Tuesday, July 12, 2011

More AIDS patients may get cheaper drugs (AP)

LONDON � Gilead Sciences Inc. will allow some of its AIDS drugs to be made by generic manufacturers, potentially increasing their availability in poor countries, particularly in Africa, officials said Tuesday.

In the first deal of its kind, the pharmaceutical company has agreed to allow four of its AIDS drugs to be made by generic drug companies at a cheaper cost in return for a small proportion of royalties, United Nations health officials said.

Most of the 33 million people worldwide who have HIV, the virus that causes AIDS, live in Africa. One of the drugs will also be used to treat people with hepatitis.

The deal was negotiated by the Medicines Patent Pool, part of a U.N.-led partnership that raises money for AIDS, tuberculosis and malaria by things like taxing airplane tickets. Among the partnership's 29 member countries, only Chile, France, Korea, Mali and Niger are actually implementing the airline tax.

"We will continue to work with Gilead and others to expand access to all people living with HIV in developing countries," said Ellen 't Hoen, executive director of the Medicines Patent Pool.

Gilead will receive from three to five percent royalties on its four drugs, which will be supplied to about 100 countries.

Until now, its drugs have been mainly sold in rich countries, and profits from the new deal are expected to be a tiny fraction of those Gilead gets from the West.

Typically, patients in poor countries have to wait for years until the patents expire on new drugs before they can be made more cheaply by generic companies.

But some experts questioned whether the deal went far enough and pointed out it specifically excludes manufacturers in Thailand and Brazil, which both produce large amounts of generic drugs.

"This agreement is an improvement over what other big pharma companies are doing to ensure access to their patented AIDS medicines in developing countries," said Michelle Childs, a director at Doctors Without Border's campaign for access to essential medicines. Still, she warned caution was necessary and that the new deal "should not become the template for future agreements."

Other major drugmakers including Johnson and Johnson, Abbott Laboratories and Merck & Co. have so far declined to formally negotiate with the U.N.-led group.

____

Online:

http://www.unitaid.eu

http://www.msf.org.uk



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Monday, July 11, 2011

Science seeks ways to take sting out of sunburn (AP)

WASHINGTON � If you've hit the beach, chances are you've experienced an unfortunate rite of summer: The sunburn. Skin so swollen it hurts to bend. The heat that rises from reddened shoulders. The "ow, ow, ow" from the shower after you'd thought the pain had faded.

For all the creams that promise to soothe, there aren't super treatments for a sunburn. Dermatologists say the best bet: Some of the same pills you pop for a headache � like the ibuprofen found in Motrin and Advil, or naproxen brands such as Aleve.

If that sounds too simple, well, scientists don't know exactly what causes this kind of touch-sensitive pain. But research is getting them closer to some answers.

British scientists found a clue in some healthy people who volunteered to be sunburned for science. Don't worry � they controlled the beams of ultraviolet light so that only a small patch of the volunteers' arms got a medium burn, just enough for a unique kind of testing.

One reason sunburns are so common is that by the time you see pink and head indoors, more damage already is brewing. Unlike an immediate burn from, say, touching a hot stove, a sunburn's pain is delayed as the red darkens over the next 24 to 48 hours.

Researchers from Kings College London tracked how their volunteers' sunburned skin became more sensitive. At the peak of pain, they cut away a small bit of damaged skin to analyze all the biochemical changes inside � and found a protein that's responsible for triggering the cascade of pain and redness.

The protein summons inflammation-causing immune cells to the damaged spot as sunburned skin cells die off. Its activity increased more than did other pain-related chemicals as the sunburn worsened, the researchers reported last week the journal Science Translational Medicine.

It took further experiments with rats to show the molecule, named CXCL5, was a key culprit. Most intriguing, injecting rats' sunburned feet with a substance that tamped down the protein also tamped down the pain, a finding that might lead to new medications. The researchers will next study whether the protein plays a role in more long-lasting types of pain.

What about today's sunburns? About a third of adults get one each year, and two-thirds of them have more than one, according to the Centers for Disease Control and Prevention. That's a bigger problem than pain � sunburns are believed to increase risk of the most serious type of skin cancer, melanoma. There aren't good figures on how often children get sunburned, but their tender skin can burn especially easily.

While water and sand reflect UV rays to increase exposure, it's not just the beachgoer who's at risk. A sunburn can sneak up on anyone, from the kids playing T-ball and their watching families to the afternoon gardener.

First-degree sunburns tend to peel in a few days. But more severe second-degree burns can blister and even require a doctor's care, especially if they cover large areas or come with fever and chills, says Dr. Roger Ceilley of the American Academy of Dermatology and the University of Iowa. A bad burn hinders how well your body cools itself, so it's important to cool down and keep hydrated.

To self-treat the pain, take ibuprofen or similar over-the-counter painkillers known as NSAIDs within a few hours of reddening skin, Ceilley advises. Those pills fight various kinds of inflammation. While they may not directly block the pain-causing protein the British researchers discovered, they do act on related pain chemicals, he notes.

But don't use those pills before going in the sun; they're among a host of medicines that can make your skin more sun-sensitive.

Cool compresses can soothe, and some patients find relief from aloe. But "you don't want to put a lot of heavy ointments on," Ceilley cautions. They can trap in heat.

At Wake Forest University, dermatology professor Dr. Steven Feldman also advises anesthetic sprays to numb the area, and for more serious burns a hydrocortisone cream.

But more important, "Don't get a sunburn," Feldman stresses. The advice:

_Stay out of direct sun when it's most intense, between 10 a.m. and 4 p.m.

_When you are out, wear sun-protective clothing and seek shade such as beach umbrellas. Feldman likes to tell of the dermatologists' convention in Hawaii where beachgoers wore long-sleeved swim cover-ups and big hats.

_Don't forget the sunscreen, especially on the face, hands and arms that are exposed to sun just about every day.

Sunscreen isn't a substitute for the first two tips, Feldman warns, because it doesn't guarantee protection if you stay out too long, use too little or miss a spot.

Still, picking a sunscreen should get less confusing next summer when new government regulations kick in. Those rules will prohibit claims like "waterproof" � you do need to reapply after swimming or sweating � and will assure protection against both types of skin-damaging UV rays.

___

EDITOR's NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington.



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Saturday, July 9, 2011

Aging boomers strain cities built for the young (AP)

NEW YORK � America's cities are beginning to grapple with a fact of life: People are getting old, fast, and they're doing it in communities designed for the sprightly.

To envision how this silver tsunami will challenge a youth-oriented society, just consider that seniors soon will outnumber schoolchildren in hip, fast-paced New York City.

It will take some creative steps to make New York and other cities age-friendly enough to help the coming crush of older adults stay active and independent in their own homes.

"It's about changing the way we think about the way we're growing old in our community," said New York Deputy Mayor Linda Gibbs. "The phrase `end of life' does not apply anymore."

With initiatives such as using otherwise idle school buses to take seniors grocery shopping, the World Health Organization recognizes New York as a leader in this movement.

But it's not alone.

Atlanta is creating what it calls "lifelong communities." Philadelphia is testing whether living in a truly walkable community really makes older adults healthier. In Portland, Ore., there's a push to fit senior concerns such as accessible housing into the city's new planning and zoning policies.

Such work is getting a late start considering how long demographers have warned that the population is about to get a lot grayer.

"It's shocking how far behind we are, especially when you think about this fact � that if you make something age-friendly, that means it is going to be friendly for people of all ages, not just older adults," said Margaret Neal of Portland State University's Institute on Aging.

While this fledgling movement is being driven by nonprofit and government programs, New York aims to get private businesses to ante up, too.

Last year, East Harlem became the city's first "aging improvement district." Sixty stores, identified with window signs, agreed to put out folding chairs to let older customers rest as they do their errands. The stores also try to keep aisles free of tripping hazards and use larger type so signs are easier to read. A community pool set aside senior-only hours so older swimmers could get in their laps without faster kids and teens in the way.

On one long block, accountant Henry Calderon welcomes older passers-by to rest in his air-conditioned lobby even if they're not customers. They might be, one day.

"It's good for business but it's good for society," too, he said.

The size of the aging boom is staggering. Every day for the next few decades, thousands of baby boomers will turn 65. That's in addition to the oldest-old, the 85- to 90-somethings whose numbers have grown by nearly one-third in the past decade, with no signs of slowing.

By 2050, 1 in 5 Americans will be seniors. Worldwide, almost 2 billion people will be 60 or older, 400 million of them over 80.

That's almost always viewed as a health issue, preparing for the coming wave of Alzheimer's, or as a political liability, meaning how soon will Social Security go bust?

"We think this is something we should be celebrating," says Dr. John Beard, who oversees the World Health Organization's Global Network of Age-Friendly Cities. "They need to live in an environment that allows them to participate."

In East Harlem, a yellow school bus pulls up to a curb and 69-year-old Jenny Rodriguez climbs off. The bus had already dropped a load of kids at school. Now, before the afternoon trip home, it is shuttling older adults to a market where they flock to fresh fruits and vegetables.

Rodriguez usually goes shopping on foot, pulling along a small cart. It can be a hike. Supermarkets aren't too common in this lower-income part of the city, and there's less to choose at tiny, pricier corner bodegas.

"You can only buy so much. Some streets, the cracks are so bad, you're pushing the shopping cart and almost go flying," Rodriguez said, examining sweet potatoes that she pronounced fresher and cheaper than at her usual store. "This is so much easier."

More than 200 times, school buses have taken older adults from senior centers to supermarkets in different neighborhoods. It's just one of a variety of initiatives begun in 2009 by the New York Academy of Medicine and the city's government to address the needs of older residents. Already, they're showing results.

A city report found the number of crashes has dropped at busy intersections in senior-heavy communities where traffic signals now allow pedestrians a few more seconds to cross the street.

Benches have been placed in nearly 2,700 bus shelters to give waiting seniors a place to rest.

The city's aging taxi fleet is scheduled to be replaced by a boxier model designed to be easier for older riders and people with disabilities to open the doors and slide in and out.

On the Upper West Side, seniors snapped up a report card of grocery stores deemed age-friendly because they offer deliveries, have public bathrooms � a rarity in the city � and sell single portions of fresh meat, poultry or fish, important for people who live alone.

Artists volunteer to teach at senior centers in return for space to work on or display their own creations.

And a "Time Bank" is letting hundreds of people of different ages and with different skills essentially barter services. A retired English teacher may do some tutoring, for example, and use the credit she earns to get computer help from another volunteer.

Aging expert Andrew Scharlach of the University of California, Berkeley, sees a common thread in these changes and the work of other cities. Combat the social isolation that too easily sneaks up on older adults and it has a huge impact not just on how many years they will live, but how well they live them.

Cities and suburbs were designed for younger people, full of stairs and cars, he explained. As they become increasingly difficult to navigate, older people gradually retreat.

Revamping a lot of infrastructure may not happen in a tough economy. But some communities are building age-friendly changes into planned upgrades or maintenance, such as New York's street crossings, or into requirements for future development.

The WHO's Beard says some changes aren't that costly, noting that seniors around the world say more benches and access to bathrooms will help them get out and about.

Among other cities' work:

_The Atlanta Regional Commission's Lifelong Communities Initiative is pushing communities that help people age in place. Efforts are under way in six metro areas, including work to adapt zoning codes to allow more of a walkable mix of housing and retail. The Mableton community of suburban Cobb County is planning that kind of a town square, and has opened a farmers market � on a weekday morning when seniors preferred to shop � and intergenerational community garden. To the east, DeKalb County is building a library near a senior center, planned senior housing and a bus stop. One town pilot-tested a shuttle for seniors to supplement bare-bones public transit.

The Atlanta Housing Authority is working with the commission to retrofit high-rise apartments that house a lot of older residents, with the goal to improve access to the surrounding community. At one site under construction, changes include a ramp entrance, safer sidewalk to the bus stop and more time for pedestrians to cross the street.

The overall move isn't without controversy.

Sometimes younger residents misunderstand and say they don't want to live in a retirement community, said commission urban planner Laura Keyes.

She said boomers, who are classified as being born from 1946 to 1964, and millenials, the children of baby boomers who came of age in the new millennium, ultimately want the same things: access to shopping, green space, more freedom from the car. The idea is a mix of ages but where older residents don't need to move if their health fails.

Keyes became interested in age-friendly communities when visiting friends in nursing homes built in commercial districts � and saw that they had nowhere to take a walk.

_Philadelphia is the oldest of the nation's 10 largest cities, with 19 percent of its residents over age 60 � and lots of multi-story rowhouses where seniors are stuck on one floor. "They become prisoners in their homes," said Kate Clark of the nonprofit Philadelphia Corporation for Aging.

In redesigning the city's zoning code, proposals are being debated that would allow seniors to rent out their upper floors, and to require that a certain amount of new housing be what's called "visitable" � with such things as ramp entrances, wide hallways and at least a half-bathroom on the main floor, she said.

With funding from the National Institutes of Health, the aging group's Allen Glicksman is studying if seniors who live in a walkable neighborhood really are healthier as a result. He has found that social capital � think friendly neighbors, low crime and good sidewalks that encourage getting out � is as important to older residents as access to supermarkets, public transportation and good housing.

Also, there are calls for age-friendlier parks, with safer steps and places to walk apart from bikers.

To sustain momentum, Clark created GenPhilly, a network of 20- and 30-somethings interested in shaping the city they'll age in by raising senior issues in varying professions.

_Portland was part of WHO's initial study of what makes a city age-friendly, an initiative that helped bring about more handicapped-accessible cars for the city's light-rail system, Neal said.

Now, aging experts are among the advisers as the city develops a master plan for the next 25 years. One issue, Neal said, is how to develop more accessible housing when the city's anti-sprawl policy means a lot of narrow, multistory houses are being squeezed into empty city lots � near transportation but still not age-friendly with all the stairs.

Integrating senior-friendly changes into everyday city policies is less visible than, say, a new retirement home but it's ultimately the goal, says Scharlach, the aging expert.

New York also hopes for some economic return.

Consider La Marqueta in East Harlem. Fifty years ago, it was a bustling, five-block market, a weekly gathering spot for families. But economic downturn left the city-owned building mostly empty for years. Now, as part of a $1.5 million economic revitalization project, an industrial kitchen in the building will train low-income women to start their own food businesses. It joins the fish and butcher shop, a farmer's market, and a high-end food importer � and busing in the seniors once a month boosts the still thin customer traffic.

But it's more than a shopping day. A quick check from a health department nurse reassured 73-year-old Maria Ilarraza that her blood pressure was OK, and she sat to catch up with friends over coffee. In another corner, a crowd listened as a university nutritionist explained how to safely freeze and thaw meat.

Art teacher Piedad Gerena showed off some of the bold landscapes and modern images her students at a nearby senior center learned to paint, and, to her delight, sometimes sell for up to $200 apiece. "Many of these people have no families," Gerena said. "The art makes them feel happy."

___

Online:

World Health Organization's Global Network of Age-Friendly Cities: http://tinyurl.com/3kdkp6q

Portland State University's Institute on Aging: http://www.pdx.edu/ioa

New York City's Aging Improvement Districts: http://tinyurl.com/3h5fo7a

New York Academy of Medicine: http://www.nyam.org/urban-health/healthy-aging

Atlanta Regional Commission's Lifelong Communities Initiative: http://tinyurl.com/3gz9lfv

Philadelphia Corporation for Aging: http://www.pcacares.org

GenPhilly: http://www.genphilly.org



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Thursday, July 7, 2011

Calif. hospital system settles celeb records cases (AP)

LOS ANGELES � Years after hospital employees were accused of snooping into the medical records of celebrity patients, UCLA Health System agreed to pay an $865,000 settlement for potential violations of federal privacy laws.

The settlement that UCLA reached with federal regulators Wednesday did not name the stars involved and did not require the hospital system to admit liability.

The investigation by the U.S. Department of Health and Human Services revealed that workers repeatedly accessed patients' electronic health records between 2005 and 2008.

The hospitals have agreed to report to a federal monitor on the implementation of its corrective plan over the next three years.

In a statement Thursday, UCLA said it has taken steps over the past three years to retrain staff and strengthen its computer systems.

UCLA Hospital System CEO Dr. David T. Feinberg said the university's facilities will "remain vigilant and proactive to ensure that our patients' rights continue to be protected at all times."

In 2008, California Department of Public Health officials announced results of their own investigation into the privacy breaches and found that UCLA hospital workers inappropriately accessed records of 1,041 patients since 2003.

The hospital later disciplined 165 employees through firings, suspensions and warnings.

At least two former UCLA employees have faced criminal charges for medical privacy violations.

Former administrative specialist Lawanda Jackson, 50, pleaded guilty to selling information to the National Enquirer from the files of Britney Spears, Farrah Fawcett and other high-profile celebrities. She died from complications of breast cancer before she could be sentenced.

Former medical school researcher Huping Zhou was sentenced to four months in federal prison and fined $2,000 for reading the confidential medical files of co-workers and celebrities such as Drew Barrymore, Arnold Schwarzenegger and Tom Hanks.

Zhou was not accused of selling the information and claimed that, as a Chinese national, he didn't know it was a violation of U.S. law to peep into the files.

The headline-grabbing breaches led California legislators to pass a bill boosting the maximum fine for privacy breaches at health facilities from $25,000 to $250,000.

Then-Gov. Arnold Schwarzenegger signed the legislation into law after his wife Maria Shriver had her records breached at UCLA Medical Center. Shriver filed for divorce last week.

The UCLA Health System includes Ronald Reagan UCLA Medical Center, Santa Monica-UCLA Medical Center and Orthopedic Hospital, and the UCLA Medical Group, a network of primary and specialty care satellite offices.



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German parliament OKs genetic embryo tests (AP)

BERLIN � After an emotional debate, German lawmakers voted Thursday to allow a procedure that looks for genetic disorders in embryos before they are implanted in the womb.

Lawmakers voted 326-260 to permit the procedure known as pre-implantation genetic diagnosis under strict conditions after a debate that cut across party lines. Eight abstained.

The procedure is sometimes used after in-vitro fertilization, when parents whose families have a history of genetic disorders want to avoid having a child with a lethal or severely debilitating birth defect.

Elsewhere in Europe and in the U.S., the test is often used in infertile couples who have failed in previous attempts to have children while using IVF in hopes that the test will boost their chances of implanting the best embryo.

The procedure's legality had been a gray area in Germany. Parliament took up the issue after a federal court last year ruled that a doctor who had performed the procedure hadn't committed any offense.

Under the law approved Thursday, an ethics commission will have to decide on a case-by-case basis whether couples can use the procedure. An expert would have to certify that a couple's child faced a high risk of a serious genetic disorder or that a miscarriage or stillbirth was likely.

A large minority of lawmakers favored a total ban, with some saying that even limited permission for genetic selection set a bad precedent.

"This is about variety: Do we want to allow it in our society?" asked Katrin Goering-Eckardt of the opposition Greens, one of those advocating a ban.

But lawmakers who backed allowing the practice said it would be an option only in a few cases, and argued that parents who worry about possible genetic defects should be trusted to decide.

"I am firmly convinced that we should not choose to close our eyes to how we can use modern medicine appropriately to support and help these long-suffering families," said Labor Minister Ursula von der Leyen.

Opposition lawmaker Soeren Bartol said he wanted to give couples at risk of passing on genetic disorders the option of deciding to have a child.

"I would also like these parents to be spared, as far as possible, the terrible experience of a miscarriage or a still birth," he added.

Debates on procedures that involve genetic selection tend to be tinged in Germany by memories of the country's Nazi past including experiments on humans, but lawmakers didn't refer to that explicitly on Thursday.

Church leaders, however, criticized the decision. The country's top Roman Catholic bishop, Archbishop Robert Zoellitsch, said that "the selection of human embryos violates the precept of respect for human dignity" and Lutheran church leader Nikolaus Schneider said he would have liked greater restrictions.

Thursday's debate centered squarely on the morality of the procedure, a test done to pick the best embryos, rather than its medical merits � which researchers say have largely been a disappointment.

Doctors had assumed the test would improve pregnancy rates, but studies showed that women who had their embryos tested were actually less likely to become pregnant, probably because scientists still can't accurately predict which embryos will succeed.

A study in its early stages presented this week at a European fertility conference in Stockholm suggested that embryos which look problematic three days after fertilization can fix themselves by day five. Many embryos created by IVF are implanted after three days, although doctors are increasingly waiting until day five if possible.

The German motion refers to tests removing one to two cells out of an embryo about three days after its fertilization � when it typically has about eight cells � to see whether it looks abnormal. Some experts say that is too early and jeopardizes the embryo's future development.

___

AP medical writer Maria Cheng contributed to this report from London.



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Obesity rates still rising in many states (AP)

WASHINGTON � In 1995, no state had an obesity rate above 20 percent. Now, all but one does.

An annual obesity report by two public health groups looked for the first time at state-by-state statistics over the last two decades. The state that has the lowest obesity rate now � Colorado, with 19.8 percent of adults considered obese � would have had the highest rate in 1995.

"When you look at it year by year, the changes are incremental," says Jeffrey Levi, executive director of the Trust for America's Health, which writes the annual report with the Robert Wood Johnson Foundation. "When you look at it by a generation you see how we got into this problem."

The study, based on 2010 data, says a dozen states top 30 percent obesity, most of them in the South. Mississippi topped the list for the seventh year in a row, with Alabama, West Virginia, Tennessee and Louisiana close behind. Just five years ago, in 2006, Mississippi was the only state above 30 percent.

No state decreased its level of obesity, which is defined as a body mass index of 30 or more. The body mass index is a measurement based on weight and height.

There was a bit of good news in the report: Sixteen states reported increases in their obesity rates, down from 28 states that reported increases last year. Levi says those increases have been gradually slowing, most likely due to greater public awareness of health issues and government attempts to give schools and shoppers better access to healthier foods.

"We're leveling off to some degree at an unacceptably high level," Levi said.

First lady Michelle Obama has tackled the issue with her "Let's Move" campaign, pushing for healthier school lunches, more access to fruits and vegetables and more physical activity. Republicans in Congress have pushed back somewhat against some of those programs, however, saying a rewrite of school lunch rules is too costly and questioning an Obama administration effort to curb junk food marketing aimed at children.

As in previous years, the study showed that racial and ethnic minorities, along with those who have less education and make less money, have the highest obesity rates. Adult obesity rates for African-Americans topped 40 percent in 15 states, while whites topped 30 percent in only four states. About a third of adults who did not graduate from high school are obese; about a fifth of those who graduated from college are considered obese.

Dr. Mary Currier, Mississippi's state health officer, says her state has struggled to drop its No. 1 status and it has been challenging because much of the state is poor and rural.

"We live in an area of the country where eating is one of the things we do, and we eat a lot of fried foods," she said. "Trying to change that culture is pretty difficult."

She says the state has had some success by making school lunches healthier, taking high-calorie foods and drinks out of school vending machines and trying to find more low-cost exercise facilities for residents of rural areas.

"It is frustrating, but we've had some progress," Currier said. "We just have to continue to work at this. It's not something that's going to change overnight."

___

Online:

Calculate your body mass index: http://www.nhlbisupport.com/bmi



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