TB threat for 200 Calgarians

Calgary health officials are testing 200 people who may have been exposed to tuberculosis while visiting a city hospital.

But the Calgary Health Region's Dr. Robert Cowie yesterday stressed the risk of contracting the disease is low and the measures are being taken as a precaution.

"It is not highly infectious -- we're just being ultra careful," said the director of the region's tuberculosis clinic.

"This particular situation is a low-risk environment."

Cowie said 200 people who visited the emergency department at the Peter Lougheed hospital March 27 may have been exposed to a patient with pulmonary tuberculosis.

Letters were sent this month to those people requesting they contact the health region to be tested for possible infection, said Cowie.

"It takes eight to 12 weeks before the test for tuberculosis infection becomes positive after someone has been exposed," he said.

As of this week, he said about 30 people have been tested and none are positive.

Cowie said the CHR calls for public testing for possible tuberculosis infection as often as 10 times each year.

"There's probably no time in the year when we aren't following up with someone who's been exposed to tuberculosis," he said.

He said anyone who tests positive for infection would be placed on a four-month course of treatment to ward off the disease.

The patient with pulmonary tuberculosis who attended the emergency department in March was unaware they had the disease, said Cowie.

The patient is receiving treatment, which takes up to nine months, he added.

Tuberculosis is an infectious disease spread through close contact over an extended period of time and is not easily spread to others, said Cowie.

In 2006, there were 56 confirmed cases in the region.
Source :http://calsun.canoe.ca

Lack of funding putting Ontario's water at risk

TORONTO — Ontario risks compromising the safety of its tap water because many small towns and cities lack the resources to meet proposed stringent new standards for operating drinking water systems, says the head of a task force that two years ago called for a sweeping overhaul of the province's water systems.

“I'm suggesting specifically they're running higher risks on public health than we should be willing to tolerate,” Harry Swain, chairman of the Water Strategy Expert Panel, said in an interview.

Seven years after the Walkerton tainted-water tragedy claimed seven lives and left thousands ill, many Ontario residents have something new to worry about – lead in their tap water.

Last week, the province's Environment Ministry ordered 36 cities and towns to test older homes – typically those built before 1955 – for possible lead contamination in their drinking water. The order went out after high levels of lead were found in one in four homes tested in London.

The lead levels were detected even after flushing, which typically replaces water that has come in contact with lead pipes. Lead poses a health risk for pregnant women and young children. The order says excessive corrosion of pipes may be causing lead to leach into the water in other municipalities, including Toronto.

Opposition members have criticized the government's response as woefully inadequate because the testing is confined to 20 single-family homes in each municipality. Progressive Conservative MPP Laurie Scott asked in Question Period this week why the government was not testing the water in more homes and also in schools and hospitals.

“It's as if the Keystone Cops are running the Ministry of the Environment,” Ms. Scott said.

Environment Minister Laurel Broten said she wasn't going to accept advice from the Tories, which left the province with the Walkerton legacy.

New Democrat MPP Peter Tabuns criticized the government for not moving faster.

“You've got a big problem with lead and you've got a bigger looming problem with water quality because the infrastructure is not getting funding that's needed,” he said.

The problem has hit close to home. This week, politicians and staff in the Ontario legislature were told not to drink the water because lead has been detected in the 114-year-old building's tap water.

Worried homeowners in Toronto have inundated city hall with calls. Lou Di Gironimo, general manager of Toronto Water, said 500 homeowners have requested water tests since the order went out, up from 50 in the first four months of this year. The city plans to meet every one of those requests, he said.

About nine per cent of the 500,000 houses in Toronto have water pipes made of lead, according to an internal briefing prepared by Mr. Di Gironimo's office. Six of 86 homes tested this year had elevated lead levels in their tap water.

Mr. Swain said he is troubled the Ontario government has not acted on a key recommendation of the panel that water utilities be consolidated. A water utility ideally should have at least 30,000 customers to give it the economies of scale to provide safe and affordable water. However, Ontario had about 640 water utilities serving fewer than 10,000 customers, according to a 2002 tally done by the Environment Ministry.

Under the government's proposal to ensure that drinking water is safe, municipal drinking water systems will need to meet quality management standards, including enhanced training for operators, before they can obtain an operating licence.

Pat Vanini, executive director of the Association of Municipalities of Ontario, said it does not make sense to amalgamate water utilities that are geographically isolated. Many municipalities are strapped for funding because the previous Progressive Conservative government shifted responsibility for many services to them, she said.

“If we could resolve the $3-billion-plus in downloading, that would add some financial capacity for municipalities to invest in services,” she said.

Amy Tang, a spokeswoman for Infrastructure Renewal Minister David Caplan, said the government needs to be flexible in implementing the panel's recommendations. “Some municipalities have been very good at investing in their water systems, others have not,” she said.
Source :http://www.theglobeandmail.com

Vietnam confirms second bird flu case in two weeks

Hanoi - Vietnam has confirmed its second human case of the H5N1 avian flu virus in two weeks, after reporting no human cases in the previous 18 months, local press reported Saturday.

In addition, a Vietnamese health official said at least two other patients are suspected of having the disease, the reports said.

Vietnamese media Saturday quoted Dr. Tran Duc Hien, director of the Hospital for Tropical Diseases in Hanoi, as saying that an employee at a slaughterhouse in the city had tested positive for the avian flu virus.

The man, whom authorities are referring to only by his first initial, T., had reported to a health station on May 19, complaining of breathing difficulties, a runny nose and a persistent chill.

Hien said T. remains in treatment at the Hospital for Tropical Diseases. Vietnam's other confirmed case, a 30-year-old man from Vinh Phuc province who tested positive for H5N1 on May 20 after killing the chickens for a friend's wedding, is being treated at Hanoi's Bach Mai Hospital.

That patient has recovered and will be released soon, according to doctors.

'He's now much better,' Dr. Tran Thuy Hanh, acting director of Bach Mai, said Saturday. 'Tests have shown that he's negative to H5N1.'

Hanh also said that besides the two confirmed cases, at least one other patient currently in treatment, and one who died Friday, are suspected of having the disease.

Hanh said the patient who died was admitted Thursday night for complications related to gout. After he died the next morning, she said, 'the hospital X-rayed him as a precaution, and found that his lungs were completely white.' Results of his H5N1 test were not yet available.

The second suspected case was also admitted on Thursday. He is a 29-year-old policeman who had taken part in the culling of sick chickens.

The latest confirmed case brings the total number of confirmed human cases in Vietnam to 94 since the disease emerged here in late 2003. International health authorities generally regard Vietnam as a success story because of its aggressive efforts to control the disease in animals and to test and treat human cases.
Source :http://news.monstersandcritics.com

Still in the shade

Sunscreen is the snake oil of the 21st-century,” said Samuel Rudman, a lawyer at Lerach Coughlin, announcing that the firm was filing a class-action lawsuit in the Los Angeles Superior Court against five leading sunscreen manufacturers. Rudman’s allegation – that the companies behind household names such as Hawaiian Tropic and Neutrogena were misleading consumers about the cancer-protective powers of their products – was based on the evidence of consumers who had worn sunscreen, but still contracted skin cancer. It sent tremors across the sun-kissed beaches of the Californian coastline.

The outcome of this case is still pending, but it’s not just our sun-spoilt friends on Santa Monica beach who should be sweating. With Britons set to bask in another scorching summer, even the more sun-savvy tanners, who slather on a high SPF, may not be as protected as they think. Why? Because the SPF rating on the average sunscreen relates only to UVB rays that cause sunburn and are associated with the development of skin cancer, not the wrinkle-causing UVA rays, which, until recently, were thought to be relatively harmless.

However, it is now believed that UVA rays penetrate the skin, distorting the structure of cells, elastin and collagen. The cumulative damage is irreversible and can go undetected for years. A growing number of scientists think that prolonged exposure to UVA rays greatly contributes to melanoma, the deadliest skin cancer. Brian Diffey, professor of photobiology at Newcastle University, warns: “By 2035, there could be 21,000 new cases of melanoma a year in the UK, as those who sunburnt badly in the 1980s and 1990s suffer the long-term effects.” Yet millions of people are oblivious to this time bomb and will still spend hours in the sun, striving for a perfect bronze glow.

Dr Des Fernandes, a plastic surgeon and founder of Environ skincare, claims that 60% of UVA rays penetrate even the best sunblock. If this is the case, why are we no clearer on what UVA protection sunscreens offer? The problem is that the men in white coats and beauty corporations have failed to establish a universal, SPF-type rating system for UVA, because they have yet to agree on a method of measuring the effectiveness of UVA-blocking products. So, while protection against UVB rays is indicated with a number, such as SPF 15, UVA protection is denoted in many different ways, including broad-spectrum, broad-band protection, numbers and stars.

Boots has been commended for attempting to bring clarity to the issue by introducing the star-rating system for UVA protection as early as 1991. However, Cancer Research UK describes it as “vague” and “confusing” in the way it measures UVA protection only in relation to UVB: for example, a high-SPF sunscreen with two stars may give better overall protection than a low SPF with three stars. And other critics point out that the star system does not account for photostability (the ability of the product to remain on the skin during sun exposure).

Faced with the challenge of creating a standardised guide to UVA protection, beauty companies argue that as long as there is no universal method to objectively measure the long-term effects of UVA on the skin, such a system seems a long way off. Animal testing has proved inconclusive: tests on mice suggest that UVB rays cause melanoma; tests on fish found UVA rays incubated the disease. As Chris Flower of the Cosmetic, Toiletry and Perfumery Association (CTPA), a group that promotes the interests of companies such as Estée Lauder, Johnson & Johnson and Procter & Gamble, says: “It takes time to prove a scientific theory. If UVA takes years to lead to premature ageing, how are you going to test the product’s benefit if it won’t show for years?”

Various companies claim to have discovered their own “ground-breaking” products to protect against UVA rays. L’Oréal says its patented filters, Mexoryl SX and Mexoryl XL, contained in brands such as Ambre Solaire, form the most effective UVA filtering system available. Other companies suggest that mineral filters – the zinc oxide and titanium dioxide contained in Z01 Body Protection Lotion, for example – provide the best broad-band UVA and UVB protection. Fernandes believes his Environ range of antioxidant-rich products will fight the free radicals caused by sun exposure, and that this is crucial to preventing skin cancer. The New York dermatologist Dr Dennis Gross, the man behind MD Skincare, says the answer lies in chelators, a group of metal-binding molecules. He believes chelator-rich products counteract iron, an aggressive free radical found on the skin that generates other free radicals, which, in turn, are a trigger for skin cancer.

However, many scientists say that nobody can lay claim to the ultimate UVA protection. “Skincare companies are not the founts of all knowledge. Their primary objective is to sell products,” says Diffey. “There are active ingredients that can provide equal, if not broader, UVA screening than Mexoryl. The protection provided by antioxidants is small; as for chelators, reducing free-radical damage can help, but shade and clothing can provide you with 10 times the protection of these ingredients.” His only advice to people wanting to protect themselves from harmful rays is: “Stay indoors with the curtains closed.” But, as we head into the holiday season, that is not going to happen.

However, there is hope on the horizon. The European Cosmetic Toiletry and Perfumery Association (Colipa) has developed a test-tube (in vitro) method of assessing UVA protection that meets European commission recommendations. This could form the basis for a universal system, but initially it would apply only to Europe. The CTPA has indicated that it plans to adopt Colipa’s standardised system, but due to product cycles, sunscreens featuring the Colipa logo will not appear until next year.
Source :http://women.timesonline.co.uk

Time for Universal Coverage?

Sen. Barack Obama became the latest presidential candidate to call for universal health coverage this past week.

It's been 13 years since First Lady Hillary Clinton's effort at creating universal health care helped cause Democrats to lose control of Congress. Nevertheless, Democratic presidential hopefuls are once again embracing the proposition, following the lead of some Republican governors.

Earlier this year, California Gov. Arnold Schwarzenegger unveiled a plan to cover all of the state's uninsured and Massachusetts next month implements the nation's first comprehensive coverage plan, requiring residents to buy health insurance or face tax penalties. That plan was signed into law by then-Gov. Mitt Romney, now a Republican candidate for president.

Here's a closer look at the issue:

Why the new focus on health care?

Rising public support for health-care reform reflects increasing costs for employees and employers. Health-care costs per capita will reach $7,500 this year, an $800 increase over the past two years and more than double the $3,470-per-person figure in 1993.

Meanwhile, the ranks of the uninsured have grown to 45 million from 37 million since 1993, and those costs are passed onto the government, taxpayers and insurance holders. In 2005, those with insurance paid a "hidden tax" of about $922 on their insurance premiums to cover unpaid health-care costs of the uninsured, according to a study by Families USA, a consumer advocacy group. The rising costs of the uninsured could raise premiums by an additional $1,500 by 2010.

While employers are leery of mandates that require them to insure employees or face fines, big businesses have increasingly called for government action because rising health costs put them at a competitive disadvantage with foreign companies.

How do the parties differ? Republicans support measures that minimize costs to the government and encourage greater consumer choice. Earlier this year, President Bush proposed taxing employer-provided health insurance, which is currently tax-exempt. He argues that the current system encourages workers to choose more expensive coverage in order to get a bigger tax break.

The plan, which wouldn't increase costs for the government, would give all individuals -- those who purchase their own coverage and those who have employer-sponsored coverage -- tax breaks of $15,000 for families and $7,500 for individuals. The proposal received a cool response on Capitol Hill.

Congressional Democrats tried to pass a bill earlier this year that would have allowed the government to negotiate directly with drug makers to lower drug prices for Medicare. But a Congressional Budget Office report said that allowing negotiations would have a "negligible effect" on federal spending, saving about $2 million in its first year, unless the government was willing to restrict formularies, or the lists of drugs available to beneficiaries.

Democrats also favor an expansion of the State Children's Health Insurance Program. But few advocate as ambitious an approach as the 1993 Clinton plan, which included an employer insurance mandate and would have created competitive but highly regulated HMOs.

How would candidates pay for their reforms? Both John Edwards and Mr. Obama would fund their plans by ending President Bush's tax cuts for the wealthy, effectively raising taxes on those who make more than $250,000. Mr. Obama would repeal the Bush tax cuts on capital gains and dividends and Mr. Edwards advocates increased efforts to collect capital gains taxes by requiring brokerage houses to report capital gains from stock sales.

Would Americans support higher taxes to pay for reforms? Polls show that they might. According to a March NBC News/Wall Street Journal poll, 52% of respondents would pay higher taxes in order to provide universal health insurance, compared with 41% that opposed.

Americans cited health care as the top domestic priority, and the second-most important priority overall after the Iraq war in an April poll, topping issues such as illegal immigration, energy and the economy.

Does either party have an edge among voters? A March survey by Harris Interactive and The Wall Street Journal Online showed that more Americans trust Democrats to improve health-care policies, at 50% and up from 45% last year, than Republicans, whose support fell to 28% from 31% last year.
Source :http://online.wsj.com

Medical biller accused of scamming $300G from GHI

The accused brains behind a medical billing scam for phony neurosurgeries proved to be no brain surgeon himself, federal prosecutors said.

A Mount Vernon man who worked as a medical biller for a Hawthorne company concocted a scheme to submit bogus claims and post-operative reports to the insurer Group Health Inc. for 20 brain surgeries for three New York City municipal workers and their family members, federal authorities said. The scheme netted more than $300,000 for Charles Pritchett and his three alleged co-conspirators, according to federal prosecutors.

The scam fell apart when an internal audit by Manhattan-based GHI found so many brain operations clustered among three subscribers. GHI received claims for nine brain surgeries from one family and nine from another.

The third alleged co-conspirator submitted claims for brain surgeries for himself and his wife.

"We picked it up through the audit process," said Ilene Margolin, GHI's senior vice president for corporate affairs, "It raised red flags."

Pritchett, 39, of South Ninth Avenue, was arrested Thursday along with Dorothy L. Smith, 42, of Manhattan, and Michael Biscotti, 37, of Staten Island. A fourth suspect, Stanley Cannella, 36, of Manhattan, has not yet been arrested. It is unclear how Pritchett knew the other defendants. They were all charged with health care fraud and mail fraud in a six-count indictment unsealed in U.S. District Court in Manhattan.

Pritchett's lawyer Edward D. Wilford did not return calls seeking comment. Lawyers for the other defendants could not be reached for comment. Cannella's home number has been disconnected.

The scheme began in 2003 when Pritchett used his access to the medical billing company's computer to download legitimate insurance claim forms and post-operative reports from a Manhattan neurosurgeon, federal prosecutors said. Those forms provided the templates he would use for the next three years, federal authorities and GHI said.

Pritchett swapped out the two patients' identifying information for that of two of his alleged co-conspirators, Cannella and Smith, and started submitting bogus claims. On May 30, 2003, the first of the bogus claims was paid by GHI. The insurance provider cut a check for $14,142 to Cannella, who deposited it in his bank account, federal prosecutors said.

Between April 2003 and September 2006, Pritchett and Cannella submitted nine claims for reimbursement for brain surgeries on Cannella, his wife and his two sons. None of those procedures ever occurred, federal authorities said. But all of them were paid, to the tune of $142,268.

Smith and Pritchett submitted nine claims for Smith, her husband and their two daughters between June 2003 and December 2005. All nine claims were paid, including three for the same bogus operation. In all, GHI paid Smith $131,397 in phony claims, federal authorities said.

Biscotti and Pritchett submitted bogus claims for his and hers brain surgeries on Biscotti and his wife in March and June 2004, according to federal authorities. GHI paid Biscotti $31,041 for the two bogus claims.

After GHI did the internal audit, it launched its own investigation and then contacted the U.S. postal inspector and the U.S. Attorney's Office, Margolin said.
Source :http://www.thejournalnews.com

6 Billion Bits of Data About Me, Me, Me!

JAMES D. WATSON, who helped crack the DNA code half a century ago, last week became the first person handed the full text of his own DNA on a small computer disk. But he won’t be the last.

Soon enough, scientists say, we will all be able to decipher our own genomes — the six billion letters of genetic code containing the complete inventory of the traits we inherited from our parents — for as little as $1,000.

Just what we will do with the essence of who we are once we bottle it, however, is likely to be as much a social experiment as a scientific one.

As thousands of people decode their DNA over the next few years, they are likely to find themselves facing a genetic mirror whose reflection changes on an almost daily basis.

The more genomes that scientists have to work with, the more they can learn about them. So staying on top of your own health outlook may begin to resemble checking the performance of your stock portfolio. One day you find you have a gene that puts you at risk for diabetes; the next it’s one that may make you live longer.

“Nobody quite knows how to manage expectations in such a rapidly changing and deeply personal field,” said George M. Church, a Harvard Medical School geneticist who directs the Personal Genome Project. “The picture is getting more and more complete, but along the way there’s going to be a lot of, ‘You told us this last week and now you’re telling us this!’ ”

By the end of the summer, Dr. Church’s research project promises to deliver sequences to its first 10 volunteers. Unlike Dr. Watson, whose complete genome cost $1 million, the project’s volunteers will receive the one percent of their genome currently deemed most useful at a cost of $1,000.

One start-up company, 23andme, recently announced plans to provide affordable chunks of their DNA to individual consumers, along with tools to help them keep track of and understand their genetic information.

And technology companies like Illumina, Applied Biosystems and 454 Life Sciences, which solicited Dr. Watson’s DNA to prove its abilities, say the price of a complete human genome has already dropped to $100,000. They are competing for a $10 million “X prize” to sequence 100 human genomes within 10 days. (Dr. Watson’s took about two months.)

Those who have signed up to be sequenced as part of the competition include Paul Allen, co-founder of Microsoft; the astrophysicist Stephen Hawking; the television interviewer Larry King; and the financier Michael Milken.

“It’s the start of an era of comparative individual genomics,” said J. Craig Venter, who as president of the Celera Corporation sequenced much of his own genome in 2000 and recently completed it. “Hopefully we’ll have tens of thousands to compare in the next year or two.”

Dr. Venter said he consulted his genetic profile every time a new announcement of a gene discovery came out. Just last month, having read a report in this newspaper about a gene that raises the risk of heart disease, he found that he indeed carried the mutation.

He might have guessed that from his family history, but knowing his individual risk, rather than a statistical average, is a stronger motivator to change, Dr. Venter said. Because of another risk gene he carries for heart disease, he altered his diet and has been taking a cholesterol-lowering drug for several years.

“Now we can do something to alter what might have been our genetic destiny,” he added.

Beyond heart disease, there are a growing number of genes already known to influence predispositions to common diseases like breast and colon cancer, depression and dementia.

There are other reasons to unravel your genome. Embracers of nature over nurture may sift through their 20,000 genes to find an explanation for personality traits thought to have a partial genetic basis — like early rising, risk-taking, shyness and addiction.

And the curiosity is unlikely to be restricted to our own genetic code. A generation of personally motivated amateur geneticists may seek out others who have similar traits and similar quirks in their genetic code, hoping to deduce a connection.

Friends and families, too, may begin to compare notes.

“You can imagine a family who won’t let someone marry their daughter until they examined her prospective husband’s genome,” Dr. Watson suggested at a news conference on Thursday. “You’ll want to know what your mate is going to have.”

The mate, of course, may not want to know himself. Dr. Watson told the company that sequenced his genome not to reveal to him the status of one gene known to predispose people to Alzheimer’s disease. “Who wants to know that?” he said.

But Dr. Watson, 79, may yet learn that his genome contains Alzheimer’s risk genes that may be discovered tomorrow or next month or next year. On the other hand, he may find that he carries genes that offset the risk. Or both.

Moreover, because the way genes influence health and behavior depends heavily on their interaction with the environment, what our genome can tell us may change depending on lifestyle choices.

People who learn they carry a higher genetic risk of Type II diabetes, for instance, may see that risk increase if they start to gain weight. A gene that makes it difficult for some people to sweat in extreme heat might not matter to you if you live in Seattle. But if you are thinking of moving to Miami, knowing it exists in your genome could prove useful.

The lack of established medical authorities to interpret or filter such information could cause deep discomfort, some experts caution. And the technology is quickly outpacing social debate over how it should be handled.

“Some people are going to have information that they don’t know what to do with,” said Angela Trepanier, president elect of the National Society of Genetic Counselors. “And that can do more harm than good.”

Still, the early boosters of the personal genome say the best bet for improving individual health care is not only to embrace genetic knowledge about ourselves, but to share it with others.

If hundreds of thousands of people make their genomes public — along with personal information about their ancestry, their health history, what they look like, what they do and where they live — they argue, scientists will finally be able to draw meaningful correlations between variations in DNA sequence and any trait that has even a partial genetic basis, from what drugs we should take to what foods we like to eat.

As that happens, everyone with a sequenced genome will learn how the new findings affect them.

“Let’s sequence prominent Texans,” Dr. Watson said at the press conference in Houston last week. “What we really want now is a lot of data.”

Until then, even Dr. Watson, who posted his genome on the Internet last week, has to wait. At a ceremony marking the occasion, he stared at the disk containing his genome for a few seconds, then stuck it in his pocket.
Source :http://www.nytimes.com/

New Treatments for Tough Cancers Show Promise

Advances in treating lung and head/neck cancers could have immediate implications for patients, new research suggests.

Three studies detailing the findings were presented at a press conference Saturday at the American Society of Clinical Oncology annual meeting, in Chicago.

These types of cancer are notoriously difficult to treat, and have extremely low survival rates. Lung cancer is currently the number one cancer killer in the world. Head and neck cancers rank sixth, with 500,000 new cases and 300,000 deaths worldwide each year. Progress, particularly with lung cancer, comes in small increments.

"These are two very difficult-to-treat cancers," said Dr. Roy S. Herbst, moderator of the press conference and a professor of medicine and cancer biology at the University of Texas M.D. Anderson Cancer Center in Houston.

One study found, for the first time, that giving Avastin (bevacizumab) to patients with advanced non-small cell lung cancer, along with the chemotherapy drugs cisplatin and gemcitabine, slowed the growth of the cancer by up to 25 percent. The data confirms earlier results.

"This cancer is very hard to treat. There have been some advances, but we have reached a treatment plateau and we need more agents which may help us to offer better treatment to patients," said study author Dr. Christian Manegold, a professor of medicine at the University of Heidelberg in Germany. "We were able to confirm that Avastin adds efficacy to standard chemotherapy and provides hope for patients suffering from a deadly disease."

The U.S. Food and Drug Administration approved Avastin in October to be used in combination with chemotherapy drugs carboplatin and paclitaxel. The new study looked at Avastin with chemotherapy drugs cisplatin and gemcitabine. The study was funded by Hoffman-La Roche, parent company of Genentech, which makes Avastin.

Thirty-four percent of patients in the low-dose Avastin group and 30 percent of those in the high-dose Avastin group saw their tumors shrink, compared with only 20 percent in the chemotherapy-alone group. The duration of response was 6.1 months in both Avastin groups vs. 4.7 months in the control group.

A second study found that radiation delivered directly to the head in patients who have advanced-stage small cell lung cancer cut the risk that the cancer would spread to the brain by about two-thirds.

This type of lung cancer represents about 15 percent of all lung cancer cases in the United States, and tends to be more aggressive. "At diagnosis, about two-thirds of patients already have disseminated disease," said study author Dr. Ben Slotman, professor and chairman of radiation oncology at VU University Medical Center in Amsterdam, the Netherlands.

"The prognosis is poor," agreed Dr. Corey Langer, a medical oncologist at Fox Chase Cancer Center in Philadelphia. "The first shot [of treatment] is the best shot."

In the study, 286 patients who had already responded to chemotherapy were randomly chosen to receive radiation to the head or no radiation.

One year later, 14.6 of patients in the radiation group had developed brain metastases, vs. 40.4 percent in the control group. Also, 27 percent in the radiation group were alive at one year, compared with only 13.3 percent in the control group.

"This study shows that prophylactic cranial radiation [PCI] significantly reduces the risk of brain metastases at one year and it also shows that PCI prolongs survival," Slotman said. "It was well-tolerated, and it didn't adversely influence quality of life. Based on these results, PCI should now routinely be offered to all patients responding with small cell lung cancer who respond to chemotherapy."

Other experts aren't so sure, however. For one thing, study participants in the control group had a shorter survival than usually seen, making it unclear if the participants were representative, Langer said. "I don't know if this will make a wholesale adoption of PCI possible, but it offers justification for giving PCI to certain patients."

In a third study, adding the targeted therapy Erbitux (cetuximab) to a first-line chemotherapy that included cisplatin or carboplatin extended survival for patients with head and neck cancer that had spread to other parts of the body.

"The worst category are patients who have recurrent or metastatic disease," said study author Dr. Jan B. Vermorken, a professor of oncology at the University of Antwerp, in Belgium. "These patients are being treated in general with chemotherapy but, over the last 25 years, not much has changed in outcome when we treat these patients with chemotherapy. The median survival is six to seven months."

But patients who received Erbitux plus chemotherapy lived a median of 10.1 months, compared to 7.4 months in the control group, which had received only chemotherapy.

"This is a very unique observation. We have never seen this before in the last 25 years -- that adding a drug to chemotherapy is giving a better survival for these patients," Vermorken said.

One side effect, a skin rash, is particularly problematic, however. "It's not a mild rash," Langer said. "It potentially compromises quality of life. This isn't a free ride."

Two additional studies presented at the press conference looked at markers of lung and head and neck cancers.

Researchers at Duke University identified molecular pathways that are altered in advanced non-small cell lung cancer that could offer a new target for treatment.

The final study, funded by Bristol-Myers-Squibb, showed that variations in genes involved with metabolizing chemotherapy drugs may help explain why American and Japanese patients with advanced non-small cell lung cancer respond differently to therapies.

"We looked at normal DNA within the host [patient] and how to exploit these molecular profiles to improve therapeutic outcome," explained study author Dr. David Gandara, director of clinical research at the University of California, Davis.
Source :http://www.forbes.com

TB patient: 'I hope they forgive me'

DENVER — An Atlanta attorney quarantined with a dangerous strain of tuberculosis apologized to his fellow plane passengers in an interview aired Friday, and said he was told he wasn't contagious or a threat to anyone.

"I feel awful," Andrew Speaker said, speaking through a mask with ABC's "Good Morning America" at his hospital room in Denver. "I've lived in this state of constant fear and anxiety and exhaustion for a week now, and to think that someone else is now feeling that, I wouldn't want anyone to feel that way.

"I don't expect those people to ever forgive me. I just hope they understand that I truly never meant them any harm."

Speaker, 31, said he, his doctors and the federal Centers for Disease Control and Prevention all knew he had TB before he flew to Europe for his wedding and honeymoon last month. But he said he was told that he wasn't contagious or a danger to anyone. Officials said they would rather he didn't fly but didn't forbid it, he said.

His father, also a lawyer, taped that meeting, he said.

"My father said, 'OK, now are you saying, prefer not to go on the trip because he's a risk to anybody, or are you simply saying that to cover yourself?' And they said, we have to tell you that to cover ourself, but he's not a risk."

Speaker, his new wife and her 8-year-old daughter were already in Europe when the CDC contacted him and told him to turn himself in immediately at a clinic there and not take another commercial flight.

Speaker said he felt as if the CDC had suddenly "abandoned him." He said he believed if he didn't get to the specialized clinic in Denver, he would die.

"Before I left, I knew that it was made clear to me, that in order to fight this, I had one shot, and that was going to be in Denver," he said. If doctors in Europe tried to treat him and it went wrong, he said, "it's very real that I could have died there."

Even though U.S. officials had put Speaker on a warning list, he caught a flight to Montreal and then drove across the U.S. border on May 24 at Champlain, N.Y. A border inspector who checked him disregarded a computer warning to stop Speaker, officials said Thursday.

The unidentified inspector later said the infected man seemed perfectly healthy and that he thought the warning was merely "discretionary," officials briefed on the case told The Associated Press. They spoke on condition of anonymity because the matter is still under investigation.

The inspector ran Speaker's passport through a computer, and a warning — including instructions to hold the traveler, don a protective mask in dealing with him, and telephone health authorities — popped up, officials said. About a minute later, Speaker was instead cleared to continue on his journey, according to officials familiar with the records. The inspector has since been removed from border duty.

Colleen Kelley, president of the union that represents customs and border agents, declined to comment on the specifics of the case, but said "public health issues were not receiving adequate attention and training" within the agency.

The next day, Speaker became the first infected person to be quarantined by the U.S. government since 1963.

He was flown by medical transport Thursday to National Jewish Medical and Research Center, where doctors put him in an isolation room where he will be treated with oral and intravenous antibiotics.
Source :http://www.chron.com