Target Health Inc. is proud to be a contributor to The Millennium Villages project, supported by The Earth Institute at Columbia University, Millennium Promise, the United Nations Development Programme, and the UN Millennium Project. Columbia University’s Professor Jeffrey Sachs MD is the Head of The Earth Institute.

NEW YORK, June 15, 2007 – A new initiative from Columbia University Medical Center will be the first to target chronic oral health problems in sub-Saharan Africa, where the vast majority of chronic diseases are left undetected and untreated. The initiative is the result of an anonymous $1.5 million gift to support the Millennium Villages, which aims to fight extreme poverty and related challenges such as disease, hunger and lack of access to water and sanitation though scientifically sound and sustainable interventions. A third of the gift will be devoted to supporting the oral health program.

Dr. Syrop in Ethiopia

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Dr. Steven Syrop and a patient in Koraro, Ethiopia

Chronic diseases will soon become the leading cause of health problems in the developing world, and oral health conditions are one of the most common chronic disorders, according to the World Health Organization. Initial Columbia research in the village of Koraro, Ethiopia, found that more than half of the population complained of oral pain. The generous donation will fund the first extensive initiative, led by Columbia’s College of Dental Medicine, to directly target oral health problems in sub-Saharan Africa with a sustainable prevention and treatment program.

“Oral health is important to total health, so it’s essential that efforts to improve the lives of impoverished communities include a dental component,” said Ira Lamster, DDS, dean of the College of Dental Medicine at Columbia University Medical Center. “The faculty and students of Columbia’s College of Dental Medicine are committed to addressing the global epidemic of chronic oral health problems through treatment and prevention programs.”

“There is currently no access to dental care whatsoever in the remote villages of the world,” said Steven Syrop, DDS, associate clinical professor of dentistry at the College of Dental Medicine, who is leading the dental component of the Millennium Villages. “There are only 48 dentists in the entire country of Ethiopia, and most are in the capital, Addis Ababa. We’re going to bring dental care to villages where there are no dentists.”

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Dental student Jeff Laughlin and Dr. Syrop in Koraro, Ethiopia

The health component of the Millennium Villages grew out of the United Nations Millennium Project and the World Health Organization Commission on Macroeconomics and Health, both of which showed the direct link between improving public health and economic growth. Those reports explained that health improvements can only happen through a broad range of inter-related public health reforms.

The Millennium Villages project, supported by The Earth Institute at Columbia University, Millennium Promise, the United Nations Development Programme, and the UN Millennium Project, currently includes 12 sites in 10 sub-Saharan countries. It reaches more than 400,000 people with plans to increase its reach over time. The project empowers the local health care sector by supporting basic health interventions, building or upgrading clinics, and expanding the pool of community or village health workers. The participating villages are integral partners in the project and take responsibility for the interventions.

In addition to the oral health initiative, the new funding will support Columbia-led interventions to address chronic cardiovascular and mental health disorders in the region.

The dental component of the project is the result of research by Dr. Syrop and his team, who traveled to Koraro, Ethiopia, in the fall of 2006 to assess the oral health situation in the village of 5,100 people. In addition to the common complaint of oral pain, the team found a high incidence of hardened plaque (calculus) and gingival bleeding. Ninety-five percent of the people they examined had significant dental erosion because of the presence of sand in their food as a result of the arid environment and lack of water for rinsing crops.

“We were surprised by the extent of the oral health crisis in Ethiopia,” said Dr. Syrop. “In an area where the population has little access to sugary food and fermentable carbohydrates, we didn’t expect the problem to be as bad as it is. Developing a sustainable oral health program is an essential ingredient to improving the lives of these people.”

Teams of five or so Columbia faculty, staff and students will travel this fall to sub-Saharan countries, including Tanzania, Rwanda and Senegal, to collect data and assess the population’s oral health needs. They will use the data to develop a program for three or four villages initially, and then ultimately incorporate oral health as an integral component of improving health care at all of the Millennium Village sites.

The Columbia teams will train local health care workers to provide basic essential dental care, including extractions and control of infections. Additionally, the teams will introduce a comprehensive prevention program in the schools and the overall community by working with local teachers to develop a curriculum that is appropriate and sustainable for the individual village. They also will develop a prevention program to educate mothers about caring for the oral health of their young children.

“Treating and preventing oral health problems is one spoke in the wheel of improving conditions in sub-Saharan Africa,” said Dr. Syrop. “By improving their health, we enable this population to be more productive, helping them to improve their economic situation and lift themselves out of poverty.”

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Columbia University Medical Center provides international leadership in pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, nurses, dentists, and public health professionals at the College of Physicians & Surgeons, the College of Dental Medicine, the School of Nursing, the Mailman School of Public Health, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. www.cumc.columbia.edu

June 16, 2007

Source: Infectious Diseases Society of America

New vaccines are available to make significant gains against cervical cancer deaths and debilitating pain from shingles, but infectious diseases experts warn that their full potential will not be realized without changes in the way vaccines for adults and adolescents are promoted, financed, and delivered in the United States.

The Infectious Diseases Society of America (IDSA) has released a new “blueprint for action” to prevent tens of thousands of deaths and illnesses caused by these and other diseases that can be avoided with a few simple shots. The blueprint is published in the June 15 issue of Clinical Infectious Diseases.

“We have done a great job in this country delivering vaccines to children, but we have done an awful job delivering vaccines to adults,” said Neal A. Halsey, MD, professor at the Johns Hopkins University Bloomberg School of Public Health and chair of the IDSA Immunization Work Group that developed the policy blueprint.

For example, he points out that more than 90 percent of U.S. children are immunized against measles, mumps, whooping cough, hepatitis B, and other diseases. Rates of these diseases are at or near historic lows. In contrast, an estimated 175,000 adults are hospitalized and 6,000 die each year from pneumococcal pneumonia, but one in three adults over 65 has not been vaccinated against it. The Centers for Disease Control and Prevention (CDC) estimates that the cost of treating diseases that vaccines could prevent exceeds $10 billion annually.

Cost is one factor in why adults do not get vaccinated–particularly the uninsured. “CDC has very effective systems for delivering vaccines to underserved children,” said IDSA work group member Walter A. Orenstein, MD, associate director of the Emory Vaccine Center and former head of CDC’s immunization program. “One of them is Section 317 of the Public Health Service Act, which helps state and local health departments provide vaccines to uninsured or underinsured patients–largely children–for free. Section 317 must now be expanded to catch underserved adults at highest risk.”

While the program is cost-effective, expanding Section 317 will require a significant infusion of cash. Section 317’s current $520 million budget will need an additional $170 million per year in order to cover all vaccines for uninsured adults, according to a recent CDC estimate. “It is essential that we provide adults access to these vaccines that save lives and prevent illnesses,” Dr. Orenstein said, “but immunizing adults must not be done at the expense of children.”

IDSA also is calling for all plans to cover all adult and adolescent vaccines recommended by CDC’s Advisory Committee on Immunization Practices and to pay physicians adequately for office costs associated with immunization. Further, managed care plans should be measured in part on how well they immunize patients. Another principle supports exploring where immunization can appropriately take place outside the traditional office setting. Funding to support research into vaccines and vaccine delivery must be increased, and resources must be available to gather data on safety, efficacy, and usage.

Physicians and patients also must be part of the solution, according to the IDSA blueprint. “Part of the problem lies with physicians, who are not accustomed to offering vaccines during routine visits with adult patients; and with patients, who are unaware the vaccines exist,” said IDSA work group member William Schaffner, MD, chair of the Department of Preventive Health at Vanderbilt University. Doctors who serve adults must begin assessing adult immunization needs during routine preventive health care visits. Also, CDC should launch an education campaign to help improve awareness about vaccines and the illnesses they can prevent in adults.

“As health care workers, we set an example for our patients,” Dr. Schaffner added. “We all must be fully immunized.”

“We have the tools to make dramatic improvements in adult and adolescent health, as we have for children,” said Andrew T. Pavia, MD, chair of IDSA’s National and Global Public Health Committee, Chief of Pediatric Infectious Diseases at the University of Utah, and a member of the National Vaccine Advisory Committee. “IDSA’s blueprint outlines the steps we must take to use these tools effectively. Now all we need is the will to take those steps.”

Reference: IDSA blueprint, “Actions to Strengthen Adult and Adolescent Immunization Coverage in the United States.”

Note: This story has been adapted, by Science Daily, from a news release issued by Infectious Diseases Society of America.

New York Times
By WALT BOGDANICH

After a drug ingredient from China killed dozens of Haitian children a decade ago, a senior American health official sent a cable to her investigators: find out who made the poisonous ingredient and why a state-owned company in China exported it as safe, pharmaceutical-grade glycerin.

The Chinese were of little help. Requests to find the manufacturer were ignored. Business records were withheld or destroyed.

The Americans had reason for alarm. “The U.S. imports a lot of Chinese glycerin and it is used in ingested products such as toothpaste,” Mary K. Pendergast, then deputy commissioner for the Food and Drug Administration, wrote on Oct. 27, 1997. Learning how diethylene glycol, a syrupy poison used in some antifreeze, ended up in Haitian fever medicine might “prevent this tragedy from happening again,” she wrote.

The F.D.A.’s mission ultimately failed. By the time an F.D.A. agent visited the suspected manufacturer, the plant was shut down and Chinese companies said they bore no responsibility for the mass poisoning.

Ten years later it happened again, this time in Panama. Chinese-made diethylene glycol, masquerading as its more expensive chemical cousin glycerin, was mixed into medicine, killing at least 100 people there last year. And recently, Chinese toothpaste containing diethylene glycol was found in the United States and seven other countries, prompting tens of thousands of tubes to be recalled.

The F.D.A.’s efforts to investigate the Haiti poisonings, documented in internal F.D.A. memorandums obtained by The New York Times, demonstrate not only the intransigence of Chinese officials, but also the same regulatory failings that allowed a virtually identical poisoning to occur 10 years later. The cases further illustrate what happens when nations fail to police the global pipeline of pharmaceutical ingredients.

In Haiti and Panama, the poison was traced to Chinese chemical companies not certified to make pharmaceutical ingredients. State-owned exporters then shipped the toxic syrup to European traders, who resold it without identifying the previous owner — an attempt to keep buyers from bypassing them on future orders.

As a result, most of the buyers did not know that the ingredient came from China, known for producing counterfeit products, nor did they show much interest in finding out.

China itself was a victim of diethylene glycol poisoning last year when at least 18 people died after ingesting poisonous medicine made there. In the wake of the deaths, and reports of pet food and other products contaminated with dangerous ingredients from China, officials there announced that they would overhaul the regulation of food, drugs and chemicals.

Beyond the three incidents linked to Chinese diethylene glycol, there have been at least five other mass poisonings involving the mislabeled chemical in the past two decades — in Bangladesh, Nigeria, Argentina and twice in India.

“This problem keeps coming back,” said Dr. Joshua G. Schier, a toxicologist with the Centers for Disease Control and Prevention. And no wonder: the counterfeiters are rarely identified, much less prosecuted.

Finding a way to keep diethylene glycol out of medicine, particularly in developing countries, has confounded health officials for decades. “It is preventable and we have to figure out some way of stopping this from happening again,” said Carol Rubin, a senior C.D.C. official.

In a global economy, ingredients for drugs are often bought and sold many times in different countries, sometimes without proper paperwork, all of which increases the risk of fraud, the authorities say.

The Panama poison passed through five hands, the Haitian poison six. In both cases, the factory’s original certificate of analysis, attesting to the contents of the shipment and its provenance, did not accompany the product as it moved around the world.

“Where there is a loophole in the system, a frailty in the system, it’s the ability of an unscrupulous distributor to take industrial or technical material and pass it off as pharmaceutical grade,” said Kevin J. McGlue, a board member of the International Pharmaceutical Excipients Council.

Uncovering that deception can be difficult. “It’s impossible to get anyone to do the trace-backs,” said Dr. Michael L. Bennish, co-author of a 1995 medical journal article on a poisoning epidemic in Bangladesh.

One reason, Dr. Bennish said, is the clout of local manufacturers. “We tried to follow up as amateur Sherlocks, investigators, but you don’t go down to the wholesale market and ask questions,” he said. “You are going to get your fingers burnt.”

A Crisis in Haiti

By the end of June 1996, the F.D.A. knew it might have an international crisis on its hands. A poison had found its way into fever syrup in Haiti, and the F.D.A. wanted to know if more of the same might be heading to the United States or, for that matter, to any other country. But to learn that, the agency needed to find the manufacturer.

This was not just any poison. Virtually every young poisoning victim who showed up at the main hospital in Port-au-Prince, Haiti’s capital, died.

Labeled pharmaceutical-grade glycerin, the toxic syrup was mixed into thousands of bottles of fever medicine. For months, parents gave it to children, then watched them die, in agony, from kidney failure. No one suspected the medicine until much later.

Officially, at least 88 children died, nearly half under the age of 2. But those 88 were only the ones doctors remembered or for whom hospital records could be found.

The F.D.A. traced the poison to a German broker, Chemical Trading and Consulting, but the company’s records were not much help. “They cannot trace glycerine lots to their manufacturer,” David Pulham, an F.D.A. investigator, wrote on June 30, 1996.

Chemical Trading had arranged for a Dutch company, Vos B.V., to sell 72 barrels of the suspect syrup to Haiti, records show. The agency dispatched an investigator, Ann deMarco, who made an unsettling discovery: sitting in Vos’s warehouse near Rotterdam were 66 more barrels labeled glycerin, all containing lethal concentrations of diethylene glycol.

“Some of this second shipment has been sold,” Ms. deMarco wrote in a memorandum on July 4, 1996. Although the missing barrels had gone to an industrial user, not a drug maker, the F.D.A.’s worries grew.

Ms. deMarco learned that another broker, Metall-Chemie, a German trader, had arranged for Vos to buy the barrels from Sinochem International Chemicals Company, a giant exporter in Beijing owned by the Chinese government.

But Metall-Chemie also did not know the manufacturer, and one of its officials predicted that the F.D.A. would have trouble finding that out. “It is difficult to get any information from Chinese traders,” Ms. deMarco wrote.

More complete shipping records would have identified who made the poison. But in this case, records provided few clues.

“The original source of the material had been obliterated on documents and product containers,” Ms. deMarco wrote to senior F.D.A. officials. “One trader referred to this practice as ‘neutralization.’ I was advised that neutralization is a common practice among traders in order to protect their business interests.”

With no paper trail, American officials turned to Sinochem for help.

Initially, they took an indirect approach. In July 1996, the American Embassy in China contacted the company and asked for a list of Chinese glycerin makers, without saying that it was investigating the Haiti poisonings. Sinochem, however, “would not reveal the names of actual manufacturers in order to prevent the prospective foreign customer from bypassing Sinochem,” an embassy official reported to Washington.

In early August, American officials asked Sinochem representatives specifically about the origin of the Haiti poison. “They want to investigate further and were unable (or unwilling) to give the name of the manufacturer at this time,” the officials reported.

Federal investigators sought help from senior Chinese drug regulators, who promised to help find the manufacturer, but said it “will take time,” records show.

When another month passed without any word from either regulators or Sinochem, the embassy tried again. Chinese regulators said they had done nothing to find the factory, according to a confidential State Department telegram from September 1996.

Sinochem did finally offer the manufacturer’s name: the Tianhong Fine Chemicals Factory in the city of Dalian in northeastern China. But Sinochem “refused” to provide an address, saying it was illegible. A telephone number would have to suffice, it said.

That, too, was unproductive. When American investigators called the plant manager, Zhang Gang, they were told he was not available. Send a fax, they were told. That did not work either. “The phone was always busy,” investigators reported.

Finally, they got Mr. Zhang on the phone, but he, too, refused to give out his factory’s address. He said that tests had found no signs of diethylene glycol, adding that “there had been no cases in China of poisoning resulting from the ingestion” of glycerin contaminated by diethylene glycol, investigators wrote.

After months of trying to trace the poison to its source, United States investigators were at a dead end.

“The Chinese officials we contacted on this matter were all reluctant to become involved,” a State Department official wrote in late September 1996, saying that drug regulators and the plant manager had insisted on communicating only on the telephone “to avoid leaving a paper trail.”

He added, “We cannot be optimistic about our chances for success in tracking down the other possible glycerine shipments.”

The following May, Mr. Pulham, who was part of the original F.D.A. investigative team in Haiti, tried to revive the investigation. “Is it possible to block-list all Chinese pharmaceutical products until we gain cooperation?” he asked.

The suggestion went nowhere. Five months later, Ms. Pendergast of the F.D.A. wrote her memorandum, imploring investigators to keep digging.

“China is turning into one of the major bulk pharmaceutical producers in the world,” she wrote. “Unless they have an open, transparent and predictable system for dealing with problems and other countries, it is going to be rough sledding in the years ahead.”

On Nov. 17, 1997, federal investigators once again questioned Sinochem officials. They denied any wrongdoing, saying that two certificates of analysis showed that the suspect shipment was safe, pharmaceutical-grade syrup. But when the F.D.A. asked to see them, Sinochem refused.

“The officials were not willing to explain why they could not provide the copies,” an American official reported at the time.

Chen Liusuo, who handled the glycerin sales, strongly disputed the F.D.A.’s account. In an interview with The Times, Mr. Chen said Sinochem cooperated. “We gave them everything they wanted,” Mr. Chen said, adding that the agency was satisfied.

“The product we sold was glycerin,” he said. “It passed through three or four companies after us. To find the problem you need to look at every link in the supply chain.”

A Chinese government official familiar with the F.D.A.’s inquiries said the Americans’ frustration might have stemmed from their misunderstanding about who regulated chemical companies, which led them to seek help from the wrong officials. “This was a truly tragic event, and we expressed our sadness and sympathy,” said the official, who asked not to be identified.

At the end of 1997, a year and a half after the F.D.A. began tracing the poisonous shipments, one of its investigators, Ted Sze, finally got inside the Tianhong chemical plant in Dalian. But glycerin was no longer made there, and Mr. Sze had no records to inspect. The plant manager, Mr. Zhang, told investigators that he had received no complaints about his products and that his company had not produced the poison.

Mr. Sze, now retired from the F.D.A., said in an interview that he had no choice but to accept the manager’s word and clear the company of wrongdoing. “By the time I went there, the plant was already shut down,” he said. “The agency can only do so much.”

The Experts’ Recommendations

The United States may not have gotten what it wanted from China, but the Haiti crisis did bring together health groups to search for ways to stop diethylene glycol poisonings. At a workshop in Washington in February 1997, health experts recommended that certificates of analysis be improved to allow users to “trace the product back through every intermediary, broker and repackager to the original manufacturer.”

The workshop participants also called for better testing of drug ingredients and asked governments to tighten oversight of drug manufacturing.

The next year, the World Health Organization offered many of the same recommendations. And a 1998 article in JAMA, the Journal of the American Medical Association, warned that failure to strictly follow the guidelines could cause poisonings “even in countries where quality control procedures are usually strictly applied.”

Much of this had been said before, yet the poisonings have continued.

Just as the JAMA article was being published, three dozen children began dying of acute renal failure at two hospitals in Delhi, India. A local drug maker had unwittingly mixed diethylene glycol into acetaminophen syrup, much as the Haitian pharmacist had.

The drug maker was prosecuted, but according to interviews and government records no progress had been made in identifying the supplier of the poison.

“My experience as an investigator tells me that many of these things will not be proven,” said Dr. M. Venkateswarlu, the drug controller general of India.

Finding counterfeiters often means pursuing leads across foreign borders, and no international authority has the power to do that. Dr. Howard Zucker, who helps to oversee drug issues for the W.H.O., said individual countries must conduct their own trace-back investigations.

But if the United States could not do that on behalf of Haiti, poorer, less influential nations would have little chance of tracking down counterfeiters.

After the Haiti poisoning, a more accurate, less expensive test for diethylene glycol was developed, but last year’s case in Panama shows that suppliers and governments do not always use it.

And as long as counterfeiters do not fear prosecution, the poisonings are likely to continue, experts say.

Dr. Mohammed Hanif, a prominent physician in Dhaka, Bangladesh, said the foreign suppliers of diethylene glycol were never prosecuted for the deaths of thousands of children from 1982 to 1992. “The traumatizing memories of those days still torment me,” said Dr. Hanif, who wrote a paper about the deaths from toxic medicine.

In Argentina, a court official said no one had been prosecuted for supplying the diethylene glycol that ended up in a health supplement, killing 29 people in 1992.

David Mishael, a Miami lawyer, knows the difficulty of assigning blame in these deaths. For 10 years, Mr. Mishael has unsuccessfully pursued legal claims in the United States and Europe against European traders that helped to arrange the shipment of toxic syrup to Haiti. “You can imagine the cost,” said Mr. Mishael, who is representing Haitian parents whose children died from the fever medicine.

He said Dutch authorities assessed a $250,000 fine against Vos, which tested the counterfeit syrup, found it impure and did not alert anyone in Haiti. But given how many died, he called the size of the fine “a joke.” A lawyer who represents Vos, Jeffrey B. Shapiro, declined to comment.

A few children survived after being flown to the United States by humanitarian groups. One of them, Faika Jean, was 2 months old at the time and nearly died en route. Now 11, she has learning disabilities as a result of the poisoning, said her father, Wislin Jean.

Ms. Pendergast, now a private lawyer and consultant, said China had the most to answer for. “Everybody else is just reacting to initial failures,” she said. “It needs to take steps to protect not just its own consumers but also consumers all around the world.”

After The Times reported in May that the Panama poison had been made and exported by Chinese companies as 99.5 percent pure glycerin, Chinese regulators said they would reopen their investigation of the incident. Three weeks later, the officials acknowledged some “misconduct” in how Chinese companies labeled the toxic syrup.

But most of the blame, they said, rested with a Panamanian importer who changed the paperwork to make the syrup look safer than it actually was.

The F.D.A. disagrees, saying the deception began with Chinese companies falsely labeling a poisonous product glycerin. “If the drums had been 99.5 percent glycerin, the deaths in Panama would never have occurred,” the F.D.A. said in a statement.

A Dissatisfied Customer

The F.D.A.’s Haiti investigation never did find more counterfeit glycerin from China, despite a global hunt. But its concerns, it turns out, were not unfounded.

In 1995, the same year babies began to die in Haiti, 284 barrels of a chemical labeled glycerin arrived in New York on container ships. Although the chemical was not intended for use in drugs, it was labeled 98 percent pure. An official with the company that bought the barrels, Dastech International, of Great Neck, N.Y., would later say, “It smelled like glycerin, it looked like glycerin.” But after one of its customers complained, Dastech took a closer look.

Although the chemical was labeled 98 percent pure glycerin, Dastech said in court records that the syrup actually contained sugar compounds — as well as diethylene glycol.

The exporter was Sinochem. Claiming that it was fleeced, Dastech tried to get its money back from the broker who arranged the sale, court records show.

It never did.

Reporting was contributed by Jake Hooker from Beijing, Hari Kumar from New Delhi, Anand Giridharadas from Mumbai, and Julfikar Ali Manik from Dhaka, Bangladesh.

Collaboration with the Health Authority of Abu Dhabi will enhance delivery of healthcare in the Middle East and extends Cleveland Clinic’s brand globally.

Cleveland Clinic has signed an agreement with the Health Authority of Abu Dhabi to manage Sheikh Khalifa Medical City (SKMC), a network of healthcare facilities in Abu Dhabi. The agreement is designed to transform health services in Abu Dhabi, the capital city of the United Arab Emirates.

SKMC consists of 700-bed Sheikh Khalifa Hospital, a 150-bed Behavior Sciences Pavilion and the 100-bed Abu Dhabi Rehabilitation Center, in addition to more than 12 specialized outpatient clinics and nine primary healthcare centers around the city of Abu Dhabi.

“As a global healthcare institution, Cleveland Clinic has sought to cultivate opportunities to further expand our presence abroad, sharing state-of-the-art medical practices, procedures and administrative capabilities and raising healthcare standards worldwide,” said Delos M. “Toby” Cosgrove, CEO and President of Cleveland Clinic. “In partnering with the Health Authority of Abu Dhabi, we have committed to integrating our medical expertise and Best in Class practices with SKMC to achieve the highest clinical outcomes possible and enhance research and training. This partnership stands to redefine what is possible in healthcare worldwide.”

This announcement follows the agreement Cleveland Clinic and Mubadala Development signed in September of last year to design and build a new preeminent first-class specialty hospital on Al-Suwwa Island within the next three years.

Kenneth Ouriel, M.D., to Lead Sheikh Khalifa Medical City in Abu Dhabi; Tommaso Falcone, M.D., to Be Interim Chairman of Surgery
Cleveland Clinic also announced that Kenneth Ouriel, M.D., will serve as Chief Executive Officer of Sheik Khalifa Medical City in Abu Dhabi. Dr. Ouriel, Chairman of Cleveland Clinic’s Division of Surgery and a vascular surgeon, assumes his new role immediately.
“Cleveland Clinic is known worldwide for offering the latest, most advanced medical treatment with superior clinical outcomes,” said Delos M. “Toby” Cosgrove, M.D., President and CEO of Cleveland Clinic. “In broadening our presence abroad, we look forward to bringing our best practices to SKMC under the talented leadership of Dr. Ken Ouriel.”
SKMC consists of the 700-bed Sheikh Khalifa Hospital, a 150-bed Behavior Sciences Pavilion and the 100-bed Abu Dhabi Rehabilitation Center, in addition to more than 12 specialized outpatient clinics and nine primary healthcare centers around the city of Abu Dhabi.
In his new role, Dr. Ouriel will lead the management team of SKMC in implementing strategic initiatives and working with the Health Authority of Abu Dhabi to incorporate Cleveland Clinic’s healthcare model. On Cleveland Clinic’s campus, Tommaso Falcone, M.D., Associate Chief of Staff and Chairman, Obstetrics and Gynecology, has been named the Interim Chairman of the Division of Surgery.
“I look forward to embarking on this unique and exciting opportunity to work with the premier hospital of Abu Dhabi,” Dr. Ouriel said. “This partnership will help raise the quality standards of healthcare around the world and I’m honored to be a part of that.”

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By NATALIE ANGIER
The New York Times

Sperm are some of the most extraordinary cells of the body, a triumph of efficient packaging, sleek design and superspecialization. Human sperm are extremely compact, and they’ve been stripped of a normal cell’s protein-making machinery; but when cast into the forbidding environment of the female reproductive tract, they will learn on the job and change their search strategies and swim strokes as needed.

Sperm are also fast and as cute as tadpoles. They have chubby teardrop heads and stylish, tapering tails, and they glide, slither, bumble and do figure-eights. So while a father may not be entitled to take the same pride in his sperm as he does in his kids, it’s fair to celebrate the single-minded cellular commas that helped give those children their start.

Sperm are pretty much the tiniest cells in the human body. The head of a mature, semen-ready sperm cell spans about 5 microns, or two ten-thousandths of an inch, less than half the width of a white blood cell or a skin cell. And a sperm cell is absurdly dwarfed by its female counterpart, the egg, which, fittingly or not, is among the biggest cells in the body. At 30 times the width of a sperm, the egg is massive enough to be seen with the naked eye.

But men have the overwhelming quantitative edge in the gamete games. Whereas current evidence suggests that a human female is born with all the eggs she will have, and that only about 500 of her natal stock of one million will ever ripen and have a shot at fertilization, a male from puberty onward is pretty much a nonstop sperm bakery. Each testicle generates more than 4 million new sperm per hour, for a lifetime total of maybe 12 trillion sperm per man (although the numbers vary with the day and generally slope downward with age).

The average ejaculation consists mostly of a teaspoon’s worth of nonspermic seminal fluid, a viscous mix of sugars, citric acid and other ingredients designed to pamper and power the sperm cells and prepare them for difficult times ahead; the sperm proper account for only about 1 percent of the semen mass. Yet in that 1 percent may be found 150 million sperm, 150 million human aspirants yearning to meet their mammoth other halves.

To which one can crack, dream on. Not only are there far too few eggs to go around, but also the majority of sperm couldn’t fertilize an ovum if it were plunked down in front of them. “Only a perfectly normal sperm can penetrate an egg,” said Dr. Harry Fisch, a urologist at Columbia University Medical Center, “and the majority of sperm are abnormally shaped.” Some may have pinheads, others have two heads, some lack tails, a third don’t move at all. As a rule, Dr. Fisch said, a man is lucky if 15 percent of his sperm are serviceable. “One guy I saw had 22 percent,” he said, “but that’s rare.”

Creating sperm is a complex, multistep operation in which immature cells spend one or two months wending through a labyrinth of tubules coiled in the testes, at each stage losing a bit more of the blobby contours and yolky contents of standard cells and assuming the streamlined profile of sperm cells. The operation is a delicate one that must be performed at temperatures some 2 degrees below that of the body, which is why the testicles hang outside the body, where breezes can keep them cool; why a man hoping to become a father is advised to skip the hot baths and saunas; and why a bout of high fever can disrupt fertility for months.

The model sperm that emerges at tubule’s end has, like an insect, three basic body segments. Of crowning importance is the head, which is taken up largely by a supercondensed tangle of 23 chromosomes, half the complement of DNA found in a normal body cell and thus the right number to merge with an egg’s 23 chromosomes and begin tapping out a whole new body. At the tip of the sperm head is the acrosome, a specialized sack of enzymes that help the sperm penetrate through what Joseph S. Tash, a male fertility expert at the University of Kansas Medical Center, calls the “forest” of ancillary cells and connective tissue that surrounds the ripe, ready egg.

Below the head is the midpiece, which is packed with the tiny engines called mitochondria that lend the sperm its motility, and below the midpiece is the tail, a bundle of 11 entwined filaments that thrashes and propels a sperm forward at the estimable pace of one-twelfth of an inch per minute, the equivalent of a human striding at four miles an hour.

Sperm do not really hit their stride until they are deposited in the female reproductive tract, at which point chemical signals from the vaginal and cervical mucus seem to spark them to life. Released from the buffering folds of their seminal delivery blanket, they at first swim straight ahead, torpedo-style, “with very little back and forth of the head,” Dr. Tash said. They may linger in the cervical mucus for a couple of days, or cross the cervix and enter the uterus.

If an egg has burst from its ovarian follicle and been plucked by a fallopian tube, sperm can sense its signature, a telltale shift in calcium ions. The sperm become “hyperactivated,” said Moira O’Bryan, a sperm expert at Monash University in Australia, switching to “a crazed figure-eight motion” ideal for boring through barriers. The ovum eggs them on, signaling some to play the sacrificial kamikaze and explode their enzyme sacks prematurely, loosening the corridor for other, shapelier sperm to pass through intact. A few dozen fine-figured sperm find their way to the final barrier, the egg’s plasma membrane, where they waggle with all their crazy-eight might and beg to be chosen — but only one will be taken, will fuse with the egg and be absorbed into its rich inner sanctum.

In a fraction of a second, an electrical, ionic jolt dramatically changes the egg’s outer coat, to forestall the lethal intrusion of additional sperm.

kohlenstoffnanoroehre_animation.gifMany experts believe that carbon nanotubes could eventually replace silicon in microelectronics because of their potential for superior speed and reduced power consumption. nanotube_circuit_x220.jpgAnd over the past several years, researchers have made transistors out of carbon nanotubes. However, it’s still difficult to make reliable circuits out of them. One problem is that the nanotubes, used for transistors that make up the circuits, tend to be fabricated in different directions, making it impossible to know which nanotube form which transistor. And such a chaotic arrangement can lead to electrical malfunctions. But now researchers at Stanford University have written a program that finds a working circuit layout, no matter how disorganized or misaligned the nanotubes.

http://www.technologyreview.com/Nanotech/18893/

From New York Times
By DENISE GRADY

Cancer experts have identified a set of health problems that may be symptoms of ovarian cancer, and they are urging women who have the symptoms for more than a few weeks to see their doctors.

The new advice is the first official recognition that ovarian cancer, long believed to give no warning until it was far advanced, does cause symptoms at earlier stages in many women.

The symptoms to watch out for are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly and feeling a frequent or urgent need to urinate. A woman who has any of those problems nearly every day for more than two or three weeks is advised to see a gynecologist, especially if the symptoms are new and quite different from her usual state of health.

Doctors say they hope that the recommendations will make patients and doctors aware of early symptoms, lead to earlier diagnosis and, perhaps, save lives, or at least prolong survival.

But it is too soon to tell whether the new measures will work or whether they will lead to a flood of diagnostic tests or even unnecessary operations.

Cancer experts say it is worth trying a more aggressive approach to finding ovarian cancer early. The disease is among the deadlier types of cancer, because most cases are diagnosed late, after the cancer has begun to spread.

This year, 22,430 new cases and 15,280 deaths are expected in the United States.

If the cancer is found and surgically removed early, before it spreads outside the ovary, 93 percent of patients are still alive five years later. Only 19 percent of cases are found that early, and 45 percent of all women with the disease survive at least five years after the diagnosis.

By contrast, among women with breast cancer, 89 percent survive five years or more.

The new recommendations, expected to be formally announced on June 25, are being made by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society.

More than 12 other groups have endorsed them, including CancerCare; Gilda’s Club, a support network for anyone touched by cancer; and several medical societies.

“The majority of the time this won’t be ovarian cancer, but it’s just something that should be considered,” said Dr. Barbara Goff, the director of gynecologic oncology at the University of Washington in Seattle and an author of several studies that helped identify the relevant symptoms.

In a number of studies by Dr. Goff and other researchers, these symptoms stood out in women with ovarian cancer as compared with other women.

“We don’t want to scare people, but we also want to arm people with the appropriate information,” said Dr. Goff, who is also a spokeswoman for the Gynecologic Cancer Foundation.

She emphasized that relatively new and persistent problems were the most important ones. So, the transient bloating that often accompanies menstrual periods would not qualify, nor would a lifelong history of indigestion.

Dr. Goff also acknowledged that the urinary problems on the list were classic symptoms of bladder infections, which is common in women. But it still makes sense to consult a doctor, she said, because bladder infections should be treated. Urinary trouble that persists despite treatment is a particular cause for concern, she said.

With ovarian cancer, even a few months’ delay in making the diagnosis may make a difference in survival, because the tumors can grow and spread quickly through the abdomen to the intestines, liver, diaphragm and other organs, Dr. Goff said.

“If you let it go for three months, you can wind up with disease everywhere,” she said

Dr. Thomas J. Herzog, director of gynecologic oncology at the Columbia University Medical Center, said the recommendations were important because the medical profession had until now told women that there were no specific early symptoms.

“If women were more pro-active at recognizing these symptoms, we’d be better at making the diagnosis at an earlier stage,” Dr. Herzog said.

“These are nonspecific symptoms that many people have,” he added. “But when the symptoms persist or worsen, you need to see a specialist. By no means do we want this to result in unnecessary surgery. But I would not expect that to occur in the vast majority of cases.”

Although the American Cancer Society agreed to the recommendations, it did so with some reservations, said Debbie Saslow, director of breast and gynecologic cancer at the society.

“We don’t have any consensus about what doctors should do once the women come to them,” Dr. Saslow said. “There was a lot of hope that we’d be able to say, ‘Go to your doctor, and they will give you this standardized work-up.’ But we can’t do that.”

At the same time, Dr. Saslow said, the cancer society recognized that in some cases doctors had disregarded symptoms in women who were later found to have ovarian cancer, telling the women instead that they were just growing old or going through menopause.

“There are so many horror stories of doctors who have told women to ignore these symptoms or have even belittled them on top of that,” Dr. Saslow said.

In a survey of 1,700 women with ovarian cancer, Dr. Goff and other researchers found that 36 percent had initially been given a wrong diagnosis, with conditions like depression or irritable bowel syndrome.

“Twelve percent were told there was nothing wrong with them, and it was all in their heads,” Dr. Goff said.

Dr. Goff and other specialists said women with the listed symptoms should see a gynecologist for a pelvic and rectal examination. (The best way for a doctor to feel the ovaries is through the rectum.) If there is a question of cancer, the next step is probably a test called a transvaginal ultrasound to check the ovaries for abnormal growths, enlargement or telltale pockets of fluid that can signal cancer. The ultrasound costs $150 to $300 and can be performed in a doctor’s office or a radiology center. A $100 blood test should also be conducted for CA125, a substance called a tumor marker that is often elevated in women with ovarian cancer.

Cancer specialists say any woman with suspicious findings on the tests should be referred to a gynecologic oncologist, a surgeon who specializes in cancers of the female reproductive system.

An unresolved question is what exactly should be done if the test results are normal and yet the woman continues to have symptoms, Dr. Saslow said.

“Do you do exploratory surgery, which has side effects, which are sometimes even fatal?” she asked. “What do you do? We don’t have the answer to that.”

Depending on the test results, the woman may just be monitored for a while or advised to undergo a CT scan or an MRI. But if cancer is strongly suspected, she will probably be urged to go straight to surgery. A needle biopsy, commonly used for breast lumps, cannot be safely performed to check for ovarian cancer because it runs a risk of rupturing the tumor and spreading malignant cells in the abdomen. Instead, the surgeon must carefully remove the entire ovary or the abnormal growth on it and examine the rest of the abdomen for cancer.

While the patient is still on the operating table, biopsies are performed on the tissue that was removed, so that if cancer is found, the surgeon can operate more extensively. Experts say such an operation should be carried out just by gynecologic oncologists, who have special training in meticulously removing as much of the cancerous tissue as possible. This procedure, called debulking, lets chemotherapy work better and greatly improves survival.

Dr. Carol L. Brown, a gynecologic oncologist at the Memorial Sloan Kettering Cancer Center in Manhattan, said, “Ideally, we need to develop a screening tool or a test to find ovarian cancer before it has symptoms.”

No such screening test exists, Dr. Brown said, and until one is developed, the list of symptoms may be the best solution.

“This is something that women themselves can do,” she added, “and we can familiarize clinicians with, to help make the diagnosis earlier.”

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Watch a prostate cancer patient undergo da VinciTM robotic-assisted surgery at Sharp Memorial Hospital.

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Cancer Wonder Drug

ST1 571, or Imatinib, also known as 1) ___ is a cancer pill, approved by the FDA in 2001, that is being used to treat CML, 2) ___ ___ ___and may be effective in treating certain types of brain, specifically glioblastoma, as well as stomach cancers, especially gastrointestinal stromal tumors (GIST), a rare cancer of the digestive system’s connective tissue. STI-571 is a part of a growing group of molecularly targeted treatments in which drugs are designed to treat diseases with specific 3) ___ changes. It blocks a signal that the abnormal 4) ___ sends out, preventing the abnormal growth and production of other cancerous cells. In GIST, imatinib blocks a different abnormal enzyme found on the tumor cells. The drug has turned one of the commonest forms of leukemia from a deadly disease to a manageable chronic illness. Trials have shown that around 90% of patients with CML who take Gleevec are alive and well after 5) ___ years. Gleevec is also showing good progress with related cancers. Although it does not cure the cancer, it keeps it under control. This one-a-day cancer pill is hailed a life-saver. It is recommended for those for whom a 6 ___ ___ transplant – the normal radical treatment for CML – is not an option. Patients will have to take the drug for 7) ___ and although it takes some weeks normally before real benefits can be measured, it means that the leukaemia becomes manageable. Imatinib is being investigated for its effectiveness against other kinds of cancer, as well, including acute lymphocytic leukemia and hypereosinophilic syndrome (HES). 8) ___, the maker of imatinib, has a Patient Assistance Program, (PAP) to help patients who may be eligible for financial assistance in covering the cost of the drug.

ANSWERS: 1) Gleevec; 2) chronic myeloid leukaemia; 3) genetic; 4) protein; 5) five; 6) bone marrow; 7) life; 8) Novartis

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