May

14

On This Day: May 14, 1796, Edward Jenner Administered the First Vaccination Against Smallpox.

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Edward Jenner (1749-1823)

Jenner was born at a time when the patterns of British medical practice and education were undergoing gradual change. Slowly the division between the Oxford- or Cambridge-trained physicians and the apothecaries or surgeons—who were much less educated and who acquired their medical knowledge through apprenticeship rather than through academic work—was becoming less sharp, and hospital work was becoming much more important.


Edward Jenner, an English surgeon and country doctor, discovered the vaccination for smallpox.

Jenner was a country youth, the son of a clergyman. Because Edward was only five when his father died, he was brought up by an older brother, who was also a clergyman. Edward acquired a love of nature that remained with him all his life. He attended grammar school and at the age of 13 was apprenticed to a nearby surgeon. In the following eight years Jenner acquired a sound knowledge of medical and surgical practice. On completing his apprenticeship at the age of 21, he went to London and became the house pupil of John Hunter, who was on the staff of St. George’s Hospital and was one of the most prominent surgeons in London. Even more important, however, he was an anatomist, biologist, and experimentalist of the first rank; not only did he collect biological specimens, but he also concerned himself with problems of physiology and function.

The firm friendship that grew between the two men lasted until Hunter’s death in 1793. From no one else could Jenner have received the stimuli that so confirmed his natural bent—a catholic interest in biological phenomena, disciplined powers of observation, sharpening of critical faculties, and a reliance on experimental investigation. From Hunter, Jenner received the characteristic advice, “Why think [i.e., speculate]—why not try the experiment?”

In addition to his training and experience in biology, Jenner made progress in clinical surgery. After studying in London from 1770 to 1773, he returned to country practice in Berkeley and enjoyed substantial success. He was capable, skillful, and popular. In addition to practicing medicine, he joined two medical groups for the promotion of medical knowledge and wrote occasional medical papers. He played the violin in a musical club, wrote light verse, and, as a naturalist, made many observations, particularly on the nesting habits of the cuckoo and on bird migration. He also collected specimens for Hunter; many of Hunter’s letters to Jenner have been preserved, but Jenner’s letters to Hunter have unfortunately been lost. After one disappointment in love in 1778, Jenner married in 1788.

Smallpox was widespread in the 18th century, and occasional outbreaks of special intensity resulted in a very high death rate. The disease, a leading cause of death at the time, respected no social class, and disfigurement was not uncommon in patients who recovered. The only means of combating smallpox was a primitive form of vaccination called variolation—intentionally infecting a healthy person with the “matter” taken from a patient sick with a mild attack of the disease. The practice, which originated in China and India, was based on two distinct concepts: first, that one attack of smallpox effectively protected against any subsequent attack and, second, that a person deliberately infected with a mild case of the disease would safely acquire such protection. It was, in present-day terminology, an “elective” infection—i.e., one given to a person in good health. Unfortunately, the transmitted disease did not always remain mild, and mortality sometimes occurred. Furthermore, the inoculated person could disseminate the disease to others and thus act as a focus of infection.

Jenner had been impressed by the fact that a person who had suffered an attack of cowpox—a relatively harmless disease that could be contracted from cattle—could not take the smallpox—i.e., could not become infected whether by accidental or intentional exposure to smallpox. Pondering this phenomenon, Jenner concluded that cowpox not only protected against smallpox but could be transmitted from one person to another as a deliberate mechanism of protection.

The story of the great breakthrough is well known. In May 1796 Jenner found a young dairymaid, Sarah Nelmes, who had fresh cowpox lesions on her hand. On May 14, using matter from Sarah’s lesions, he inoculated an eight-year-old boy, James Phipps, who had never had smallpox. Phipps became slightly ill over the course of the next 9 days but was well on the 10th. On July 1 Jenner inoculated the boy again, this time with smallpox matter. No disease developed; protection was complete. In 1798 Jenner, having added further cases, published privately a slender book entitled An Inquiry into the Causes and Effects of the Variolae Vaccinae.

The reaction to the publication was not immediately favorable. Jenner went to London seeking volunteers for vaccination but, in a stay of three months, was not successful. In London vaccination became popularized through the activities of others, particularly the surgeon Henry Cline, to whom Jenner had given some of the inoculant, and the doctors George Pearson and William Woodville. Difficulties arose, some of them quite unpleasant; Pearson tried to take credit away from Jenner, and Woodville, a physician in a smallpox hospital, contaminated the cowpox matter with smallpox virus. Vaccination rapidly proved its value, however, and Jenner became intensely active promoting it. The procedure spread rapidly to America and the rest of Europe and soon was carried around the world.

Complications were many. Vaccination seemed simple, but the vast number of persons who practiced it did not necessarily follow the procedure that Jenner had recommended, and deliberate or unconscious innovations often impaired the effectiveness. Pure cowpox vaccine was not always easy to obtain, nor was it easy to preserve or transmit. Furthermore, the biological factors that produce immunity were not yet understood; much information had to be gathered and a great many mistakes made before a fully effective procedure could be developed, even on an empirical basis.

Despite errors and occasional chicanery, the death rate from smallpox plunged. Jenner received worldwide recognition and many honors, but he made no attempt to enrich himself through his discovery and actually devoted so much time to the cause of vaccination that his private practice and personal affairs suffered severely. Parliament voted him a sum of £10,000 in 1802 and a further sum of £20,000 in 1806. Jenner not only received honors but also aroused opposition and found himself subjected to attacks and calumnies, despite which he continued his activities on behalf of vaccination. His wife, ill with tuberculosis, died in 1815, and Jenner retired from public life.

May

14

An Old Care-Giving Model Comes Back Into Being

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About a Physician Whose Paychecks Were Signed By His Patients Only

Introduction

By Robert A. Forester, MD - May 2008, Medscape.com - Seven years ago, I was a contented doctor in what I considered to be an above-average practice. Our group of seven family physicians earned incomes well above the national average. I had a panel of 2,600 patients and was taking six to eight weeks of vacation per year.

But our profitability came with a cost. We were passing patients through the office faster and faster, with more and more things falling through the cracks. Worst of all, many of my patients who lost their health insurance were no longer able to pay for the care they needed. I came to realize that I wanted something more for my patients and myself.

In a moment of inspiration, I decided to create a cash-only, low-overhead, technology-enabled, retainer-model practice in which I could care for patients who could afford to pay out-of-pocket for enhanced service as well as uninsured patients who could pay little or nothing at all. The practice’s feasibility depended on a simple concept. I would recruit a small panel of patients willing to pay an up-front annual fee in exchange for extended patient visits (30 to 60 minutes), exceptional service, same-day access for all needs, direct access to me via electronic messaging or cell phone, and 24-hour on-call coverage. From these patients’ enrollment fees, I could earn enough to spend half of my time providing primary care at no cost to uninsured patients who were ineligible for government health programs. It would be the ultimate self-sustaining nonprofit clinic. With this setup, I would regain my status as a physician whose paycheck was signed by his patients and not by third-party payers.

Formulating a Plan

The more I thought about the idea, the better it sounded. I was fairly sure it would work, but I was nervous about making the leap. Then, in early 2002, my motivation increased after reading a series of articles in FPM by Gordon Moore, MD, on going solo in a small, low-overhead practice. I shared my idea with another family doctor from across town. He suggested we open the practice together. I realized that a two-physician practice would remove many of the concerns I had about cross-coverage for vacation and sick days. We could also share the overhead of hiring one medical assistant.

It was time to crunch the numbers. I knew from 14 years in a mostly capitated practice that my patients visited me an average of 3.6 times per year for 15-minute appointments. To provide the quality of care that we believed patients would expect in exchange for the retainer fee, we determined that we would need to be able to provide each one (we call these patients “benefactors”) with approximately five 30-minute visits per year. We figured we needed about $600,000 in revenue per year to run the practice and pay ourselves and our medical assistant. At five visits per benefactor per year, we could see a total of 600 benefactors per year. To take in $600,000, we would need to charge an average of $1,000 per benefactor per year. For a breakdown of all of these calculations, see sidebar “How we did the math”

My colleague and I began meeting weekly to outline the details of our plan. We formed a mission statement with concise goals. As practicing Catholics, we wanted the practice to have a distinctly Catholic flavor. We discussed the idea with our bishop’s representative and later received a letter of his spiritual (but not financial) support. We began to contact friends and acquaintances with special skills who were willing to volunteer their time to the project: an accountant, two attorneys, a small-business consultant, an insurance broker, a priest and a graphic designer. We formed a board of directors and committed to an ambitious start date just 12 months away.

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Figure 1.
St. Luke’s Family Practice is governed by a board of directors that meets regularly. Pictured are (from left to right) Douglas R. Hibl; J. Peter Herrmann, MBA; Dr. Forester; Terrance P. Withrow, CPA; and John Dunn, JD.

The Nuts and Bolts

The AAFP book On Your Own: Starting a Medical Practice From the Ground Up (available for purchase at http://www.aafp.org/catalog) provided a helpful outline for building our new practice from scratch. The attorneys on our board of directors helped us with articles of incorporation and bylaws. We applied for federal tax-exempt 501(c)(3) status as a nonprofit public benefit corporation.

Next we verified details of our status with several PPOs, Medicare and TRICARE, to be certain that when we made referrals or ordered tests for our benefactors that those providers’ claims would be paid. The insurers repeatedly emphasized: “Yes, but you won’t be able to bill us at all. Your patients will be wholly responsible for paying for your services.” After a while, we quit trying to explain that we didn’t want to bill insurance companies.

We developed a corporate identity, including a logo and an information pamphlet. We began designing a Web site (http://www.stlukesfp.org) that we would use initially for marketing and later for online scheduling, password-protected electronic messaging and patient education.

Seven months before opening, we told our respective physician partners of our plan. From our current lists of patients, we selected prospective benefactors and contacted them to explain our new practice concept. Three months out, we mailed pamphlets that included an invitation to upcoming informational meetings. We held three such meetings at local churches. They were well attended, with 50 to 100 people at each. About two-thirds of attendees were existing patients. We developed a 20-minute slide presentation to explain the basic idea behind the practice. After we made the presentation, we answered questions for 20 to 30 minutes. Enrollment pledges began to trickle in.

At the same time, we began preparing to provide free care to the uninsured (we refer to these patients as “recipients”). We wanted to offer our services to patients for whom other forms of financial assistance weren’t available, so we met with the local directors of Medi-Cal (California’s Medicaid program) and our county’s Medically Indigent Adult Program and developed a simple checklist that we could use to confirm that a patient is not qualified for these or other government programs (e.g., Medicare or Veterans benefits).

Finally, we began to prepare the office itself. We decided on a modest 970 square feet space in a favorable location. We rolled the cost of our tenant improvements into a five-year lease. We selected an electronic health record (EHR), ChartWare, and began with very basic software programs for electronic patient management (Quicken and Microsoft Office). We financed the EHR and a simple computer network (one server with three desktop computers) over two years. A local medical supply company donated a significant amount of quality used equipment for startup. We were on our way.

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Figure 2.
One of the characteristics of his practice that Dr. Forester appreciates most is not being rushed during office visits. Most visits are at least 30 minutes long.

Successes and Setbacks

As our grand opening neared, we spent many nights cleaning, painting and preparing our new office. When we opened our practice on Jan. 1, 2004, we had more than 250 benefactors prepaid for the first year’s care. The local newspaper wrote two articles that generated community interest. We made about 30 presentations to service organizations throughout the community, but most important, our practice grew by word of mouth.

For the first three months, we strove to get every benefactor into the office for a comprehensive exam and entered into our EHR system. We worked out the bugs in our Web site messaging and scheduling system. Three months later we began offering services to the uninsured. After one year, we had more than 400 benefactors between us and had conducted almost 900 office visits for uninsured patients. We were able to pay all our expenses, and we each took home a net salary of $78,000.

During the next year, the practice grew. Our net incomes in 2005 were $178,000. Last year they were $177,000, plus we made $15,000 deferrals to our retirement accounts. As we finish our fourth year of operations, we have about 550 enrolled benefactors. Since our inception, we’ve conducted 6,250 uninsured office visits and provided $500,000 in free care.

Our benefactors have chosen our practice for a variety of reasons. Some of them had an established relationship with my partner or me. Some wanted to support us out of a concern for the uninsured. Some were techies who loved the idea of electronic messaging with their doctor and scheduling appointments online. Many business owners and business travelers appreciated our capacity to be flexible about their appointment times and to treat them promptly.

Regardless of what initially drew them to us, our benefactors seem to like St. Luke’s. After the first year, we had a 96-percent re-enrollment rate. Our billings are a snap - we send out one statement in mid-November, and by Jan. 31, we have collected over 80 percent of the year’s charges with no additional effort.

Our biggest unforeseen challenge was securing nonprofit 501(c)(3) status for our practice from the Internal Revenue Service (IRS). The IRS had rules for nonprofit community hospitals, nonprofit emergency rooms, nonprofit drug treatment and counseling centers, and nonprofit educational programs, but they claimed never to have come across a nonprofit medical office. Very few nonprofit medical organizations give even 10 percent of their care at no cost, but we were giving 50 percent. We were small and different, and the IRS seemed content to bury us in unrelenting paper work and requests for further information. Our local attorneys and accountant had done about everything they could do when one of our new benefactors, a local developer who wanted to assist our efforts to help the uninsured, offered to contact a friend who was the principal of a high-powered Washington law firm specializing in charitable and philanthropic works. We quickly sent them our documents for review, and they agreed to help. After a few more months corresponding with the IRS, we flew to Washington for a meeting with the IRS attorneys, addressed their concerns and hammered out the final details.

On Dec. 21, 2005, almost two years after the start of operations, we were granted nonprofit 501(c)(3) status retroactively to our date of inception. The principal of the law firm generously wrote off his fee, and the benefactor’s family foundation paid the fees of the other two attorneys - all because they believed in our practice’s mission.

I would encourage other practices that are interested in following this model to apply to the IRS for nonprofit status. Any physician who wishes to apply can cite this article as support that such a model exists. We would also be happy to provide any similar organization our IRS determination letter or other information related to our application process.

Practicing Rewarding Medicine

One of the greatest joys of St. Luke’s Family Practice is taking care of people who have no other viable medical care option. Though at first we were intimidated treating those with uncontrolled diabetes and severe mental disorders as outpatients, with time and experience we became more comfortable doing so through close follow-up. Some of our most important and rewarding new referrals have come from local emergency departments and hospital discharge planners requesting that we provide outpatient follow-up for uninsured patients.

Perhaps I became soft after 14 years of middle- and upper-middle-class practice, but one of the things I have really appreciated about caring for the uninsured is seeing more significant pathology. When someone doesn’t seek a doctor’s care for 10 or 20 years and then suddenly feels an urgent need, the problem is usually significant. Over the past four years, we have made more than a dozen diagnoses of life-threatening diseases at treatable and curable stages among our uninsured recipients.

Through our experiences, we have also learned about other community resources we can work with to help patients get the care they need, such as medications, immunizations and cancer screening. A few colleagues in subspecialties provide phone consultations liberally and occasionally see our uninsured patients for a small fee or no charge. When a patient’s medical needs become so acute as to require emergency or inpatient services, they are frequently covered by the emergency Medicaid benefits. (For more details about our practice, see “Sidebar: Answers to Frequently Asked Questions About St. Luke’s Family Practice”)

The Payoff

Throughout our practice’s creation and development, there have been trade-offs and challenges. Trying to practice medicine in the 21st century on a very limited budget can be difficult. But like anything else, our confidence and skills grow with practice. We no longer have to review insurance contracts, attend IPA meetings or scrutinize insurance aging reports.

One of the best parts of our practice model is that everyone who comes to St. Luke’s wants to see us and hear our opinion. Without feeling rushed, we have the time to carefully listen to complaints, ask the necessary questions and perform thorough clinical examinations. We can fully utilize the Internet and electronic decision-making software to help us in real time. We also have time to call consultants and ask their advice as necessary.

We never could have created our practice without the initial inspiration, the support and confidence of our board of directors, our benefactors, our community and our families. After four years of success, we are glad we tried.

Send comments to fpmedit@aafp.org .

Sidebar: How We Did The Math

The following equations demonstrate how we calculated the number of benefactors we would need to enroll in our new practice and the average amount we would need to charge them to meet our revenue goal of $600,000 per year.

Number of available visits per year:

48 weeks/year x 4 days/week x 7 hours/day x 2 patients/hour x 2 doctors = 5,376 weekday visits/year (This number was rounded to 6,000 visits to account for weekend, holiday and after-hours calls.)

Number of benefactors we could accommodate per year:

3,000 benefactor visits/year ÷ 5 visits/benefactor = 600 benefactors (The remaining 3,000 visits would be used by uninsured patients.)

Average amount we needed to charge per benefactor:

$600,000 ÷ 600 benefactors = $1,000/benefactor
We then estimated the age demographic of our benefactors and developed our payment schedule:

Children < 19 years

$500/year

College students < 23

$500/year

Young adults < 35

$900/year

Adults 35 to 60

$1,200/year

Seniors > 60

$1,500/year

Sidebar: Answers To Frequently Asked Questions About St. Luke’s Family Practice

Q. Why have you focused on outpatient care for the uninsured?

A. Primary care cognitive services are not the biggest health care expense for patients; however, getting patients into the primary care doctor’s office is often the first and most important step to better health care. Providing free care to the uninsured offers basic health care services to those who might not otherwise go to the doctor due to financial concerns.

Q. What procedures and services do you provide?

A. The lab tests we provide include urinalysis, microscopy, blood glucose, A1C, urine pregnancy and hematocrit. The diagnostic procedures we perform include ECG, spirometry, pulse oximetry, audiometry and PPD for tuberculosis. We also provide influenza and tetanus-diphtheria vaccinations, and corticosteroid, ceftriaxone, antihistamine and promethazine injections. Casting and splinting, as well as office “lump and bump” surgery, are also performed in-house. We pay for all the supplies and charge nothing for the service.

Q. What about payment for other labs and diagnostic studies?

A. Because we see patients more frequently and spend more time on the history and physical exam, we can sometimes order fewer lab tests. We send patients to the county facility to pay cash for labs (e.g., $15 for complete blood count, $30 for a comprehensive metabolic panel, $38 for a lipid profile). For radiographs, our patients get a 50-percent discount at a local radiology office for cash payment at the time of service. Most plain radiographs are $30 to $100. An upper GI runs about $120. Pelvic and abdominal sonograms run about $100 to $120. Most CTs are about $300 without contrast.

Q. How do patients get prescription medications?

A. Our practice strives for an evidence-based medicine approach that usually requires fewer and less expensive medications. We try to be price-sensitive when prescribing. A local pharmacy donates bulk medications (doxycycline, atenolol, metformin, hydrochlorothiazide and glyburide) that we divide into appropriate units and dispense free of charge. For medications with difficult substitutions, we provide limited pharmaceutical samples (e.g., thiazolidinediones, angiotensin receptor blockers, some antidepressants, atypical antipsychotics, nasal steroids). We also direct patients to a local pharmacy that offers selected prescription medications for $4. Additionally, we use patient assistance programs through the Partnership for Prescription Assistance (http://www.helpingpatients.org).

Q. Do you provide inpatient care?

A. We provide care at all sites for our benefactors - office, home, hospital, or rehab or skilled nursing facility as needed. We do not offer that same level of care for our recipients. It would take too much time away from outpatient care, which is what we feel we do best.

Q. How do you make sure recipients really don’t qualify for other programs?

A. The county has a network of eligibility workers who work to sign up as many people as possible for Medicaid. Sometimes patients take advantage of our practice, but we concentrate our efforts where they can do the most good.

Q. Do the recipients pay anything?

A. The medical assistant asks recipients if they would like to make a donation at the end of their visit. If they ask us to suggest a donation amount and are from a working family, we suggest one hour’s wage. On average, we collect about $12 per visit. The donations we receive from recipients are almost enough to pay our medical assistant’s salary.

Dr. Forester practiced in a conventional office for 14 years before co-founding St. Luke’s Family Practice with Dr. R.J. Heck in 2003 in Modesto, Calif.

Disclosure: nothing to disclose.

May

13

Good News About Cancer: Revolutionary Treatments Are Saving Lives

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Photo by Kristine Larsen

By Barbara Basler, May 2008 - AARP Bulletin Today - Cancer is still a formidable foe, but in the last few years alone, scientists have gained intimate knowledge of this enemy and are using it to outmaneuver these deadly cells—prolonging life and improving cure rates for thousands of patients. As science learns more and more about human genetic makeup, researchers have identified scores of genes implicated in various cancers.

Today, hit-or-miss therapies are giving way to carefully targeted drugs that attack these genes at the most basic level, subverting the abnormal mechanisms they use to survive and grow.

The drug Avastin, for example, blocks the growth of blood vessels that carry vital nutrients to cancer cells. Already used for several years to slow the growth of advanced colon and lung cancer, Avastin was approved for treatment of metastatic breast cancer in February. Doctors say they are just beginning to tap its potential. One big problem: The drug can cost as much as $92,000 a year.

“For the past 50 years oncologists tested hundreds of thousands of compounds on cancer cells to see if they would slow the growth or destroy them,” says Gabriel N. Hortobágyi, M.D., director of the multidisciplinary breast cancer research program at the University of Texas M.D. Anderson Cancer Center in Houston. “It was very inefficient.”

Now “we can profile cancer genes, understand what makes them abnormal, then look for very specific ways to disrupt those processes,” Hortobágyi says. “This is a revolution. Instead of developing 50 drugs over 50 years, we’re developing 10 or 20 drugs every year.”

According to a survey released in March, one-quarter to one-half of all new cancer treatments that enter later-stage clinical trials are eventually proved to be effective. And “this pattern of successes has become more consistent over time,” say the researchers at the University of South Florida who conducted the review.

At the same time, older therapies are being refined, almost reinvented. Radiation therapy now uses what one oncologist calls “Star Trek technology” to target cancers with great precision, sparing healthy tissue and reducing side effects.

Progress is measurable, says John Mendelsohn, M.D., president of M.D. Anderson. “When I was born, only about a third of all cancer patients lived five years or more. Today, two-thirds do.”

Almost 1.5 million people, the American Cancer Society says, will be diagnosed with cancer in 2008, many with lung, breast, colon or prostate cancer. Because age is a primary risk factor for cancer, 77 percent of all cancers will occur in people age 55 and older.

Here are some new treatment developments for these four cancers:

Lung Cancer
Researchers last month announced they had identified genetic quirks that increase the risk of lung cancer in smokers and former smokers by 21 to 81 percent. Three international teams each pinpointed the same genetic link to cancer risk.

Smoking accounts for 85 to 90 percent of all lung cancers. But only about 15 percent of smokers and ex-smokers develop cancer. The findings on genetic links, reported in Nature and Nature Genetics, are a major step forward and should help researchers identify people at high risk for nonsmall cell lung cancer, the most common form of the disease. Identifying those at high risk is key because there are usually no symptoms until the cancer is in an advanced stage and harder to treat.

Another treatment advance: image-guided radiation therapy. “I would guess almost everyone living in the U.S. is now within an hour of a center that has this,” says Kenneth Rosenzweig, M.D., a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York. The system gives radiologists a clearer, more accurate picture of the lung tumor, allowing them to target it more precisely. Better targeting also reduces the number of treatments needed for early-stage lung cancer from 30 to 40 treatments over two months to three or four spread over one week, Rosenzweig says.

For those with advanced cancer confined to the lungs, survival rates have gone “from nothing to as high as 35 percent with chemo and radiation or surgery,” says Roy Herbst, M.D., chief of thoracic medical oncology at M.D. Anderson.

Breast Cancer
There are at least four major subtypes of breast cancer, and researchers have developed specific therapies for each—with some dramatic results.

The effectiveness of a new treatment to prevent a recurrence of estrogen-fueled cancer—the most common type in postmenopausal women—was confirmed in March by two major studies at Massachusetts General Hospital and at the University of Vermont College of Medicine. The findings suggested that women can protect themselves by taking an aromatase inhibitor (AI) drug after

finishing a five-year course of tamoxifen.

While tamoxifen is a potent estrogen blocker, after five years it has been known to stimulate estrogen production, especially in older women. AIs also block estrogen but with a different mechanism, and they can be taken safely for years. Long-term protection is key because half of those with this type of breast cancer who relapse do so after five years.

“Older women in their 70s took AIs and tolerated them as well as younger women,” says Nancy Lin, M.D., an oncologist at Boston’s Dana-Farber Cancer Institute who reviewed the studies.

“This is a real advance and one that older patients with this cancer should know about,” says Larry Norton, M.D., deputy physician-in-chief for breast cancer programs at Memorial Sloan-Kettering.

Another striking development—two drugs that target a highly aggressive type of breast cancer, HER-2 positive. About one in five breast cancers is HER-2 positive. In 2006 a blockbuster drug, Herceptin, previously used only in late-stage cancer, was approved by the Food and Drug Administration for use in the early stages. It now prevents a relapse in half of the women who were likely to have had a recurrence. This year, a second drug, Tykerb, was approved for women with advanced HER-2 positive breast cancer who did not respond well to Herceptin. Tykerb acts to inhibit two key proteins, while Herceptin blocks one.

“This was one of the worst types of breast cancer, with one of the worst outcomes,” says Eric Winer, M.D., chief of breast oncology at Dana-Farber. “Now it is highly curable in many, many women with early HER-2 cancer. For those with more advanced HER-2 cancer, these drugs mean they can live years longer.”

Winer predicts that in the next two years doctors will have several more drugs that target HER-2 positive cancer. “This may be the first type of breast cancer we look back on and say, ‘This used to kill but it doesn’t anymore,’ ” he says.

Colon Cancer
For 50 years there was only one drug to treat colon cancer. Today five new drugs—three chemo agents and two targeted therapies—have been integrated into highly effective treatments, says Raymond Dubois, M.D., a specialist in this cancer and the provost of M.D. Anderson.

Of the two targeted therapies, one (Avastin) works to starve the cancer cells, while the other (Erbitux or Vectibix) blocks a protein on the surface of the tumor cells.

FOLFOX, a cocktail of new chemo agents, changed the standard of treatment for advanced colon cancer, improving survival rates and reducing the likelihood of relapses among patients whose colon cancer spread into the lymph nodes, says Robert J. Mayer, M.D., director of the center for gastrointestinal oncology at Dana-Farber.

“With these new therapies the median survival rate for those with late-stage colon cancer has moved from six to nine months to upwards of two years,” Mayer says.

The protein inhibitors, however, are toxic and expensive, $15,000 a month, and in 45 percent of patients they appear to have no effect, says Axel Grothey, M.D., chairman of the colorectal cancer group at the Mayo Clinic in Rochester, Minn.

He predicts that by the end of the year doctors will have a test that will allow them to exclude patients unable to benefit from this therapy, saving them debilitating side effects and expense. “This opens a new door” to personalized medicine, Grothey says.

Prostate Cancer
Death threats—ostensibly from prostate cancer patients—were sent to several doctors who helped persuade the FDA not to approve a new drug, Provenge, which a small study suggested might prolong the survival of men with advanced cancer. But the FDA may reconsider its 2007 decision after the results of a larger clinical trial are announced this fall. If the drug—a vaccine to stimulate the body’s own immune system to fight the cancer—does work, “that would be a real sea change, because immunotherapy in general has not been successful in any cancers,” says Philip Kantoff, professor of medicine at Harvard University and the leader of Dana-Farber’s prostate cancer program.

While older patients with other cancers are often undertreated, a growing census holds that “there is a significant amount of overtreatment” in older men with localized prostate cancer, says Theodore DeWeese, M.D., chair of the Department of Radiation Oncology and Molecular Radiation at the Johns Hopkins School of Medicine in Baltimore. He and other oncologists say older men with low-grade prostate cancer—and especially men with another disease—are good candidates for “watchful waiting.” That means having an annual biopsy, testing levels of PSA—a protein that can signal cancer—and forgoing treatment unless those tests indicate some danger.

May

13

The Stigma of Mental Illness Is Never Far Away

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May 12, 2008, Newstex - IN the YouTube video, Liz Spikol is smiling and animated, the light glinting off her large hoop earrings. Deadpan, she holds up a diaper. It is not, she explains, a hygienic item for a giantess, but rather a prop to illustrate how much control people lose when they undergo electroconvulsive therapy, or ECT, as she did 12 years ago.

In other videos and blog postings, Ms. Spikol, a 39-year-old writer in Philadelphia who has bipolar disorder, describes a period of psychosis so severe she jumped out of her mother’s car and ran away like a scared dog.

In lectures across the country, Elyn Saks, a law professor and associate dean at the University of Southern California, recounts the florid visions she has experienced during her lifelong battle with schizophrenia — dancing ashtrays, houses that spoke to her — and hospitalizations where she was strapped down with leather restraints and force-fed medications.

Like many Americans who have severe forms of mental illness such as schizophrenia and bipolar disorder, Ms. Saks and Ms. Spikol are speaking candidly and publicly about their demons. Their frank talk is part of a conversation about mental illness (or as some prefer to put it, “extreme mental states”) that stretches from college campuses to community health centers, from YouTube to online forums.

“Until now, the acceptance of mental illness has pretty much stopped at depression,” said Charles Barber, a lecturer in psychiatry at the Yale School of Medicine. “But a newer generation, fueled by the Internet and other sophisticated delivery systems, is saying, ‘We deserve to be heard, too.’ ”

About 5.7 million Americans over 18 have bipolar disorder, which is classified as a mood disorder, according to the National Institute of Mental Health. Another 2.4 million have schizophrenia, which is considered a thought disorder. The small slice of this disparate population who have chosen to share their experiences with the public liken their efforts to those of the gay-rights and similar movements of a generation ago.

Just as gay-rights activists reclaimed the word queer as a badge of honor rather than a slur, these advocates proudly call themselves mad; they say their conditions do not preclude them from productive lives.

Mad pride events, organized by loosely connected groups in at least seven countries including Australia, South Africa and the United States, draw thousands of participants, said David W. Oaks, the director of MindFreedom International, a nonprofit group in Eugene, Ore., that tracks the events and says it has 10,000 members.

RECENT mad pride activities include a Mad Pride Cabaret in Vancouver, British Columbia; a Mad Pride March in Accra, Ghana; and a Bonkersfest in London that drew 3,000 participants. (A follow-up Bonkersfest is planned next month at the site of the original Bedlam asylum.)

Members of the mad pride movement do not always agree on their aims and intentions. For some, the objective is to continue the destigmatization of mental illness. A vocal, controversial wing rejects the need to treat mental afflictions with psychotropic drugs and seeks alternatives to the shifting, often inconsistent care offered by the medical establishment. Many members of the movement say they are publicly discussing their own struggles to help those with similar conditions and to inform the general public.

“It used to be you were labeled with your diagnosis and that was it; you were marginalized,” said Molly Sprengelmeyer, an organizer for the Asheville Radical Mental Health Collective, a mad pride group in North Carolina. “If people found out, it was a death sentence, professionally and socially.”

She added, “We are hoping to change all that by talking.”

The confessional mood encouraged by memoirs and blogs, as well as the self-help advocacy movement in mental health, have deepened the understanding of bipolar disorder and schizophrenia. Books such as Kay Redfield Jamison’s autobiography, “An Unquiet Mind: A Memoir of Moods and Madness,” have raised awareness of bipolar disorder, and movies like “Shine” and “A Beautiful Mind” have opened discussion on schizophrenia and related illnesses. In recent years, groups have started antistigma campaigns, and even the federal government embraces the message, with an ad campaign aimed at young adults to encourage them to support friends with mental illness.

Members of MindFreedom International, which Mr. Oaks founded in the 1980s, have protested drug companies and participated in hunger strikes to demand proof that drugs can manage chemical imbalances in the brain. Mr. Oaks, who was found to be schizophrenic and manic-depressive while an undergraduate at Harvard, says he maintains his mental health with exercise, diet, peer counseling and wilderness trips — strategies that are well outside the mainstream thinking of psychiatrists and many patients.

Other support groups include the Mad Tea Party in Chicago and the Freedom Center in Northampton, Mass., which provides education, acupuncture, yoga and peer discussions to about 100 participants.

The Icarus Project, a New York-based online forum and support network, says it attracts 5,000 unique visitors a month to its Web site, and it has inspired autonomous local chapters in Portland, Ore., St. Louis and Richmond, Va. Participants write and distribute publications, stage community talks, trade strategies for staying well and often share duties like cooking or shopping.

The Icarus Project says its participants are “navigating the space between brilliance and madness.” It began six years ago, after one of its founders, Sascha Altman DuBrul, now 33, wrote about his bipolar disorder in The San Francisco Bay Guardian, a weekly newspaper. Mr. DuBrul, who is known as Sascha Scatter, received an overwhelming response from readers who had experienced similar ordeals, but who felt they had no one to discuss them with.

“We wanted to create a new language that resonated with our actual experiences,” Mr. DuBrul said in a telephone interview.

Some Icarus Project members argue that their conditions are not illnesses, but rather, “dangerous gifts” that require attention, care and vigilance to contain. “I take drugs to control my superpowers,” Mr. DuBrul said.

While psychiatrists generally support the mad pride movement’s desire to speak openly, some have cautioned that a “pro choice” attitude toward medicine can have dire consequences.

“Would you be pro-choice with someone who has another brain disease, Alzheimer’s, who wants to walk outside in the snow without their shoes and socks?” said Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute in Chevy Chase, Md.

Dr. Torrey, a research psychiatrist who specializes in schizophrenia and manic depression, said he understood the roots of the movement. “I suspect that not an insignificant number of people involved have had very lousy care and are still reacting to having been involuntarily treated,” he said.

Many psychiatrists now recognize that patients’ candid discussions of their experiences can help their recoveries. “Problems are created when people don’t talk to each other,” said Dr. Robert W. Buchanan, the chief of the Outpatient Research Program at the Maryland Psychiatric Research Center. “It’s critical to have an open conversation.”

Ms. Spikol writes about her experiences with bipolar disorder in The Philadelphia Weekly, and posts videos on her blog, the Trouble With Spikol (http://trouble.philadelphiaweekly.com/).

Thousands have watched her joke about her weight gain and loss of libido, and her giggle-punctuated portrayal of ECT. But another video shows her face pale and her eyes red-rimmed as she reflects on the dark period in which she couldn’t care for herself, or even shower. “I knew I was crazy but also sane enough to know that I couldn’t make myself sane,” she says in the video.

IN a telephone interview, she described one medication that made her salivate so profusely she needed towels to mop it up. “Of course it’s heartbreaking if you let it be,” she said. “But it’s also inherently funny. I’d sit there watching TV and drool so much, it would drip on the couch.”

Ms. Spikol said she has a kind doctor who treats her with respect, and she takes her pharmaceutical drugs to stabilize her mood. “I have asthma, and I use medications to maintain it, too,” she said.

Ms. Saks, the U.S.C. professor, who recently published a memoir, “The Center Cannot Hold: My Journey Through Madness,” has come to accept her illness. She manages her symptoms with a regimen that includes psychoanalysis and medication. But stigma, she said, is never far away.

She said she waited until she had tenure at U.S.C. before going public with her experience. When she was hospitalized for cancer some years ago, she was lavished with flowers. During periods of mental illness, though, only good friends have reached out to her.

Ms. Saks said she hopes to help others in her position, find tolerance, especially those with fewer resources. “I have the kind of life that anybody, mentally ill or not, would want: a good place to live, nice friends, loved ones,” she said.

“For an unlucky person,” Ms. Saks said, “I’m very lucky.”

May

13

US Health Secretary Says Heparin From China Now Safe

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US to step up scrutiny of imports

SHANGHAI, China, May 12, 2008 (AP Online delivered by Newstex) — A blood thinner manufactured in China and linked to dozens of deaths in the United States is now safe because of tighter testing and controls, a top American health official said Monday, while warning that all U.S. imports would face closer scrutiny in the future.

The U.S. Food and Drug Administration has linked 81 deaths and hundreds of allergic reactions to a contaminant found in China-made shipments of the drug heparin.

“We have put in place processes that we believe can ensure the safety of the heparin supply within the United States,” U.S. Health and Human Services secretary Mike Leavitt told The Associated Press in an interview in Shanghai.

He said all exporters of food, drugs and other products must prepare to meet more stringent guidelines of quality and safety, following a raft of product safety problems stemming from lax standards among overseas producers, especially in China.

“We believe the system that we have for ensuring safety is a good one but completely inadequate for the future,” Leavitt said.

“What you’ll see from the United States is a substantial change in our strategy,” he added, noting Washington’s plans to station Food and Drug Administration inspectors in China and other countries.

Leavitt said he was optimistic that American and Chinese officials could soon resolve a dispute over the FDA’s investigation into the cause of deaths and reactions linked to heparin.

Washington plans to set up FDA offices in China to help improve product safety following allegations that many of Beijing’s exports — from toys to fish — are shoddy or dangerous.

China’s drug safety agency has accused the U.S. of blocking its own inquiry into the problem by refusing to provide details on victims and specifics about production. Beijing contends that it is too early to conclude that a contaminant found in raw heparin exported to the United States caused the adverse reactions.

A report published Friday said the FDA was concerned that some medical facilities may still have heparin in stock.

Leavitt said that the need to prevent a shortage of heparin, widely used in dialysis and other common medical procedures, required that the FDA find ways to maintain the supply and quality of the drug.

“The FDA is satisfied that that which is coming into the United States is safe,” he said. “Testing regimens have been put in place to ensure that.”

Leavitt was due to meet later with China’s minister of health to discuss various issues, including a viral outbreak that has killed at least 34 children and sickened thousands.

He said he planned to reiterate a U.S. offer to help China in its fight against the outbreaks of hand, foot and mouth disease.

May

12

Nima Arkani-Hamed, a Theoretical Physicist, May Change Ideas of Spacetime for the First Time Since Einstein

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(CNN) — Visiting a particle accelerator is like a religious experience, at least for Nima Arkani-Hamed.

-2.jpgNima Arkani-Hamed, a leading theoretical physicist, thinks the universe has at least 11 dimensions.

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This magnet at the Large Hadron Collider may help physicists explore new properties of nature.

Immense detectors surround the areas where inconceivably small particles slam into one another at super-high energies, collisions that may confirm Arkani-Hamed’s predictions about undiscovered properties of nature.

Arkani-Hamed is only in his mid-30s, but he has already distinguished himself as one of the leading thinkers in the field of particle physics.

His revolutionary ideas about the way the universe works will finally be put to the test later this year at Switzerland’s Large Hadron Collider, which, when completed, will be the world’s most powerful particle accelerator.

The accelerator, estimated to cost between $5 billion and $10 billion, could provide answers to questions physicists have had for decades. Thousands of scientists from around the world are collaborating on the project at the European Organization for Nuclear Research, or CERN.

If the results confirm any of Arkani-Hamed’s predictions, they would be the first extension of our notions of spacetime since Albert Einstein.

“We’re essentially guaranteed that there’s going to be something surprising,” Arkani-Hamed said of the Large Hadron Collider, which will operate inside a 17-mile circular tunnel.

Regarded as a “gem,” Arkani-Hamed is “opening our minds and creating a new world of ideas that challenge deep-grained preconceptions about spacetime,” said Chris Tully, professor of physics at Princeton University, who is working on the Compact Muon Solenoid experiment at the Large Hadron Collider.

“From the point of view of the big experiments at the LHC, there is no amount of money or craftsmanship that would produce the kind of insight that comes from sharing LHC data with a true visionary like Nima Arkani-Hamed,” Tully said.

Formerly a professor at Harvard, Arkani-Hamed currently sits on the faculty at the prestigious Institute for Advanced Study in Princeton, New Jersey, where Einstein served from 1933 until his death in 1955.

“He was lured from Harvard to the IAS — I’m sure that’s considered quite a coup,” said Daniel Marlow, a physics professor at Princeton who is also collaborating on the CMS experiment.

Arkani-Hamed has had a hand in explaining how the world can operate according to Einstein’s theory of general relativity, which describes the universe on a very large scale, and at the same time follow quantum mechanics, laws that describe the universe on a scale smaller than the eye can see.

Some of the key mysteries that stem from these clashing theories include why gravity is so weak, relative to the other fundamental physical forces such as electromagnetism, and why the universe is so large. These issues come up because on an inconceivably small scale, the particles that make up our world seem to behave completely differently than one might imagine.

For example, if you are driving a car, your GPS tells you where you are, and your speedometer tells you how fast you are moving. But on the scale of particles like electrons, it is impossible to know both position and speed at once — the very act of trying to find out requires incredible amounts of energy.

If it takes so much energy just to try to pin down a particle, then, in theory, all particles should have temporary energy changes around them called “quantum fluctuations.” This energy translates into mass, since Einstein famously said that mass and energy are interchangeable through the equation E=mc2.

“It makes it extremely mysterious that the electron, or indeed, everything else that we know and love and are made of, isn’t incredibly more massive than it is,” Arkani-Hamed said.

A theory that has emerged in recent decades that claims to bring some relief to physics mysteries like these is called superstring theory, or string theory for short. While previously, scientists believed that the smallest, most indivisible building blocks of our world were particles, string theory says that the world is made of extremely small vibrating loops called strings.

In order for these strings to properly constitute our universe, they must vibrate in 11 dimensions, scientists say. Everyone observes three spatial dimensions and one for time, but theoretical models suggest at least seven others that we do not see.

Arkani-Hamed proposed, along with physicists Savas Dimopoulos and Gia Dvali, that some of these dimensions are larger than previously thought — specifically, as large as a millimeter. Physicists call this the ADD model, after the first initials of the authors’ last names. We haven’t seen these extra dimensions yet because gravity is the only force that can wander around them, Arkani-Hamed said.

String theory has come under attack because some say it can never be tested — the strings are supposed to be smaller than any particle ever detected, after all. But Arkani-Hamed says the Large Hadron Collider could potentially lead to the direct observation of strings, or at least indirect evidence of their existence.

In fact, by slamming particles into one another, the Large Hadron Collider may detect particles slipping in and out of the dimensions that Arkani-Hamed has worked on describing.

Particle collisions should begin at the Large Hadron Collider in August or September, according to the US/LHC Web site. Evidence of theories such as the ADD model could be discovered by 2009, Marlow said.

Data reflecting Arkani-Hamed’s work on large extra dimensions “would really provide the first confirmation in this very profound way we might think about nature,” Marlow said.

Arkani-Hamed always had a great love of the natural world as a child. Though his parents are also physicists, he considers it his “act of teenage rebellion to become one too,” as his mother wanted him to become a doctor.

He remembers being impressed around age 14 that Newton’s laws could enable him to calculate such things as the minimum speed that a space shuttle had to attain to escape the Earth’s gravitational field. He’d wondered whether scientists had reached the figure of 11 kilometers per second by trial and error, shooting things in the air until the right speed emerged, until he could calculate it himself.

“When I figured out how to do that for myself, I just thought it was just the coolest thing, that little old me, scratching away on my piece of paper, could figure this out,” he said. “From about 13 or 14, I knew that this is what I wanted to do.”

May

12

Colony Collapse Disorder, Dysfunctional Bees?

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Bee Swarm Cleared From Newspaper Box in Manhattan

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A professional beekeeper was called in to remove a swarm of honeybees in the city Wednesday.

NEW YORK (WABC), May 7, 2008 — A professional beekeeper was called in to remove a swarm of honeybees from their perch atop an Upper East Side newspaper box Wednesday afternoon.

NYPD and FDNY units were called to the corner of East 76th Street and 2nd Avenue after the swarm of some 5,000 bees descended on the newspaper box. Emergency responders called the Bronx Zoo for guidance, and the zoo called in beekeeper Jim Fisher.

Fisher used water to wet the wings of the swarn to prevent them from flying off, then used a whisk broom to sweep the bees into a cardboard box. Once the queen bee was inside, the rest of the bees followed her pheremones into the box.

Fisher says the bees had been on the box for about an hour and likely landed in desperation, having come from a nearby hive that had split its population in two. Half flew off with the new queen bee in search of a new home, while the other half remained with the existing hive and the old queen bee. It’s behavior that’s not unusual this time of year, Fisher said.

The bees that bolted were looking for a space about the size of a corner mailbox to call their new home. Fisher says that while 5,000 sounds like a lot of bees, it’s really pretty small as swarms go. All of the bees together weighed about a pound and could have fit inside a woman’s handbag. The swarm was docile, having no hive or honey to defend.

Thanks to Fisher, the bees now have a new home north of New York City. They’ve taken up residence with another beekeeper who lost a hive of bees to disease some time ago.

May

9

New Reason For Bee Hive Collapse: Ecologists Tease Out Private Lives Of Plants And Their Pollinators

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May 6, 2008 — The quality of pollen a plant produces is closely tied to its sexual habits, ecologists have discovered. As well as helping explain the evolution of such intimate relationships between plants and pollinators, the study — one of the first of its kind and published online in the British Ecological Society’s journal Functional Ecology — also helps explain the recent dramatic decline in certain bumblebee species found in the shrinking areas of species-rich chalk grasslands and hay meadows across Northern Europe.

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Loss of biodiversity in pollination networks may threaten the persistence of plant communities.

Relationships between plants and pollinators have fascinated ecologists since Darwin’s day. While ecologists have long known that pollinators such as honeybees and bumblebees are often faithful to certain flowers, and have done much work on the role of nectar as a food source, very little is known about how pollen quality affects these relationships.

Working on Salisbury Plain, the largest area of unimproved chalk grassland in north west Europe, ecologists from the universities of Plymouth, Stirling and Poitiers in France collected pollen from 23 different flowering plant species, 13 of which are only pollinated by insects while the other 10 species can either pollinate themselves or be insect pollinated. They analyzed the pollen for protein content and, in the second part of the study, recorded bumblebee foraging behavior.

They found that without exception, plants that rely solely on insects for pollination produce the highest quality pollen, packing 65% more protein into their pollen than plant species that do not have to rely on insect pollinators. They also discovered that bumblebees prefer to visit plants with the most protein-rich pollen. According to the lead author of the study, Dr Mick Hanley of the University of Plymouth: “Bumblebees appear to fine-tune their foraging behavior to select plants offering the most rewarding pollen. Although there is some debate about how they can tell the difference, it is possible they are using volatile compounds.”

By helping understand the advantages and disadvantages of plant-pollinator relationships where particular plants rely on particular insects to reproduce, and those insects rely on the same plants for food, the results could help ecologists conserve certain bumblebee species and the species-rich chalk grassland and hay meadow communities in which they live, all of which are becoming increasingly rare.

“For the plant, relying on a small group of insects such as bumblebees as pollinators is very beneficial because it ensures efficient pollen transfer. Bumblebees quickly learn to visit the most rewarding flowers, so providing protein-rich pollen is one way plants can encourage bumblebees to be faithful. But this close relationship has many potential pitfalls, because if the pollinators are lost, the flowers may not be able to reproduce, and this may be what we are seeing in the hay meadows, chalk grasslands and bumblebees species throughout Northern Europe,” Hanley says.

Journal reference: Michael Hanley et al (2008). Breeding system, pollinator choice and variation in pollen quality in British herbaceous plants, Functional Ecology, doi: 10.1111/j.1365-2435.2008.01415.x, is published online on 6 May 2008. Retrieved May 7, 2008, from http://www.sciencedaily.com /releases/2008/05/080505211806.htm

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May

9

Creating Homes That Please America’s Wild Bees

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ScienceDaily (Apr. 9, 2008) — Just like people who are looking for a perfect place to live, some female bees search for the ideal place to build their nests.

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Studies of the blue orchard bee–shown here visiting an apple blossom–may reveal new ways to lure these proficient pollinators to live and work in orchards and fields. (Credit: Image courtesy T. L. Pitts-Singer)

Agricultural Research Service (ARS) entomologist Theresa L. Pitts-Singer is discovering more about the “nesting cues” that influence wild bees’ house-hunting decisions. It’s information that may help entice more of the hardworking pollinators to take up residence in new, ready-to-occupy nesting structures that growers and beekeepers provide.

Some bees like living in snug, dark recesses called “nesting cavities.” These range from deep holes drilled into wooden boards, to bundles of cardboard tubes or hollow reeds. Growers and beekeepers place bee housing in orchards and fields where they need the bees to live and work.

Wild bees augment the work of the European honey bee, currently plagued by a puzzling problem known as colony collapse disorder. That’s according to Pitts-Singer, with the ARS Pollinating Insect Biology, Management and Systematics Research Unit in Logan, Utah.

Scientists already know that female blue orchard bees (Osmia lignaria) and certain other wild bees prefer to nest in cavities that other females of their species once occupied. That’s problematical because old nests may be contaminated with disease-causing spores.

To find out what’s making old nests alluring, Pitts-Singer is investigating components from the old homes, including old pollen, leaves, mud, and a fluid bees apply to cavity walls.

In one test, Pitts-Singer and colleagues used glass tubes to approximate drilled nesting holes, then collected the now-dry fluid that bees had left on walls. The scientists are using sophisticated laboratory instruments to glean some of the first-ever information about the chemical composition of the fluid.

Perhaps secreted by bees to differentiate one home from another, the fluid may also add to the overall appeal of a previously occupied nesting site. If that’s the case, Pitts-Singer’s investigations might lead to using synthetic versions of the fluid to make tomorrow’s new nesting structures more inviting.

Adapted from materials provided by US Department of Agriculture.

US Department of Agriculture (2008, April 9). Creating Homes That Please America’s Wild Bees. Retrieved May 7, 2008, from http://www.sciencedaily.com /releases/2008/04/080405092526.htm

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Bumblebee in flight. (Image Credit: Christian Stamm / via German Wikipedia)

May

9

Some (Bumblebees) Like It Hot

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Cambridge University - Bumblebees prefer warmer flowers and can learn to use color to predict floral temperature before landing, a new study reports.
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Colonies which learn colours quickly are more successful. (Credit: Image courtesy of Queen Mary, University Of London)

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