Small Business Health Insurance

November 30, 2008

China pledges to fight AIDS discrimination

Filed under: Uncategorized — hope @ 1:53 pm
BEIJING (AP) -- Chinese health authorities and the U.N. AIDS agency pledged to fight discrimination against people with the disease in China with the unveiling Sunday of a massive red ribbon, the symbol of AIDS awareness, at the Olympic Bird's Nest stadium in Beijing.

Organizers said the fear of being stigmatized at work or in their communities is discouraging many people at risk of HIV infection from being tested. HIV is the virus that causes AIDS.

After years of denying that AIDS was a problem, Chinese leaders have shifted gears in recent years, confronting the disease more openly and promising anonymous testing, free treatment for the poor and a ban on discrimination against people with the virus.

State television Sunday showed Chinese Premier Wen Jiabao visiting a village hit particularly hard by AIDS in eastern China's Anhui province. Wen, who makes such annual visits to mark World AIDS Day, observed Monday, held hands with children orphaned by AIDS and spoke to patients in beds.

The topic, however, still remains very sensitive and authorities regularly crack down on activists and patients seeking more support and rights.

"About half of all Chinese would not want to share a meal with a person with HIV/AIDS, and a quarter would not want to shake hands," said Dr. Bernhard Schwartlander, country coordinator of UNAIDS in China. "People will not come forward to be tested. They won't benefit from treatment. They won't talk to their partners and colleagues about HIV/AIDS - putting themselves and others potentially at risk for HIV."

Schwartlander was speaking at the Bird's Nest stadium, a main Olympic venue, during the unveiling of a 66-foot by 50-foot (20-meter by 15-meter) banner on which the red AIDS awareness ribbon was printed.

"Stigma and discrimination are major obstacles in an effective response to AIDS. We need to engage all sectors of society in China to combat these issues and work together to stop the disease," said Minister of Health Chen Zhu. He did not specify any steps they would take.

Official estimates put the number of people living with HIV in China at about 700,000, with around 85,000 people with full-blown AIDS, UNAIDS said in a statement. But the number of officially reported HIV cases remains only 264,302 - far lower than the estimated total, in part because of reluctance to seek testing.

© 2008 The Associated Press.

Bases brace for surge in stress-related disorders

Filed under: Uncategorized — hope @ 1:53 pm
FORT CAMPBELL, Ky. (AP) -- Some 15,000 soldiers are heading home to this sprawling base after spending more than a year at war in Iraq and Afghanistan, and military health officials are bracing for a surge in brain injuries and psychological problems among those troops.

Facing prospects that one in five of the 101st Airborne Division soldiers will suffer from stress-related disorders, the base has nearly doubled its psychological health staff. Army leaders are hoping to use the base's experiences to assess the long-term impact of repeated deployments.

The three 101st Airborne combat brigades, which have begun arriving home, have gone through at least three tours in Iraq. The 3rd Brigade also served seven months in Afghanistan, early in the war. Next spring, the 4th Brigade will return from a 15-month tour in Afghanistan. So far, roughly 10,000 soldiers have come back; the remainder are expected by the end of January.

Army leaders say they will closely watch Fort Campbell to determine the proper medical staffing levels needed to aid soldiers who have endured repeated rotations in the two war zones.

"I don't know what to expect. I don't think anybody knows," said Gen. Peter Chiarelli, vice chief of staff of the Army, as he flew back to Washington from a recent tour of the base's medical facilities. "That's why I want to see numbers from the 101st's third deployment."

What happens with the 101st Airborne, he said, will let the Army help other bases ready for similar homecomings in the next year or two, when multiple brigades from the 4th Infantry Division and the 1st Cavalry Division return.

Noting that some soldiers in the 101st Airborne units have been to war four or five times, Chiarelli said he is most worried the military will not be able to find enough health care providers to deal effectively with the troops needing assistance.

Many of the military bases are near small or remote communities that do not have access to the number of health professionals who might be needed as a great many soldiers return home.

More than 63,600 active duty Army soldiers have done three or more tours in Iraq or Afghanistan. That is a nearly 12 percent of the total number of soldiers who have deployed at least once. Roughly four in 10 soldiers who have gone to war have served more than one deployment - and that number is growing steadily.

One solution under discussion is the formation of mobile medical and psychological teams that can go to Army bases when they are expecting a surge in activity from returning units.

At Fort Campbell, the director of health services, Col. Richard Thomas, has roughly doubled his authorized staff of psychologists and behavioral specialists to 55 and is trying to hire a few more.

"I think we have enough staff to meet the demands of the soldiers here, but I could use more, and I'll hire more if I can," said Thomas. "I'll hire them until they tell me to stop."

He said he expects the increased staffing levels to last at least through next year.

For the first time, Thomas said, every soldier returning home will have an individual meeting with a behavioral health specialist and then go through a second such session 90 days to 120 days later.

The second one is generally the time when indications of stress surface, after the initial euphoria of the homecoming wears off and sleeplessness, nightmares, and other symptoms show up.

"We're seeing a lot of soldiers with stress related issues," he said. "They're not bipolar or schizophrenic. But they're deploying three and four times and the stress is tremendous. They're having relationship issues, financial issues, marital problems - all stress related."

According to Dr. Bret Logan, deputy commander for managed care at the base, extended war zone stints that have lasted as long as 38 months over the course of the wars in Afghanistan and Iraq have taken a severe toll.

More than 3,000 of the 15,000 troops returning home, Logan estimated, probably will experience headaches, sleep disorders, irritability, memory loss, relationship strains or other symptoms linked to stress disorder.

Medical staff at Fort Campbell say they also worry that there will be a new surge of suicides - an escalating problem in recent years, largely related to the stresses of war.

Jon Soltz, an Iraq war veteran and chairman of VoteVets.org, said more soldiers will have stress-related problems, and the military must be vigilant in diagnosing and treating post-traumatic stress disorder to head off more serious issues.

"The longer you are there (at war), the more PTSD you're going to see. You wonder when it's going to be your time," he said.

Each returning soldier is evaluated through a seven-day reintegration program. It includes medical checkups, tests, lectures on suicide prevention and relationships, and other sessions to help them transition back into life at the base and with their families.

During his visit to Campbell, Chiarelli took a spin on one of the base's simulators, which are used for soldiers having neurological or stress problems. The simulator can be used to test soldiers' reflexes or as a way to work someone back into everyday situations.

With occupational therapist Eileen Hayes watching over his shoulder, Chiarelli adeptly negotiated the city streets, sudden turns and other obstacles moving at him on the small screen.

The simulators said Logan, put patients in high stress scenarios to test their decision-making ability while under duress.

While soldiers have been routinely deploying for 15-month tours, most Marines serve about seven months and airmen deploy for about four months, although some may serve for tours of six months or longer.

Late this past summer, Pentagon leaders ordered a change, saying any soldier who deployed in August or after would serve 12-month tours. Army leaders say they want to reduce that to nine months, but doing so will be difficult considering the strains of fighting two wars at once.

Logan said that some 85 percent of those soldiers with stress disorder symptoms will recover with the help of some treatment or medication. But the other 15 percent will require more intensive help.

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On the Net:

Defense Department: http://www.defenselink.mil

Fort Campbell: http://www.campbell.army.mil/crisis/index.html

© 2008 The Associated Press.

November 28, 2008

Patients treat serious illness as laughing matter

Filed under: Uncategorized — hope @ 1:51 pm
NEW YORK (AP) -- The off-color jokes flew around the room. As the anecdotes got bawdier, the laughter intensified. Some recited from memory, others read from notebooks they brought along.

The setting for the hilarity was the Montefiore Einstein Cancer Center at Montefiore Hospital. The participants were cancer patients, some with advanced stages of the illness.

They were taking part in the hospital's monthly "Strength Through Laughter" therapy. It is one of several types of laughter or humor therapy being offered by medical facilities around the country for patients diagnosed with cancer or other chronic diseases.

The programs feature joke sessions, clown appearances and funny movies.

While the verdict is out on whether laughter plays a role in healing, the American Cancer Society and other medical experts say it reduces stress and promotes relaxation by lowering blood pressure, improves breathing and increases muscle function.

On a recent day before Halloween, many of the two dozen patients at Montefiore arrived in costume to "spook cancer."

"The session makes you feel better," said Luz Rodriguez, 57, a breast cancer patient now in remission, who came disguised as a security officer. "I feel healthy when I laugh."

The laughs generated a warmth among the group that was palpable, particularly when Rodriguez changed into an angel costume and went around offering a red rose and a hug or kiss to each of the participants.

Their facilitator, senior oncology social worker Gloria Nelson, started the session five years ago to help cancer patients focus on living, instead of dying.

"They have such amazing strength, but it's a constant challenge, the fear of it coming back, how to go on living knowing you have cancer," said Nelson, who came dressed as the mother of the bride. "Every time they laugh, it's like kicking cancer out the door. You're taking control, you're saying it's not controlling me."

The most famous case of laughter's therapeutic effects on the body was described by Norman Cousins, editor of the Saturday Review, in his 1979 book, "Anatomy of an Illness." He claimed that a combination of laughter and vitamins cured him of a potentially fatal illness.

"I made the joyous discovery that 10 minutes of genuine belly laughter had an anesthetic effect," he wrote.

Still, laughter therapy is not for everyone. Some cancer patients are so overwhelmed with their diagnosis that they are unable to participate. Medical experts stress that laughter and other complementary therapies like acupuncture, massage and meditation are not substitutes for traditional medical treatment but can be used to help relieve the anxiety brought on by the disease.

At the Cancer Treatment Centers of America in Zion, Ill., patients experience another form of laughter therapy that bypasses jokes. In this version, patients practice laughter sounds like "he-he," "ha-ha," and "ho-ho," greet each other with laughter instead of words and engage in games like a pretend snowball fight until laughter overtakes them.

The staff at the center first tried it in 2004. They felt "weird and silly" but when they tried it out with patients the next day, the laughter soon because contagious, said Katherine Puckett, a licensed clinical social worker and a mind-body medicine expert.

The therapy has since been integrated into the culture of the hospital, and is also offered at the center's facilities in Philadelphia, Tulsa and Seattle.

Steve Wilson, a psychologist who runs the World Laughter Tour, which also trains and certifies laughter club leaders, said about two dozen hospitals around the country have asked to be trained in the method in the past two to three years. One hospital wants to try the therapy with lung transplant patients because laughter allows more oxygen to move through the body.

An international program with a similar goal but totally different approach is "Caring Clowns." The Thomas Jefferson University Hospital in Philadelphia uses the program of costumed volunteers to get patients to giggle - or at least smile - and open up.

"One of the challenges of being diagnosed with cancer is preserving your dignity ... when we tell you to put on a gown where the back half is missing and everyone's examining you and asking about bodily functions," said Dr. Richard Wender, former president of the American Cancer Society and the hospital's chief of family medicine.

The clown volunteers, he said, create a sense of comfort that helps narrow the "interpersonal gap" between patient and medical staff.

Robbie Robinson, 52, a non-Hodgkin's Lymphoma survivor, became a certified laughter leader after witnessing the "coping mechanism" laughter offered him as a patient at CTCA.

"Some people came in wheelchairs, some were helped by family and friends. You could tell people were down ... then I noticed that through some stimulated laughter, people started smiling. They forgot their troubles. You could see the pressure come off them."

The nonprofit Rx Laughter, meanwhile, focuses on managing patient pain and improving mental health through comic entertainment, including films and TV clips. It is a unique collaboration between the entertainment and medical fields that was founded in 1998 by Sherry Dunay Hilber, one-time director of prime time programming for ABC and CBS.

Rx Laughter's participation in two large medical studies discovered that patients who watched funny videos during certain painful procedures were more relaxed and tolerated the pain longer. It also found that cancer patients had less pain and slept better after such entertainment. The organization offers a variety of programs for hospitals, nursing homes, cancer support groups and rehabilitation clinics.

"Comic entertainment is at our fingertips 24/7. ... Watching our favorite shows and films can get us through very stressful times - all the more important in light of the cost of psychotherapy that many people cannot afford, and the problematic side effects of too many pain killers," said Hilber.

© 2008 The Associated Press.

November 27, 2008

FTC tosses guidance on tar, nicotine in cigarettes

Filed under: Uncategorized — hope @ 1:50 pm
WASHINGTON (AP) -- The cigarette industry for 42 years has made factual claims about tar and nicotine levels based on machine testing blessed by the Federal Trade Commission.

Now the FTC has dropped the test, known as the Cambridge Filter Method, like a hot rock.

The commission has rescinded guidance it issued 42 years ago, saying the test method is flawed. It also said the resulting marketing touting tar and nicotine levels could cause consumers to believe that lighter cigarettes were safer.

As a result, future advertising that lists tar levels for cigarettes won't be able to use terms such as "by FTC method."

"Our action today ensures that tobacco companies may not wrap their misleading tar and nicotine ratings in a cloak of government sponsorship," said Commissioner Jon Leibowitz. "Simply put, the FTC will not be a smokescreen for tobacco companies' shameful marketing practices."

The commission rescinded the guidance by a 4-0 vote.

Under the current system, cigarettes with a tar rate above 15 milligrams per cigarette are commonly referred to by the industry as "full flavor." Cigarettes with a tar rating of less than 15 milligrams are referred to as "low" or "light." Cigarettes with a tar rate below 6 are described as "ultra low" or "ultra light."

The National Cancer Institute found that changes in cigarette design reduced the amount of tar and nicotine measured by smoking machines using the Cambridge Filter Method. However, there was no evidence those changes reduced disease for smokers. The machine doesn't take into account the way smokers adjust their behavior, such as taking more or deeper puffs to maintain nicotine levels.

"The most important aspect of this decision is that it says to consumers that tobacco industry claims relating to tar and nicotine are at best flawed and most likely misleading," said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

The commission said it originally believed in the 1960s that giving consumers uniform, standardized information about tar and nicotine yields of cigarettes would help them make informed decisions about cigarettes. At the time, most public health officials believed that reducing the amount of tar in a cigarette could reduce a smoker's risk of lung cancer. However, that premise is no longer valid.

Sen. Frank Lautenberg, D-N.J., introduced legislation this year that would prohibit companies from making claims based on data derived from the FTC's testing method, but the bill did not make it to the full Senate for a vote.

"Tobacco companies can no longer rely on the government to back up a flawed testing method that tricks smokers into thinking these cigarettes deliver less tar and nicotine," Lautenberg said.

One FTC commissioner, Pamela Jones Harbor, urged Congress to approve the regulation of tobacco by the Food and Drug Administration. The bill would authorize government scientists to track, analyze and regulate the components of cigarettes.

Tobacco companies have stated clearly over the years that there is no such thing as a safe cigarette. In a statement, Philip Morris USA, the nation's largest tobacco company, said it remains committed to working with the FTC and other federal authorities to identify and adopt testing that improves on the Cambridge method.

The FTC noted that all four major domestic cigarette makers told commissioners the 1966 guidance should be retained until a replacement test method was approved.

Philip Morris warned commissioners that elimination of the guidance could lead to a new "tar derby" in which cigarette makers would use different methods of measuring the yields in their cigarettes, thereby leading to greater consumer confusion.

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On the Net:

Federal Trade Commission: http://www.ftc.gov

© 2008 The Associated Press.

Patient-led drug trials defy medical establishment

Filed under: Uncategorized — hope @ 1:50 pm
CLAREMONT, Calif. (AP) -- Until last year, Alan Felzer was an energetic engineering professor who took the stairs to his classes two steps at a time. Now the 64-year-old grandfather sits strapped to a wheelchair, able to move little but his left hand, his voice a near-whisper.

Felzer suffers from ALS, also known as Lou Gehrig's disease. The fatal neurological disorder steals the body's ability to move, speak and ultimately to breathe. But rather than succumb to despair along with his illness, Felzer turned to the Web to become his own medical researcher - and his own guinea pig.

Dozens of ALS patients are testing treatments on their own without waiting on the slow pace of medical research. They are part of an emerging group of patients willing to share intimate health details on the Web in hopes of making their own medical discoveries.

Some doctors caution that such patient-led research lacks rigor and may lead to unreliable results, false hopes and harm to patients.

"The Internet is a wonderful tool, but you know, it's buyer beware," said Dr. Edward Langston, immediate past chairman of the American Medical Association's board.

In Felzer's case, the experiment's results illustrate the obstacles that stand between patients and self-discovered breakthroughs. The drug he tried did no good. But he and his family felt they had little time and little to lose in trying.

"ALS is such a short illness," said Felzer's wife, Laura. She helps her husband communicate using sign language with his one good hand when his slow, halting words become difficult to understand. "You want to do what you can as fast as you can."

The U.S. Food and Drug Administration has approved only one drug to treat ALS symptoms. It only works for some patients, and its effects are limited. As a result, Internet forums for ALS patients brim with links to the latest research offering any hint of promise. After Alan Felzer was diagnosed last year, his 33-year-old daughter, Karen, dived into the forums and found new hope.

In a recent small study, Italian scientists reported that every ALS patient given the drug lithium, commonly used to treat bipolar disorder, saw the disease's progress slow substantially.

Many ALS patients began trying lithium on their own. They persuaded their doctors to prescribe it "off-label" - a use not approved by federal drug regulators. Off-label prescribing is a common practice, researchers say, when patients are facing a terminal illness.

Despite the risks, Langston of the AMA pointed out that doctors often stumble upon treatments, and patients could possibly do the same. "If patients are willing to share their experiences, that may in fact occur," he said.

Felzer began taking lithium in January, and his scientifically minded family reached out to other ALS patients. "All those people are taking it anyway," said Alan Felzer, whose smile remains bright and his gaze sharp even as the rest of his body fails him. "So it only made sense to keep track of what was happening."

The task of leading the ALS-lithium project fell to Felzer's daughter, Karen, a U.S. Geological Survey earthquake researcher. Her partner in the effort was Humberto Macedo, a 42-year-old computer systems analyst, father of six and ALS patient in Brasilia, Brazil.

The study grew naturally out of the strong reliance of ALS patients on one another for information, Macedo said.

Working online, Karen Felzer and Macedo recruited nearly 200 patients worldwide to take a specific lithium dosage and answer standard surveys to gauge their symptoms. They began running their study through a Web site called PatientsLikeMe.com, using it to attract volunteers and track their progress.

On the site, patients share detailed information about their symptoms and the drugs they are taking. The site focuses on conditions that have stubbornly resisted medical science, such as ALS, Parkinson's and multiple sclerosis.

The site's founders hope professional and amateur researchers alike will dip into the resulting pool of data and emerge with insights that lead to better treatments.

"My ultimate frustration that drove this site into existence was an overall feeling that there was a lack of transparency and speed or urgency" by the medical system, said Jamie Heywood, who co-founded PatientsLikeMe months before his own brother died of ALS.

Heywood too hoped that lithium was the breakthrough he and others had been seeking.

But after six months, none of the 87 people who stuck with the study showed any letup in the disease's progress, said Karen Felzer. She now doubts the Italian study's results.

"It's obvious to everyone it's not the miracle drug we thought at first," she said. She also thinks other tests of lithium for ALS should be halted to spare patients the drug's possible side effects, such as tremors, weakness and difficulty breathing. Her father stopped taking the drug, though Macedo is continuing.

However, other reseachers say professional lithium studies should go forward. Dr. Merit Cudkowicz, a Harvard Medical School professor, is set to begin one in December with 84 patients. Her study will stick to the so-called gold standard of research, in which each patient will be randomly chosen to take the drug in question or a placebo. Neither patients or researchers will know who got the drug to avoid introducing bias.

Because the patient-led lithium study lacked those tight controls, it is unreliable as a measure of safety and effectiveness, Cudkowicz said. With an incurable disease, she said, "You don't want to be throwing something away that works because of a bad study."

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On the Web:

Patient-led ALS lithium study: http://alslithium.atspace.com/

PatientsLikeMe: http://www.patientslikeme.com/

© 2008 The Associated Press.

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