(whitehouse.gov)

Doctor Tiger.

As U.S. lawmakers work toward a final agreement on overhauling health care, President Barack Obama says some of the reforms will take effect this year.  The president admits, however, that other changes will not be in place for several years.

President Obama is working with Democrats in both houses of Congress to merge their two versions of health reform.  

In the meantime, the president is using his weekly radio and Internet address to assure Americans that once he signs a health overhaul bill, they will see immediate benefits. “We are on the verge of passing health insurance reform that will finally offer Americans the security of knowing they will have quality, affordable health care whether they lose their jobs, change their jobs, move or get sick.  The worst practices of the insurance industry will be forever banned,” he said.

Mr. Obama hopes to sign the bill into law by early February.  

Some consumers and advocates are disappointed that parts of the plan will not take effect until as late as 2014.  The president acknowledges that some of the changes will take time to implement, but he says others will start working sooner. “Now, it will take a few years to fully implement these reforms in a responsible way.  But what every American should know is that once I sign health insurance reform legislation into law, there are dozens of protections and benefits that will take effect this year,” he said.

Mr. Obama says before year’s end, insurance companies will be prohibited from dropping coverage when a person becomes ill, people with medical conditions will be allowed to buy affordable health insurance, and some small businesses will get government help in covering their employees. “All told, these changes represent the most sweeping reforms and toughest restrictions on insurance companies that this country has ever known,” he said.

The president began his address by talking about the economy.  The U.S. unemployment rate remained at 10 percent in December, and 85,000 more Americans lost their jobs last month.  Mr. Obama said the road to recovery will be long and sometimes bumpy.

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Doctor Tiger.

Anti-depressants are widely used to help relieve suffering.  But after reviewing previous studies, researchers at the University of Pennsylvania may have hit on something that could change the way anti-depressants are prescribed.  

The researchers looked at data from earlier studies on two antidepressants. The studies included patients with severe, moderate and mild forms of depression. Some were given antidepressants.  Others received a placebo.  Jay Fournier, the study’s lead author, said, “What we found was that patients who are on the lower end of the severity, the medications weren’t doing much more than the placebo was. For patients at the higher end of the severity, the medications had a very potent effect.”

Doctors have been sharply divided on how to treat patients with less serious symptoms of depression. The study does not make treatment recommendations, but it has implications for treatment. 

Psychiatrist Stuart Sotsky conducted one of the studies included in the review. “I hope that what a study like this will do would be to help alert clinicians, residents in training, and medical students that severity is an important factor to consider in planning treatment,” he said.

Dr. Sotsky says some moderately depressed patients could still benefit from antidepressants, but his study showed that many others could do just as well with exercise, talk therapy, support groups or self help. “While they may not respond to antidepressants, the good news is that there are other, effective treatments that can be employed to help,” he said.

The study was published in the Journal of the American Medical Association.

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Doctor Tiger.

Africa’s top football, or soccer, teams (other than the team from Togo) are in Angola for the  African Nations Cup. A partnership of football stars, civic groups, corporations and public donors is taking advantage of the sport’s popularity to launch a campaign against malaria which is a major killer in Africa. 

The United Against Malaria Partnership has launched a major media campaign to fight the disease 

A spokesman for the Roll Back Malaria Partnership, Herve Verhoosel, said the 30-second public service announcements feature football stars from African nations who urge viewers to use treated mosquito nets. “We will use the power of football to communicate on malaria prevention. When a player speaks on TV or on the radio or in the press, when the player says to the young children, ‘Sleep under a bed net,’ people are listening,” he said.

Angola’s national football association this week joined similar associations from Ivory Coast, Ghana, Uganda, Zambia and the United States in the anti-malaria group. Other members include the national teams of Mali and Tanzania and European Champions Barcelona of Spain.

Malaria is caused by a parasite that is transmitted through a certain type of mosquito. It kills some 850,000 people in Africa ever year. The illness also causes extensive loss of productivity because of its debilitating symptoms.

But Verhoosel says malaria can be prevented. “We have everything to prevent and to cure malaria and we still have a child dying from malaria every 30 seconds. What we need today is political leadership,” he said.

He says football stars can also influence African leaders to focus greater resources on malaria.

The group wants to provide universal access to mosquito nets and anti-malaria medicine to people living in malaria zones by the end of this year. It says this is a first step toward the target of reducing deaths from malaria by 80 percent in five years.

The partnership, which is supported by international donors and corporate sponsors, plans to extend its campaign to South Africa in time for the football World Cup which kicks off in June.

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Doctor Tiger.

Scientists in the United States have developed a powerful new method to help calm the abnormal brain activity associated with diseases such as epilepsy and Parkinson’s.  The technique involves the use of laser light stimulation of special proteins implanted in key areas of the brain. 

So-called neural “super silencers,” were developed by scientists at Massachusetts Institute of Technology from two genes found in fungi and bacteria.  The genes, called Arch (ARK) and Mac, are responsible for making light-sensitive proteins that help the organisms convert light into energy.

But when those genes are inserted into the brain, neurons can be engineered to express the proteins, making it possible to manipulate them with a laser beam and calm irritated nerve cells that are responsible for epilepsy, Parkinson’s disease and chronic pain syndromes.

Ed Boyden is a professor of brain and cognitive sciences at MIT.  He is the lead author of a study that showed how neurons containing the genes could be turned on and off with pulses of laser-beam light. “If you could turn off those neurons that are behaving inappropriately just for the right amount of time, that allows you to cancel out the aberrant neural dynamics with fewer side effects than if you were to bathe the entire brain in a pharmacological agent,” he said.

Boyden says the laser light activates the genetically modified brain cells, lowering the voltage in the neurons and stopping them from firing inappropriately.  

“We’ve shown in the current paper that we could express these molecules from fungus and archi-bacteria and so on and they would express just fine for months in mice.  And we also showed we could get safe and effective optical silencing of these neurons.  When we turned the light off, the neurons just go back to their normal activity,” he said.

Scientists are now trying to develop a neural feedback system that would become active when brain cells start to become over-stimulated, as in the case of epilepsy. “So, for example, one of the things we are working on is can we detect a certain brain state using electrodes the same way that it’s been done for almost a hundred years and use it to monitor the brain and then deliver a pulse of light just at the right time to shut down a pathological state in the brain,” Boyden said.

With the new tools, Boyden says researchers may someday be able to identify and correct complex neural networks that lead to disease by engineering different neurons to respond to different colors of light.
For example, in the study, researchers found that brain cells implanted with the Arch gene were silenced by yellow light, while neurons modified by the Mac gene were silenced by blue light.

“We’re screening even more species now to try to broaden our ecological biodiversity screen.  But we’re also starting to do longer and longer measurements of the safety and efficacy in more clinically interesting scenarios,” he said.

Boyden’s team has begun experimenting with light-sensing proteins to calm the brains of non-human primates. 

While the use of light tools to treat human brain diseases is still a long way off, Boyden says other researchers are starting to use the technology to develop new and improved drugs.

Ed Boyden and colleagues describe their work programming brain activity with light-sensing genes this week in the journal Nature.

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Doctor Tiger.

Ginkgo biloba is often recommended to prevent memory loss associated with aging. However, an eight year study shows that long-term use of the supplement does not slow the rate of mental decline in older adults.

Practitioners of alternative medicine have recommended ginkgo biloba as a means of maintaining and even improving memory among older adults. But until now, strong clinical evidence about its effectiveness has not been forthcoming.

For eight years, researchers at six universities across the U.S. studied more than three thousand adults, aged 72 to 96, with normal mental functioning or with mild cognitive impairment. Participants received either a 120-mg dose of gingko extract twice a day, or a sugar pill. Researchers found that gingko had no specific effect on memory or attention.

“What we can say is that we find no evidence that ginkgo, over this long period of time made a difference in whether someone’s slow change in memory function, as a function of normal aging, was affected at all by the medication,” said Dr. Steven Dekosky, at the University Of Virginia.

Earlier research showed that gingko did nothing for people with symptoms of Alzheimer’s disease, nor did it help reduce other forms of dementia.

Researchers say this latest study is notable because it was conducted with the largest number of participants, and it rules out the herbal supplement as a useful treatment for memory loss. 

“We found that there was no effect of the ginkgo biloba on these very slow but, clearly detectable changes in thinking function in late life,” added Dr. Steven Dekosky. 

But the researchers added one caveat: While gingko biloba is not effective in slowing down the mental changes of aging, they say it is safe and has no side effects.

Doctor Tiger.

A team of American scientists has discovered a molecule that could block transmission of HIV, the virus that causes AIDS.  Researchers say the preventive agent might someday be used in a topical cream to help prevent infection with the deadly virus.

Scientists have long known that after the HIV virus enters the human body, it struggles to gain a foothold.  But a naturally occurring protein in the male’s seminal fluid, called SEVI, makes the virus 100-thousand times more infectious than it would otherwise be, aiding HIV’s ability to attach itself to its victim’s white blood cells and in so doing, destroy the host immune system.

Now, US investigators have discovered that a molecule called surfen can interfere with SEVI’s action. Warner Greene is the director of the Gladstone Institute of virology and immunology in San Francisco, California, where the test-tube studies have been conducted.

“What we have found is this small molecule by the name of surfen can block SEVI binding to HIV virions [viruses] and thus interrupt the infectious cycle or the transmission cycle,” said Warner Greene.

Greene says surfen, first described by scientists back in 1939, is both an anti-inflammatory and anti-bacterial agent. He explains that surfen prevents infection by binding itself to both the AIDS virus and to the blood cells targeted by HIV. 

Research into topical medications know as microbicides – creams and gels containing anti-HIV agents that are usually applied before sexual intercourse – has been disappointing, and the method has not been effective preventing the spread of the AIDS virus.  But Greene is hopeful surfen will make a difference.

“I think that the concept of using agents that target not only the virus but the host factor propelling the virus infection – I think that combination might produce a therapeutic synergy [enhanced interaction] that could be quite effective,” he said.

Greene says similar so-called “cocktail” therapies have proved to be effective weapons in treating AIDS patients.

“Just as we use combination anti-retroviral therapy to treat patients with HIV infection, we might be able to prevent transmission of HIV using combination microbicides,” said Greene.

Warner Green and colleagues describe surfen’s anti-AIDS properties in the current issue of  the Journal of Biological Chemistry.

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Doctor Tiger.

Autism Spectrum Disorder is said to be the fastest growing neurobiological condition in the world. Autistic children and adults often have trouble interacting with others, are slow to learn language, and are frequently more interested in objects than people.  It is hard to know how prevalent autism is in many countries because statistics are hard to come by. But we are told by the Autism Society that it affects more than one million people in China,  with slightly more than a million in the United States, and as many as two million in India.  But what about those in Africa?

In Africa, a lack of awareness and resources prevents many children with autism from getting help. They are stigmatized by their families and communities. 

Brigitte Kobenan is the mother of an autistic child. During her reign as Miss Ivory Coast and Miss Congeniality World in recent years, she decided to make autism a central part of her platform, creating the Autism Community of Africa. She recently came to the Ivorian embassy in Washington, D.C. to talk about her own son. She says he often sat in a corner at home, lost in his own world.

“He was spinning objects, he would just look at a fan spinning and he would go around and around, he would line up toys, you know, instead of playing with them,” Kobenan explained.

Kobenan decided she wouldn’t hide him away from society, regardless of his condition. Instead, she led by example. Soon people noticed.

“I had a woman who…came to my mom and said because of your daughter I can take my child out. I am not ashamed anymore,” she said. “We look at this woman with a worldwide crown and she is not afraid of showing her son, so why should I hide mine?”

Dawn Cooper Barnes is the wife of the Liberian ambassador in Washington. She is also the mother of a 19-year-old autistic boy. She says she finds many Africans are superstitious when it comes to autism.

“Children in Africa living with autism may be thought to being possessed by the evil spirit or bad omens,” she said.

She says people just need to be better informed.

“What we need is more information. What is autism? How does it affect children? What can we do to help children with autism? We need to dispel some of the myths that are surrounding mental illness and mental conditions in Africa,”  Barnes said.

For Jeff Sell, the vice president of the World Autism Organization, recent data on the prevalence of autism is alarming.

“When my boys were born, it was one in a 1,000, now it’s one in a 100. We have a worldwide epidemic, we have a worldwide problem,” he noted. 

There is growing awareness about autism in Africa and the need for treatment facilities.  In Cameroon, for example, centers now provide specialized care for this developmental disorder. 

But Brigitte Kobenan says many more facilities are needed. She hopes to build a new treatment center in her own country, Ivory Coast, with money raised during her event in Washington.

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Doctor Tiger.

More infants are being immunized than ever before, according to a joint report by UN agencies and the World Bank. But experts say much more needs to be done to protect the world’s poorest children from needless suffering.

Ann Veneman, Executive Director of UNICEF, said, “The numbers of children vaccinated today are at an all time high.  We have numbers to prove this.”

She says global efforts have stopped a downward trend in vaccinations and have even boosted the number of children and infants being vaccinated. 

The results are nothing short of phenomenal. 

“Worldwide there have been nearly three quarters drop in deaths due to measles since 2000,” she added. 

Now the Americas are measles-free.   

“The disease that is measles has been eliminated in the region of the Americas and that is great news,” she noted.

The information is in a report called “State of the World’s Vaccines and Immunization,” issued by UN agencies and the World Bank.  

It says that for the first time, the number of children dying every year has fallen below 10 million and immunization saves 2.5 million children every year.  

UNICEF’s Mickey Chopra says the report is a call to increase funding for immunizations. 

“Focusing on immunization coverage often can be a way of focusing on those who are excluded from society, excluded from health services, more than just the vaccines,” he said.

Most vaccines help prevent disease in children, but reaching children in remote rural areas is often a challenge especially in poorer and war-torn countries. 

It can only be done, experts say, if the government in power approves and with help from non-governmental organizations.

Richard Greene is an infectious disease expert with the U.S. Agency for International Development.

“Civil Society plays a key role in helping to communicate the need for mothers to bring their children in early for vaccines – to complete the vaccination series – to make sure that non-governmental organizations deliver and offer vaccines not only one day a week necessarily but on a regular basis,” he said.

Vaccines that protect against pneumonia and diarrhea are a top priority for health experts seeking more funding.  

Pneumonia and diarrhea account for over one third of all deaths among children under the age of five. 

More than 80 new vaccines are in late-stage clinical trials. Thirty of them target diseases for which there are no immunizations, like malaria and dengue fever.

The report says if all countries immunize 90 percent of children under five with vaccines already available, that would prevent another two million deaths a year.

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Doctor Tiger.

Researchers are testing a new way to prevent the world’s most common nutritional problem.

Iron deficiency affects an estimated 3.5 billion people worldwide. In adults, it causes fatigue and lost productivity. It can increase the risk of infection and death in young children, and can also limit their motor skills and ability to learn later in life. 

Iron deficiency and its more serious consequence, anemia, are especially common among people who don’t eat meat or can’t afford it, and who therefore subsist on grains. Wheat and maize are often fortified with iron. But rice has proved hard to fortify without adversely affecting its appearance or flavor. 

Re-assembled rice

Diego Moretti at Wageningen University in the Netherlands and his colleagues tried using “fake” rice made out of iron-fortified rice-flour dough and shaped by machine into grains that look like the local variety.

“At first sight it sounds silly to first [grind] rice and then reassemble it with a machine,” he says. 

It may sound silly, but it worked. In a 2006 study in the American Journal of Clinical Nutrition, Moretti and colleagues mixed grains of fortified pseudo-rice in with real rice and served it to iron-deficient school children in India. Anemia fell by half among these children, while those who just ate regular rice did not improve. And the children could not tell the difference between fortified and unfortified rice. 

Minimal cost

Mark Beinner at Brazil’s Federal University of Minas Gerais just published a study in the January issue of the Journal of Nutrition in which he and his Brazilian colleagues used a version of this imitation rice to help improve the iron intake in very young children. He says when produced commercially at an industrial scale, the added cost is minimal.

“We’re looking at a 3 to 5 percent increase in the cost of a 5-kilo bag of rice,” he says. “That’s not a lot. The cost of not doing anything is much more substantial in years of life lost not treating young populations that are anemic.”

Brown University’s Jennifer Friedman works in maternal and child health in the developing world. She says starting commercial production of the fortified rice is an essential first step. “But maintaining that over time is what’s very hard. Really keeping that going, making sure those companies stay in business. Marketing that product in a way that people who often don’t want to change their lifestyle and what they’re doing is the other part that becomes costly.”

The nonprofit organization PATH is giving it a try, working to commercialize a version called Ultra Rice in Brazil, Colombia, and India.

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Doctor Tiger

Medical tourism brought in $1 billion in 2007 and that is expected to triple by 2012, when the Health Ministry expects more than two million medical tourists.

Asia is being seen as a growth center in the globalization of health services thanks to rising demand from developed countries as well as the region’s expanding middle class. But there are concerns that so-called medical tourism will shift resources away from public to private health care systems.

Over much of the past 10 years Thailand has led the growing medical tourism market, as foreigners sought lower cost health services and ready access to treatment.

The services available range from complicated cardiac surgery, to cosmetic surgery to dentistry and even alternative care, such as Chinese medicine, yoga and traditional Ayurvedic treatments.

Rising international travel and the availability of information on the Internet have boosted the number of travelers seeking treatment.

In Thailand, as many as 1.4 million visitors arrived seeking medical care in 2007, the most recent year numbers are available – up from half a million in 2001. Medical tourism brought in $1 billion in 2007 and that is expected to triple by 2012, when the Health Ministry expects more than two million medical tourists.

The largest numbers come from the European Union, followed by the Middle East and the United States.

Kenneth Mays, international marketing director for Bumrungrad International Hospital in Bangkok, says the high standard of care has been a drawing card.

“Thailand offers a very ideal combination of medical quality and service quality. There are both private and public hospitals and it’s very consumer driven because most people pay for their own medical care. Americans will come here because its 60 to 80 percent less expensive for equivalent treatment,” said Mays. 

But Thailand faces growing competition as more countries invest in medical services. Singapore, Malaysia, South Korea and the Philippines are all promoting medical tourism.

Ruben Toral, chief executive officer of health industry consulting firm Medeguide, says more people will weigh low cost against quality guarantees when choosing destinations for treatment.

“You will pay for Singapore but you absolutely know what you will be getting. If you want absolute guarantees, you go to Singapore. If you want absolute price, you go to India. Thailand and Malaysia right now represent the value plays – good quality, great service, good product,” said Toral.

He says medical tourism is likely to grow. 

“Asia will be and will continue to be the dominant force in medical tourism. Why? Because this is where you find number one the world’s biggest chunk of population – really between India and China there you have it, two-thirds the population just settled in this area. And this is also where you have a major emerging middle-class market,” he said.

Toral says that aging patients from North America, Europe, Australia and Japan also will look for places with plenty of access to low-cost care.

But there are concerns that increased investment in medical services for the wealthy will draw resources from the region’s public hospitals. 

Critics say many public health facilities already are under strain and fear more professionals will abandon the public system for private practice.

Viroj Na Ranong, an economist with the Thailand Development Research Institute, a policy research agency, fears that shift is under way.

“When you compare the purchasing power – the foreign purchasing power would be much higher than the middle-class or upper-class purchasing power in Thailand. This is a fundamental issue whenever there is a burst of foreign patients then the doctor would be drawn to the private sector,” said Viroj Na Ranong.

Thailand’s National Health Commission reports that scores of medical specialists have moved from the state system to private health care. 

The National Institute of Development Administration says medical tourism has exacerbated shortages of physicians, dentists and nursing staff in public facilities. 

But Bumrungrad’s Mays doubts those claims.

“It doesn’t hold up to serious mathematics because Thailand sees about 1.4 million medical travelers from outside. That is a fraction of the total visits to doctors and admits [admissions] from Thais themselves,” said Mays. “It’s very important to the country’s economy and has a lot of advantages to the country – but we don’t think it’s taking a lion’s share of resources or too many resources from Thais themselves.” 

May says that due to expanding private health care in Thailand – and limits on foreign doctors working in the country – there has been a reverse brain drain; Thai medical workers employed overseas are returning home. 

Other medical professionals say many work part-time at private hospitals and also serve in public hospitals.

Several medical industry analysts say Asia’s rising economic strength and increasing investment in health services will be able to meet demand for affordable care both for people in the region and for world travelers.

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