After cuts in California dental insurance, ER visits went up
A dentist checks the teeth of a U.S. patient, at a dental clinic in San Jose, November 1, 2012.
(Reuters Health) - After dental benefits were removed from California's public health insurance for the poor, emergency room visits for dental problems went up, a new study shows.
Removing comprehensive dental benefits from the state's Medicaid program in 2009 led to nearly 1,800 additional ER visits per year for dental problems, the researchers estimate.
"California used to provide comprehensive dental benefits for adults," said Astha Singhal, the study's lead author from the University of Iowa in Iowa City. "During the recent economic recession they were looking for ways to cut costs and save money."
The findings are especially important as U.S. states either expand or consider expanding their Medicaid programs under the 2010 Affordable Care Act (ACA) - also known as Obamacare, Singhal said.
The study, published May 4 in Health Affairs, looked at ER visits for Medicaid-enrolled adults in California between 2006 and 2011, which is three years before and two years after dental benefits were removed from the program.
Overall, 113,309 adults on California's Medicaid program made 121,869 ER visits for dental problems in those six years.
For every 100,000 people on Medicaid there, there were about 42 ER visits per year before the policy change in 2009, and about 56 visits after the change.
Applying those findings to the 3.48 million Californians on Medicaid means that more than 1,800 additional ER visits for dental problems occurred each year after the benefits were stopped.
The most common diagnoses during those visits were "other dental disease," problems inside the tooth and cavities.
The researchers say the policy change significantly affected younger adults, whites, blacks, Hispanics and those living in large metropolitan areas.
After adjusting for inflation, the costs of dental ER visits increased by 68% after the policy change, according to the report.
Dr. Peter Damiano, the study's senior author, said the state's Medicaid program likely still paid for some of the care people received in the ER for dental problems, because it's often billed as medical services.
"They’re usually giving them antibiotics and some pain killers," said Damiano, who is from the University of Iowa Public Policy Center.
Since those medications don't necessarily treat the underlying dental problem, he said the dental treatments get pushed back.
"The money being spent on them at the (ER) is basically being wasted," Damiano said, adding that those additional visits add to already crowded waiting rooms.
Singhal said California reinstated some - but not all - of the Medicaid dental benefits that were cut in 2009, but other states are currently looking at possible dental benefit cuts.
While the ACA guarantees dental coverage for children on Medicaid, Damiano said the law "did not change the coverage for dental care among adults in Medicaid."
"I think in this case the major takeaway is that there are unintended consequences that need to be evaluated when you make policy decisions," he said.
SOURCE: bit.ly/1F4nE3O
CDC to help Washington state find source of E. coli outbreak at milk fest
Public health officials in Washington state said on Friday they had asked for assistance from the federal government in tracking the source of an E. coli outbreak that has sickened more than 40 people who attended a milk festival last month.
So far, eight people have been hospitalized, including a teenager treated for acute kidney failure, after being sickened by E. coli bacteria during the three-day Milk Makers Fest in Lynden, Washington, state health officials said.
The Milk Makers Fest is an annual event for first grade students in Whatcom County to promote dairy products and dairy farming, according to the website.
More than 1,000 young children attended the event and made up the majority of those sickened, local health officials said. Several older students and adults have also fallen ill.
On Friday, the Washington State Department of Health said it had asked the Centers for Disease Control and Prevention for assistance in tracking the source of the outbreak, since it was unknown whether it was linked to food, milk, livestock, a petting zoo or another source.
There have been 22 confirmed cases and 20 probable cases linked to the festival, Whatcom County officials said.
Help from federal public health officials is standard in these kinds of outbreaks, said state health department spokeswoman Kelly Stowe.
The milk festival's organizers said in a statement they welcomed the CDC’s participation.
E. coli and Salmonella are the most common sources of food borne illness in the United States, according to the CDC.
E. coli bacteria lives in the intestines of humans and animals and most types are harmless. But some strains can cause severe illness and even lead to kidney failure and death in some cases.
WHO adds hepatitis C drugs to essential list, urges lower prices
The World Health Organization (WHO) logo is pictured at the entrance of its headquarters in Geneva, January 25, 2015.
The World Health Organization has added new curative treatments for hepatitis C to its essential medicines list, but the U.N. agency said prices needed to fall to make them accessible to patients in poorer countries.
The treatment of hepatitis C, which affects about 150 million people globally and kills around half a million each year, has been transformed by the arrival of new drugs, such as Gilead's Sovaldi.
These products can cure hepatitis C but are out of reach at Western prices to patients in poor countries, with a single Sovaldi pill costing $1,000 in the United States.
"While some efforts have been made to reduce their price for low-income countries, without uniform strategies to make these medicines more affordable globally the potential for public health gains will be reduced considerably," WHO assistant director general Marie-Paule Kieny said.
While Gilead has slashed its price for several low-income countries, campaigners say more needs to be done to ensure worldwide access, including in middle-income countries.
The WHO's Model List of Essential Medicines, which is updated every two years, is used by governments around the world to help determine which treatments they should make available. The latest version, published on Friday, includes several new drugs for cancer and multi-drug resistant tuberculosis.
China to increase health care subsidies, deepen reform
Flags flutter ahead of the opening session of Chinese People's Political Consultative Conference (CPPCC) at Tiananmen Square in Beijing, March 3, 2015.
China will increase its healthcare subsidies by 19 percent this year as part of efforts to deepen social reforms and strengthen safety nets, the government said on Saturday.
Government healthcare subsidies for qualified urban and rural residents will be raised to 380 yuan ($61.21), from 320 yuan last year, the cabinet said in a statement posted on the website of the National Health and Family Planning Commission.
Measures will also be taken to reduce the cost of drugs and medical checks, reform the salaries of healthcare workers and increase the availability of doctors in rural areas, the statement said.
China has a scarcity of doctors, partly caused by low wages. That has led to bottlenecks at hospitals, and doctors sometimes accept bribes from frustrated patients who want to receive better medical attention.
Out-of-pocket expenses for patients can also be high due to low insurance coverage.
Economists say it is crucial for China to improve the quality of its healthcare if it wishes to remake its economy and boost domestic consumption. They say a stronger safety net will encourage Chinese to spend more and save less.
As the world's most populous nation, China's heathcare bill is estimated to hit $1 trillion by 2020, according to consultancy McKinsey & Co.
The government had said in March it would double the number of general doctors by 2020.
California may require warnings on products containing chemical BPA
A worker picks up a plastic bottle before a news conference in Taipei November 4, 2009.
Plastic drinking bottles, canned goods and other items containing the chemical bisphenol-A (BPA) distributed in California might soon be required to carry a label disclosing that the compound can cause reproductive harm to women.
Thursday's decision by a board of scientific experts to include BPA on a list of chemicals known to cause harm is the latest in a years-long dispute between state experts and the chemical industry, which says the substance is safe.
The decision was welcomed by the Natural Resources Defense Council, an environmental group, which called it "an important step forward in protecting public health."
A non-profit organization generally supportive of industry positions said the decision highlights the "sheer ridiculousness" of California's law requiring disclosure of chemical compounds known to cause harm.
"Regulators are just stirring up more needless fear about safe products," said Joseph Perrone, chief science officer for the non-profit Center for Accountability in Science.
That voter-passed law, Proposition 65, set up a system under which chemicals found to cause developmental or reproductive impairment would have to be disclosed, whether they are in consumer products, used in the construction of buildings or used in other ways.
A chemical industry group sued the state in 2013, when experts tried to require disclosure of PBA as causing developmental harm. The state won that case, but the industry appealed, and the chemical remains off the list while the litigation continues, said Sam Delson, a spokesman for California's Office of Environmental Health Hazard Assessment.
The product is used in plastic drinking bottles and in the lining of some canned food containers, among other purposes.
Even with Thursday's decision that BPA belongs on the state's list of harmful chemicals, disclosure will not be required for another year, if at all, Delson said. That depends on a second state process, under which experts must decide at what level the chemical is harmful to women's reproductive systems.
If the amount in bottles or cans falls below that threshold, a warning would not be required, he said.
Liberia declared Ebola-free, but outbreak continues over border
Liberia was declared free from Ebola by the government and the World Health Organisation (WHO) on Saturday after 42 days without a new case of the virus, which killed more than 4,700 people there during a year-long epidemic.
However, celebrations were muted by thoughts for the dead and medical charity Medecins Sans Frontieres (MSF) urged vigilance until the worst outbreak of the disease ever recorded was also extinguished in neighboring Guinea and Sierra Leone.
A total of 11,005 people have died from Ebola in the three West African neighbors since the outbreak began in December 2013, according to the WHO.
President Ellen Johnson Sirleaf, who toured Ebola treatment units in the capital Monrovia, said that, while Liberia could take pride in winning the battle against the disease, work was not finished.
"At times when you are at your worst, it is when you become your best. That was what happened to us," she said during a speech at the country's incident management center. "The task is not yet over ... The challenge is that we stay at zero."
Monday has been decreed by the government as a day of thanksgiving. The country's Christians have been asked to pray for the dead on Sunday, with Muslims to do the same on Friday.
Liberia was recording hundreds of new cases a week at the peak of the outbreak between August and October, causing international alarm.
The United States sent in hundreds of soldiers to help build treatment clinics in a country founded by freed U.S. slaves, a move seen as a game changer in the battle to stem the disease, contracted through physical contact with sick people.
The White House welcomed the news as a milestone for Liberians but cautioned there was more work to be done in Sierra Leone and Guinea.
Also critical in Liberia was the government's national awareness campaign to educate Liberians on how to protect themselves from Ebola.
"It is a tribute to the government and people of Liberia that determination to defeat Ebola never wavered, courage never faltered," Alex Gasasira, the WHO's representative in Monrovia, said on Saturday.
NO COMPLACENCY
MSF said that Liberia's completion of the WHO's benchmark for the end of an Ebola outbreak - 42 days without a new case, marking twice the maximum incubation period of the virus - should not lead to complacency.
“We can’t take our foot off the gas until all three countries record 42 days with no cases,” Mariateresa Cacciapuoti, MSF’s head of mission in Liberia, said in a statement.
She urged Liberia to step up cross-border surveillance to prevent Ebola slipping back into the country.
The U.N. Special Envoy on Ebola, David Nabarro, said on Tuesday that, even though fewer than 20 new cases were reported in Guinea and Sierra Leone last week, it could take months to get to zero.
International aid organizations were forced to step in as the Ebola outbreak ravaged the region's poorly equipped and understaffed healthcare systems.
According to the WHO, a total of 868 health workers have caught the virus in Guinea, Liberia, and Sierra Leone since the start of the outbreak, of whom 507 died.
“We are not afraid," health worker Nathaniel Dovillie said at the event with President Sirleaf. "We are also now in a preparatory stage to be able to meet up with this challenge just in case its comes back."
(Additional reporting by Derick Snyder in Monrovia and Doina Chiacu in Washington; Writing by Daniel Flynn and Joe Bavier; Editing by Larry King and Clelia Oziel)
Women from a evangelical Christian community locally referred to as 'prayer warriors' celebrate after the WHO declared the country Ebola-free in Monrovia, Liberia, May 9, 2015.
Online info about braces can be improved
Internet information about orthodontic braces varies in quality and may not be entirely accurate, according to a new study from the Netherlands.
Orthodontic patients may look for information on the Web, but some people have questioned the quality of that information, the researchers write in the Journal of the American Dental Association.
The study team used the search engines Google, Yahoo and Bing to find websites giving advice on oral hygiene for braces.
They used the search terms “cleaning braces,” “brushing braces” and “oral hygiene and braces."
Overall, they evaluated 62 websites for accessibility, usability, reliability, readability and completeness of information, such as instructions about tooth brushing, dietary advice, fluoride recommendations, and dental care accessories.
The majority of websites evaluated were authored by professionals in the field. More than 70% were edited by orthodontists. But for 15%, the author was unknown.
The websites scored, on average, at the high end of the moderate range for accessibility. Websites with video instructions were considered more accessible, because they may be more helpful to patients with impaired vision or hearing.
In terms of readability, the pages were rated to be moderate, meaning that on average, they were easily understandable for 13- to 15-year-olds.
The completeness of information varied, but was also scored as moderate. Most websites had information about brushing methods and diet information, and about half recommended fluoride toothpaste. Only 17 websites gave complete guidelines for oral hygiene, however.
The researchers say accurate information about cleaning braces is important for dental health. Patients who do not properly clean their teeth may be more likely to suffer from gingivitis and difficult-to-treat white spots on their teeth, they write.
Study author Dr. Christos Livas from the University of Groningen feels that although the scores were moderate overall, there is much room for improvement, saying in an email that there is, “need for further development of orthodontic information e-resources.”
Martyn Cobourne, a professor of orthodontics at King's College London Dental Institute, warned by email that on the Internet, “medical information is uncensored, not peer reviewed and can often be plain wrong.”
Cobourne, who was not involved in the study, note that some websites advertise braces that will move teeth more quickly, despite a lack of any scientific evidence.
Although the recommendations for the upkeep of braces are not very contentious, Cobourne notes that for more controversial issues, unreliable information can be very damaging for patients.
The best bet is for people to use official sites from national orthodontic societies, Cobourne said.
Livas advises patients to consult their orthodontists, who may refer them to “valid Internet patient education materials.”
SOURCE: bit.ly/1Q8c4Z4
EU watchdog disagrees with negative view on UniQure gene therapy
European regulators do not agree with the negative view expressed by one adviser about the efficacy of UniQure's drug Glybera, the Western world's first gene therapy.
The Dutch company said it had received a final assessment report from the European Medicines Agency's Committee for Advanced Therapies (CAT) following doubts raised by the adviser, a so-called rapporteur.
"The CAT did not agree with the negative view of the rapporteur," UniQure said in a statement, adding that the views of the CAT were endorsed by the agency's senior body, the Committee for Human Medicinal Products.
UniQure's Nasdaq-listed shares fell last month when it emerged that the rapporteur believed Glybera lacked efficacy. A German regulator for new drugs also suspended its assessment of the product.
The drug, which is sold by UniQure's unlisted Italian marketing partner Chiesi for treating an ultra-rare blood disorder, has had a tortuous journey to market as regulators have struggled to assess its effectiveness because of the very small number of patients available for clinical tests.
The medicine was approved in Europe two years ago but its launch was delayed to allow for the collection of six-year follow-up data on its benefits.
UniQure is also developing other gene therapies that are viewed as more important to its commercial future. In April it signed a major collaboration deal with Bristol-Myers Squibb.
UN hails progress on Ebola as new weekly cases below 20
U.N. special envoy on Ebola Dr. David Nabarro speaks during an interview at the United Nations Headquarters in New York January 15, 2015.
(Reuters) - The U.N. envoy on Ebola on Tuesday hailed "extraordinary progress" against the outbreak in West Africa after new cases last week fell below 20 for the first time since mid-2014, but he warned it would take time to end the epidemic completely.
David Nabarro said that in the week to May 3 only nine new cases were reported in Guinea and the same number in neighboring Sierra Leone. Liberia once again had no new cases.
Nabarro said he was optimistic that Liberia would be declared Ebola-free on May 9, when it is due to reach the official World Health Organization (WHO) standard of 42 days without a new Ebola case. That period marks twice the maximum official incubation period for the deadly hemorrhagic virus.
"This is extraordinary progress. For those of us involved in this, we have got used to having good news one week, bad news the next, so we are not starting to celebrate yet, but we are feeling positive," Nabarro told a news conference in Dakar.
The WHO said in its latest update on Tuesday that the world's worst recorded Ebola outbreak - which erupted in remote southeastern Guinea in December 2013 - had killed a total of 10,980 people and infected more than 26,500.
Nabarro said the share of new cases which have come into contact with previous identified Ebola victims - a key marker of how well health officials have isolated the epidemic - now exceeded 50 percent and was headed towards 75 percent.
"We are moving towards the end, but we just don't know when it will come. In Liberia it took a long time - it took about two months to move from single-figure cases to zero - so we are not anticipating that this will be a very rapid thing," he said.
"That's why I am telling everyone ... don't turn away, don't let off the effort: we must finish it and finish it well."
The U.N. mission for Ebola Emergency Response, established in September, is due to wind up at the end of July and Nabarro said its responsibilities would be handed over to other agencies of the United Nations.
WHO projections warn of burgeoning obesity crisis in Europe
File photo of a passenger Heathrow airport's terminal four in London August 12, 2006.
(Reuters) - Europe will face an obesity crisis of vast proportions by 2030, according to new World Health Organization projections, with many countries likely to see far more than half of adults above the healthy weight limit.
The figures, which predict 89 percent of Irish men and 77 percent of Greek men will be overweight by 2030, present "a worrying picture of rising obesity across Europe", researchers said, with very few countries showing decreasing trends.
"Although there is no silver bullet for tackling the epidemic, governments must do more to restrict unhealthy food marketing and make healthy food more affordable," said Dr Laura Webber of the UK Health Forum, which worked with the WHO and the European Commission to produce the new projections.
She also said insufficient data from some countries in the WHO's European region - which comprises 53 nations - made surveillance of obesity more difficult, hampering efforts to make accurate predictions.
A body mass index (BMI) - calculated by dividing a person's weight in kilograms by the square of their height in meters - of more than 25 is classified as overweight. A BMI of more than 30 is classed as obese.
The latest predictions used data from across the region and compared the proportions of overweight people and obese people in 2010 with projected future levels.
They showed that by 2030, a third of women in the UK are forecast to be obese, compared with 26 percent in 2010. For UK men, almost three-quarters will be overweight and 36 percent are likely to be obese in 2030, compared with 70 percent and 26 percent respectively in 2010.
The researchers, who were due to present their data at the European Congress on Obesity in Prague on Wednesday, said other countries with projected steep rises in obesity included Greece, Spain, Sweden, Austria and the Czech Republic.
The proportion of obese Greek men will more than double from 20 percent to 44 percent between 2010 and 2030, and the proportion of obese Greek women is seen doubling to 40 percent.
Even in countries usually recording a lower prevalence of obesity, such as Sweden, obesity rates are predicted to rise sharply. An estimated 26 percent of Swedish men will be obese by 2030 compared with 14 percent in 2010, while for women obesity rates will rise from 12 percent to 22 percent.
Most countries not protecting antibiotics, says WHO
Three-quarters of countries do not have plans in place to preserve antimicrobial medicines, the World Health Organization says.
The body has repeatedly warned that the globe is heading into a "post-antibiotic era" in which much of modern medicine becomes impossible.
Its report showed "a lot more needs to be done" to prevent the rise of resistance in a range of infections.
Experts said it was an "appalling state of affairs".
It is in the very nature of microbes to develop resistance to the drugs we use against them.
If the drugs stop working, then common infections, such as tuberculosis, will kill again. Surgery and cancer treatment are also reliant on the drugs to keep patients alive.
While much of the attention has been on antibiotics, there are also warnings around HIV resistance to antiviral drugs and the malaria parasite becoming resistant to the last treatment.
No plan
In advance of a meeting of the WHO's World Health Assembly next month, officials have assessed the state of 133 countries' efforts to combat the problem.
Their report showed that only 34 countries had a "national plan" for how to deal with rising levels of resistance.
Dr Charles Penn, co-ordinator for antimicrobial resistance at the WHO, told the BBC News website: "Antimicrobial medicines are a very precious and valuable resource and something we cannot take for granted.
"This is the first report to capture on a worldwide basis what is currently being done.
"Only one in four had in place a national action plan and that's too few, a lot more needs to be done.
"Public awareness of the issue is low in all regions, many people still believe antibiotics that kill bacteria will work for viruses such as the common cold or flu."
The meeting of the World Health Assembly in May will discuss a global plan for all countries to adopt.
"We need the world to act as a whole, we need all countries to put things in place to address the problem and for every country to be travelling in the same direction," said Dr Penn.
Commenting on the report, Dr Mike Turner from the Wellcome Trust medical charity, said: "Drug-resistant infections are one of the biggest threats to the future of global health.
"Yet in most areas of the world we have no idea which drugs are being sold to whom and for what purpose. This is an appalling state of affairs.
"We cannot hope to stop bacteria becoming resistant to drugs unless we have simple, basic information in place."
'First natural birth' for diabetic woman with artificial pancreas
Catriona Finlayson-Wilkins had her son after wearing the device to keep her blood sugar levels normal
A diabetic woman has become the first in the world to give birth naturally after using an artificial pancreas while pregnant, experts have said.
Catriona Finlayson-Wilkins, 41, of Knapton, Norfolk, gave birth to son Euan on Tuesday at the Norfolk and Norfolk University Hospital.
She is also the first woman to give birth after using the device outside the main research site in Cambridge.
Ms Finlayson-Wilkins said she was "thrilled" by her son's safe arrival.
The new mother-of-two has Type 1 diabetes and wore the piece of kit throughout her pregnancy to produce insulin and prevent symptoms of the disease.
Three other mothers have previously given birth in Cambridge after using the device but by caesarean section.
Artificial pancreas breakthrough
The artificial pancreas is made up of a glucose monitor, digital controller and insulin pump
An artificial pancreas device system (APDS) is a small portable piece of equipment designed to carry out the function of a healthy pancreas.
It helps to control blood glucose levels using digital communication technology to automate insulin delivery.
An APDS is worn on the body during pregnancy and has a continuous glucose monitor (CGM), a digital controller and an insulin pump.
The device carries out the function of a healthy pancreas in controlling blood sugar levels
Ms Finlayson-Wilkins, who is a face and body painter and has also decorated models for local charity Break's GoGo gorilla and dragon art trails, said: "I'm thrilled.
"It's a huge weight off your mind after being pregnant and diabetic, which is really risky.
"It's the most amazing piece of kit and I can really see how it's going to benefit all types of people with diabetes in the future."
Her first son was taken into intensive care when he was born because his blood sugar levels dropped dangerously low and she did not see him for a day.
Baby Euan was born at the Norfolk and Norwich University Hospital and weighed 8lb 14oz (4kg)
Dr Helen Murphy, principal investigator of the study Ms Finlayson-Wilkins took part in, said Euan's arrival was an exciting step in the treatment of diabetes in pregnancy.
"Women who have diabetes in pregnancy face higher rates of birth defects, over-sized babies, pre-term delivery and stillbirth than other pregnant women," she said.
"Treating diabetes in pregnancy can be particularly challenging because hormone levels are constantly changing and blood sugars can be difficult to predict."
The results of the ongoing National Institute for Health Research's Closed Loop in Pregnancy study are due to be published later this year.
Its findings could mean the technology benefits more pregnant women with diabetes.
3D windpipe 'saves children's lives'
Kaiba is now a healthy three-year-old
Three babies have been saved from a life-threatening condition by using 3D printed windpipe splints to help them breathe, a pilot study reveals.
The patients suffer from a rare illness that means their windpipes can collapse and prevent air getting in.
The device was rapidly customised for each individual. And unlike most 3D implants, it was made of material that changed shape as the children grew.
The research appears in Science Translational Medicine.
Last resort
Due to the small number of children involved in the study it does not prove it will work in every case.
But it does show the splints could be a promising option for a condition that has no cure, researchers from CS Mott Children's Hospital at the University of Michigan say.
One in 2,000 children have tracheobronchomalacia - a weakening and collapse of the windpipe (trachea) that would normally allow air to travel to the lungs.
Those with the most severe form have a poor chance of surviving. But if they can get to the the age of three, their windpipes have often strengthened enough to allow them to breathe well.
Kaiba Gionfriddo had the procedure when he was just three months old. He was in a critical condition, needing intensive care because his body was not getting the oxygen it needed.
So doctors sought emergency approval to use the device as a a last resort.
Lead researcher Dr Glenn Green described it as a ground-breaking case.
Kaiba is now "an active, healthy three-year old in preschool with a bright future", researchers said.
Dissolving device
Almost three years later the splint shows signs of melting away as planned. And doctors say his windpipe appears strong enough for him to breathe without its support.
April Gionfriddo, Kaiba's mum, said: "The first time he was hospitalised, doctors told us he may not make it out.
"It was scary knowing he was the first child to ever have this procedure, but it was our only choice and it saved his life."
The team have now carried out the surgery on two other children.
Both are doing well and are back at home, though one continues to need a machine to help his breathing, because of problems the splint could not address.
Dr Patrick Finlay, of the Institution of Mechanical Engineers, described it as an advanced piece of engineering.
He said: "The problem represents some formidable difficulties.
"You have to construct something that can cope with growth and coughing and sneezing.
"And they seem to have done this - it is very exciting."
He said the splint could be thought of as similar to a section of vacuum cleaner pipe that had been split in the middle.
It is customised to match the exact anatomy of each patient and made of a bio-absorbable material.
Doctors sew it in place on the outside of the windpipe as an incomplete ring.
The aim is for it to provide support without constricting growth.
Prof Paolo De Coppi of Great Ormond Street Hospital described this as a very attractive way of doing the procedure.
He said: "Other options can include internally placed stents - but these can cause bleeding and other complications.
"It is very encouraging news to see at three years that it appears safe and effective in this child."
US researchers have filed a patent on the device and are now embarking on a larger trial.
US 'will not fund research for modifying embryo DNA'
Francis Collins is the director of the US National Institutes of Health
Modifying the DNA of embryos is a "line that should not be crossed", a leading figure in US research says.
Dr Francis Collins, National Institutes of Health director, was responding to reportsthat the first embryos had been modified in China.
He argued there were "serious and unquantifiable safety issues", big ethical questions and no compelling medical reason to do it.
He said the NIH would not fund such research in the US.
The advent of "Crispr technology" - which is a more precise way of editing DNA than anything that has come before - has spurred huge progress in genetics.
But there had been growing concern these tremendous advances were making the modification of human embryos more likely.
Dr Tony Perry, a pioneer in cloning, told the BBC News website in January that designer babies were no longer "HG Wells" territory.
Concerns were also raised in the journal Nature as rumours circulated that it had already taken place.
World first
Last week a team at Sun Yat-sen University, in Guangzhou, reported using Crispr to modify defective parts of DNA that lead to a blood disorder called beta thalassaemia.
Their world first, reported in the journal Protein and Cell, showed the correction was successful in seven out of 86 attempts.
However, there were a number of other "off-target" mutations introduced to the genetic code.
The embryos used were "non-viable" so could never have led to a child.
There have been repeated calls for a worldwide freeze on such research while society as a whole decides what should be allowed.
However, the US National Institutes of Health has made its position clear - that no such research should take place.
Dr Collins, who was also a key player in the Human Genome Project, released a statement saying: "The concept of altering the human germline in embryos for clinical purposes has been debated over many years from many different perspectives, and has been viewed almost universally as a line that should not be crossed.
"Advances in technology have given us an elegant new way of carrying out genome editing, but the strong arguments against engaging in this activity remain.
"These include the serious and unquantifiable safety issues, ethical issues presented by altering the germline in a way that affects the next generation without their consent, and a current lack of compelling medical applications."
Dr Marcy Darnovsky, from the Center for Genetics and Society in the US, argued: "There is no persuasive medical reason to manipulate the human germline because inherited genetic diseases can be prevented using embryo screening techniques, among other means.
"Is the only justification for trying to refine germline gene editing the prospect of so-called enhancement?"
Avian Flu Infections Are Found at Five More Iowa Poultry Farms
By REUTERSAPRIL 30, 2015
The highly pathogenic H5 avian flu turned up in initial tests at five more farms in Iowa, including a commercial egg operation housing up to 5.5 million birds, Iowa’s agriculture department said on Thursday.
If the virus is confirmed at the farms in additional tests underway at a federal Agriculture Department laboratory, the number of American cases could surpass 20 million birds and result in the biggest death toll in a bird flu outbreak in United States history.
The latest case, at an egg farm in Buena Vista County, could be the largest single operation to be hit in the current outbreak.
The egg farm’s owner, Rembrandt Foods, one of the top egg producers in the United States, confirmed the outbreak but disputed the number of birds affected. The state did not identify the affected farm by name.
Avian flu was probable at four other commercial farms in Buena Vista, Sioux and Clay Counties, the Iowa Department of Agriculture and Land Stewardship said. If the virus is confirmed at all five farms in the coming days, the number of sites where H5 has been found in Iowa would rise to 17.
Hours earlier on Thursday, state officials confirmed that an Iowa-based chicken broiler breeding farm had initially tested positive for the virus.
The farm, in Kossuth County, was comparatively small, with an estimated 19,000 birds. But it was thought to be the first time in this outbreak that the virus had affected a broiler breeding farm; such farms are said to have better biosecurity systems. And it underscores the potential for the outbreak to have a wide-ranging effect on the country’s poultry supply chain.
Infections with the H5N2 strain have picked up pace in the last few weeks. On Monday, officials in Iowa reported probable cases at five farms affecting an estimated six million chickens, and a turkey farm in Wisconsin with more than a million birds tested positive.
Two bird flu strains have been found in the United States this year. The H5N2 strain has been reported in Arkansas, Idaho, Iowa, Kansas, Kentucky, Minnesota, Missouri, Montana, North Dakota, Oregon, South Dakota, Washington and Wisconsin. It has also been identified on farms in Ontario, Canada.
The H5N8 strain has been identified in California and also in Idaho, according to the Agriculture Department.
The potential economic cost of the outbreak is unclear. The number of birds affected by the outbreak so far represents a fraction of the United States commercial flock. Poultry processors slaughtered nearly 8.7 billion chickens in 2014 and about 237 million turkeys, according Agriculture Department data.
The virus can kill nearly an entire infected flock in 48 hours.
In the outbreak of 1983 to 1984 in the Northeast, so far the largest in American history, about 17 million birds were culled.
Indiana Governor to Approve Needle Exchanges to Fight H.I.V.
Gov. Mike Pence of Indiana has said he will sign a bill allowing cities and counties to create needle exchange programs if they are experiencing an outbreak of H.I.V. or hepatitis C because of intravenous drug use.
The bill requires the state health commissioner to approve each such program by declaring a public health emergency that must be renewed after a year.
Mr. Pence, a Republican who has said he opposes needle exchanges as antidrug policy, authorized a temporary exchange in Scott County in March because of a growing outbreak of H.I.V. there. More than 140 people in the rural county have tested positive for the virus since December.
In a statement, Mr. Pence praised the legislation for allowing “limited and accountable” needle exchanges that “will save lives.” But critics said the legislation required too many steps before an exchange could be established.
Pine Ridge Indian Reservation Struggles With Suicides Among Its Young
A portrait of Santana Janis, a 12-year-old Lakota Indian, in the home of her grandfather Keith Janis, foreground, on Pine Ridge Indian Reservation in South Dakota. Since December, nine young people, including Santana, have committed suicide on the reservation.CreditKristina Barker for The New York Times
PINE RIDGE INDIAN RESERVATION, S.D. — A few days before Christmas, Santana Janis, a 12-year-old Lakota Indian, decided that she did not want to live anymore.
A bright, outgoing girl with a shy smile and passion for horseback riding, Santana’s moods had turned dark. She lived in a derelict two-bedroom trailer with a grandfather, Earl Tall, and as many as a dozen siblings and cousins. Her mother, an alcoholic, was an intermittent presence in her life. Their town, Manderson, was torn by drinking, fighting and violence.
Mr. Tall overheard his granddaughter’s talk of suicide and called her other grandfather, Keith Janis, who immediately drove 40 miles to see her. “I sat down with her and said, ‘Please, promise Grandpa you’ll never do that,’ ” Mr. Janis recalled last week. “She gave me that big, beautiful smile of hers and said, ‘O.K., Grandpa, O.K.’ ”
Six weeks later, Santana hanged herself in a small, unheated building next to the trailer.
Since December, the Pine Ridge reservation, a vast, windswept land of stunning grasslands and dusty plateaus, has been the scene of an unfolding crisis: nine people between the ages of 12 and 24 have committed suicide here.Photo
John Yellow Bird Steele, the Oglala Sioux tribe president, last week. He declared an emergency on the reservation in February. CreditKristina Barker for The New York Times
Two teenagers hanged themselves in December. In the next three months, seven more young people were found dead, including Alanie Martin, 14, who was known for her love of basketball, cheerleading and traditional Indian hand games. When Santana killed herself in February, she followed another recent suicide of a boy who attended her school, Wounded Knee, so named for the 1890 massacre that occurred where the reservation stands today.
Many more youths on the reservation have tried, but failed, to kill themselves in the past several months: at least 103 attempts by people ages 12 to 24 occurred from December to March, according to the federal Indian Health Service. Grim-faced emergency medical workers on the reservation, which is the size of Delaware and Rhode Island combined, say they have been called to the scenes ofsuicide attempts sometimes several times a day.
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Tribe officials, clergy members and social workers say they cannot remember such a high rate of suicides and attempts in such a short period of time on the reservation, which is already overwhelmed with high rates of unemployment, poverty, domestic abuse and alcohol addiction.
In 2013, five people, including adults and children, killed themselves in a single year, according to the Oglala Sioux tribe. But officials at Pine Ridge said they were mystified by the far more pronounced increase in the past several months and had searched, unsuccessfully, for answers.
As the suicides began to mount in February, the Oglala Sioux tribe president, John Yellow Bird Steele, declared an emergency on the reservation. In response, the Indian Health Service deployed additional counselors, but many people here say it is not nearly enough: There are only six mental health professionals on the entire reservation, which has a population of 16,000 to 40,000 members of the tribe.
“It is devastating,” Mr. Steele said. “I don’t know if they were cyberbullied, or if they had living conditions they didn’t want to put up with, or they were sexually abused. Were they hungry? I don’t know.”
“When you have a good understanding of what’s happening,” he said, “come back and tell me.”Photo
The Badlands, viewed from the Pine Ridge reservation. The reservation is already overwhelmed with high rates of unemployment, poverty, domestic abuse and alcohol addiction. CreditKristina Barker for The New York Times
But family members and tribe officials said they had seen disturbing clues.
Outside the Pine Ridge School, where four of its 800 students have committed suicide in recent months, Myra Slow Bear, 15, a friend of Alanie’s, said that other students had been bullying Alanie.
“I knew she was depressed,” she said. Among teenagers at the school, she said, attempting suicide is not unusual.
“It’s just a common thing,” she said.
Mr. Tall, Santana’s grandfather, also said that she had conflicts with other students at school. An official with knowledge of the case said that shortly before Santana committed suicide, another girl at school had written to her on Facebook, urging her to kill herself.
Several officials with knowledge of the cases said that at least one of the youths who committed suicide was influenced by Slender Man, a tall, faceless creature who appears in storytelling websites, often as a figure who stalks and kills victims. Two girls in a Milwaukee suburb last summer said the character had inspired them in the attempted murder of a classmate.
“They call him the Tall Man spirit,” said Chris Carey, a minister who works with youths, some of them suicidal, on the reservation. “He’s appearing to these kids and telling them to kill themselves.”Photo
“It’s just a common thing,” said Myra Slow Bear, 15, of suicide attempts on the reservation. Her friend Alanie Martin, 14, committed suicide this year. CreditKristina Barker for The New York Times
Mr. Steele, who said many Native Americans traditionally believe in a “suicide spirit” similar to Slender Man, said that young people had been sharing disturbing videos on Facebook that encourage suicide. One video, he said, gave instructions on tying a hangman’s noose. Another directed children to go to a specific place outside the village, saying there were ropes there. “Go use them,” the video instructed.
John Two Bulls, a pastor who works with youths on the reservation, said that two months ago, he was tipped off to a group suicide planned in a wooded area outside the town of Pine Ridge. Frantic, he drove to the spot.
“It was cold, it was dark, and there was a row of trees with ropes hanging off the branches,” he said. “I was thankful that we were able to get there without finding anybody hanging from those ropes.”
Some teenagers had already congregated there, he said, and he urged them to gather around. “I counseled them, prayed with them, talked with them,” he said. They told him that “they were tired of the lives they had at home, no food, with parents all intoxicated, and some were being abused, mentally or sexually.”
Mental health professionals said they suspected that in some cases, young people might have been influenced by previous suicides. Feeling neglected, they can be attracted to the public displays of mourning that follow a death; and once they hear about the method of suicide, they imitate it.
“Contagion does occur with teenagers,” said Stephanie Schweitzer Dixon, the executive director of the Front Porch Coalition, a suicide prevention group in Rapid City, S.D. “Kids are young, they don’t think clearly, their brains aren’t fully developed. I know that things seem to be getting worse for kids. Things seem to be getting more dire.”
Ted Hamilton, the superintendent of the Red Cloud Indian School, a Jesuit school on the reservation, said that suicide is an issue that schools grapple with constantly.Photo
Boys playing basketball on the reservation last week. Children on reservations face a variety of challenges including a legacy of oppression and forced removals and the lack of jobs and economic opportunity. CreditKristina Barker for The New York Times
“To be Lakota in this world is a challenge because they want to maintain their own culture, but they’re being told their culture is not successful,” Mr. Hamilton said.
Children on Indian reservations, he added, have extraordinary challenges: the legacy of oppression and forced removals, the lack of jobs and economic opportunity, and the high levels of drug and alcohol use around them.
“The federal government has dropped the ball in terms of mental health resources,” Mr. Hamilton said. “The system is overwhelmed. No matter which reservation you go to, that’s what you’ll find.”
Ron Cornelius, the Great Plains director of the Indian Health Service, said in a statement that the recent suicides were “an incredibly sad situation” that the agency was determined to address. “I.H.S. is committed to working with the tribe to address this heartbreaking problem,” he said.
When Mr. Janis, a longtime activist, talks about Santana’s death, he points to the “multigenerational trauma” inflicted on Native Americans by whites and the tensions that still exist between the groups. On an overnight trip to Rapid City over the New Year, a group of girls including Santana overheard a white woman call them “filthy Indians” as they passed through a hotel lobby, he said.
“My beautiful Lakota granddaughter,” he said. “She had to hear that. Our kids today just want to die because they’re sick of all this oppression.”
Last week, at the Pine Ridge Gospel Fellowship, a small, white clapboard church in the heart of the reservation, a group of clergy members, social workers and tribal elders met for an informal prayer session.
As one pastor played hymns on an acoustic guitar, Norma Blacksmith, who lost a grandson to suicide several years ago, bowed her head and closed her eyes.
“In our culture, Lord, the children are sacred,” she said. “We thank you that there have been no suicides in this last week. You answered our prayer.”
Bill to Speed Approvals for Drugs Is Cut Back
WASHINGTON — Legislation that would have accelerated the pace of federal drug approvals in a way that critics said threatened to erode patient safety was formally released this week, in a scaled-back version with many of the most controversial provisions left out.
The draft bill presented at a hearing in the House on Thursday represents a less aggressive streamlining of the drug approval process, critics of the earlier draft said, and seems to have secured strong bipartisan support.
The legislation, called 21st Century Cures, has been in the works for months. Its lead sponsor, Fred Upton, Republican of Michigan, said it would speed the pace of drug cures by removing unnecessary hurdles from the regulatory process.
Critics, including top officials at the Food and Drug Administration, had expressed concern that the changes would risk patient safety — for example, by potentially permitting shorter clinical trials and letting drug companies use alternative measures of health as evidence of a drug’s effectiveness and safety.
The bill’s supporters said it was a work in progress that had been assembled in one of the most collaborative, transparent processes Congress has seen in years. The sponsors held eight hearings and more than a dozen round-table meetings in districts across the country to gather comment.
“We have a chance to do something big, and this is our time,” Mr. Upton said.
His co-sponsor, Diana DeGette, Democrat of Colorado, said the lawmakers had made “tremendous progress,” recalling “that hokey video” that she and Mr. Upton made to promote the effort last year.
The draft — at about 200 pages it is half its former size — seemed to allay fears among some experts that it would fundamentally rewire the way drugs are approved. Earlier proposals to give drug companies broad powers to promote their products for uses other than the approved ones and to market brand-name drugs for a longer time without generic competition were not included.
The F.D.A. has defended its record for drug approval speed, saying that in 2014, it approved the most new drugs in almost 20 years, and that it moves faster than its counterparts in other wealthy countries. Experts note that pathways exist for expedited approval, and that the F.D.A. is held to relatively strict timelines under other rules set by Congress. Instead, they say, the bottleneck for new drugs is often a matter of the years of research it takes to find them.
Diana Zuckerman, the president of the National Center for Health Research, said earlier versions of the legislation had “considerable micromanaging of the F.D.A. and enormous power given to industry.”
She added, “Most of that is gone.”
But she cautioned that the bill still held numerous provisions she believed put people at risk, including ones she described as lowering standards for the approval of medical devices and antibiotics. The bill would increase the work the F.D.A. must perform, but not the money it receives, and Dr. Janet Woodcock, an agency official who testified Thursday, said that was a concern.
“We are very stretched in our resources,” she said.
One point that is likely to concern the F.D.A. is a provision that would reduce its authority to regulate some software associated with medical devices.
An earlier version of the bill would have let drugmakers use quicker measures for a drug’s effectiveness during testing — for example, changes in blood sugar level instead of a more final outcome, like development of diabetes. The new draft instead suggests ways the F.D.A. could use those alternative measures, called biomarkers.
The F.D.A. says it already uses them in a substantial share of drug approvals, and Dr. Woodcock told the lawmakers Thursday that the agency did not need additional authority on this count. Progress has been slow in adopting more biomarkers, she said, because they often did not produce enough evidence to allow scientists to draw firm conclusions.
“You have to know those biomarkers are reliable before you can take a chance on a human life,” she said.
Easing Diabetes Risk, One Beverage at a Time
Substituting just one serving a day of water or unsweetened tea or coffee for one serving of a sugar-sweetened soft drink or dairy beverage can significantly reduce the incidence of Type 2 diabetes, a new study has found.
The study, in Diabetologia, used data on diet and diabetes incidence from more than 25,000 British men and women ages 40 to 79. Researchers tracked consumption of soft drinks, tea and coffee, fruit juice and sweetened milk drinks like hot chocolate and milkshakes.
Almost everyone habitually drank something sweet, usually soft drinks or sweetened tea or coffee. After adjusting for body mass index, calorie intake and a range of diet, behavioral and socioeconomic factors, the researchers found that one serving per day of either a soft drink or sweetened milk drink increased the risk of diabetes by 14 percent to 27 percent.
Each additional 5 percent of total calories consisting of sweetened drinks raised the risk of diabetes by 18 percent. Drinking sweetened tea or coffee did not change the risk for diabetes, and consuming those beverages without sugar lowered the risk. After an adjustment for all the variables, fruit juice had no effect on the risk of diabetes.
“We hear a lot about the bad health effects of these drinks,” said the senior author, Dr. Nita G. Forouhi of the University of Cambridge. “We usually give the bad news, but here we have some solutions for what good replacement drinks are: water and unsweetened tea and coffee.”
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Richard Suzman, 72, Dies: Researcher Influenced Global Surveys on Aging
Richard Suzman
Richard Suzman once chased a Nobel-winning psychologist through a Washington rainstorm, as a scientific meeting was breaking up, to whet the psychologist’s interest in a new project. In the middle of the night, Dr. Suzman liked to email social scientists, urging them to take immediate action on a project. Other times, an email or phone call would all but order a researcher to apply for a grant.
A social psychologist by training who left his native South Africa as a teenager, Mr. Suzman built a government career like few others.
As a longtime official at the National Institutes of Health with an ambitious definition of his job, he influenced economics, public health and other fields over three decades.
He died at 72 on April 16 in Bethesda, Md. The cause was complications of amyotrophic lateral sclerosis, said Janice Krupnick, his wife of 39 years and a clinical psychologist at Georgetown University.
Dr. Suzman used his position as the director of the Behavioral and Social Research division at the National Institute of Aging, part of the N.I.H., not merely to evaluate incoming grant proposals but also to act as a scientific hub.
“Richard was a uniquely entrepreneurial, proactive bureaucrat,” said Alan B. Krueger, a Princeton professor and former chairman of the Council of Economic Advisers under President Obama.
Dr. Suzman connected researchers across disciplines and shaped their proposals. To do so, he relied on both his sway over federal research funds and an intensity that could be gruff, impish or affectionate.
His signature accomplishment was the central role he played in creating a global network of surveys on aging, which have upended conventional wisdom about aspects of health and medical care. The original survey, the Health and Retirement Study, began in the United States under Mr. Suzman in the early 1990s. With his global evangelizing for similarly rigorous research, the survey has spread to Europe, Mexico, Brazil, China and India.
The results have made clear how often financial problems cause health problems for people, and vice versa. The survey has shown that middle-aged adults in the United States are less healthy than those in Britain, in part because of childhood illnesses, even when both sets of adults have similar amounts of insurance coverage. And the data has increased understanding of why people of higher social classes live longer. James P. Smith, an economist at the RAND Corporation, called the survey “the most successful new study in the last 25 years.”
Dr. Suzman also encouraged the rise of behavioral economics, a once-marginalized discipline that dared to point out that human beings were not as rational as classical economic models assumed. Behavioral economics is a core part of mainstream economics today, because of researchers whose work Mr. Suzman — as well as the Russell Sage Foundation in New York — helped finance. In some cases, he introduced the researchers to one another.
“Descriptions of him sound like an oxymoron,” said Daniel Kahneman, the winner of the Nobel in economic science whom Mr. Suzman chased down in the rain. He was, Mr. Kahneman added, “an original and creative bureaucrat,” “a brilliant scientist who does not do science” and “a tyrant with a twinkle.”
Richard Michael Suzman was born in Johannesburg on Aug. 9, 1942, one of four sons of a barrister. He became active in the anti-apartheid movement in the wake of the 1960 Sharpeville massacre. After his first year of college, his family grew nervous that Dr. Suzman would be arrested. Some of his friends had been.
He left South Africa, with some haste, in the summer of 1961 and moved to London, where he planned to study at the University of London. But lacking the required Latin credentials, he could not enroll immediately. His father then called an acquaintance at Harvard and urged the university to look at his son’s transcript. Several weeks later, Richard entered the college with sophomore standing.
After a postdoctorate program at Stanford University, he was preparing to move back east in 1975, most likely for a position at the National Academy of Sciences in Washington, when he met a young woman — Ms. Krupnick — at a local pool and soon abandoned the plan.
Instead he took a position in the human development and aging program at the University of California, San Francisco, which led to a job at the National Institute of Aging.
He lived in Chevy Chase, Md. In addition to his wife, he is survived by their daughter, Jessica; their son, Daniel; and three brothers, David, Peter, and Stephen.
Mr. Suzman’s academic reach was wide, touching research on happiness, financial savings, the job market and risky behaviors. But his greatest impact was on the Health and Retirement Study and similar studies in other countries.
James M. Poterba, an M.I.T. economist and president of the National Bureau of Economic Research, said that Mr. Suzman had recognized that the fractured nature of research on aging was hampering the field. Academics in different fields and different countries were each using small data sets to study the same questions — and not talking to one another about the results.
“He dangled the lure of a rich new data set before researchers in each of these fields,” Mr. Poterba said. In return, Mr. Suzman insisted that they detail their research plans in advance, which then improved the quality of the survey. Within the government, he often defended the survey, which was not inexpensive, because it was following the same people over many years.
The survey also allowed Mr. Suzman a chance to reconnect with his native country. In 1994, he had already had the satisfaction of voting for Nelson Mandela, at a voting station in the Washington embassy of the country he had fled 33 years earlier. In his final years at the National Institutes of Health, he helped expand the network of large health surveys in several African countries, including South Africa. Marijuana and the Body
CreditVictoria Roberts
Q&A
Q. Leaving aside questions of addiction and brain effects, what is known about the effects of marijuana on things like the lungs and digestive tract?
A. The limited formal studies that have been done on marijuana and cancer have yielded complex and often conflicting results, according to a summary of researchupdated last year and published by the National Cancer Institute for health professionals.
For example, a large study reviewing the medical records of 64,855 men in the United States found that use of cannabis was not associated with tobacco-related cancers and a number of others, but was linked to an increased risk of prostate cancer. But a smaller study in North Africa, involving 430 cases and 773 controls, did find an increased risk of lung cancer in those who also smoked tobacco.
A recent survey of large cross sections of adults in the United States found that daily smoking of marijuana for up to 20 years did not harm lung function as measured by airflow on exhalation. As for the digestive tract, marijuana and its derivatives have been used to improve appetite and fight nausea in cancer patients, but inhaled marijuana has been subject to only three small formal anti-nausea studies, and the results were inconclusive, the N.C.I. said. question@nytimes.com
question@nytimes.com
Questions of general interest will be answered, but requests for medical advice cannot be honored and unpublished letters cannot be answered individually.
The Dutch company said it had received a final assessment report from the European Medicines Agency's Committee for Advanced Therapies (CAT) following doubts raised by the adviser, a so-called rapporteur.
"The CAT did not agree with the negative view of the rapporteur," UniQure said in a statement, adding that the views of the CAT were endorsed by the agency's senior body, the Committee for Human Medicinal Products.
UniQure's Nasdaq-listed shares fell last month when it emerged that the rapporteur believed Glybera lacked efficacy. A German regulator for new drugs also suspended its assessment of the product.
The drug, which is sold by UniQure's unlisted Italian marketing partner Chiesi for treating an ultra-rare blood disorder, has had a tortuous journey to market as regulators have struggled to assess its effectiveness because of the very small number of patients available for clinical tests.
The medicine was approved in Europe two years ago but its launch was delayed to allow for the collection of six-year follow-up data on its benefits.
UniQure is also developing other gene therapies that are viewed as more important to its commercial future. In April it signed a major collaboration deal with Bristol-Myers Squibb.
UN hails progress on Ebola as new weekly cases below 20
U.N. special envoy on Ebola Dr. David Nabarro speaks during an interview at the United Nations Headquarters in New York January 15, 2015.
(Reuters) - The U.N. envoy on Ebola on Tuesday hailed "extraordinary progress" against the outbreak in West Africa after new cases last week fell below 20 for the first time since mid-2014, but he warned it would take time to end the epidemic completely.
David Nabarro said that in the week to May 3 only nine new cases were reported in Guinea and the same number in neighboring Sierra Leone. Liberia once again had no new cases.
Nabarro said he was optimistic that Liberia would be declared Ebola-free on May 9, when it is due to reach the official World Health Organization (WHO) standard of 42 days without a new Ebola case. That period marks twice the maximum official incubation period for the deadly hemorrhagic virus.
"This is extraordinary progress. For those of us involved in this, we have got used to having good news one week, bad news the next, so we are not starting to celebrate yet, but we are feeling positive," Nabarro told a news conference in Dakar.
The WHO said in its latest update on Tuesday that the world's worst recorded Ebola outbreak - which erupted in remote southeastern Guinea in December 2013 - had killed a total of 10,980 people and infected more than 26,500.
Nabarro said the share of new cases which have come into contact with previous identified Ebola victims - a key marker of how well health officials have isolated the epidemic - now exceeded 50 percent and was headed towards 75 percent.
"We are moving towards the end, but we just don't know when it will come. In Liberia it took a long time - it took about two months to move from single-figure cases to zero - so we are not anticipating that this will be a very rapid thing," he said.
"That's why I am telling everyone ... don't turn away, don't let off the effort: we must finish it and finish it well."
The U.N. mission for Ebola Emergency Response, established in September, is due to wind up at the end of July and Nabarro said its responsibilities would be handed over to other agencies of the United Nations.
WHO projections warn of burgeoning obesity crisis in Europe
File photo of a passenger Heathrow airport's terminal four in London August 12, 2006.
(Reuters) - Europe will face an obesity crisis of vast proportions by 2030, according to new World Health Organization projections, with many countries likely to see far more than half of adults above the healthy weight limit.
The figures, which predict 89 percent of Irish men and 77 percent of Greek men will be overweight by 2030, present "a worrying picture of rising obesity across Europe", researchers said, with very few countries showing decreasing trends.
"Although there is no silver bullet for tackling the epidemic, governments must do more to restrict unhealthy food marketing and make healthy food more affordable," said Dr Laura Webber of the UK Health Forum, which worked with the WHO and the European Commission to produce the new projections.
She also said insufficient data from some countries in the WHO's European region - which comprises 53 nations - made surveillance of obesity more difficult, hampering efforts to make accurate predictions.
A body mass index (BMI) - calculated by dividing a person's weight in kilograms by the square of their height in meters - of more than 25 is classified as overweight. A BMI of more than 30 is classed as obese.
The latest predictions used data from across the region and compared the proportions of overweight people and obese people in 2010 with projected future levels.
They showed that by 2030, a third of women in the UK are forecast to be obese, compared with 26 percent in 2010. For UK men, almost three-quarters will be overweight and 36 percent are likely to be obese in 2030, compared with 70 percent and 26 percent respectively in 2010.
The researchers, who were due to present their data at the European Congress on Obesity in Prague on Wednesday, said other countries with projected steep rises in obesity included Greece, Spain, Sweden, Austria and the Czech Republic.
The proportion of obese Greek men will more than double from 20 percent to 44 percent between 2010 and 2030, and the proportion of obese Greek women is seen doubling to 40 percent.
Even in countries usually recording a lower prevalence of obesity, such as Sweden, obesity rates are predicted to rise sharply. An estimated 26 percent of Swedish men will be obese by 2030 compared with 14 percent in 2010, while for women obesity rates will rise from 12 percent to 22 percent.
Most countries not protecting antibiotics, says WHO
Three-quarters of countries do not have plans in place to preserve antimicrobial medicines, the World Health Organization says.
The body has repeatedly warned that the globe is heading into a "post-antibiotic era" in which much of modern medicine becomes impossible.
Its report showed "a lot more needs to be done" to prevent the rise of resistance in a range of infections.
Experts said it was an "appalling state of affairs".
It is in the very nature of microbes to develop resistance to the drugs we use against them.
If the drugs stop working, then common infections, such as tuberculosis, will kill again. Surgery and cancer treatment are also reliant on the drugs to keep patients alive.
While much of the attention has been on antibiotics, there are also warnings around HIV resistance to antiviral drugs and the malaria parasite becoming resistant to the last treatment.
No plan
In advance of a meeting of the WHO's World Health Assembly next month, officials have assessed the state of 133 countries' efforts to combat the problem.
Their report showed that only 34 countries had a "national plan" for how to deal with rising levels of resistance.
Dr Charles Penn, co-ordinator for antimicrobial resistance at the WHO, told the BBC News website: "Antimicrobial medicines are a very precious and valuable resource and something we cannot take for granted.
"This is the first report to capture on a worldwide basis what is currently being done.
"Only one in four had in place a national action plan and that's too few, a lot more needs to be done.
"Public awareness of the issue is low in all regions, many people still believe antibiotics that kill bacteria will work for viruses such as the common cold or flu."
The meeting of the World Health Assembly in May will discuss a global plan for all countries to adopt.
"We need the world to act as a whole, we need all countries to put things in place to address the problem and for every country to be travelling in the same direction," said Dr Penn.
Commenting on the report, Dr Mike Turner from the Wellcome Trust medical charity, said: "Drug-resistant infections are one of the biggest threats to the future of global health.
"Yet in most areas of the world we have no idea which drugs are being sold to whom and for what purpose. This is an appalling state of affairs.
"We cannot hope to stop bacteria becoming resistant to drugs unless we have simple, basic information in place."
'First natural birth' for diabetic woman with artificial pancreas
Catriona Finlayson-Wilkins had her son after wearing the device to keep her blood sugar levels normalA diabetic woman has become the first in the world to give birth naturally after using an artificial pancreas while pregnant, experts have said.
Catriona Finlayson-Wilkins, 41, of Knapton, Norfolk, gave birth to son Euan on Tuesday at the Norfolk and Norfolk University Hospital.
She is also the first woman to give birth after using the device outside the main research site in Cambridge.
Ms Finlayson-Wilkins said she was "thrilled" by her son's safe arrival.
The new mother-of-two has Type 1 diabetes and wore the piece of kit throughout her pregnancy to produce insulin and prevent symptoms of the disease.
Three other mothers have previously given birth in Cambridge after using the device but by caesarean section.
Artificial pancreas breakthrough
The artificial pancreas is made up of a glucose monitor, digital controller and insulin pumpAn artificial pancreas device system (APDS) is a small portable piece of equipment designed to carry out the function of a healthy pancreas.
It helps to control blood glucose levels using digital communication technology to automate insulin delivery.
An APDS is worn on the body during pregnancy and has a continuous glucose monitor (CGM), a digital controller and an insulin pump.
The device carries out the function of a healthy pancreas in controlling blood sugar levelsMs Finlayson-Wilkins, who is a face and body painter and has also decorated models for local charity Break's GoGo gorilla and dragon art trails, said: "I'm thrilled.
"It's a huge weight off your mind after being pregnant and diabetic, which is really risky.
"It's the most amazing piece of kit and I can really see how it's going to benefit all types of people with diabetes in the future."
Her first son was taken into intensive care when he was born because his blood sugar levels dropped dangerously low and she did not see him for a day.
Baby Euan was born at the Norfolk and Norwich University Hospital and weighed 8lb 14oz (4kg)Dr Helen Murphy, principal investigator of the study Ms Finlayson-Wilkins took part in, said Euan's arrival was an exciting step in the treatment of diabetes in pregnancy.
"Women who have diabetes in pregnancy face higher rates of birth defects, over-sized babies, pre-term delivery and stillbirth than other pregnant women," she said.
"Treating diabetes in pregnancy can be particularly challenging because hormone levels are constantly changing and blood sugars can be difficult to predict."
The results of the ongoing National Institute for Health Research's Closed Loop in Pregnancy study are due to be published later this year.
Its findings could mean the technology benefits more pregnant women with diabetes.
3D windpipe 'saves children's lives'
Kaiba is now a healthy three-year-oldThree babies have been saved from a life-threatening condition by using 3D printed windpipe splints to help them breathe, a pilot study reveals.
The patients suffer from a rare illness that means their windpipes can collapse and prevent air getting in.
The device was rapidly customised for each individual. And unlike most 3D implants, it was made of material that changed shape as the children grew.
The research appears in Science Translational Medicine.
Last resort
Due to the small number of children involved in the study it does not prove it will work in every case.
But it does show the splints could be a promising option for a condition that has no cure, researchers from CS Mott Children's Hospital at the University of Michigan say.
One in 2,000 children have tracheobronchomalacia - a weakening and collapse of the windpipe (trachea) that would normally allow air to travel to the lungs.
Those with the most severe form have a poor chance of surviving. But if they can get to the the age of three, their windpipes have often strengthened enough to allow them to breathe well.
Kaiba Gionfriddo had the procedure when he was just three months old. He was in a critical condition, needing intensive care because his body was not getting the oxygen it needed.
So doctors sought emergency approval to use the device as a a last resort.
Lead researcher Dr Glenn Green described it as a ground-breaking case.
Kaiba is now "an active, healthy three-year old in preschool with a bright future", researchers said.
Dissolving device
Almost three years later the splint shows signs of melting away as planned. And doctors say his windpipe appears strong enough for him to breathe without its support.
April Gionfriddo, Kaiba's mum, said: "The first time he was hospitalised, doctors told us he may not make it out.
"It was scary knowing he was the first child to ever have this procedure, but it was our only choice and it saved his life."
The team have now carried out the surgery on two other children.
Both are doing well and are back at home, though one continues to need a machine to help his breathing, because of problems the splint could not address.
Dr Patrick Finlay, of the Institution of Mechanical Engineers, described it as an advanced piece of engineering.
He said: "The problem represents some formidable difficulties.
"You have to construct something that can cope with growth and coughing and sneezing.
"And they seem to have done this - it is very exciting."
He said the splint could be thought of as similar to a section of vacuum cleaner pipe that had been split in the middle.
It is customised to match the exact anatomy of each patient and made of a bio-absorbable material.
Doctors sew it in place on the outside of the windpipe as an incomplete ring.
The aim is for it to provide support without constricting growth.
Prof Paolo De Coppi of Great Ormond Street Hospital described this as a very attractive way of doing the procedure.
He said: "Other options can include internally placed stents - but these can cause bleeding and other complications.
"It is very encouraging news to see at three years that it appears safe and effective in this child."
US researchers have filed a patent on the device and are now embarking on a larger trial.
US 'will not fund research for modifying embryo DNA'
Francis Collins is the director of the US National Institutes of HealthModifying the DNA of embryos is a "line that should not be crossed", a leading figure in US research says.
Dr Francis Collins, National Institutes of Health director, was responding to reportsthat the first embryos had been modified in China.
He argued there were "serious and unquantifiable safety issues", big ethical questions and no compelling medical reason to do it.
He said the NIH would not fund such research in the US.
The advent of "Crispr technology" - which is a more precise way of editing DNA than anything that has come before - has spurred huge progress in genetics.
But there had been growing concern these tremendous advances were making the modification of human embryos more likely.
Dr Tony Perry, a pioneer in cloning, told the BBC News website in January that designer babies were no longer "HG Wells" territory.
Concerns were also raised in the journal Nature as rumours circulated that it had already taken place.
World first
Last week a team at Sun Yat-sen University, in Guangzhou, reported using Crispr to modify defective parts of DNA that lead to a blood disorder called beta thalassaemia.
Their world first, reported in the journal Protein and Cell, showed the correction was successful in seven out of 86 attempts.
However, there were a number of other "off-target" mutations introduced to the genetic code.
The embryos used were "non-viable" so could never have led to a child.
There have been repeated calls for a worldwide freeze on such research while society as a whole decides what should be allowed.
However, the US National Institutes of Health has made its position clear - that no such research should take place.
Dr Collins, who was also a key player in the Human Genome Project, released a statement saying: "The concept of altering the human germline in embryos for clinical purposes has been debated over many years from many different perspectives, and has been viewed almost universally as a line that should not be crossed.
"Advances in technology have given us an elegant new way of carrying out genome editing, but the strong arguments against engaging in this activity remain.
"These include the serious and unquantifiable safety issues, ethical issues presented by altering the germline in a way that affects the next generation without their consent, and a current lack of compelling medical applications."
Dr Marcy Darnovsky, from the Center for Genetics and Society in the US, argued: "There is no persuasive medical reason to manipulate the human germline because inherited genetic diseases can be prevented using embryo screening techniques, among other means.
"Is the only justification for trying to refine germline gene editing the prospect of so-called enhancement?"
Avian Flu Infections Are Found at Five More Iowa Poultry Farms
By REUTERSAPRIL 30, 2015
The highly pathogenic H5 avian flu turned up in initial tests at five more farms in Iowa, including a commercial egg operation housing up to 5.5 million birds, Iowa’s agriculture department said on Thursday.
If the virus is confirmed at the farms in additional tests underway at a federal Agriculture Department laboratory, the number of American cases could surpass 20 million birds and result in the biggest death toll in a bird flu outbreak in United States history.
The latest case, at an egg farm in Buena Vista County, could be the largest single operation to be hit in the current outbreak.
The egg farm’s owner, Rembrandt Foods, one of the top egg producers in the United States, confirmed the outbreak but disputed the number of birds affected. The state did not identify the affected farm by name.
Avian flu was probable at four other commercial farms in Buena Vista, Sioux and Clay Counties, the Iowa Department of Agriculture and Land Stewardship said. If the virus is confirmed at all five farms in the coming days, the number of sites where H5 has been found in Iowa would rise to 17.
Hours earlier on Thursday, state officials confirmed that an Iowa-based chicken broiler breeding farm had initially tested positive for the virus.
The farm, in Kossuth County, was comparatively small, with an estimated 19,000 birds. But it was thought to be the first time in this outbreak that the virus had affected a broiler breeding farm; such farms are said to have better biosecurity systems. And it underscores the potential for the outbreak to have a wide-ranging effect on the country’s poultry supply chain.
Infections with the H5N2 strain have picked up pace in the last few weeks. On Monday, officials in Iowa reported probable cases at five farms affecting an estimated six million chickens, and a turkey farm in Wisconsin with more than a million birds tested positive.
Two bird flu strains have been found in the United States this year. The H5N2 strain has been reported in Arkansas, Idaho, Iowa, Kansas, Kentucky, Minnesota, Missouri, Montana, North Dakota, Oregon, South Dakota, Washington and Wisconsin. It has also been identified on farms in Ontario, Canada.
The H5N8 strain has been identified in California and also in Idaho, according to the Agriculture Department.
The potential economic cost of the outbreak is unclear. The number of birds affected by the outbreak so far represents a fraction of the United States commercial flock. Poultry processors slaughtered nearly 8.7 billion chickens in 2014 and about 237 million turkeys, according Agriculture Department data.
The virus can kill nearly an entire infected flock in 48 hours.
In the outbreak of 1983 to 1984 in the Northeast, so far the largest in American history, about 17 million birds were culled.
Indiana Governor to Approve Needle Exchanges to Fight H.I.V.
Gov. Mike Pence of Indiana has said he will sign a bill allowing cities and counties to create needle exchange programs if they are experiencing an outbreak of H.I.V. or hepatitis C because of intravenous drug use.
The bill requires the state health commissioner to approve each such program by declaring a public health emergency that must be renewed after a year.
Mr. Pence, a Republican who has said he opposes needle exchanges as antidrug policy, authorized a temporary exchange in Scott County in March because of a growing outbreak of H.I.V. there. More than 140 people in the rural county have tested positive for the virus since December.
In a statement, Mr. Pence praised the legislation for allowing “limited and accountable” needle exchanges that “will save lives.” But critics said the legislation required too many steps before an exchange could be established.
Pine Ridge Indian Reservation Struggles With Suicides Among Its Young
A portrait of Santana Janis, a 12-year-old Lakota Indian, in the home of her grandfather Keith Janis, foreground, on Pine Ridge Indian Reservation in South Dakota. Since December, nine young people, including Santana, have committed suicide on the reservation.CreditKristina Barker for The New York TimesPINE RIDGE INDIAN RESERVATION, S.D. — A few days before Christmas, Santana Janis, a 12-year-old Lakota Indian, decided that she did not want to live anymore.
A bright, outgoing girl with a shy smile and passion for horseback riding, Santana’s moods had turned dark. She lived in a derelict two-bedroom trailer with a grandfather, Earl Tall, and as many as a dozen siblings and cousins. Her mother, an alcoholic, was an intermittent presence in her life. Their town, Manderson, was torn by drinking, fighting and violence.
Mr. Tall overheard his granddaughter’s talk of suicide and called her other grandfather, Keith Janis, who immediately drove 40 miles to see her. “I sat down with her and said, ‘Please, promise Grandpa you’ll never do that,’ ” Mr. Janis recalled last week. “She gave me that big, beautiful smile of hers and said, ‘O.K., Grandpa, O.K.’ ”
Six weeks later, Santana hanged herself in a small, unheated building next to the trailer.
Since December, the Pine Ridge reservation, a vast, windswept land of stunning grasslands and dusty plateaus, has been the scene of an unfolding crisis: nine people between the ages of 12 and 24 have committed suicide here.Photo
John Yellow Bird Steele, the Oglala Sioux tribe president, last week. He declared an emergency on the reservation in February. CreditKristina Barker for The New York TimesTwo teenagers hanged themselves in December. In the next three months, seven more young people were found dead, including Alanie Martin, 14, who was known for her love of basketball, cheerleading and traditional Indian hand games. When Santana killed herself in February, she followed another recent suicide of a boy who attended her school, Wounded Knee, so named for the 1890 massacre that occurred where the reservation stands today.
Many more youths on the reservation have tried, but failed, to kill themselves in the past several months: at least 103 attempts by people ages 12 to 24 occurred from December to March, according to the federal Indian Health Service. Grim-faced emergency medical workers on the reservation, which is the size of Delaware and Rhode Island combined, say they have been called to the scenes ofsuicide attempts sometimes several times a day.
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Tribe officials, clergy members and social workers say they cannot remember such a high rate of suicides and attempts in such a short period of time on the reservation, which is already overwhelmed with high rates of unemployment, poverty, domestic abuse and alcohol addiction.
In 2013, five people, including adults and children, killed themselves in a single year, according to the Oglala Sioux tribe. But officials at Pine Ridge said they were mystified by the far more pronounced increase in the past several months and had searched, unsuccessfully, for answers.
As the suicides began to mount in February, the Oglala Sioux tribe president, John Yellow Bird Steele, declared an emergency on the reservation. In response, the Indian Health Service deployed additional counselors, but many people here say it is not nearly enough: There are only six mental health professionals on the entire reservation, which has a population of 16,000 to 40,000 members of the tribe.
“It is devastating,” Mr. Steele said. “I don’t know if they were cyberbullied, or if they had living conditions they didn’t want to put up with, or they were sexually abused. Were they hungry? I don’t know.”
“When you have a good understanding of what’s happening,” he said, “come back and tell me.”Photo
The Badlands, viewed from the Pine Ridge reservation. The reservation is already overwhelmed with high rates of unemployment, poverty, domestic abuse and alcohol addiction. CreditKristina Barker for The New York TimesBut family members and tribe officials said they had seen disturbing clues.
Outside the Pine Ridge School, where four of its 800 students have committed suicide in recent months, Myra Slow Bear, 15, a friend of Alanie’s, said that other students had been bullying Alanie.
“I knew she was depressed,” she said. Among teenagers at the school, she said, attempting suicide is not unusual.
“It’s just a common thing,” she said.
Mr. Tall, Santana’s grandfather, also said that she had conflicts with other students at school. An official with knowledge of the case said that shortly before Santana committed suicide, another girl at school had written to her on Facebook, urging her to kill herself.
Several officials with knowledge of the cases said that at least one of the youths who committed suicide was influenced by Slender Man, a tall, faceless creature who appears in storytelling websites, often as a figure who stalks and kills victims. Two girls in a Milwaukee suburb last summer said the character had inspired them in the attempted murder of a classmate.
“They call him the Tall Man spirit,” said Chris Carey, a minister who works with youths, some of them suicidal, on the reservation. “He’s appearing to these kids and telling them to kill themselves.”Photo
“It’s just a common thing,” said Myra Slow Bear, 15, of suicide attempts on the reservation. Her friend Alanie Martin, 14, committed suicide this year. CreditKristina Barker for The New York TimesMr. Steele, who said many Native Americans traditionally believe in a “suicide spirit” similar to Slender Man, said that young people had been sharing disturbing videos on Facebook that encourage suicide. One video, he said, gave instructions on tying a hangman’s noose. Another directed children to go to a specific place outside the village, saying there were ropes there. “Go use them,” the video instructed.
John Two Bulls, a pastor who works with youths on the reservation, said that two months ago, he was tipped off to a group suicide planned in a wooded area outside the town of Pine Ridge. Frantic, he drove to the spot.
“It was cold, it was dark, and there was a row of trees with ropes hanging off the branches,” he said. “I was thankful that we were able to get there without finding anybody hanging from those ropes.”
Some teenagers had already congregated there, he said, and he urged them to gather around. “I counseled them, prayed with them, talked with them,” he said. They told him that “they were tired of the lives they had at home, no food, with parents all intoxicated, and some were being abused, mentally or sexually.”
Mental health professionals said they suspected that in some cases, young people might have been influenced by previous suicides. Feeling neglected, they can be attracted to the public displays of mourning that follow a death; and once they hear about the method of suicide, they imitate it.
“Contagion does occur with teenagers,” said Stephanie Schweitzer Dixon, the executive director of the Front Porch Coalition, a suicide prevention group in Rapid City, S.D. “Kids are young, they don’t think clearly, their brains aren’t fully developed. I know that things seem to be getting worse for kids. Things seem to be getting more dire.”
Ted Hamilton, the superintendent of the Red Cloud Indian School, a Jesuit school on the reservation, said that suicide is an issue that schools grapple with constantly.Photo
Boys playing basketball on the reservation last week. Children on reservations face a variety of challenges including a legacy of oppression and forced removals and the lack of jobs and economic opportunity. CreditKristina Barker for The New York Times
“To be Lakota in this world is a challenge because they want to maintain their own culture, but they’re being told their culture is not successful,” Mr. Hamilton said.
Children on Indian reservations, he added, have extraordinary challenges: the legacy of oppression and forced removals, the lack of jobs and economic opportunity, and the high levels of drug and alcohol use around them.
“The federal government has dropped the ball in terms of mental health resources,” Mr. Hamilton said. “The system is overwhelmed. No matter which reservation you go to, that’s what you’ll find.”
Ron Cornelius, the Great Plains director of the Indian Health Service, said in a statement that the recent suicides were “an incredibly sad situation” that the agency was determined to address. “I.H.S. is committed to working with the tribe to address this heartbreaking problem,” he said.
When Mr. Janis, a longtime activist, talks about Santana’s death, he points to the “multigenerational trauma” inflicted on Native Americans by whites and the tensions that still exist between the groups. On an overnight trip to Rapid City over the New Year, a group of girls including Santana overheard a white woman call them “filthy Indians” as they passed through a hotel lobby, he said.
“My beautiful Lakota granddaughter,” he said. “She had to hear that. Our kids today just want to die because they’re sick of all this oppression.”
Last week, at the Pine Ridge Gospel Fellowship, a small, white clapboard church in the heart of the reservation, a group of clergy members, social workers and tribal elders met for an informal prayer session.
As one pastor played hymns on an acoustic guitar, Norma Blacksmith, who lost a grandson to suicide several years ago, bowed her head and closed her eyes.
“In our culture, Lord, the children are sacred,” she said. “We thank you that there have been no suicides in this last week. You answered our prayer.”
Bill to Speed Approvals for Drugs Is Cut Back
WASHINGTON — Legislation that would have accelerated the pace of federal drug approvals in a way that critics said threatened to erode patient safety was formally released this week, in a scaled-back version with many of the most controversial provisions left out.
The draft bill presented at a hearing in the House on Thursday represents a less aggressive streamlining of the drug approval process, critics of the earlier draft said, and seems to have secured strong bipartisan support.
The legislation, called 21st Century Cures, has been in the works for months. Its lead sponsor, Fred Upton, Republican of Michigan, said it would speed the pace of drug cures by removing unnecessary hurdles from the regulatory process.
Critics, including top officials at the Food and Drug Administration, had expressed concern that the changes would risk patient safety — for example, by potentially permitting shorter clinical trials and letting drug companies use alternative measures of health as evidence of a drug’s effectiveness and safety.
The bill’s supporters said it was a work in progress that had been assembled in one of the most collaborative, transparent processes Congress has seen in years. The sponsors held eight hearings and more than a dozen round-table meetings in districts across the country to gather comment.
“We have a chance to do something big, and this is our time,” Mr. Upton said.
His co-sponsor, Diana DeGette, Democrat of Colorado, said the lawmakers had made “tremendous progress,” recalling “that hokey video” that she and Mr. Upton made to promote the effort last year.
The draft — at about 200 pages it is half its former size — seemed to allay fears among some experts that it would fundamentally rewire the way drugs are approved. Earlier proposals to give drug companies broad powers to promote their products for uses other than the approved ones and to market brand-name drugs for a longer time without generic competition were not included.
The F.D.A. has defended its record for drug approval speed, saying that in 2014, it approved the most new drugs in almost 20 years, and that it moves faster than its counterparts in other wealthy countries. Experts note that pathways exist for expedited approval, and that the F.D.A. is held to relatively strict timelines under other rules set by Congress. Instead, they say, the bottleneck for new drugs is often a matter of the years of research it takes to find them.
Diana Zuckerman, the president of the National Center for Health Research, said earlier versions of the legislation had “considerable micromanaging of the F.D.A. and enormous power given to industry.”
She added, “Most of that is gone.”
But she cautioned that the bill still held numerous provisions she believed put people at risk, including ones she described as lowering standards for the approval of medical devices and antibiotics. The bill would increase the work the F.D.A. must perform, but not the money it receives, and Dr. Janet Woodcock, an agency official who testified Thursday, said that was a concern.
“We are very stretched in our resources,” she said.
One point that is likely to concern the F.D.A. is a provision that would reduce its authority to regulate some software associated with medical devices.
An earlier version of the bill would have let drugmakers use quicker measures for a drug’s effectiveness during testing — for example, changes in blood sugar level instead of a more final outcome, like development of diabetes. The new draft instead suggests ways the F.D.A. could use those alternative measures, called biomarkers.
The F.D.A. says it already uses them in a substantial share of drug approvals, and Dr. Woodcock told the lawmakers Thursday that the agency did not need additional authority on this count. Progress has been slow in adopting more biomarkers, she said, because they often did not produce enough evidence to allow scientists to draw firm conclusions.
“You have to know those biomarkers are reliable before you can take a chance on a human life,” she said.
Substituting just one serving a day of water or unsweetened tea or coffee for one serving of a sugar-sweetened soft drink or dairy beverage can significantly reduce the incidence of Type 2 diabetes, a new study has found.
The study, in Diabetologia, used data on diet and diabetes incidence from more than 25,000 British men and women ages 40 to 79. Researchers tracked consumption of soft drinks, tea and coffee, fruit juice and sweetened milk drinks like hot chocolate and milkshakes.
Almost everyone habitually drank something sweet, usually soft drinks or sweetened tea or coffee. After adjusting for body mass index, calorie intake and a range of diet, behavioral and socioeconomic factors, the researchers found that one serving per day of either a soft drink or sweetened milk drink increased the risk of diabetes by 14 percent to 27 percent.
Each additional 5 percent of total calories consisting of sweetened drinks raised the risk of diabetes by 18 percent. Drinking sweetened tea or coffee did not change the risk for diabetes, and consuming those beverages without sugar lowered the risk. After an adjustment for all the variables, fruit juice had no effect on the risk of diabetes.
“We hear a lot about the bad health effects of these drinks,” said the senior author, Dr. Nita G. Forouhi of the University of Cambridge. “We usually give the bad news, but here we have some solutions for what good replacement drinks are: water and unsweetened tea and coffee.”
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Richard Suzman, 72, Dies: Researcher Influenced Global Surveys on Aging
Richard Suzman once chased a Nobel-winning psychologist through a Washington rainstorm, as a scientific meeting was breaking up, to whet the psychologist’s interest in a new project. In the middle of the night, Dr. Suzman liked to email social scientists, urging them to take immediate action on a project. Other times, an email or phone call would all but order a researcher to apply for a grant.
A social psychologist by training who left his native South Africa as a teenager, Mr. Suzman built a government career like few others.
As a longtime official at the National Institutes of Health with an ambitious definition of his job, he influenced economics, public health and other fields over three decades.
He died at 72 on April 16 in Bethesda, Md. The cause was complications of amyotrophic lateral sclerosis, said Janice Krupnick, his wife of 39 years and a clinical psychologist at Georgetown University.
Dr. Suzman used his position as the director of the Behavioral and Social Research division at the National Institute of Aging, part of the N.I.H., not merely to evaluate incoming grant proposals but also to act as a scientific hub.
“Richard was a uniquely entrepreneurial, proactive bureaucrat,” said Alan B. Krueger, a Princeton professor and former chairman of the Council of Economic Advisers under President Obama.
Dr. Suzman connected researchers across disciplines and shaped their proposals. To do so, he relied on both his sway over federal research funds and an intensity that could be gruff, impish or affectionate.
His signature accomplishment was the central role he played in creating a global network of surveys on aging, which have upended conventional wisdom about aspects of health and medical care. The original survey, the Health and Retirement Study, began in the United States under Mr. Suzman in the early 1990s. With his global evangelizing for similarly rigorous research, the survey has spread to Europe, Mexico, Brazil, China and India.
The results have made clear how often financial problems cause health problems for people, and vice versa. The survey has shown that middle-aged adults in the United States are less healthy than those in Britain, in part because of childhood illnesses, even when both sets of adults have similar amounts of insurance coverage. And the data has increased understanding of why people of higher social classes live longer. James P. Smith, an economist at the RAND Corporation, called the survey “the most successful new study in the last 25 years.”
Dr. Suzman also encouraged the rise of behavioral economics, a once-marginalized discipline that dared to point out that human beings were not as rational as classical economic models assumed. Behavioral economics is a core part of mainstream economics today, because of researchers whose work Mr. Suzman — as well as the Russell Sage Foundation in New York — helped finance. In some cases, he introduced the researchers to one another.
“Descriptions of him sound like an oxymoron,” said Daniel Kahneman, the winner of the Nobel in economic science whom Mr. Suzman chased down in the rain. He was, Mr. Kahneman added, “an original and creative bureaucrat,” “a brilliant scientist who does not do science” and “a tyrant with a twinkle.”
Richard Michael Suzman was born in Johannesburg on Aug. 9, 1942, one of four sons of a barrister. He became active in the anti-apartheid movement in the wake of the 1960 Sharpeville massacre. After his first year of college, his family grew nervous that Dr. Suzman would be arrested. Some of his friends had been.
He left South Africa, with some haste, in the summer of 1961 and moved to London, where he planned to study at the University of London. But lacking the required Latin credentials, he could not enroll immediately. His father then called an acquaintance at Harvard and urged the university to look at his son’s transcript. Several weeks later, Richard entered the college with sophomore standing.
After a postdoctorate program at Stanford University, he was preparing to move back east in 1975, most likely for a position at the National Academy of Sciences in Washington, when he met a young woman — Ms. Krupnick — at a local pool and soon abandoned the plan.
Instead he took a position in the human development and aging program at the University of California, San Francisco, which led to a job at the National Institute of Aging.
He lived in Chevy Chase, Md. In addition to his wife, he is survived by their daughter, Jessica; their son, Daniel; and three brothers, David, Peter, and Stephen.
Mr. Suzman’s academic reach was wide, touching research on happiness, financial savings, the job market and risky behaviors. But his greatest impact was on the Health and Retirement Study and similar studies in other countries.
James M. Poterba, an M.I.T. economist and president of the National Bureau of Economic Research, said that Mr. Suzman had recognized that the fractured nature of research on aging was hampering the field. Academics in different fields and different countries were each using small data sets to study the same questions — and not talking to one another about the results.
“He dangled the lure of a rich new data set before researchers in each of these fields,” Mr. Poterba said. In return, Mr. Suzman insisted that they detail their research plans in advance, which then improved the quality of the survey. Within the government, he often defended the survey, which was not inexpensive, because it was following the same people over many years.
The survey also allowed Mr. Suzman a chance to reconnect with his native country. In 1994, he had already had the satisfaction of voting for Nelson Mandela, at a voting station in the Washington embassy of the country he had fled 33 years earlier. In his final years at the National Institutes of Health, he helped expand the network of large health surveys in several African countries, including South Africa.
Q&A
Q. Leaving aside questions of addiction and brain effects, what is known about the effects of marijuana on things like the lungs and digestive tract?
A. The limited formal studies that have been done on marijuana and cancer have yielded complex and often conflicting results, according to a summary of researchupdated last year and published by the National Cancer Institute for health professionals.
For example, a large study reviewing the medical records of 64,855 men in the United States found that use of cannabis was not associated with tobacco-related cancers and a number of others, but was linked to an increased risk of prostate cancer. But a smaller study in North Africa, involving 430 cases and 773 controls, did find an increased risk of lung cancer in those who also smoked tobacco.
A recent survey of large cross sections of adults in the United States found that daily smoking of marijuana for up to 20 years did not harm lung function as measured by airflow on exhalation. As for the digestive tract, marijuana and its derivatives have been used to improve appetite and fight nausea in cancer patients, but inhaled marijuana has been subject to only three small formal anti-nausea studies, and the results were inconclusive, the N.C.I. said. question@nytimes.com
question@nytimes.com
Questions of general interest will be answered, but requests for medical advice cannot be honored and unpublished letters cannot be answered individually.
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