring sugar. And "cholesterol-free" is silly — only animal products contain cholesterol.

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Marilynn Marchione can be followed on Twitter at http://twitter.com/MMarchioneAP

___

Online:

Academy of Pediatrics on juice: http://tinyurl.com/qtkls

FDA: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm

WIC program advice: http://bit.ly/sYXqAi

Industry: http://www.fruitjuicefacts.org

Associated Press

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Hitting The 'Off' Switch On Antibiotic Resistance

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Doctors are running out of effective antibiotics, as bacteria evolve ways to evade one drug after another. Now DARPA has called for alternatives to conventional antibiotics. Nanotechnologist Chad Mirkin discusses one such weapon—tiny globs of DNA and RNA that can switch off the bugs' antibiotic resistance. Nanotechnologist Chad Mirkin discusses next-generation antibiotics that target a bacterium's DNA.

IRA FLATOW, HOST:

This is SCIENCE FRIDAY. I'm Ira Flatow. In the battle of antibiotics versus bacteria, the bugs are winning. Not only are they evolving resistance to our arsenal of drugs, but we're running out of new antibiotics to launch at them. And antibiotic-resistant bacteria aren't just a problem for hospitals and patients. Think about wounded soldiers on the battlefield, infected with superbugs or a bioterrorism attack using resistant or engineered pathogens.

Would we be able to handle it? That's why DARPA, the research arm of the Defense Department, has called on scientists to develop new, next-generation antibiotics. One promising technology is DNA-based drugs that not only target the superbugs, but they can evolve right along with them, preventing antibiotic resistance.

Chad Mirkin is director of the International Institute for Nanotechnology at Northwestern University in Evanston, Illinois. Welcome back to SCIENCE FRIDAY, Dr. Mirkin.

DR. CHAD MIRKIN: It's a pleasure to be here.

FLATOW: These are little nanoparticle-sort-of-sized things?

MIRKIN: Yeah, they're really interesting structures. In fact, their structure is made out of DNA or RNA that are made on a gold nanoparticle, in fact a variety of different types of particles, but they're strands of DNA that are arranged on the surface of these spherical particles.

And when you make them in this manner, they have properties that are very different from the normal type of DNA that we're all familiar with, duplex, linear type of DNA, and one of those properties is they have the ability to enter cells, including bacterial cells, very, very efficiently.

FLATOW: And when they get in the cell, what do they do?

MIRKIN: Well, the beauty is what we can do. We can design them so that they can go in and flip switches, genetic switches, that either turn off resistance so that a conventional antibiotic will work or, better yet, stop replication and ultimately cause bacterial cell death.

FLATOW: So is there then no need for a standard antibiotic?

MIRKIN: Well, this would be a different route to the standard antibiotics, which are typically small molecules. This would be a genetic-based root, and the beauty of that is that, as you said in your opening, you can move with the bug. As the bug evolves, you can change the sequence and target different genetic components of the bug so that you can constantly battle its response to the new drug.

FLATOW: So as the bug changes, you tailor-make the new stuff to mimic what the bug is doing.

MIRKIN: That's the idea. I mean, this is very early in this whole process. This is actually part of a big platform that we call spherical nucleic acids that we've been developing at Northwestern now for about 15 years and are part of a company that we started called Arosense(ph) that can really go after any sort of genetic disease.

And that's the beauty of it: You can tailor it on a disease-by-disease basis, as long as you have good genetic information about the different types of switches that you have to turn on or off to effect treatment.

FLATOW: If you have - then if you have genetic diseases that are not, you know, antibiotic related, maybe like cancer or something like that, could you not go in and stop the cancers from spreading that way?

MIRKIN: That's exactly right. In fact, we have a very active program in that regard. The beauty of these constructs, they're part of a larger field called gene regulation, which actually has won the Nobel Prize for its promise, the idea that you could use this - a concept of switching off genes or down-regulating genes so that you could adjust protein levels and take effectively a diseased cell and make it healthy, or in the case of a cancer selectively cause it to die.

The problem with conventional approaches is that they often have to have materials to help carry the genetic material into the cells, and they're not very good at targeting. In addition, they cause all sorts of toxic side effects. So you run into the problem where the therapy causes as many problems as the disease originally did.

In this case, these structures, this kind of spherical form of nucleic acid, has this incredible property that it requires no co-carrier. You can treat diseases based upon that genetic information, and you can either locally deliver - for example we have projects with a dermatologist named Amy Paller, where we have the first constructs that can be delivered through the skin to go after things like melanoma and psoriasis.

Or another project involves a guy named Alex Steig(ph), where we're going after brain cancer, and we can systemically deliver these. They go everywhere, but they cause no toxic side effects, and so they accumulate in a lot of cells, including tumor cells in the brain, and you can selectively go after those cells based upon the genetic differences of those cells causing them to selectively die.

FLATOW: So even though they get into the cells, their little genetic pieces don't match up with the wrong cells then?

MIRKIN: That's exactly right. You've got almost a lock-and-key type of shutoff here.

FLATOW: You know, there are a lot of people who were concerned about pumping a bunch of nanoparticles into their body, and I guess they would be concerned about this, too.

MIRKIN: Well, potentially. I mean, the interesting thing about this is, so typically, we will use a gold particle, and we'll arrange the nucleic acid, the DNA or RNA on the surface on the particle. And that itself can be a therapeutic, and we have a lot of therapeutic leads based upon those types of materials.

But we've also figured out ways of what's called cross-linking, attaching the DNA strands on the surface of the particle to each other, and we can dissolve the gold, and we literally can use effectively pure nucleic acid in that case. And those types of constructs work just as well.

FLATOW: All right, now for the $64 question, which I know you knew would be coming, right? You could probably ask it of yourself: When are we going to have a product that is going to be available to try?

MIRKIN: Well, I think the more important question to ask is when are we going to go into trials. So we have incredible in-vivo data in animals, small animals, that suggests that this works and works extremely well. And it can do things that frankly no other gene regulation construct has ever done before, and that is delivery through the skin, very effectively, knock down in animals and also this idea of systemic delivery.

And what's really difficult in this field is getting these big drugs - because they're big particles compared to the small-molecule drugs that we've been talking about - getting them across the blood-brain barrier. And the beautiful thing about these constructs is they show the ability to do that.

And so the real question is how soon will we be into trials? And we're really shooting for next year. So we're hopeful that we're going to be into human trials sometime next year, pushing for the early part but certainly before the end of the year.

FLATOW: And as far as antibiotics are considered, do you consider them old hat now?

MIRKIN: No, I wouldn't consider them old hat. I mean, this may end up being a co-therapy, or it may be a replacement for existing antibiotics. But a lot of work has to be done. So the DARPA program is actually new. It was I think really insightful for them to take this on and to challenge the community to come up with new ways because the world desperately needs these types of constructs.

We have to really go through and validate these in the context of bacteria, like we have in the context of diseases like cancer in small animals. And so what we're going to be doing over the next year on the bacteria side of things is really starting with cells and then moving up through bacteria and then animal studies.

FLATOW: And why is it that DARPA has to jump in here? What's wrong with our own medical system?

MIRKIN: Well, DARPA - I don't know if it's a matter of what's wrong. It's a matter of creating challenges. And so there are business challenges, and one of the problems, of course, in the antibiotic area is that from a drug standpoint, they're not nearly as big a market as, for example, an oncology type of drug.

But there are also just challenges in - grand challenges in terms of chemistry and material science that have to be overcome, and you have to get a lot of different folks together to solve big problems. And DARPA is extremely good at doing that.

They move very rapidly when they recognize you have a big problem. They're able to first of all put together substantial resources, which is needed in this case, to challenge the academic community in this case to come up with alternative solutions and to think outside of the box. And they're one of the best agencies for doing that.

FLATOW: So what you're saying is that the people are willing to spend money on the military to do this where they might not in the civilian case.

MIRKIN: Well, yeah, the military has a different set of drivers, right. So they're not...

FLATOW: So where we used to think of the military as making weapons and transistors and things, they're now making drugs.

MIRKIN: They make a lot of things. They made our GPS, as well. They make a lot of things that positively affect civilians in day-to-day life, and this would be a big one.

FLATOW: All right, thank you very much, Dr. Mirkin, for taking time to be with us. We'll have you back on when you get some results, when the trials begin.

MIRKIN: Thank you.

FLATOW: Chad Mirkin is director of the International Institute for Nanotechnology at Northwestern University in Evanston, Illinois.

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Health Management

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FDA examines level of arsenic in apple juice

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WASHINGTON (AP) — The Food and Drug Administration is considering tightening restrictions for the levels of arsenic allowed in apple juice after consumer groups pushed the agency to crack down on the contaminant.

Studies show that apple juice has generally low levels of arsenic, and the government says it is safe to drink. But consumer advocates say the FDA is allowing too much of the chemical — which is sometimes natural, sometimes man made — into apple juices favored by thirsty kids.

There is little consensus on whether these low levels could eventually be harmful, especially to children. Michael Taylor, FDA's deputy commissioner for foods, said Wednesday the agency has already stepped up testing and research on arsenic in apple and other juices and is seriously considering lowering the FDA's so-called "level of concern" for the contaminant.

"We continue to think that apple juice is generally safe based on the fact that the vast majority of samples are very low," Taylor said. "But we want to minimize these exposures as much as we possibly can."

Arsenic is naturally present in water, air, food and soil in the two forms — organic and inorganic. According to the FDA, organic arsenic passes through the body quickly and is essentially harmless. Inorganic arsenic — the type found in pesticides — can be toxic and may pose a cancer risk if consumed at high levels or over a long period.

The FDA uses 23 parts per billion as a guide to judge whether apple juice is contaminated. The agency has the authority to seize apple juice that exceeds those levels, though it has never done so.

Consumer groups say the FDA's level is too high and isn't enforced with enough urgency. Consumers Union, publisher of Consumer Reports, released a study on Wednesday calling for the levels to be as low as 3 parts per billion. The Environmental Protection Agency has set levels for drinking water — it's consumed at much greater quantities than apple juice — at 10 parts per billion.

The Consumer Reports study showed that nine of 88 samples of apple juice taken from grocery stores had more arsenic than the EPA's standard for drinking water. But none of the samples exceeded the FDA's standards for inorganic, or man-made, arsenic.

Urvashi Rangan of the Consumers Union says the group has been in talks with the FDA on the issue and is encouraged by the discussion. Another advocacy group, Food and Water Watch, has lobbied the agency on the issue, and Dr. Mehmet Oz has highlighted the issue on his nationally syndicated daytime show.

"We look at apple and grape juice as a poster child for arsenic in the food supply in general," Rangan said. "Chronic low-level exposure of carcinogen is something we should be concerned about."

Molly Kile, a professor at Oregon State University who has studied arsenic for a decade, says more research is needed to determine whether arsenic levels in juice are a problem.

"It is unclear at this point whether or not the arsenic found in apple juice is safe or unsafe," she said. "And really the question is what do these low levels exposure of arsenic mean in terms of health and children's health?"

So what is the parent of a juice-drinking toddler to do?

All of the experts — including the government and the consumer advocates — agree that drinking small amounts of apple juice isn't harmful. The concern is over the effects of drinking large amounts of juice over long periods of time. Parents with a real concern about arsenic should try to diversify the brands of juice they buy in case one brand tends to have more chemical exposure, Consumers Union says.

Another point of agreement is that children under 6 shouldn't be drinking much juice anyway because it's high in calories. Health experts say children under 6 shouldn't drink any more than 6 ounces of juice a day — about the size of a juice box. Infants under 6 months shouldn't drink any juice at all.

Gail Charnley of the Juice Products Association says the industry regularly tests arsenic levels and will follow the FDA's lead.

"Of course parents have concerns but they should know that the juice producers are committed to safety," she said. "Producers have children who drink juice too."

Oz has said he would still serve juice to his own children, though he strongly believes the government isn't doing enough.

"The absolute safest level for arsenic in your food is zero," he said Wednesday while acknowledging "that is impossible to achieve."

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Find Mary Clare Jalonick on Twitter at http://twitter.com/mcjalonick

Associated Press

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First 3D Movie of Orgasm in the Female Brain

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An orgasm has now been imaged in 3D video in the brain as it happens - and for possibly the first time in the history of science, women came first.

The video, which was presented at the recent Society for Neuroscience conference in Washington, D.C., is the first to look at the exact order in which women's brain regions are activated in the progression that culminates in sexual climax. The findings have not yet been peer reviewed for publication.

While this may seem like a silly line of research, in fact, understanding how the brain experiences the most pleasurable sensations may be essential for figuring out what underlies conditions in which desire and motivation go awry, like addiction and depression.

Lead author Barry Komisaruk, professor of psychology at Rutgers University, imaged brain activity in several women who were able to masturbate to orgasm in the decidedly unsexy atmosphere of a functional MRI machine. (Orgasm was achieved by either manual stimulation or use of a "passive dildo" in the form of a Lucite rod; vibrators contain metal, which cannot be placed in magnetic scanners.)

MORE: Mind Reading: What We Can Learn From the Dutch About Teen Sex

Komisaruk discovered activity in more than 80 regions of the brain, including the prefrontal cortex, which is involved in higher-order thinking, and which earlier imaging of the female orgasm by Dutch researchers had found to be inactive. "There's an apparent contradiction in the literature," says Komisaruk. "The group in Holland says that the frontal cortex goes down in activity during orgasm and we see that it goes up."

That could be due to differences in technical scanning, Komisaruk says. Or, a more interesting reason may involve the fact that in the Dutch study, sexual stimulation was applied by the women's partners, rather than themselves. "It could be different [because] women orgasm-inducing in themselves may involve executive control characteristic of the prefrontal cortex, whereas in partner-induced stimulation, women may surrender to their partner and that could be the basis for the reduction in activity," he explains.

The sequence of brain activity itself is telling. First, not surprisingly, activation is seen in the sensory regions of the brain that map the genitals. Earlier research by Komisaruk's group showed that nipple stimulation also agitated this sensory region, helping explain why it can be erotic.

Next, a region called the insula lights up. "Not only is [the insula] active during orgasm, it's also active in response to pain," says Komisaruk, explaining that brain imaging is difficult to interpret because "activation" can mean different things in different brain cells. If inhibitory neurons are active, this actually reduces the signaling of other neurons - and could mean something is being prevented rather than processed. "We see strong inhibitory interaction between orgasm and pain," he says. "During orgasm, women are much less sensitive to pain."

Komisaruk notes that facial expressions during orgasm (the "O face") are often indistinguishable from those made in pain, and suggests this may be explained by activity in the insula.

MORE: The Female Erotic Brain, Mapped

Next, the anterior cingulate, an area related to the insula, lights up before the action moves to the amygdala. Although it is best known for processing fear-related information, the amygdala is actually involved in all types of emotion - and may provide some of the intense positive emotion typically experienced during orgasm.

Activity is seen next in the hippocampus, which processes memories and may be involved either in sexual fantasy or in recording the experience or both. The hippocampus is also able to activate many brain regions at once, which may underlie its role in both orgasm and seizure. "The hippocampus is often involved in epileptic seizure activity," says Komisaruk. "There's a lot of similarity between seizures and orgasms in the sense that they involve many brain regions concurrently."

After the hippocampus, Komisaruk saw activity in the prefrontal cortex, the region involved in planning, abstract thought and behavior control. He's currently doing a study comparing partner-induced self-stimulated to orgasm and see if he can resolve the question of why some studies show activation here and others don't.

Following the cortex, activation flowed through a region involved in movement and muscle tension, which occurs during orgasm. Next, the hypothalamus came online. This region releases oxytocin, the notorious "love hormone" involved in social and emotional bonding and connection.

Finally, it's on to the brain's "pleasure center", for the peak experience of orgasm, which likely involves release of dopamine in the highly activated nucleus accumbens.

And then, the brain goes quiet.

MORE: Real-Time Video: First Look at a Brain Losing Consciousness Under Anesthesia

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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Wal-Mart's Health Plans for 2012 to Increase Premiums for Smokers

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Penalty per pay period that Wal-Mart's health insurance plans will require of employees who smoke in 2012. The cost will amount to $260 to $2,340 extra per year for those who want health coverage. According to the benefits consulting firm Mercer, several other large employers also charge higher premiums to workers who smoke; among the largest employers, about 28% adjust their premiums based on workers' tobacco use. [via The New York Times]

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NYC recommends AIDS drugs for any person with HIV

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NEW YORK (AP) — Health officials in the nation's largest city are recommending that any residents living with HIV be offered AIDS drugs as soon as the virus is diagnosed, an aggressive move that has been shown to prolong life and stem the spread of the disease.

Standard practice has been to have patients put off the expensive pill regimen — which can cost up to $15,000 a year in the United States — until the immune system weakens.

But New York City Health Commissioner Thomas Farley said recent studies have shown that the benefits of early treatment, combined with education and testing, appear to be a promising strategy for countering the epidemic.

"I'm more optimistic now than I've ever been about this epidemic that we can drive our new rates down to zero or close to it — eventually. I don't know how soon. But I'm very optimistic of the direction that it's going to take the epidemic to," Farley said Wednesday.

More than 110,000 people in New York City are infected with HIV, more than in any other U.S. city and about 75 percent of all cases in the state. San Francisco, which had more than 18,000 people living with HIV, is believed to be the only other major city to have made a similar recommendation, in 2010.

City health officials said the new recommendation could initially help about 3,000 people get on medications. About 66,000 New Yorkers living with HIV that the Health Department tracks are being effectively treated with AIDS drugs, they said. But they said it was difficult to estimate how many people would eventually need the medications.

Some doctors agree with the Department of Health that it is time to update the guidelines for initiating AIDS drug treatment.

"The New York City health department is a little bit ahead of the curve. In my opinion, the rest of the country will follow, and I think it will be pretty quick," said Dr. Michael Saag of the University of Alabama at Birmingham and past chairman of the HIV Medicine Association.

The standard measure of the CD4 count — a way to measure the strength of the immune system — is an outdated trigger for therapy, a relic from research on early antiretroviral drugs, Saag said.

"It's an anachronism. It's old school. It's yesterday," Saag said. "I agree completely with the New York City health department."

Dr. Joel Gallant of Johns Hopkins University School of Medicine and vice chair of the HIV Medicine Association also agrees with the New York recommendation for offering early treatment. He recommends early treatment for his own patients.

"Nobody I know who is an HIV expert feels that it's a bad idea to treat HIV at high CD4 counts from a medical or scientific standpoint," Gallant said. "If there are objections, they'd usually be based on cost or feasibility."

Saag said the cost questions are very important because brand-name drugs can retail for $1,200 to $1,600 per month.

"For sure, they're very expensive drugs and we should be careful about that," he said, though he added that the medications are going generic so costs should come down.

City health officials said they anticipated that the cost for expanding the use of AIDS drugs would be covered by private insurance or by the AIDS Drug Assistance Program, a $270 million program for the uninsured or underinsured that is partially funded through federal dollars. The health officials said they expect the benefits over the long term would far outweigh the initial costs because there would be fewer hospitalizations and new HIV cases.

"There will be some increasing costs over the short term," Farley said. "But over the long term, it's absolutely the right thing for the epidemic."

HIV experts are split about whether early therapy should be recommended or optional. Besides the high costs, the pills have side effects from nausea to liver damage. Patients unwilling to take them religiously for life could develop drug resistance.

A panel that recently updated U.S. guidelines was divided evenly, with half favoring starting therapy early for everyone and half regarding an early start as elective.

But there's growing evidence that untreated HIV can lead to cancers and heart disease. What's more, antiretroviral drugs are safer, have fewer side effects and work better than they did in the past. New research also indicates that people live better, healthier lives and their sex partners are less likely to get infected.

The new research cited by the city's Health Department in making its recommendations includes a nine-nation study whose preliminary results were announced earlier this year and showed that earlier treatment meant patients were 96 percent less likely to spread the virus to their uninfected partners.

Dr. Moupali Das, the director of research at the San Francisco Department of Health HIV Prevention Section, said its surveillance data indicated that physicians were treating their HIV patients early even before the city recommended doing so. She said the average amount of time from diagnosis to having no virus in the blood went from 32 months in 2004 to eight months in 2008.

"That reflects that the newer medications are more potent and efficacious, and the doctors were likely initiating them earlier," she said.

She said they are currently analyzing what has happened since the recommendations went into effect. But, anecdotally, she said that there has been a change among patients seeking treatment. "It's changed the dialogue and empowered our patient population," she said.

Public health experts predict the guidelines for starting AIDS drugs treatment will shift toward a clear recommendation for early treatment.

But New York City's health commissioner said officials there could not wait to respond.

"What we're doing here is we're making a really clear and unequivocal statement that we think this is good for the health of the patient, good for the health of the entire population, good for the response to the epidemic," Farley said.

___

AP Medical Writer Carla K. Johnson in Chicago contributed to this report.

Associated Press

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The Healthland Podcast: Super Broccoli, Yo-Yo Dieting, and Why Toddlers Are Terrible

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SEARCH TIME.COM Full Archive Covers Videos Skip to contentMedicineDiet & FitnessLove & FamilyMental HealthPolicy & Industry The Healthland Podcast: Super Broccoli, Yo-Yo Dieting, and Why Toddlers Are TerribleBy Sora Song Friday, October 28, 2011 | View Comments « Previous Post Film Your Kids, Strike It Rich? Making Videos That Go ViralNext Post » Daily Aspirin Cuts Colon Cancer in High-Risk Adults SCOTT DUNLAP / GETTY IMAGES

Comment Print Email Digg Facebook Twitter MORE Add to my: del.icio.us Technorati reddit Google Bookmarks Mixx StumbleUpon Blog this on: TypePad LiveJournal Blogger MySpace Related Topics: aggression, aggressive kids, Alzheimer's, dieting, genetic testing, gps shoes, healthland podcast, high cholesterol, Multimedia, Podcast, Pregnancy, super broccoli, weight loss Tweet

Welcome back! This week on the podcast: why dieters can't seem to keep the weight off, a new breed of super broccoli that promises to lower your cholesterol, and research suggesting that kids' aggression can be traced back to Mom. Listen by clicking the play button below, or go to iTunes. Better yet, download the podcast to your mobile device — and subscribe for free so that it's updated each week automatically.

For reference while listening, here are the stories we discussed:

Why Dieters Can't Keep the Weight OffU.K. Scientists Grow Super BroccoliKids Behaving Badly? Blame It on MomDo All Women Need Genetic Testing Before Pregnancy?A GPS-Enabled Shoe to Track Wandering Alzheimer's Patients

This week, in the absence of our usual stalwart host, John Cloud (@JohnAshleyCloud) — momentarily felled by a nasty bug that's been going around (feel better, John!) — TIME editor-at-large and podcast regular Belinda Luscombe (@youseless) deftly took over the reins. We also welcomed TIME senior editor and resident food-obsessive Julie Rawe (@julierawe) as a first-time guest.

With thanks to our indefatigable producer, Valerie Lapinski (@lapinski), we all had a lot of fun chatting this week, so I hope you'll have fun listening.

Please leave your thoughts and comments below. (You've got to give John something to do while he's laid up.) See you next week!

Related Topics: aggression, aggressive kids, Alzheimer's, dieting, genetic testing, gps shoes, healthland podcast, high cholesterol, Multimedia, Podcast, Pregnancy, super broccoli, weight loss

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Florida city battles fear and denial

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Wade Price, who is gay and living with AIDS, has struggled to find acceptance. HIV/AIDS is like "hush-hush" says one man who tested positive this yearAdvocates say they can't post red ribbons on their offices because of stigmaNew HIV infection rates are increasing in northern Florida cityEditor's note: This week, CNN Health's team is taking a close look at the HIV/AIDS epidemic in the Southeast with a series leading up to World AIDS Day on December 1. Learn more about the problem and our upcoming stories here.

Jacksonville, Florida (CNN) -- When the topic of HIV/AIDS enters a conversation, Earl Thompson hears that it's "just what gays get."

"It's not a gay disease," said Thompson. "It's a human disease."

When a person gets a disease like cancer, support pours in, said Thompson, a slender 27-year-old with a boyish face. Family and friends fund raise and make sure their loved one gets proper care. But that's not the case with HIV.

"It's like hush-hush," said Thompson, a Jacksonville native, who learned before his birthday in April that he has HIV. "You feel unlovable. You feel tainted. They're going to point a finger at me and be judging me.

"Just from the community, I know they don't talk about it. Jacksonville has many years before we're close to Miami, Orlando or Tampa. If something goes wrong, you don't talk about it."

It's a problem all across the Bible Belt. The Southeast is disproportionately struck with higher HIV/AIDS rates than much of the rest of the country.

$Earl Thompson said HIV/AIDS is kept \$ Earl Thompson said HIV/AIDS is kept "hush-hush."

Dealing with the epidemic in the South "is extremely challenging, because the stigma and discrimination is worse," said Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention. "There is less discourse around prevention, sexual health, comprehensive sex education in schools or having strong, community-based advocacy activities."

Pastor fights HIV stigma in rural town

Jacksonville has the fifth-highest number of AIDS diagnoses among U.S. cities, according to CDC statistics from 2008.

The state says this could have been a statistical aberration because surveillance methods and HIV/AIDS reporting laws changed in Florida in 2007, causing fluctuations in the data.

But local HIV advocates in northeast Florida say the problem is a real one, not just a statistical blip.

"Here in Jacksonville, we're kind of the buckle in the Bible belt," said Donna Fuchs, executive director of Northeast Florida AIDS Network. "HIV carries a huge stigma in our city."

Fuchs said the organization had trouble finding office space in 2000. One property owner refused to rent to the group, saying he didn't want people with AIDS in his buildings.

Today, the office sits on a quiet, tree-lined street with a simple sign that reads: NFAN. A red ribbon, the ubiquitous sign for HIV/AIDS, usually adorns the logo for the organization. But not here.

"Clients didn't want a red ribbon on the door," said Fuchs. "We had to take it down."

Donna Fuchs had trouble finding an office that would rent out to the HIV/AIDS group.

Four blocks away, there is another HIV organization -- one named for NBA star Magic Johnson, who revealed in 1991 that he is HIV-positive.

When that clinic opened a decade ago, the ribbon-cutting ceremony was held inside the lobby. Organizers moved the event indoors because people feared being seen and associated with the disease.

Today, that one-story clinic tucked behind a towering magnolia tree no longer bears Johnson's name.

"The only way we can get people to come through the front door is to create a fictitious name." said Todd Reese, associate director of Health Care Center operations at the AIDS Healthcare Foundation. "No one walks into any building or floor that has any association with HIV."

Although visible HIV signs may be scrubbed from public view, the epidemic has worsened.

HIV cases in Duval County, which mostly consists of Jacksonville, increased by 33% in the first half of 2011. This year, the county Health Department reports an increase in new cases.

"It's really not acceptable," said Dr. Bob Harmon, the county's Health Department director. "This disease is ruining lives, and it's still killing people, especially low-income people who don't get tested enough and who don't get treated early."

Several HIV/AIDS advocates in Jacksonville criticized sex education in schools that emphasized abstinence. The mentality is that HIV/AIDS is not an issue here, several advocates said.

"Denial is the biggest problem," said Reese.

And those who reveal their HIV status struggle to find acceptance.

Thompson observed that some people who knew about his HIV status avoided physical contact with him. In social settings, they watched their drinks to make sure their glasses didn't get mixed up.

"Sometimes you feel like a pin cushion, like you're never going to find acceptance," Thompson said. "You feel like you're going to be looked at as a disease, not as a person."

No one walks into any building or floor that has any association with HIV.
Todd Reese, associate director of Health Care Center operations at the AIDS Healthcare Foundation

What perpetuates the epidemic is a social issue, Reese said.

In Florida, the HIV/AIDS focus has historically been placed in southern part of the state. Some of the earliest HIV cases were found in Miami and in the Haitian immigrant population in South Florida. Miami still struggles with new HIV/AIDS cases; often, it has the highest AIDS rates in the country.

"You can go to Miami and you can put up a billboard, you can talk about condoms, AIDS and sex," Reese said. "You can't do that in Jacksonville. People will be offended. They don't want to talk about it or see it. They don't want to see billboards about it."

And Jacksonville is no small town: It has about 821,000 residents.

iReporters share their stories on World AIDS Day

It's a different population, said Harmon.

Wade Price said the virus has been ignored.

"In north Florida, our population profile is more like Georgia, Alabama, Mississippi than it is central and south Florida. That generally means higher rates of poverty, lower rates of completing high school and college, and higher percentage of African-American population."

Duval County has a high percentage of African-Americans, and in Jacksonville, 71% of the total HIV cases are African-Americans.

Wade Price, 46, is a black gay man, proud father of three and grandfather of three.

He keeps a half-dozen orange prescription bottles of anti-HIV medications on his nightstand next to his red leather-bound Bible. The pages of his well-worn Bible are patchworks of green and orange highlights. He reads scriptures every night and attends a Baptist church twice a week.

Because his faith is crucial, Price decided to tell the head minister of his church how he struggled with being gay. He wanted to have prayer meetings with ministers and start a church support group.

Price told the minister: "I'm not the only one. Lots of people are keeping quiet, living double lives."

The minister rebuffed him, saying, "Wow, it's times like this, I don't like being a minister."

"That's one aspect of black churches," Price said. "They want to turn blind eyes to it. ... I'm fighting this battle on my own."

Price left that church and found another one last month that is more accepting.

"We pretend it's not happening," Price said. "The virus is being spread. You want to pretend like sex isn't happening. They say, 'Condoms, oh, no! That's not for God!' What's not for God is living with ignorance."

The social climate in northern Florida tends to be more conservative, said Harmon.

Veronica Hicks said things are changing and that more people are paying attention to HIV/AIDS in her community.

"There may be a reluctance to talk about this in the family, in the church, in other social settings and to perhaps ignore it," he said.

But there are signs of change. Churches in the community have started to talk about the HIV/AIDS epidemic, said Veronica Hicks, 50.

Hicks has never felt the need to hide her AIDS diagnosis and told her fellow church members and her pastor.

"They embrace me with it," she said. And Hicks's church has already started an HIV/AIDS testing and awareness ministry in Jacksonville.

While stigma persists in the community, it's getting better, she said.

She reported seeing growing HIV support groups, increasing turnout at community HIV/AIDS events and a recent line of people waiting to get tested at a mobile clinic.

"It shows me that people are willing to become more educated because HIV is prevalent and relevant."

Patrick Packer, executive director of the Southern AIDS Coalition, describes the HIV epidemic as the "perfect storm."November 30, 2011 -- Updated 1203 GMT (2003 HKT)

An addict her story tells of going from a life with "everything I needed" as a youth to drugs, homelessness and HIV.November 29, 2011 -- Updated 1628 GMT (0028 HKT)

Stigma about HIV/AIDS persists in small, rural towns across the South, but this mentality also exists in a city as big as Jacksonville.November 28, 2011 -- Updated 1542 GMT (2342 HKT)

Brenda Byrth deals with fear, poor education and a lack of funding in her fight against AIDS in a small South Carolina community.

How does your county's health measure up against others? Select a health issue from the menu to see the most recent data available.

Three out of four people with HIV in the U.S. do not have their infection under control with the proper medication, the CDC says.

Thirty years ago, the CDC published its first mention of the HIV virus. See the people and events who will forever live in our memories.

Has AIDS and HIV touched your life or that of someone you know? Have you been inspired to take action in some way?

Today's five most popular stories More

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Big Solar Project Moves Forward Without Uncle Sam

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Lend Lease

SolarCity has received financing from Bank of America Merrill Lynch to install solar electricity systems on houses on military bases, like one here at Soaring Heights Communities at Davis Monthan Air Force Base outside Tucson, Ariz.

We've heard a lot about Solyndra, a solar panel maker that went bankrupt despite lots of federal subsidies. But on Wednesday, a solar installation company and one of the country's biggest banks announced a billion-dollar project to put solar systems on the roofs of military housing. And they're doing it without the kind of federal help Solyndra got.

When SolarCity CEO Lyndon Rive came up with a plan to put solar on the rooftops of military housing around the country, he was sure he'd need federal backing to get loans for such a big project.

But after his company and the Department of Energy missed a deadline to get that help, SolarCity and its lender, Bank of America Merrill Lynch, didn't give up.

Now they're announcing a deal to install solar systems on up to 120,000 military homes.

"It will be the largest residential deployment of solar in American history," says Rive.

The deal signals that companies are finally finding a way around what has long been one of the biggest obstacles to broader adoption of solar power — inadequate financing.

"There really weren't a lot of financing tools available, so it was done one rooftop at a time," said Jonathan Plowe, who heads up the new energy team at Bank of America Merrill Lynch.

Enlarge Lend Lease

Workers install solar panels at the Soaring Heights Communities at Davis-Monthan Air Force Base outside Tucson, Ariz.

Lend Lease Workers install solar panels at the Soaring Heights Communities at Davis-Monthan Air Force Base outside Tucson, Ariz.

He says the real breakthrough represented by his company's agreement with SolarCity is that it puts long-term financing in place for so many installations. It's the first time a project of this scale has been launched without federal loan guarantees. That's when the government lowers the risk for lenders by basically co-signing the loans.

Even without loan guarantees, solar projects still get tax credits and other subsidies.

Plowe says there's lots of demand for rooftop solar, so his Bank of America team plans to do more of these projects.

"As the costs of the systems continue to come down and the cost of the capital continues to come down, the industry will be able to continue to grow," says Plowe.

Bank of America will provide up to $350 million, so SolarCity will need to attract additional investors for what it hopes will be a $1 billion project.

'Economies Of Scale'

SolarCity will install and own the solar systems and sell the electricity to the private companies that manage military housing at a discount of about 10 percent compared with utility prices, according to the company.

It's a business model that now dominates the solar industry. The lender gained confidence that SolarCity was a good bet because of the work it had done on earlier projects.

The company installed solar systems at Davis-Monthan Air Force base in Tucson, Ariz., and it is working on a project at the joint Navy-Air Force Base Pearl Harbor-Hickam near Honolulu.

Rive says by installing lots of solar panels in one area, the company has shown it can save money and turn solar power into a reliable business.

"It worked extremely well. It also allowed us as a company to get economies of scale on a concentrated area," Rive said. "There's a lot of inefficiencies when you have to go back and forth to different homes in different communities."

Lend Lease, the company that manages the housing at both bases, says it's saving lots of money that it can use to build more housing and update existing units.

Lend Lease manages 40,000 housing units at 21 military bases around the country. It's planning to do more solar projects, including some with SolarCity.

"They've demonstrated that they can get extremely competitive pricing for solar. So who wouldn't do it if you could save money and you could get the green benefits of doing that?" says Simon Muir, a vice president of Lend Lease.

The solar installation industry in the U.S. has doubled in each of the past two years, according to Rhone Resch, who heads the Solar Energy Industries Association.

"The fact that SolarCity is now able to attract money, I think, really demonstrates how mainstream solar has become, how confident investors are in both the technology, its performance and its returns," Resch says.

Solar still only provides a tiny portion of U.S. electricity, and it has not yet taken off as a major electricity source.

But Mark Bachman, an analyst specializing in the solar industry for the investment banking firm Avian Securities, is more cautious.

"I think it's gaining momentum. I wouldn't call it a breakthrough time in the U.S.," he says.

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