Matt's Blog

Organ-transplant black market thrives in India
Anuj Chopra, Chronicle Foreign Service
Saturday, February 9, 2008
Tears well up in P. Guna's eyes as he stares at a long scar running down his
side. A year ago, he attempted to stave off mounting debt by swapping one of his
healthy kidneys for quick cash.
"Humans don't need two kidneys, I was made to believe," he said. "I can sell my
extra kidney and become rich, I thought."
At the time, an organ trader promised Guna, 38, a motorized-rickshaw driver with
a fourth-grade education, $2,500 for the kidney, of which he eventually received
only half. Since then, he has experienced excruciating pain in his hip that has
kept him from working full time and pushed him deeper in debt.
In recent years, many Indian cities - like Chennai in southern India - have
become hubs of a murky business in kidney transplants, despite a 1994 nationwide
ban on human organ sales (the Transplant of Human Organ Act states only
relatives of patients can donate kidneys).
An influx of patients, mainly foreigners, seeking the transplants, has made the
illicit market a lucrative business. Some analysts say the business thrives for
the same reasons that have made India a top destination for medical tourism: low
cost and qualified doctors. In fact, medical tourism is expected to reach $2.2
billion by 2012, according to government estimates.
Not surprisingly, an organized group of organ traders in cahoots with
unscrupulous doctors is constantly on the prowl for donors like Guna.
In Gurgaon, a posh New Delhi suburb, police last month busted an illegal organ
racket, which included doctors, nurses, pathology clinics and hospitals. In the
past 14 years, the participants allegedly removed kidneys from about 500 day
laborers, the majority of them abducted or conned, before selling the organs to
wealthy clients.
Police say the doctor believed to be the mastermind behind the operation, Amit
Kumar, searched for donors by cruising in luxury cars outfitted with medical
testing machines, and kept sophisticated surgical equipment in a residential
apartment. In his office, police found letters and e-mail messages from 48
people from nine countries inquiring about transplants.
On Thursday, police arrested Kumar in Chitwan, a Nepalese jungle resort. Local
news reports said he was identified by a hotel employee who recognized him from
Indian television broadcasts seen in Nepal. "I have not duped anybody," Kumar
later told reporters in Kathmandu, according to the Associated Press.
Nepalese authorities say they won't extradite Kumar until they finish an
investigation on whether he violated currency laws by not declaring $230,000 in
cash and a check for $24,000 that he was carrying when arrested. He is scheduled
to appear in a Nepalese court Sunday.
In another high-profile arrest, a renowned Chennai surgeon, Palani Ravichandran,
was arrested in October in Mumbai for involvement in a kidney racket. He
admitted to arranging organ transplants for wealthy foreigners - mainly from
Persian Gulf states and Malaysia, whom he charged up to $25,000. Mumbai police
say Ravichandran had performed between 40 and 100 illegal transplants since
2002.
Police say kidney donors can earn between $1,250 and $2,500, while recipients
pay as much as $25,000, according to ActionAid India, an anti-poverty
organization that has worked with kidney trade victims in the southern state of
Tamil Nadu.
The same procedure can cost as much as $70,000 in China and $85,000 in the
United States.
"These middlemen act more like cut-and-grab men whose only interest is to hack
out the organ," said Annie Thomas, a field co-coordinator for ActionAid in
Chennai, formerly known as Madras. "This is a reprehensible abuse of the poor,
and this practice needs to be curbed."
Thomas says many middlemen typically masquerade the donors as relatives to
circumvent the law while many foreigners in need of a kidney arrive on tourist
visas rather than the required medical visas; some resort to false documents.
In Korkkupet, a teeming slum, the trade is prevalent, local activists say.
Although they offer no specific estimates, the activists say it's difficult to
find a family that doesn't have a relative who has sold a kidney.
Two years ago, A. Muttama, 39, a fisherwoman, received just $1,250 for a kidney
after being promised $3,750 from a man known only as Kurrupiah. Residents say he
is a Korkkupet resident who goes from house to house searching for donors.
"He told me, 'Follow my example. I was a very poor man. Now, look at me. I
became rich after I sold my kidney,' " Muttama recalled.
Kurrupiah's three-story mansion is reached through a labyrinth of garbage-choked
lanes, which meander through an endless sprawl of dilapidated shacks.
His wife, who, residents allege, also sold a kidney to her middleman husband,
stood at the entrance, festooned with gold bangles, gold earrings and a
glittering necklace.
A bevy of burly guards stood by. Kurrupiah, a middle-aged man, denied that he
had anything to do with the kidney trade, and he refused to explain his source
of income.
Chennai physicians say a scarcity of organ donors is the main factor behind the
illicit trade.
Sunil Shroff, a well-known renal transplant surgeon, says the best practice to
prevent the thriving commerce in living donors would use donors who are declared
brain dead. "If the government is keen on ending the kidney trade, it should
encourage cadaver-based transplants in a big way," he said.
But some doctors say even a campaign to use deceased-donor organs would only
reduce the trade in living donors, and benefit just those who can afford the
expensive operation. Patients receiving cadaver-harvested organs have to be on
immunosuppressant drugs for life, which cost hundreds of dollars monthly,
according to R. Ravichandran, the director of the Madras Institute of
Nephrology.
"What is needed is a regulated system for legal live related organ donation," he
said, which protects the interests of both donors and recipients.
"The choice before us in not between buying or not buying organs. This is
happening regardless of the law. The choice is whether transplant operations and
the sale of organs will be regulated or not."
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/02/09/MN23UPQ0K.DTL

2 to sue doc over syringes
BY MICHAEL AMON.michael.amon@...
February 9, 2008
A Bay Shore couple intends to file a $20 million lawsuit against a Manhasset
physician who state authorities say reused syringes while giving out flu shots
last year, according to court papers filed Thursday.
Jean Jones-Lockridge, 42, received a flu shot from Dr. E. Jacob Simhaee last
fall and was one of 36 patients to get letters from the
obstetrician-gynecologist in January urging tests for hepatitis B and C and HIV,
said her attorney Joseph Stroble of Sayville.
A state Department of Health investigation found Simhaee used a single syringe,
holding up to six doses of vaccine, on multiple patients. Infection-control
procedures require a new syringe be used for each patient, health authorities
said.
Simhaee's shots have not been found to have passed on a disease to patients, and
the risk was believed to be "extremely low," authorities said last month.
In the court summons, Jones-Lockridge and her husband, Shawn Lockridge, seek $20
million in damages for unspecified "personal injuries and loss of consortium."
The summons, filed in Queens because that's where Simhaee lives, will be
followed by a formal complaint, Stroble said.
Jones-Lockridge did not test positive for infectious diseases after notification
from Simhaee, whom she had seen for years. The lawsuit was for "emotional
distress," Stroble said.
"She's in the medical industry, and she's seen a lot of patients come down with
these diseases, so she understands the severity of it," Stroble said.
A message left at Simhaee's office was not returned. Simhaee's attorney, Craig
Schaum of Garden City, declined to comment.
Simhaee was the second Long Island doctor in two months to be accused of reusing
syringes by the Department of Health. More than 10,000 patients of Dix Hills
physician Dr. Harvey Finkelstein were notified of risk for blood-borne diseases
after at least one patient contracted hepatitis C.
Both cases have prompted calls for legislation banning multidose vials and
multiuse syringes.
http://www.newsday.com/news/local/suffolk/ny-lisuit095570507feb09,0,825628.story

India seeks extradition of doctor accused of running organ transplant ring
Indian authorities say transplant specialist held donors at gunpoint
12:00 AM CST on Saturday, February 9, 2008
The Associated Press
NEW DELHI - The Indian government said Friday it is seeking the extradition of a
man accused of heading an organ transplant ring that illegally removed hundreds
of kidneys, sometimes from unwilling donors held at gunpoint.
An international manhunt for the fugitive doctor, Amit Kumar, ended Thursday
night when police arrested him in Chitwan, a Nepalese jungle resort 100 miles
south of Katmandu, local police chief Kiran Gautam said.
Local news reports said he was identified by a hotel employee who recognized him
from Indian television broadcasts.
Authorities believe up to 500 kidneys were sold to clients who traveled to India
from around the world over the last nine years. Some victims were forced onto
the operating table at gunpoint, while others were tricked with promises of
work, police said last month.
"That is wrong, absolutely wrong. I have not duped anybody," Dr. Kumar said when
he was briefly brought before reporters in Katmandu. "I can only say that I have
not committed any crime."
Late Friday, Indian Foreign Ministry spokesman Navtej Sarna said investigators
already were talking to Nepalese authorities about Dr. Kumar's extradition.
Hours earlier, Nepalese authorities said Dr. Kumar would first be charged and
tried there for violating currency laws by not declaring money he was carrying.
He had $230,000 in cash and a $24,000 check when arrested.
Police also were investigating whether he was involved in illegal kidney
transplants in Nepal. A preliminary investigation suggested Dr. Kumar was a
frequent visitor to the country and had been looking for land where he could
build a hospital for kidney transplants, said Upendra Aryal, a top police
officer.
http://www.dallasnews.com/sharedcontent/dws/news/world/stories/DN-kidney_09int.A\
RT.State.Edition1.45550b6.html
'I can only say that I have not committed any crime,' Dr. Amit Kumar said after
his capture at a jungle resort in Nepal.

well now I didn't see the 'no need to post this'...but thank you soo
much Richard..we're all glad to be of help..only 12 weeks more..YOU GO
DUDE!

Strict gay organ donor regs worry physicians
New gov't regulations may discourage many "high-risk" patients from
donating: MDs
By Graham Lanktree
New Health Canada regulations intended to restrict "high-risk" organ
donations have been met with accusations that they discriminate against gays.
The new regulations, which were introduced last June and took effect in
December, put gay men - technically, men who have had sex with men within the
past five years - at the end of the list of eligible donors, along with prison
inmates, people with recent tattoos or piercings, prostitutes and hemophiliacs.
Health Canada officials say the practice of refusing donations from groups
at high risk for HIV and hep C is longstanding and merely entrenched by the new
regulations. But some senior Canadian transplant surgeons and politicians say
the government's policy is unfair to monogamous gay men and may discourage valid
candidates from checking off 'yes' on their donor cards.
In a recent interview with the Halifax Chronicle Herald, Dr Mark Walsh,
the surgical director of liver and kidney transplantation at the Queen Elizabeth
II Health Sciences Centre in Halifax, called the policy "ridiculous:" "We should
be careful about telling people 'Don't bother even thinking about donation.'"
LOOPHOLES AND LABELS
Health Canada spokesperson Carole Saindon says the policy has a built-in
loophole and physicians have got the ideas behind the new regulations confused.
The regulations say that surgeons may transplant a "high-risk" organ if organs
deemed safe aren't available, with the informed consent of the recipient or in
an emergency.
But Dr Gary Levy, who heads Canada's largest organ transplant program at
Toronto's University Health Network, is upset the new policy labels all
homosexual men - including monogamous men - high-risk donors. "If you have a
same-gender partner and you've had that same-gender partner for 30 years, you're
not [in] a high-risk group," he told Reuters.
The new policy suggests donors from high-risk groups should be flagged as
such before they undergo any tests. Gay activists have called for Health Canada
to focus on risky sexual behaviour in donor questionnaires rather than the
individual's sexual orientation.
However, no screening program is flawless. Last year, organs from a
high-risk donor in Chicago infected four patients with HIV and hep C after the
donor tested negative for both. The donor is suspected to have contracted both
diseases within three weeks of donating, before they would have appeared on
tests.
http://www.nationalreviewofmedicine.com/issue/2008/02/5_policy_politics02_2.html

thank you so much for your hard work on this site.i get several other
hepc emails, but hands down your the best.am down to 3 mnths left on
this treatment and all goes well for me.your emails have been more
helpful than you can know.THANKS AGAIN richard

Organ Transplant Organization Helps Both the Organ Recipient and Donor Families
By: Julia Campbell
Intermountain Donor Services is based in Salt Lake City and oversees the
procurement of organ and tissue donation in Utah, southeastern Idaho, western
Wyoming and Elko, Nev. It is a nonprofit community service organization
dedicated to recovery and transplant of organs and tissues. IDS also provides
many donor family services including education and counseling.
Steve Bird, donor liver recipient, and Lisa Osmond, donor Adam Glen Osmond's
mother, are volunteers for IDS to take the message of the organ donor program to
the public.
Bird received a new liver from Osmond's son when he died Oct. 29, 2003. Bird and
his wife, Doralee, met Lisa and her husband, Vic, along with their children
about a year later in Oct. 2004.
Many times Bird and Osmond present the donor program at the same function as
they each tell their story. They tell of their appreciation for the donor
program and inform people of what the donor program does. If they need to speak
at any function or if IDS comes down, they are available to help.
"We take a message out, mainly facts about being a donor," Bird said. "A lot of
those kids coming up on 16 years of age want to get their driver license and
they mark yes, no, or undecided on being a donor."
Bird said there are about 97,000 people on the list right now waiting for a
donor. The majority of organ donations are kidneys, but others include liver,
heart, lungs, pancreas, as well as tissue donations. Surgeons started doing
split livers in 1988. The smaller portion of a split liver can go to an infant
or child.
"Tissue donations of one person alone can help 50 or more people. Being an organ
donor can help up to nine people and help save their lives," Steve Bird said.
Both Osmond and Bird are also employed by IDS in the education system as they go
around to the intermediate, middle, and high schools to tell their story. Bird
covers Hurricane, Cedar City, and Parowan while Osmond covers the rest of
Washington County. They usually present about an hour program during a health
class on educating the kids on becoming donors to give them correct information.
The kids can then go home and talk to their families about whatever they decide.
Before getting involved with the donor program almost two years ago, Osmond was
involved with teaching about drugs in the schools.
Upon receiving his liver transplant, Oct. 29, 2003, Bird said there are many ups
and downs the first year after a transplant. He had three rejections where he
had to undergo steroid treatments the first time and an increase of medication
the last two times. His weight went from 175 pounds before the operation down
and bottomed out at 128 pounds.
Even though many lives are saved through organ transplantation, the number of
organs donated doesn't keep pace with the need. Thousands of people die each
year waiting for an organ donation.
Bird said he is thankful to wake up in the morning and be able to see his family
grow, referring to his grandchildren. He believes it a miracle he is still here.
He said the technology of the doctors and his faith brought much intervention
when he went through his transplant. A lot of prayers were offered from many
denominations in his behalf.
"You can be a live donor for a liver and a kidney, but that is quite remarkable
anymore. You can be a live donor for a liver, because the liver is the only
organ in the body that will regenerate itself," Doralee Bird said. "The liver
has over 450 different functions in the body."
Bird and his wife moved from Salt Lake to La Verkin in June 2005. Osmond and her
family live in St. George.
Wearing a green donor bracelet to remind him of being a donor recipient, Bird
said it also gives him an opportunity to tell other people about getting the
gift of life. Osmond and Bird both believe it is imperative to get the IDS
message out to help people realize the importance for both people registering to
donate and donor recipients to receive the gift of life.
Call (800) 833-6667, (801) 366-6744, or check out www.idslife.org or call
24-Hour Donor Hotline: (800) 833-6667.
http://www.cedarcityreview.com/articles.php?id=4244&art_title=Organ_Transplant_O\
rganization_Helps_Both_the_Organ_Recipient_and_Donor_Families

New Virus
I thought you would want to know about this e-mail virus.
Even the most advanced programs from Norton or McAfee cannot take care of this
one. It appears to mostly affect those who were born prior to 1965.
Symptoms:
1. Causes you to send the same e-mail twice Done that!
2. Causes you to send a blank! e-mail! That too!
3. Causes you to send e-mail to the wrong person. Yep!
4. Causes you to send it back to the person who sent it to you.. Who me?
5. Causes you to forget to attach the attachment. Well darn!
6. Causes you to hit 'SEND' before you've finished. Oh no - not again!
7. Causes you to hit 'DELETE' instead of 'SEND.' I just hate that!
8. Causes you to hit 'SEND' when you should 'DELETE.' Oh No!
IT IS CALLED THE 'C-NILE VIRUS.'

How to defeat a virus
Many viruses have found ways to escape the body's defence system. The slyest of
the lot is the Hepatitis-C virus. The virus sabotages the protective system of
millions of infected people by making trillions of new viruses every day, for
years. Aashruti Kak finds out what is being done to beat the "silent killer"
The Hepatitis-C virus (HCV) was first identified in 1989. However, this dreadful
disease has been spreading unknowingly since the early 1960s, mainly through
blood transfusions. Reliable blood tests became available only in 1992. Besides,
more recently, the increased prevalence of intravenous drug use and other
unrecognisable transmission routes have added to the spread of the disease. For
example, the practice of self-inflicted injury as a part of the religious rites
by certain religious communities and some tribals has also increased the spread
of the disease in India. Dr Samir Shah, Consultant Hepatologist and
Gastroenterologist, Jaslok Hospital and Research Centre and Breach Candy
Hospital, says, "Indirectly, you can come to know whether you are infected or
not through the blood donor data because anybody who goes to donate blood is
automatically checked for HCV and HIV. And around 0.6 to 0.9 percent of blood
donors test positive for HCV in the process. These are apparently healthy
people, so you can extrapolate." He further says, "Mortality will depend whether
the infected people go out to develop liver disease, because not all would
develop that condition. It is a very slow virus which affects the liver over
20-40 years. Around 20 percent of the infected will not develop liver disease."
Existing approved therapies
The standard treatment for HCV is the combination therapy with PEGylated
interferon-alpha and ribavirin. But unfortunately, the treatment, the only
available one, is inadequately efficient, has poor tolerability, and involves a
huge expense. Prashant Tewari, Managing Director, USV, says, "Interferon-alpha
is the only known drug to induce sustained HCV clearance and cause an
improvement in liver histology. IFN-alpha monotherapy is limited by adverse side
effects such as severe flu-like syndrome, leucopoenia and thrombocytopenia.
Besides, a sustained virological response (SVR) is achieved in only 15 percent
of patients." He goes on to say, "The combination with ribavirin yields an
systemic vascular resistance (SVR) in 35-40 percent of patients. PEGylated
interferon is more effective than Interferon-alpha. Yet, overall 50 percent of
treated patients do not experience significant long-term benefits from the
current PEGylated interferon and ribavirin-based combination therapy." Hence,
there is an urgent need for new treatment options that are more potent and less
toxic.
The fact that there is a considerable drop out rate due to adverse side effects
in patients on the treatment just makes it worse. "We do have good treatments,
but either the treatment may not work because the person does not respond or the
person comes too late with liver failure; then the treatments are useless. If
the patient reacts adversely to the treatment than we have to discontinue it,
and there is no other alternative left," says Shah. It becomes even more
difficult to treat patients in case of corresponding illnesses. Shah elaborates,
"If the patient has got kidney disease then we cannot use ribavirin because the
haemoglobin is already low and ribavirin causes a further drop in RBCs. And when
the main drug is taken away, the injection (interferon-alpha) does not work well
in the absence of the tablets. If the patient has got both HIV and Hepatitis-C
then there is double problem."
International developments
In November 2002, Innogenetics of Belgium had reported that its
therapeutic vaccine could stop and sometimes even reverse liver damage in Hep-C
patients. The vaccine candidate went into phase III trials in 2006. In January
2006, Inovio Biomedical, a late stage developer of cancer and other therapies
using electroporation to deliver drugs and nucleic acids in the US, had signed
an agreement with Swedish-based Tripep AB to develop a therapeutic vaccine for
HCV. The vaccine was based on Tripep's proprietary HCV antigen and was to be
delivered to infected individuals using Inovio's Medpulser DNA delivery system.
The phase I/II trials of the vaccine, ChronVac-C, began in November 2007.
Vertex Pharmaceuticals' candidate, telaprevir (VX-950), an oral protease
inhibitor is in phase II trials and is being tested in combination with two
medicines considered to be the current standard of treatment-a long-acting
interferon from Roche and the antiviral drug ribavirin-against the standard
drugs alone. This could help significantly cut the time patients must be treated
for the serious liver disease. Schering-Plough also has a candidate, SCH 503034,
which is being evaluated in a phase II study in combination with peginterferon
alfa-2b. In August 2007, Tokyo-based Toray Industries had confirmed the efficacy
of their Hep-C vaccine candidate in mice. The HCV vaccine is expected to not
only become a new prophylactic drug to prevent new HCV infection, but also serve
as a therapeutic drug for HCV-infected people. Also, Novartis and Idenix
Pharmaceuticals had collaborated for developing valopicitabine (NM283), a
first-in-class nucleoside polymerase inhibitor in phase II clinical trials last
year.
What would work?
"Since the current therapeutic regimens (interferon monotherapy IFN- in
combination with ribavirin and PEGylated interferon) do not yield adequate SVR,
and considering the rapid spread of the virus, protecting the unexposed
population is also critical. These facts make the development of an HCV vaccine
an obvious necessity," says Tewari. Shah, on the other hand, thinks that
therapies and vaccines have to go hand in hand, "Even if you develop a vaccine,
it would protect person at risk, but what about the people who already have the
virus. We need to have what you call a therapeutic vaccine, a vaccine which
treats." He explains, "The final treatment is the body's own defence mechanism.
So, if we can by some way alter the defence mechanism, the body will be able to
fight out the virus, then it becomes a therapeutic vaccine." There are two types
of vaccines available-a prophylactic vaccine, which boosts the immune system so
that the person doesn't get the virus, and a therapeutic vaccine, which
stimulates the body's immune system to clear the virus.
"Lot of new compounds are being developed, many of them being oral candidates
with polymerase and protease inhibitors and so on. But alone they do not work as
of now," says Shah. "That's the whole idea. If we can have two or three
molecules that can be combined we can have only one tablet rather than an
injection," he adds.
Market for a Hep-C vaccine
HCV has infected more than 170 million people globally and can establish a
chronic infection in up to 85 percent of cases. This is five times more than
HIV-infected individuals. Hep-C is the most common cause of hepatocellular
carcinoma and the primary reason for liver transplantations among adults. All
drugs have side-effects and troubles, and every disease has victims who want
treatment at any cost. Too much focus on these can make you lose sight of
significant things like the safety and efficacy of the developing drug over
existing therapies, and whether there is a market for it. Currently there are no
true therapeutic vaccines available, though research on several Hep-C candidates
is ongoing worldwide. "However, according to estimates the total market of
currently available Hep-C therapies is about $3 billion annually, which is
expected to quadruple by 2015" says Tewari. Hence, the market for a Hep-C
vaccine is highly competitive with several other companies developing drugs.
In India, USV seems to be the only company which is working towards the
development of a Hep-C vaccine for Indian genotype of the virus. But it is too
early to say anything as the animal tests are yet to commence. "We do not know
of any other Indian company currently into Hep-C vaccine development. In the
international scene, a number of major pharma companies like Merck, Chiron,
Novartis and Institut Pasteur are known to have ongoing Hep-C vaccine
programmes," says Tewari. There are other international companies as well that
have been, and are working on developing a Hep-C vaccine.
However Shah says, "We are currently working on a clinical trial for a vaccine,
which is a part of a global clinical trial. It is for a new compound known as
albuferon, which is albumin bound to interferon. It's an international trial
with more than 2,000 patients under trial. We are looking at the safety and
efficacy compared to the standard of care." Shah, who is also the Secreatary of
the National Liver Foundation (NLF)-a non-profit organisation promoting
awareness and prevention of liver diseases-says that NLF has taken 15 patients
free of charge, who cannot afford treatment at all, with Roche giving donations
to sustain the treatments.
Confronting fears
Development of a vaccine meets with many obstacles. Due to very high degree of
genetic variability, HCV can be classified into six main genotypes; there are
more than 30 subtypes throughout the world. Chimpanzees remain the only animal
model for HCV infection, but they are an endangered species and difficult to
work with because of high costs and other restrictions. Tewari says, "Even
though HCV infection generates antibodies, none of these seem capable of
resolving the infection. One reason might be that the virus does not appear to
circulate as free virions-virus particles that are inert carriers of the viaral
genome-but is always found in association with lipoprotein particles or immune
complexes."
Vast majority of infections in Western countries are due to genotypes 1a, 1b and
3a, whereas infections in western Africa are due to genotype 2. In Central
Africa, such as the Democratic Republic of Congo and Gabon, genotypes 1 and 4
are prevalent, while in Southern and Eastern Asia, genotypes 3 and 6 are common.
Such wide genetic variability poses a major challenge for the development of a
vaccine. Genotype 1 and 3 are commonly found in India. Of these, type 1 is more
common in the south whereas type 3 and its variants are predominant in North
India. These genotypes may vary radically in their biological effects from each
other, in terms of replication, mutation rates, type and severity of liver
damage, and detection and treatment options, which are not yet understood.
In America, genotype 1 is quite predominant (90 percent) and it is this type
which does not respond so well to treatment. "We are lucky that way because the
predominant type of the virus that we have is easily treatable. The duration of
the treatment is also short, so the treatment lasts for six months instead of
one year compared to genotype 1. The response rate is almost 80-90 percent in
genotype 3 compared to 40-50 percent in genotype 1," Shah adds. Another major
problem is that the virus becomes resistance to anti-retrovirals in a short time
because it constantly changes its structure and mutates naturally, hence
escaping the body's natural defence mechanism. And that is how it survives in
the body. "How do you plan to kill a virus? You do that by blocking its
multiplication. Now, if the virus keeps on changing its structure, the company
has already spent millions of dollars trying to attempt to block one step, while
it has already changed its structure," laments Shah.
Despite significant progress in the field of biotechnology, reliable diagnostic
procedures; an alternative animal model other than the chimpanzee, an efficient
cell culture that can support long term replication of the virus and effective
therapeutic strategies are still lacking. "Are we being a bit impatient?
Remember, diseases like diabetes have been known for centuries; however, the
real pathogenetic factor for the disease (insulin resistance) was realised only
about 20 years ago. Further, therapies based on the pathogenetic factor (insulin
sensitisers) are still being introduced." He further says, "In comparison, HCV
was first identified only in 1989. Since then, considerable progress has been
made to introduce drugs that could be used to manage the disease." He concludes,
"Let us not forget that the development time for any novel drug is about 12-15
years, if not more."
aashruti.kak@...
http://www.expresspharmaonline.com:80/20080215/research01.shtml

âNew Hep C move fails to tackle bureaucracyâ
Representative groups say the entry of a new approved insurer for the
Hepatitis C Insurance Scheme does nothing to address the problems its members
have in accessing the scheme.
The HSE has announced the participation of Bank of Ireland Life in the
Hepatitis C Insurance Scheme as an âApproved Insurerâ.
It means the company will be able to offer its life insurance and mortgage
protection insurance products to people infected with Hepatitis C and/or HIV
through the administration within the State of contaminated blood or blood
products. Bank of Ireland Life is the second company to become involved in the
HSEâs specialised insurance scheme, which has been available to eligible
participants since Sep-tember.
While Transfusion Positive welcomes the presence of an additional insurer
for providing competition in the market, it says it fails to tackle bureaucratic
problems with the scheme.
âWe still have a big problem with the bureaucracy people have to go
through to access the scheme,â said Ms Maura Long, Chairperson of Transfusion
Positive. âIt places unreasonable demands on our members, particularly the
self-employed.â
The group takes issue with the demands placed on claimaints looking for a
policy over â¬425,000.
Under the scheme, self- employed people must produce a copy of the tax
return/balancing statement, annual audited accounts, where applicable, for the
most recent income tax year, supported by a declaration from the claimantâs
accountant/
registered auditor setting out the expected level of earned income for the
current tax year.
Transfusion Positive says the need for audited accounts is unreasonable
and that a balancing statement should suffice.
PAYE workers must produce a P60 Income Tax Certificate, for the most
recent full income tax year; a certificate of earnings along with a declaration
as to whether the employment is temporary or permanent in nature, completed by
the employer; and supported by copies of recent payslips.
So far almost 300 eligible applicants have been ap-proved for
participation in the scheme.
Ms Long does not believe this is a high figure given that there are over
16,000 State-infected patients with the disease in Ireland.
âWe know of many people who want to use the scheme but canât because
of the bureaucracy involved,â she said. Ms Long claimed the HSE was unwilling
to debate the issue.
In a previous statement to IMN, the HSE said the Department of Health and
the Executive are working with those involved to deal with the difficulties they
have.
Paul Mulholland
paulm@...
http://www.irishmedicalnews.ie/articles.asp?Category=news&ArticleID=20321

SCCM: Ventilator-Associated Infections Caught Early May Head off Pneumonia
By Crystal Phend, Staff Writer, MedPage Today
Published: February 07, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
HONOLULU, Feb. 7 -- Treating ventilator-associated tracheobronchitis in the ICU
before it progresses to pneumonia may improve outcomes, researchers said here.
Antibiotic treatment was associated with a substantially lower rate of
subsequent ventilator-associated pneumonia and more than halved the rate of
mortality in the ICU, reported Saad Nseir, M.D., of Calmette Hospital in Lille,
France, and colleagues at the Society of Critical Care Medicine meeting.
These findings from a small randomized controlled trial reflect more
aggressive screening and treatment for tracheobronchitis than done in many ICUs,
commented Stephen M. Pastores, M.D., of the Memorial Sloan-Kettering Cancer
Center in New York, who moderated the session at which the results were
presented.
"Certainly at our place we don't routinely screen for this," he said.
"We're always worrying about ventilator-associated pneumonia, we're not thinking
of tracheobronchitis."
However, there may be a continuum between microbial colonization,
tracheobronchitis, and pneumonia that argues for early treatment such as that
used in the study, Dr. Nseir said.
"Maybe this is real; maybe we should be screening," Dr. Pastores said, but
at any rate the improved outcomes suggest that treatment is needed for cases
that are identified.
"We should not wait to treat [until ventilator-associated pneumonia sets
in]," he said.
The prospective multicenter study randomized 22 patients to receive
intravenous antibiotics for eight days and 36 to receive no antibiotics before
the trial was stopped early for efficacy at a planned interim analysis.
Participants had first-episode ventilator-associated tracheobronchitis
(fever, purulent sputum, and positive endotracheal aspirate culture but no new
radiographic infiltrate) diagnosed more than 48 hours after starting mechanical
ventilation.
Those with prior ventilator-associated pneumonia, do-not-resuscitate
orders, or severe immunosuppression, or who received antibiotics for other
infections after being randomized to no antibiotics, were excluded.
The specific antibiotics were selected for each patient on the basis of
results of microbial testing. Pseudomonas aeruginosa was the most commonly
isolated bacteria, followed by Staphylococcus aureus, but all were found in
similar proportions between treatment groups.
The duration of mechanical ventilation overall was similar between groups
(29 versus 26 days, P=0.81). But the number of days alive without mechanical
ventilation was substantially greater with antibiotic treatment (12 versus two,
P<0.001).
And while ICU length of stay was not shorter for antibiotic-treated
patients than nontreated patients (40 versus 36 days, P=0.55), the ICU mortality
rate was substantially reduced by treatment (18% versus 47%, odds ratio 0.24,
P=0.047).
Antibiotic-treated patients were also more than three times less likely to
go on to develop ventilator-associated pneumonia (13% versus 47%, OR 0.17,
P=0.011), supporting the idea that untreated tracheobronchitis could lead to
pneumonia in the ICU, Dr. Nseir noted.
He cautioned, though, that the study was unblinded and the sample size was
small. "We need larger studies to change our day-to-day practice," he said.
Furthermore, he said diagnosis was difficult. Baseline CT imaging was not
available in the study but may not be practical for all ICU patients at any
rate, he noted.
The findings are likely generalizable to other countries, Dr. Pastores
said, although larger studies would be needed, particularly because of concerns
over microbial resistance from overuse of antibiotics.
The study was supported by the Program Hospitalier de Recherche
Clinique. Dr. Nseir reported no conflicts of interest. Dr. Pastores reported no
relevant conflicts of interest.
Primary source: Society of Critical Care Medicine
Source reference:
Nseir S, et al "Antimicrobial treatment for ventilator-associated
tracheobronchitis: a randomized controlled multicenter study" SCCM 2008;
Abstract 62.
http://www.medpagetoday.com/MeetingCoverage/SCCM/dh/8275

Taking on Hepatitis B at UCSF
Editor's note: This story, which originally appeared in Synapse on January 24,
had some accuracy problems. We are running a corrected version, and apologize
for the errors:
Hepatitis B is a worldwide killer, with upwards of 400 million people
chronically infected. The insidious liver virus can cause cirrhosis, liver
cancer and liver failure. Hepatitis B is far more infectious than HIV, and is
transmitted through exposure to infected bodily fluid, passage from mother to
child during birth or unprotected sex. Despite these dire statistics and grim
outcomes, hepatitis B infection is preventable with a simple three shot
immunization sequence.
Asian and Pacific Islanders suffer from disproportionately large numbers of
infected individuals, with 1 in 10 Asian-Americans infected. Since without
treatment a quarter of these individuals will die from complications due to
hepatitis B, efforts have been focused on testing and immunizing the
Asian-American population here in San Francisco, with Assemblywoman Fiona Ma
spearheading the city-wide effort to "B Sure, B Tested, B Free."
UCSF's own San Francisco Hepatitis B Collaborative has also taken aim at
hepatitis B, educating San Francisco about this virus and providing a free
clinic for testing and immunization. The collaborative hosts free clinics two
Saturdays a month - one at the Chinatown Public Health Center in Chinatown, and
another at UCSF's Hepatitis B Screening and Vaccinations clinic near Mt. Zion
Hospital - where walk-in patients can get initial blood draws to determine
whether they have previous vaccination or immunity from exposure, if they are
naïve (or susceptible to the disease), or if they are in fact infected with
virus. Patients who are infected with the virus get information on health
resources and regular care at the Chinatown Public Health Center, or are
referred to their primary care physician for constant monitoring and regular
care. The collaborative is also working to find ways to help patients find
hepatologists and drug assistance programs if necessary. Those patients without
immunization can be given their first immunization shot on the spot; they leave
the clinic on the way to immunity, with a plan to return for the next two shots
of the sequence.
The Hepatitis B Collaborative is a clear UCSF success story. Started by students
in 2004, the clinics began with health fair screenings at local venues such as
community centers, churches, and other established institutions to provide
critical hepatitis B testing and services to primarily the San Francisco Asian
community. Without a stable home, according to Baotram Nguyen (MS2), "It was
hard to communicate the screening results to patients and make sure that they
seek the necessary medical care, specifically for individuals who need to get
immunized and those who are chronic carriers of HBV"
Critical to the mission of the clinics is the dedication of Dr. Cindy Lai, Dr.
Joshua Adler, and Dr. Albert Yu, who provide essential faculty guidance for each
of the clinics.
The clinics are advertised heavily and appropriately: all pamphlets, flyers and
posters are translated into the appropriate language for the area in which they
are plastered. Currently, the languages include Korean, Japanese, Vietnamese,
Tagalog and Chinese, with plans for more languages on the way. Newspapers and
magazines have carried announcements for the clinics and students even staged a
television advertisement on KTSF, a local San Francisco channel.
Also impressive is how collaborative the student organization really is. The
collaborative is both a model of inter-school cooperation - with students from
the Schools of Medicine, Pharmacy, and Nursing, even Berkeley undergraduates are
heavily involved with the clinic - and with the city as a whole - the clinics
partner with local community and interface with the citywide initiative to
eradicate hepatitis B.
All signs point to success for UCSF's recent Hepatitis B Clinic startup. With
more than eighty patients at the last Saturday clinic, it is clear that while
hepatitis B is a virulent, destructive disease, UCSF students - and San
Francisco as a whole - are not going to let the disease run rampant without a
fight.
Clinic Times and Locations:
Vietnamese Community Center
766 Geary St
San Francisco, CA 94109
First Saturday of each month, 9-noon.
Bayanihan Community Center
1010 Mission St
San Francisco, CA 94103
Second Saturday of each month, 9-noon.
http://www.ucsf.edu/synapse/articles/2008/Feb/7/hepatitis.html

Prosecutor needs 4 organ transplants to save life
By: Emily Stroud, Reporter
By: Jim Martin, Photographer
John Sellars has already changed his diet, taken medicine, and had a shunt
implanted to re-route blood between his liver and his heart.
More drastic measures will be needed to save the assistant district attorney
general, who prosecutes cases in Sevier, Grainger, Cocke, and Jefferson
counties.
One doctor recommended a liver transplant, but another expert decided that
wasn't enough.
"My health is just really deteriorating," Sellars said.
He is used to battles in the courtroom, but Sellars now faces the battle for his
own life. He will need a new liver, stomach, pancreas, and small intestine to
win this fight.
"That was what he said I needed," he said. "Not the stop-gap means that have
been tried before, or even just a simple liver transplant."
A blood disorder called Factor V Leiden has damaged his organs.
He'll move from Sevier County to Pittsburgh next week, to wait for an organ
donor to become available.
"It is the solution," Sellars said. "After I have the multi-organ transplant,
then I should be able to lead a normal life."
He plans to continue to work on his Sevier County court cases long-distance from
his new temporary home in Pittsburgh, using the Internet and fax machines.
Attorneys, friends, and even strangers are helping him cope, "offering words of
support, offering their prayers, and just telling me that they understand what
I'm going through," he said.
He's a man facing a multi-organ transplant, yet he said he's lucky.
"I'm very lucky that my family is there to help me through the whole process."
His mother will move with her son to care for him during his anticipated
year-long recovery.
"My mom is basically dropping everything that she has here, in order to move to
Pittsburgh to help support me," he said.
His sister is organizing a benefit dinner and auction on February 28th at Main
Stay Suites in Pigeon Forge.
The fundraiser from 6 p.m. to 9 p.m. will feature a live and silent auction with
donated items.
"Everybody's been great. Everybody has been great," said his sister, Connie
Cupp. "I don't think we have had anybody not to do anything that we asked. The
whole community has been wonderful."
After the transplant, John Sellars faces a lifetime of taking medicine.
"That will be a small price to pay to be able to have a normal life."
He hopes for a normal life back here in East Tennessee.
You can find more information on the benefit here, and you can find more
information on Factor V Leiden here.
http://www.wbir.com/news/local/story.aspx?storyid=54300&provider=gnews

Rogers woman's death gave others cause for hope
Thursday, 07 February 2008
by Bob Grawey
Staff writer
Christine Heideman was passionate about her work with Hennepin County,
helping disabled people in South Minneapolis. Her job was going well. Life was
good. She adored her family, and was deeply in love with her husband, George.
The couple shared a love for the outdoors as well, walking, biking and
taking camping trips together.
Christine also enjoyed watching her husband play softball, even before
they were married. In fact, it was on the way to one of George's softball games
that he proposed to Christine.
They had dated three years and George decided it was the right time to
finally take the next big step toward marriage.
On the way to his softball game in Rockford, he made a detour and pulled
up in front of a quaint country chapel they both had often admired.
George remembers it as one of their happiest days. Christine wasted no
time saying "yes."
"She was so excited with the wives of the other players when we got to the
game," George recalls, but he trails off as tears choke out his voice.
Memories are all George Heideman has now. The couple married in November
2000, but they had just 1.7 years to enjoy life together. They never imagined
their happiness would end in a crumpled heap in a parking lot on Franklin Avenue
in South Minneapolis.
Christine was leaving work on a Friday, and looking forward to the
weekend, but she never made it to her car. A brain aneurysm no one knew she had,
ruptured. She was found lying in the parking lot by a nurse. George never spoke
to his bride again. Christine never regained consciousness and died two days
later.
Hospital staff approached the grieving husband about donating his wife's
organs and tissue.
George says just two weeks earlier he and Christine had a discussion about
organ donation. She was not in favor of it personally, but after watching a
"20/20" program on the subject, he says Christine changed her mind and wanted to
donate her organs if anything ever happened to her.
Since he was quite close to his wife's family, George talked about the
hospital's request and shared with them what Christine concluded after watching
the television program.
It was quickly decided that the family would honor her request. As a
result, five people received her organs and a chance for a normal life.
Christine's kidneys were a perfect genetic match for two men. A
30-year-old man from California had been waiting for a kidney transplant for
over two years. The other man was 58-year-old family man.
A 40-year-old woman from Arizona had diabetes and needed a transplant.
Christine's pancreas means the woman will not have to have daily insulin
injections or suffer debilitating complications from the disease.
A 63-year-old married man was diagnosed with liver cancer and suffered
ultimate liver failure from a genetic condition. Without a liver transplant he
would certainly die. Christine's liver has changed the course of that man's
life.
Prior to becoming ill, a pilot who also enjoyed boating was diagnosed with
heart disease that weakened the 52-year-old man's heart muscle. The disease
progressed to the point where his heart could no longer pump blood throughout
the man's body.
This married man and the others now have a fighting chance at life.
Christine's unselfish gift in the face of tragedy made sure of that.
George has not had direct contact with any of the organ recipients. Both
parties must agree to any such communication, and he says it is something he is
now pursuing.
http://erstarnews.com/content/view/2257/64/

Alleged kidney transplant racket kingpin nabbed in Nepal
KATHMANDU, Feb. 8 (Xinhua) -- A special team of the Kathmandu police Thursday
arrested Indian national Dr. Amit Kumar, the alleged kingpin in the kidney
transplant racket, local newspaper The Himalayan Times reported on Friday.
Kumar was nabbed on Thursday afternoon from a Sauraha-based hotel in Chitwan
district close to the Indian border, some 100 km south of Nepali capital
Kathmandu. Police sources said that they tracked him down to the hotel that is
located about 60 km from the Indian border town of Raxaul.
The doctor who has been on the run ever since Indian television channels
broke the kidney transplant racket story did not resist when he was handcuffed.
The police seized Euro 145,000, 18,900 U.S. dollars and a draftworth 936,000
Indian rupees (around 23,400 U.S. dollars) from Kumar.
According to State Minister for Home Ram Kumar Chaudhari of Nepal, a police
team led by Deputy Inspector General Kiran Kumar Gautam arrested Amit Kumar.
"Police have brought Dr. Amit to District Police Office, Chitwan. He will be
brought to Kathmandu tomorrow (Friday) morning," said State Minister Chaudhari,
confirming the arrest.
Indian Embassy officials Thursday denied any knowledge of the arrest. They
said that normally the Nepali authorities inform the mission about the arrest of
any Indian national.
Senior Superintendent of Nepali Police Upendra Kanta Aryal said
investigation was underway and declined to comment further.
The illegal kidney racket operated by Amit Kumar has been in the forefront
of the media reports in India and Nepal.
Indian Police had disclosed the organized kidney racket after they arrested
five persons including Dr. Upendra Kumar, a close aide of Amit Kumar from the
latter's Hospital near Indian capital New Delhi at Guragaon on Jan. 24 in the
course of investigations.
The network spread across at least five Indian states, including
Maharashtra, Andhra Pradesh, New Delhi, Uttar Pradesh and Haryana, besides
Nepal.
A sleuth probing the kidney racket had brought out the fact that at least
three Turkish nationals had died during kidney transplants at Amit's hospital
from 2003 to 2005. The matter was allegedly covered up claiming the three died
due to cardiac failure.
Amit Kumar is said to be the mastermind behind an international racket in
illegal kidney transplants which has been operating for many years. He is
accused of having forced or duped around 500 people into donating their kidneys.
Editor: Mo Hong'e
http://news.xinhuanet.com/english/2008-02/08/content_7582119.htm

Hepatitis C Advocates UNITED!
ACTION ALERT
Urge Your Members of Congress to Fund Hepatitis C
In Their Appropriations Programmatic Request Letters
On Monday, President Bush kicked off the Fiscal Year 2009 appropriations process
with the release of his budget proposal. The President's FY2009 budget flat
funds the CDC Division of Viral Hepatitis (DVH). We need your help in raising
awareness of Members of Congress and asking their support for increased funding
for hepatitis C activities at the federal level. Hepatitis advocates are asking
for $50 million for hepatitis funding, which is an increase of $32.4 million
over the current funding of $17.6 million.
In the next few weeks, all Senators and Representatives will write their
"programmatic appropriations request letters," which ask members of the
Appropriations Subcommittees (who put together the federal funding legislation)
to include funding for their priorities. The more Members of Congress that
include a request for hepatitis funding in their letters, the greater the
likelihood the Appropriators will include additional funding in FY2009.
Hepatitis C impacts over 4 million Americans but there is only $17.6 million in
federal funding dedicated to hepatitis activities. We need you to tell your
story and ask your elected representatives to take action.
Step-by-step instructions on what to do are below:
1. Determine what Members of Congress to contact. You should contact your
personal Member of the House of Representatives and two Senators. You should
also contact other House Members in areas where your organization is located or
provides services. To determine who you Members are please go to
www.Congress.org and type in your zip code(s).
2. Call the Members Offices (www.house.gov or www.senate.gov or link from
Congress.org for contact info) to get the name and correct spelling of the staff
person handling health care. Email the staff using the draft email text below.
House staff emails are First.Last@.... Senate staff emails are
First_Last@Last name of Senator.Senate.gov.
Sample email:
Your Name
State and Zip code
Dear Name of health care staff:
My name is

Drive To Treat And Prevent Hepatitis C
Adelaide scientists will lead a $2 million five-year project to develop new
vaccines and explore better treatment options for hepatitis C sufferers.
University of Adelaide virologists Dr Michael Beard and Dr Karla Helbig will
work with colleagues from the University of NSW to develop new strategies to
treat and prevent hepatitis C, which infects more than 170 million people around
the world.
The scientists, who are also attached to the Institute of Medical and Veterinary
Science and Royal Adelaide Hospital, hope to identify antiviral proteins that
can be used in the fight against hepatitis C.
Currently there is no effective vaccine and the existing treatment is expensive
and often causes severe side effects. The success rate also varies between
50-80% so many sufferers cannot be helped by current approaches.
The funds, awarded by the National Health and Medical Research Council (NHMRC),
are part of a larger $17.7 million joint program grant, tackling both HIV/AIDS
and hepatitis C and involving nine scientists from across Australia.
Dr Beard said this was the first Australian program grant awarded to study both
HIV/AIDS and HCV/hepatitis C.
"The development of vaccines and better treatments for both these viruses are
urgent global health priorities," Dr Beard said. "This program brings together a
team of researchers with skills in basic virology and immunology with experts
who can translate laboratory findings into human clinical trials."
This latest grant is an adjunct to three NHMRC project grants awarded to Dr
Beard's team in the past two years specifically for hepatitis C research.
In 2006 the virologist was awarded more than $894,000 to investigate the link
between alcohol and hepatitis C, and the basic mechanisms of liver disease.
"In Australia, more than 264,000 people have been infected with the hepatitis C
virus and there are approximately 10,000 new infections per year. A proportion
of these are intravenous drug users, with alcohol playing a significant role in
disease progression," Dr Beard said.
He said vaccines had been trialled for HIV, but with little success. "There is
antiretroviral treatment but this does not eradicate HIV, it only keeps it under
control for a period of time. It is also very expensive and therefore not
accessible on a global scale".
Dr Beard said the program would provide a pipeline to develop and test vaccines
and novel treatments in a timely fashion.

A "Holy Grail" Of Healing
Regenerative Powder Helped Re-Grow A Man's Fingertip, And Could Change Medicine
(CBS) A new generation of researchers is changing the way we heal, one cell at a
time. This is the second in a CBS News series on the innovative field of
regenerative medicine.
You might become a believer in the power of magic dust, when you see how a
special powder re-grew the tip of Lee Spievack's finger.
He sliced off a half inch of his finger in the propeller of a hobby shop
airplane. His finger never even formed a scar.
"Your finger grew back flesh, blood, vessels and nail?" CBS News correspondent
Wyatt Andrews reports.
"Four weeks," Spievak said.
Is this essentially what re-grew Spievak's finger.
This powder is a medical product called extracellular matrix. Made from pig
bladders, it is a mix of protein and connective tissue surgeons often use to
repair tendons.
But it's the matrix's unusual power to regenerate tissue that's helping launch a
new field: regenerative medicine.
"It tells the body, start that process of tissue re-growth," said Dr. Stephen
Badalyk of the University of Pittsburgh Center for Regenerative Medicine.
Badalyk believes the matrix somehow mobilizes cells, some of them adult stem
cells whose job it is to maintain and repair injured tissue.
"It will change the body from thinking that its responding to inflammation and
injury to thinking that it needs to re-grow normal tissue," Badalyk said.
If this helped Mr Spievak's finger re-grow, could you grow a whole limb?
"In theory," Badalyk said.
That theory, that it might be possible to re-grow a limb, is about to be tested
by the United States Military. The Army, working in conjuction with the
University of Pittsburgh, is about to use that matrix on the amputated fingers
of soldiers home from the war.
Dr. Steven Wolf, at the Army Institute of Surgical Research, says the military
has invested millions of dollars in Regenerative research, hoping to re-grow
limbs, lost muscle, even burned skin.
"And it's hard to ignore this guys missing half his skin, this guy's missing his
leg," Wolf said. "Is there any way we can make that grow back? Some of that
technology exists and now its time to field it."
Several different technologies for harnessing regeneration are now in clinical
trials around the world. One machine, being tested in Germany, sprays a burn
patient's own cells onto a burn, signaling the skin to re-grow.
Badylak is about to implant matrix material - shaped like an esophagus - into
patients with throat cancer.
"We fully expect that this material will cause the body to re-form normal
esophageal tissue," Badylak said.
Some of the most advanced tests involve the heart. This patch of material is
being put on - like a band aid - to regenerate heart muscle damaged by a heart
attack.
And patient Mary Beth Babo is getting her own adult stem cells injected into her
heart, in hopes of growing new arteries. Her surgeon is Dr. Joon Lee.
"It's what we consider the Holy Grail of our field for coronary heart disease,"
Lee said.
The Holy Grail, because if stem cells can re-grow arteries, there's less need
for surgery.
"If people don't have to go through that, this would be the way to go for sure,"
Babo said.
Lee Spievak jokes he's got a 69-year-old body and a two-year-old fingertip.
But his fingertip has researchers imagining a time when re-grown limbs replace
prosthetics, when re-grown tissues replace surgery, when the body does its
healing with its own cells from within.
http://www.cbsnews.com/stories/2008/02/07/eveningnews/main3805318.shtml

Chronic Pain Disrupts Resting Brain Dynamics
By John Gever, Staff Writer, MedPage Today
Published: February 06, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine,
University of California, San Francisco
CHICAGO, Feb. 5 -- Chronic pain disrupts normal brain activity more widely than
previously recognized, researchers here said.
Patients with chronic back pain showed different patterns of brain activity than
healthy volunteers while performing a simple task, reported Dante R. Chialvo,
M.D., of Northwestern University, and colleagues in the Feb. 6 issue of the
Journal of Neuroscience.
The changes suggest that chronic pain alters brain function in the same way as
disorders involving cognitive impairment, the researchers said.
The affected regions are part of the brain's "default mode network," the
areas that are active when the consciousness is not actively engaged in a task.
Even when we are "doing nothing," Dr. Chialvo explained in an interview, the
brain does not go completely quiet.
The researchers said the results indicate that chronic pain leads to broad
changes in resting brain activity, affecting regions not traditionally
associated with pain signaling.
The new study was intended to explore the effects of chronic pain on the
default mode network.
The researchers enrolled 15 healthy people and 15 patients with back pain
of 6.3 years mean duration. Brain activity was monitored with functional MRI
scans at baseline and while the participants performed a simple target-tracking
task.
Brain areas that became less active in normal controls when they performed
the task reflect the default mode network, the researchers said.
The study revealed that several brain regions forming the default mode
remained significantly more active when the patients with chronic back pain were
performing the task. These included the medial prefrontal cortex, the posterior
cingulate/precuneus and the amygdala.
Accuracy of test performance did not differ significantly between the pain
patients and the controls.
Dr. Chialvo said this was expected. "The task is very minimally
demanding," he said. "We wanted something that everyone would perform well."
The point was to reveal differences in brain function in areas not
directly related to the task performance, he said.
He said the findings were "a clue that links pain with all the other stuff
that goes on in the brain."
"These findings suggest that the brain of a chronic pain patient is not
simply a healthy brain processing pain information, but rather is altered by the
persistent pain in a manner reminiscent of other neurological conditions
associated with cognitive impairments," the researchers concluded.
Although this line of research has focused on basic science so far, it may
have implications for the treatment of pain, Dr. Chialvo said.
For example, he said, it could shed light on the effectiveness of
cognitive therapy for chronic pain, which has been shown to help some patients.
The new study confirms that brain regions involved with cognitive processing
such as the prefrontal cortex are affected by chronic pain, he said.
In addition, the research provides "preliminary evidence" that duration of
pain is correlated with the degree of change in resting brain function.
That suggests early treatment of chronic pain could prevent the
abnormalities, Dr. Chialvo said.
He said his group is now doing similar studies in patients with other pain
conditions. They also plan to explore gender differences in the default mode
network.
The study was funded by the National Institute of Neurological
Disorders and Stroke.
No potential conflicts of interest were reported.
Primary source: Journal of Neuroscience
Source reference:
Baliki M, et al "Beyond feeling: chronic pain hurts the brain, disrupting
the default-mode network dynamics" J Neurosci 2008; 28: DOI:
10.1523/jneurosci.4123-07.2008.
http://www.medpagetoday.com/PainManagement/PainManagement/dh/8225

Public release date: 6-Feb-2008
[ Print Article | E-mail Article | Close Window ]
Contact: John Murphy
newsbureau@...
507-284-5005
Mayo Clinic
Mayo Clinic Proceedings contributors discuss impact of donor organ allocation
system
ROCHESTER, Minn. -- Liver transplant is a life saving treatment option for
people with end-stage liver disease. Unfortunately, the need for donor livers
far exceeds the supply. Each year only about one-third of people who need a
donor liver will receive one, and some patients die while waiting. In the
February issue of Mayo Clinic Proceedings, physicians explore how the current
system for allocating donor organs in the United States affects outcomes for
patients with end-stage liver disease.
In the United States, the United Network for Organ Sharing (UNOS) oversees the
allocation of donor organs. With the goal of giving available donor organs to
the most critically-ill transplant candidates, UNOS adopted a scoring system
called the Model for End-Stage Liver Disease (MELD) in February 2002. Unlike
past evaluation systems, the MELD score de-emphasizes the length of time a
patient has been waiting for a donor organ.
A patient's MELD score is calculated from the results of three laboratory tests.
Scores range between 6 and 40, with higher numbers reflecting a more urgent need
for transplantation. Research has shown that although the donor liver shortage
persists, implementing this allocation system has decreased the number of
patients who die while waiting for donor organs.
"Early referral to a liver transplant center no longer provides an advantage for
organ allocation. However, it is unclear whether it offers other advantages, or
if alternative strategies should be developed regarding timing of referral for
liver transplant," writes Jaime Aranda-Michel, M.D., a member of the Mayo Clinic
Jacksonville liver transplant team and lead researcher for a Mayo study on this
topic.
The Mayo study examined the evaluation practices and denial and acceptance
criteria for liver transplant used by the Mayo Clinic Jacksonville Transplant
Center after the MELD system was implemented.
"Obtaining a clearer understanding of these issues could result in changes in
the approach to referrals for liver transplant," writes Dr. Aranda-Michel.
Mayo researchers examined medical records from 555 patients referred for liver
transplant at Mayo Clinic Jacksonville Transplant Center from Jan. 1 through
Dec. 31, 2005. A transplant selection committee typically determines patient
eligibility for liver transplant using a variety of criteria, including a
patient's MELD score. From these 555 patients, 260 were accepted for liver
transplant at their first review, and 295 (53 percent) were denied. Among those
denied for transplant, 150 (51 percent) were considered too early for liver
transplant while the rest were excluded due to other medical conditions and
psychosocial issues that affected their eligibility. Patients seeking referral
for liver transplant often undergo repeated assessments by selection committees,
as their eligibility can change over time or following treatment and/or changes
in conditions that led to their initial exclusion.
Significance of the findings
According to Dr. Aranda-Michel, the data from the Mayo study suggest that even
though the current donor organ allocation system favors the most critically-ill
patients, a broad range of patients could benefit from early referral for liver
transplant evaluation.
"Our study suggests that early referral for liver transplant evaluation is
offers other advantages unrelated to the time patients spend on the liver
transplant waiting list. If patients too early for liver transplant were
evaluated but not listed, a liver transplant center could initiate management of
end-stage liver disease and address psychosocial issues in a subgroup of
patients who could also ultimately benefit from liver transplant. Early referral
could also lead to the earlier detection and treatment of liver cancer tumors
called hepatocellular carcinomas that accompany some forms of chronic liver
disease. If these tumors become too large, they can make a patient ineligible
for transplant," says Dr. Aranda-Michel.
In an editorial that follows, author Gennaro Selvaggi, M.D., from Miami
Transplant Institute at the University of Miami, agrees that while the MELD
system has proven to be valuable, those who are responsible for placing patients
on transplant lists face many challenges.
"One could argue that keeping a long list of active patients with low MELD
scores could burden the system. However, many patients can experience a sudden
decompensation of their liver disease, which would rapidly increase their MELD
score," writes Dr. Selvaggi.
"In the end, the most important concept advanced by Aranda-Michel is that
patients should be referred early and followed up by a team of liver transplant
specialists," writes Dr. Selvaggi.
###
A peer-review journal, Mayo Clinic Proceedings publishes original articles,
reviews and editorials dealing with clinical and laboratory medicine, clinical
research, basic science research and clinical epidemiology. Mayo Clinic
Proceedings is published monthly by Mayo Foundation for Medical Education and
Research as part of its commitment to the medical education of physicians. The
journal has been published for more than 80 years and has a circulation of
130,000 nationally and internationally. Articles are available online at
www.mayoclinicproceedings.com.
To obtain the latest news releases from Mayo Clinic, go to
www.mayoclinic.org/news. MayoClinic.com (www.mayoclinic.com) is available as a
resource for your health stories.
http://www.eurekalert.org/pub_releases/2008-02/mc-mcp020608.php

New Virus Tied to 3 Transplant Deaths
Newly Discovered Arenavirus Linked to Organ Donor and His Liver, Kidney
Recipients
By Miranda Hitti
WebMD Medical News
Reviewed by Louise Chang, MD
Feb. 6, 2008 -- A newly discovered arenavirus, a type of virus carried by
rodents, is being blamed for the deaths of three Australian women who received
tainted organ transplants.
Two of the women got kidney transplants; the third got a liver transplant. All
of those organs came from an Australian man who died of a cerebral hemorrhage
(bleeding in the brain) after a three-month trip to the former Yugoslavia.
Doctors don't know if the man was exposed to rodents on the trip. But they
suggest that it's possible, since he traveled in rural areas of the former
Yugoslavia.
The women who received transplants from the man died within four to six weeks of
their transplants, report Columbia University's Gustavio Palacios, PhD, and
colleagues.
Arenaviruses aren't new. The first arenavirus was isolated in 1933, according to
the CDC.
The innovative techniques used by Palacios' team to identify the new arenavirus
in the deceased organ donor and organ transplant recipients may "ultimately
transform microbiologic testing," writes Richard Whitley, MD, of the University
of Alabama at Birmingham, in an editorial.
The study and editorial appear in today's "online first" edition of The New
England Journal of Medicine.
http://www.webmd.com/news/20080206/new-virus-tied-to-3-transplant-deaths

Patients: Doctor Denying Claims To Save Money
ORLANDO, Fla. -- Injured employees of companies like Lynx and Republic Services
are accusing a company doctor of denying claims to save money.
The report featured Lynx driver Mary Robels, who was involved in a crash in May
2005.
Videotape of the crash showed Robels limping after the collision. But when she
reported to the company physician, Dr. Jock Snedden, he gave the veteran Lynx
driver three days off and then sent her back to work.
"You tell them there is something wrong with you and they don't want to listen
to you and the proof is right there," Robels said. "I told him to his face, 'I
hope you can sleep at night.'"
"Why did he refuse to give you an X-ray or MRI?" Local 6's Mike Holfeld asked.
"You are going to have to ask him that," Robels said.
Two orthopedic specialists agreed that Robels needed knee surgery after looking
at her.
As for Snedden's argument that it wasn't work-related, a court-ordered
specialist wrote, "I find this implausible."
"He was implying that it was arthritis," Robels said.
Snedden's occupational resource center is the gatekeeper for hundreds of
worker's compensation insurance claims.
A growing number of his patients are going public because they claim the
diagnoses don't add up, Holfeld reported.
Darlene Powell said she could barely walk after injuring her knee on the job.
Yet, despite the pain, Snedden determined she was ready to go back to work.
When Snedden would not approve a specialist, Powell said she paid for one
herself.
"He diagnosed me incorrectly," Powell said. "Maybe if he had taken an MRI and
had it done, maybe he would have seen what the specialist saw."
Also, Albert Zayas, 45, is recovering from surgery to repair two herniated
discs.
Zayas is a driver for Republic Waste Services and said he was injured while
lifting an apartment trash bin filled with rocks and debris.
The MRIs showed that Zayas had two bulging discs.
Snedden said it was an old injury and not work-related, Holfeld reported.
"He said that there was no possible way that it was a head trauma or like a say,
a recent car accident," Zayas said.
However, Zayas' surgeon noted the evidence immediately, Holfeld reported.
"He looked at it and he said, 'Did you lift something heavy,'" Zayas said.
"Those were his words?" Holfeld said.
"Those were his words and I said, 'Yes,'" Zayas said.
Veteran worker's comp attorney Monty Shoemaker said injured workers are at a
disadvantage because they have to report to the company doctor.
"Who do they believe, the medical doctor or the injured worker?" Shoemaker said.
Snedden denied any medical agenda in favor or the company, Holfeld reported.
In a phone call last week, Snedden said some patients don't want to hear they
have a pre-existing injury, the report said.
Holfeld reported that Snedden agreed to sit down with Local 6 but that has not
happened.
Watch Local 6 News for more on this story.
http://www.local6.com/news/15239956/detail.html

Two medical schools get national accreditation
They still have their opponents who say more residencies, not schools, are
needed.
By SHANNON COLAVECCHIO-VAN SICKLE, Times Staff Writer
Published February 7, 2008
The state's two newest medical schools can start recruiting their first
students, having just secured national accreditors' preliminary endorsement.
The Liaison Committee on Medical Education, a national accrediting body, has
given preliminary accreditation to the fledgling medical schools at Florida
International University in Miami and the University of Central Florida in
Orlando.
UCF and FIU officials celebrated the news with press conferences Wednesday,
nearly two years after state university system leaders approved their
controversial new medical programs.
Along with the medical school approved for Florida State University in 2000, the
UCF and FIU schools are the only medical schools created in the United States in
the past 25 years.
Combined, the UCF and FIU schools are expected to cost taxpayers about
$500-million during the next decade. It will cost roughly $20-million a year per
school after that, by the universities' own measure.
Administrators at existing medical schools worry about the new schools' effect
on their own state funding, and many argue the state needs more residency slots
- not new schools - to boost its doctor ranks.
Nonetheless, UCF and FIU are pushing forward.
"I couldn't be happier or more proud of our team," said UCF medical school dean
Deborah German. "They exceeded my expectations in every way as we strive to
build a medical school that will be a model for 21st century medical education."
"At last South Florida has a public medical school - one that will lead medical
education in the 21st Century," said FIU president Modesto A. Maidique.
The preliminary accreditation allows UCF and FIU to start admitting their
inaugural classes, 40 students each. The two medical schools got $10-million in
first-year planning money for this year, and Gov. Charlie Crist recommends they
get another $18-million next year. He also wants to spend about $5-million for
the existing medical schools at FSU, the University of South Florida and the
University of Florida.
Shannon Colavecchio-Van Sickler can be reached at svansickler@... or 813
226-3403.
[Last modified February 7, 2008, 00:05:48]
http://www.sptimes.com/2008/02/07/State/Two_medical_schools_g.shtml

Cat and crow
http://www.slide.com/r/hD6DvyAOxD9ClUhvUpVcUMABW9QzpGnQ

Hepatitis Day at Capitol
Hepatitis Day at Capitol in Tallahassee, Florida
Hi Everyone,
We have two separate events coming up at the Florida Capitol. The first one is
our annual Hepatitis Awareness Day (March 18) and the second is World Hepatitis
Day (May 19). The target audience for March 18 is lawmakers, and for May 19 the
audience is the general public. You are invited to participate in both events.
Details are below. Right now, our focus is on March 18.
Hepatitis Awareness Day at the Capitol
Tuesday, March 18, 2008
9:00 AM - 1:00 PM
Third Floor Rotunda Area
Capitol Building
* Free hepatitis A and hepatitis B vaccine will be offered by the Leon
County Health Department
* Educational booths and exhibits will be set up by DOH and community
partners
* A press conference will be held at 10:30 AM featuring:
* State Surgeon General Ana Viamonte Ros, M.D., M.P.H.
1 Division of Disease Control Director Russell W. Eggert, M.D.,
M.P.H.
2 Tom Liberti, Chief, Bureau of HIV/AIDS
3 Other speakers TBA
World Hepatitis Day
Monday, May 19, 2008
9:00 AM - 1:00 PM
First Floor Rotunda area and Capitol Courtyard
(More details to follow)
April Crowley
Health Education Coordinator
Hepatitis Prevention Program
Bureau of HIV/AIDS
Division of Disease Control
Florida Department of Health
850-245-4444, ext 2580
Fax: 850-412-1256
April_Crowley@...

Smoking Linked to Sleep Disturbance and Daytime Weariness
By Judith Groch, Senior Writer, MedPage Today
Published: February 05, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine,
University of California, San Francisco
BALTIMORE, Feb. 5 -- Nightly nicotine withdrawal may contribute to a restless
sleep and fatigue the next day, a small study showed.
Four times more smokers reported lack of restful sleep than nonsmokers
(P<0.02), Naresh M. Punjabi, M.D., Ph.D., of Johns Hopkins here, and colleagues,
reported in the February issue of Chest.
Furthermore, smokers spent less time in deep sleep and more in light sleep
than nonsmokers, with the greatest differences occurring in the early stages of
sleep, according to an objective analysis of sleep EEGs, the researchers said.
Although the exact mechanism underlying the sleep disturbances in smokers
is not known, withdrawal from nicotine is likely to be an important factor, Dr
Punjabi said.
Previous studies comparing smokers and nonsmokers have primarily used
subjective measures of sleep, the researchers said.
This study is unique, they said, because in addition to conventional home
polysomnography using visual sleep-stage scoring, sleep architectures were
studied with a technique known as power spectral analysis of sleep EEG activity.
The latter relies on a mathematical analysis (discrete fast Fourier
transform) of the different frequencies within the sleep EEG.
Not only is the method objective, but it may also detect subtle changes
overlooked with visual scoring, the researchers said.
Spectral analysis covered the spectrum for the night within contiguous
30-s epochs of sleep for the following frequency bandwidths: δ (0.8 to 4.0 Hz);
θ (4.1 to 8.0 Hz); α (8.1 to 13.0 Hz); and β (13.1 to 20.0 Hz).
The study included 40 smoker-nonsmoker pairs, all free of medical
co-morbidities -- not easy to find for smokers -- the researchers commented.
The participants were identified from the Sleep Heart Health Study, a
multicenter study of disordered breathing and cardiovascular disease.
They were matched for a list of factors, including age (mean age 56.8),
gender (20 men in each group), race, body mass index, apnea-hypopnea index, and
anthropometric measures.
Sleep stages by conventional visual scoring were similar between the two
groups, the researchers said. Caffeine consumption, although higher among the
smokers, was not associated with the findings, the investigators said.
Spectral analysis of the sleep EEG showed that, compared with nonsmokers,
smokers had a lower percentage of EEG delta bandwidth power or deep sleep (59.7%
versus 62.6%, respectively, P<0.04) and a higher percentage of EEG alpha
bandwidth power or light sleep, (15.6% versus 12.5%, respectively, P<0.001).
Differences in the EEG power spectrum between smokers and nonsmokers were
greatest in the early part of the sleep period and decreased toward the end.
This supports the premise that nicotine's effects are greatest in the
early stages of sleep and potentially decrease throughout the sleep cycle, the
researchers said.
Subjective complaints of lack of restful sleep were also more prevalent in
smokers than in nonsmokers (22.5% versus 5%, respectively, P<0.02) and were
explained, in part, by the differences in EEG spectral power, the researchers
said.
The equivalent mental health status between the two groups diminished the
possibility that mental heath conditions were responsible for the findings, the
researchers said.
One limitation of the study was its modest sample size, which precluded
the study of a dose-response relationship between the amount smoked and EEG
spectral power.
Another was that fact that the study was based on self-reports without
corresponding biochemical measurements.
Furthermore, the researchers said, restricting the study to participants
without medical comorbidities may have left out the individuals most susceptible
individuals to having disrupted sleep.
Although the exact mechanisms underlying the subjective and objective
sleep disturbances in smokers need further study, nicotine's role is likely to
be important, the researchers said.
An important implication of the study, they noted, is that spectral
analysis of the sleep EEG can uncover differences that may not be evident with
traditional measures. Thus, future research assessing the adverse effects of a
specific factor or medical condition should include quantitative EEG analysis.
The study was supported by the National Heart, Lung, and Blood
Institute through various cooperative agreements.
Dr. Punjabi and colleagues reported no significant conflicts of
interest.
Primary source: Chest
Source reference:
Zhang L, et al "Power Spectral Analysis of Electroencephalographic
Activity During Sleep in Cigarette Smokers" Chest 2008; 133: 427-432.
http://www.medpagetoday.com/PrimaryCare/Smoking/dh/8228

Grow Your Own Replacement Parts
Researchers Believe Regenerative Medicine Could Help Thousands In Need Of
Transplants
CBS) About 98,000 people are on a waiting list for transplants right now. Many
of them will die before they get one. Now, a new generation of researchers is
changing that, one cell at a time. This is the first in a two-part CBS News
series on the innovative field of regenerative medicine. Scroll to the end for
more information.
In what you might call the laboratory of the future, Dr Anthony Atala is
manufacturing body parts.
"Here you see an engineered blood vessel," he said. "You can actually see the
vessel beating."
University believe that in theory anything inside the body can be grown outside
the body, CBS News correspondent Wyatt Andrews reports. And it's real: They've
made 18 different types of tissue so far.
"That's a heart valve?" Andrews asked.
Atala said: "This is an engineered heart valve."
What he pointed to was a pulsing heart valve to be transplanted into a sheep.
"When people ask me 'what do you do,' we grow tissues and organs," he said. "We
are making body parts that we can implant right back into patients."
Once considered a Frankenstein fantasy, the field of regenerative medicine is on
the verge of unimagined breakthroughs. Scientists believe every part of the body
has cells capable of regeneration - all researchers need to do is isolate those
cells and coax them to grow.
And they use heart cells in an ink jet printer.
In the lab CBS News toured, the heart of a mouse was being made - a heart they
grew layer by layer, by spraying the cells with a printer.
"So your heart cell is programmed to make more heart tissue, your bladder cells
are programmed to make more bladder cells," Atala explained.
And it's Atala's work with human bladders that's truly on the frontier. In a
clinical trial at Thomas Jefferson Hospital in Philadelphia, a patient got a
bladder transplant - with a new bladder grown from her own cells.
Using Atala's regeneration techniques, her bladder cells were isolated,
multiplied and seeded onto a biodegradable scaffold. Eight weeks later, her new
bladder is in the operating room ready for transplant.
Dr. Patrick Shenot is her transplant surgeon.
"Its very much the future, but its today," Shenot said. "We are doing this
today."
What's coming from this technology is a future of highly personal, mail-order
medicine, where in order to cure your disease, your doctor will order you a
replacement organ or body part and it will be custom made for you, using your
own cells.
For the tens of thousands of patients who need organ transplants, this
technology brings hope.
Hugh Snyder needs a bladder. And it could be a bladder from his own cells.
"Yeah. I would never have thought this ... possible," Snyder said.
Corporate America already sees what's possible. The Tengion Company has bought
the license, built the factory, and is already making the bladders developed at
Wake Forest.
"We're actually building a very real business around a very real and compelling
patient need," said Dr. Steven Nichtberger, Tengion's CEO.
He says the company also plans to mass-produce blood vessels and kidneys.
"In regenerative medicine, I think it is similar to the semiconductor industry
of the 1980s," Nichtberger said. "You don't know where its going to go, but you
know its big."
This brand-new kind of medicine and this brand-new industry are set to change
the landscape for transplanting organs.
Patients in the future, instead of waiting years for a donated organ, will wait
a few weeks and . grow their own.

02/02/08 - President Bush has called for a $78,000 cut to federal hepatitis
programs in his proposed budget released yesterday. Outraged? Join the
Hepatitis C Advocates United listserve by sending an email to
rclary@... with "subscribe" in the subject field and help *Make A
Difference*.

Tattoos may be tomorrow's vaccines
By Ben Hirschler Wed Feb 6, 7:07 PM ET
LONDON (Reuters) - The tattoo of the future may be good for your health rather
than just your image.
German scientists said on Thursday that work on mice showed that tattooing was a
more effective way to deliver a new generation of experimental DNA vaccines than
standard injections into muscle.
Using fragments of DNA to stimulate an immune response is seen as a promising
way of making better vaccines for everything from flu to cancer. Until now,
however, the concept has been hampered by its low efficiency.
"Delivery of DNA via tattooing could be a way for a more widespread commercial
application of DNA vaccines," said Martin Mueller of the German Cancer Research
Centre in Heidelberg.
There are currently no approved DNA vaccines on the market but several drug
companies are conducting clinical trials and investing in the technology.
Pfizer Inc, the world's biggest drugmaker, placed a sizeable bet on DNA vaccines
in October 2006 when it bought British pioneer PowderMed.
Mueller and his colleagues tested tattooing by vaccinating mice with a protein
fragment of human papillomavirus, or HPV, a sexually transmitted virus that
causes cervical cancer. No ink was used, so the tattoo left no permanent mark.
They found three doses of DNA vaccine given by tattooing produced at least 16
times higher antibody levels than three intramuscular injections.
The far stronger response reflects the fact that giving a tattoo with a
vibrating needle causes a wound and inflammation. As a result, the tattoo --
measuring around 1 centimeter square -- is more painful but more efficient than
a normal injection.
"This is probably what makes it work better than normal injections because the
tissue is damaged and this affects the immune cells, which then look out for
antigens," Mueller said in a telephone interview.
His team's research was published in the online open access journal Genetic
Vaccines and Therapy.
Tattoo vaccines are unlikely to be for everyone. But they could be valuable for
delivering certain therapeutic vaccines to fight cancer or other serious
conditions, where some pain is acceptable, Mueller said.
Therapeutic, as opposed to prophylactic, vaccines are being developed to treat
disease, rather than just prevent it.
Mueller said tattooing could also have a role to play in routine vaccination of
cattle.
(editing by Elizabeth Fullerton)

Doctors: Offices in Indian River County illegally bugged
By James Kirley (Contact)
Wednesday, February 6, 2008
VERO BEACH - A business dispute among six doctors who own equal shares in an eye
clinic has boiled over into a lawsuit that includes accusations one physician
illegally bugged his colleagues' offices.
Vero Beach police were present Jan. 24 when four doctors found video and audio
devices in the ceiling tiles of their offices at Florida Eye Institute, 2750
Indian River Blvd. Officers on-scene included that information in reports filed
while investigating complaints of grand larceny and battery at the clinic.
But police are not pursuing accusations Dr. Paul Minotty used electronic
equipment to illegally spy on other doctors at the clinic, said Vero Beach
Police Lt. Kevin Martin.
Martin also decided a complaint of grand theft by Dr. Mark Gambee against Brenda
Johnson, a private investigator hired by Minotty, was unfounded. Martin wrote
that Johnson told him she believed Gambee's $3,500 personal computer belonged to
the Florida Eye Institute when she took it home to look for evidence that may
have been used against her client.
Also, Martin's report said Johnson decided not to pursue a charge of battery
against Donald Eugene Owen, the husband of a nurse who works at the institute.
According to police reports, Owen said he never touched Johnson, who alleged
that Owen shoved her when he and a second man known to Johnson only as "Estafan"
approached her in the institute's parking lot when she was returning Gambee's
computer.
"Each party had allegations against the other party," Martin said. "It's a big
civil mess and we chose not to investigate it."
James McCann of West Palm Beach is an attorney for doctors Thomas Baudo, Karen
Todd and John Valdis Zudans. They are half the institute's board and are suing
Minotty and the professional association that owns Florida Eye Institute in
circuit court.
Their lawsuit seeks damages, asks that a prior business transaction be voided
and that fired employees be reinstated. It also claims that Minotty was
illegally intercepting communications by the plaintiffs and asked the court to
stop it.
McCann said a court-ordered special master arrived at the institute Jan. 25 to
seize recording equipment that his clients suspected was locked in Minotty's
office and connected to the audio and video devices that they had found in their
own offices.
"When the special master went in there, the digital recorder was gone," McCann
said. "We don't know what was on it. We never saw the digital recorder."
Minotty's attorney, Nelson Castellano of Tampa, said his client disagrees with
all of the lawsuit's allegations.
"It's really nothing more than a business dispute," Castellano said.
On Jan. 29, Johnson went to police headquarters to report that a laptop computer
and camcorder worth $3,000 had been stolen from her unlocked vehicle during the
Jan. 24 incident. Johnson also told police that a notebook was missing.
http://www.tcpalm.com/news/2008/feb/06/doctors-offices-illegally-bugged/

Pot Smoking Linked to Early Gum Disease
By John Gever, Staff Writer, MedPage Today
Published: February 05, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
DUNEDIN, New Zealand, Feb. 5 -- Marijuana use is a powerful risk factor for
periodontal disease in young adults, researchers found.
About 26% of 32-year-olds who smoked pot weekly showed signs of serious
periodontal disease, compared with 12.1% of infrequent users and 4% of
non-users, reported W. Murray Thomson, Ph.D., of the Sir John Walsh Research
Institute here, and colleagues in the Feb. 6 issue of the Journal of the
American Medical Association.
Moreover, 24% of the heaviest users developed new sites of gum attachment
problems between the ages of 26 and 32. Only 6.5% of non-users and 11.2% of
infrequent users had new periodontal lesions during that six-year period.
The researchers said that the findings suggested a "strong probability
that regular cannabis users may be doing damage to the tissues that support
their teeth."
They followed 1,037 Dunedin residents from age 18 to 32, questioning them
periodically about their marijuana and tobacco use in the previous year. Dental
exams were conducted at ages 26 and 32. Participants were also first questioned
about their dental care habits at age 26.
After exclusions and losses to follow-up, the researchers had complete
data on 903 participants. Of those, 32.3% reported never using cannabis, 47%
said they used it an average of one to 40 times a year (infrequent users), and
about 20% said they smoked pot an average of more than 40 times a year (heavy
users).
The researchers found an adjusted relative risk of 3.13 (95% CI 1.53 to
6.38) for having at least one site of gum attachment loss measuring 5 mm or more
among the heavy users of marijuana at age 32, compared with those who never
smoked pot.
Heavy users also showed increased rates of new signs of gum attachment
loss appearing between the first and second dental exam (adjusted relative risk
of 2.15 [95% CI 1.20 to 3.85] for at least one new site of 3 mm loss).
Adjustments included tobacco exposure, gender, use of dental services, and
extent of dental plaque.
Multivariate analysis also showed that tobacco use was slightly associated
with periodontal disease. The researchers calculated a relative risk of 1.06
(95% CI 1.03 to 1.09) per pack-year for at least one site of 5 mm attachment
loss at age 32.
The relative risk associated with tobacco use for developing at least one
new site of 3 mm attachment loss after age 26 was 1.06 (95% CI 1.03 to 1.09) per
pack-year.
The researchers determined that there was no interaction between cannabis
and tobacco use in predicting gum erosion.
Failing to visit a dentist regularly did predict serious periodontal
disease at age 32 (RR 1.51, 95% CI 1.00 to 2.28), but not the development of new
attachment loss sites after the first exam (RR 0.90, 95% CI 0.60 to 1.34).
Gender, extent of dental plaque, and socioeconomic status did not
correlate consistently with gum attachment loss.
The study did not directly examine mechanisms by which cannabis use may
contribute to gum disease. However, the researchers pointed out that the
well-established link between tobacco smoking and periodontal disease is
believed to arise from systemic effects of nicotine and other components, not
from direct contact in the mouth.
Cannabis contains more than 400 compounds, the researchers observed, many
of which are similar to chemicals in tobacco and are known to have systemic
effects.
The researchers said the study's strengths included its prospective
design, the high follow-up rate, and its data on emergent periodontal disease as
well as the overall occurrence.
They noted that an earlier study had established that their study
population is broadly comparable to Americans of the same age.
The researchers also said they had measured attachment loss at only three
sites per tooth rather than the usual six, which may underestimate the actual
rate of periodontal disease in their sample.
In an accompanying editorial, Philippe Hujoel, Ph.D., of the University of
Washington in Seattle, suggested that waiting until participants were 26 to
conduct the first dental exam and to inquire about dentist visits were
significant limitations.
"Dental care and attachment loss were both ascertained between the ages of
26 and 32 years, making it difficult to determine which occurred first," Dr.
Hujoel wrote.
"Tooth loss at baseline or during follow-up (the ultimate dental outcome)
and its potential relationship to cannabis smoking were not reported," he added.
"As a result of these factors, the temporal sequence of cause and effect was
difficult to disentangle and may have contributed to biases."
Dr. Hujoel said unmeasured lifestyle factors could have confounded the
results.
Nevertheless, he said, the study helps debunk the traditional belief that
periodontal disease primarily strikes after age 35.
The findings "have the potential to help eliminate some established
beliefs and bring a more evidence-based approach to an understanding of the
etiology of destructive periodontal disease, including the role of cannabis
smoking," he wrote.
Dr. Hujoel also said that it highlights the role of dental professionals
in detecting early clinical signs of unhealthy lifestyles, including drug abuse.
The study was funded by the National Institute of Dental and
Craniofacial Research, the National Institute of Mental Health, the U.K. Medical
Research Council, and the Health Research Council of New Zealand.
No potential conflicts of interest were reported.
Primary source: JAMA
Source reference:
Thomson W, et al "Cannabis smoking and periodontal disease among young
adults" JAMA 2008; 299: 525-31.
Additional source: JAMA
Source reference:
Hujoel P, "Destructive periodontal disease and tobacco and cannabis
smoking" JAMA 2008; 299: 574-75.
http://www.medpagetoday.com/PrimaryCare/DentalHealth/dh/8212

Fed: Anti-fungal Tablets Linked to Liver Deaths
AAP News - Feb. 04, 2008
SYDNEY, Feb 4 AAP - Three people have died and several others have suffered
serious liver reactions after taking a popular tablet to treat fungal
infections, the drug regulator says. The Therapeutic Goods Administration (TGA)
has issued a warning about serious adverse side effects reported with oral
Lamisil, a pill formulation for ringworm and nail fungal problems. The
medication is commonly prescribed to people who do not respond to topical fungal
creams, but the regulator's Adverse Drug Reactions Advisory Committee (ADRAC)
warns it can cause liver failure. The committee has received 722 adverse event
reports related to Lamisil, known generically as terbinafine, including 70 liver
reactions, 61 implicating the tablet form as the sole suspected drug.
Those affected ranged from 20 to 85 years old, with half suffering their liver
reaction within the first month of taking the pills. "Most of the reports
document minor abnormalities of liver function but three describe fatal liver
failure, 10 describe hepatitis, and 12 describe jaundice," the committee's
latest drug reactions bulletin states. "Full recovery was noted in 27 reports
but 34 cases had not recovered and the outcome remained unknown in nine."
One case described in the bulletin involved an 81-year-old woman with previously
normal liver function. "(She) developed cholestatic hepatitis some three weeks
after commencing oral terbinafine treatment 250mg daily for a fungal infection
of the big toe," according to the bulletin. "The patient subsequently died in
hepatorenal (liver) failure." This is the first ADRAC report linking Lamisil to
liver dysfunction, but three others dating as back as far as 1996 have
implicated the drug in the blood condition dyscrasia. The committee warned
prescribers that the oral formulation should only be prescribed short-term and
as a last resort. "Doctors prescribing oral terbinafine should be confident
there is a clear indication for its use," the bulletin states. "Oral terbinafine
should be prescribed only after topical therapy has failed and for the shortest
time possible, in accordance with the current product information."
A spokesman for the drug's manufacturer, Novartis, said that serious and
life-threatening liver reactions were rare and well documented side-effects of
oral anti-fungal medications. The company said it agreed with the advice issued
by ADRAC. Meanwhile, the committee also received 12 reports of reactions in
patients taking both the blood-thinning drug warfarin and anti-arthritis
supplement glucosamine. It appeared some complementary medications could
increase the activity of warfarin, the bulletin stated. The committee
recommended that patients on warfarin have their blood tested within a few days
of starting or changing the dose of a complementary medicine.
http://www.therapeuticsdaily.com/news/article.cfm?contentvalue=1706165&contentty\
pe=sentryarticle&channelID=31

'It's been a long journey'
Treatment in Mexico finally takes away the debilitating pain.
By CAMILLE C. SPENCER, Times Staff Writer
Published February 4, 2008
For almost a year, Mary Sutton's body was racked with pain.
A neurological disease debilitated her left side, forcing the 33-year-old into a
wheelchair.
The smallest sensation was painful, from the light pelt of a raindrop to holding
a blow dryer. Skin ulcers ravaged her arms and legs.
So Sutton, 33, jumped at the chance to head to Mexico and undergo an
experimental treatment that would ease the pain caused by reflex sympathetic
dystrophy, or RSD, and help her regain her life.
Now Sutton is pain free and using a walker to get around.
"I feel like a brand-new person," she said. "It's been a long journey."
* * *
One day in December 2006, Sutton woke up and couldn't move her arm.
It wasn't long before a sharp, jabbing pain ripped through the left side of her
body. Neurologists prescribed pain medications, but nothing worked.
At one point, the vision in Sutton's left eye became fuzzy. Her eye doct