Reading matériel

Things have gotten busy at work -- hence the lack of new content. But I have been doing a lot of reading, and would love to point you all towards some of the more interesting things I've come across in the past few days:


A fascinating study conducted by the Kaiser Family Foundation, in conjunction with NPR and the Harvard School of Public Health, takes an in-depth look at the impact of heath care costs and the economy in two of the most important swing states in the upcoming election: Florida and Ohio. I highly recommend you click through to take a look at the analysis of the surveys and at the NPR news coverage, providing insights into the way health care costs currently affect people's daily life decisions in these battleground states.

An article in The New Republic written by a health policy junkie by the name of Don McCanne, MD on the importance and inevitability of stand-alone single payer health care system in the US.

And finally, two articles of note from this week's New England Journal of Medicine:

The first is about "Nontraditional Medical Students" (this includes myself!!) and the future of medicine, written by the young and exciting physician/author, Sandeep Jauhar, who is currently the director of the Heart Failure Program at Long Island Jewish Medical Center.

The second is about the current state of premedical education in the United States, and was written by the dean of medical education at Harvard Medical School.

Hope you find some of these pieces interesting, and I'll hopefully be able to holler back at y'all with some new content before the weekend is out.

First I have to finish up this document outlining the tentative purview of the Executive Quality Council for the hospital. Maybe I'll even share some of the work I've been doing here with you guys as it gets closer to completion.

we hood, we voting, and throwing it up

I'm hitting the road again (to Colorado, and immediately followed by a 2 week trip to Morocco) -- but I thought I'd leave to with something to watch in my absence:



Pretty catchy, isn't it? Watch this space upon my return for pics, stories, and generally more interesting topics of conversation. Holler.

Boy that escalated quickly. I mean, that really got out of hand fast...

I guess I haven't said it on this blog before but: I am a Barack Obama supporter (for a whole mess of very important reasons). And I think this editorial from today's New York Times demonstrates that they are finally starting to get the story right over there. Here is the article for your own personal inspection:


The Low Road to Victory
April 23, 2008

The Pennsylvania campaign, which produced yet another inconclusive result on Tuesday, was even meaner, more vacuous, more desperate, and more filled with pandering than the mean, vacuous, desperate, pander-filled contests that preceded it.

Voters are getting tired of it; it is demeaning the political process; and it does not work. It is past time for Senator Hillary Rodham Clinton to acknowledge that the negativity, for which she is mostly responsible, does nothing but harm to her, her opponent, her party and the 2008 election.

If nothing else, self interest should push her in that direction. Mrs. Clinton did not get the big win in Pennsylvania that she needed to challenge the calculus of the Democratic race. It is true that Senator Barack Obama outspent her 2-to-1. But Mrs. Clinton and her advisers should mainly blame themselves, because, as the political operatives say, they went heavily negative and ended up squandering a good part of what was once a 20-point lead.

On the eve of this crucial primary, Mrs. Clinton became the first Democratic candidate to wave the bloody shirt of 9/11. A Clinton television ad — torn right from Karl Rove’s playbook — evoked the 1929 stock market crash, Pearl Harbor, the Cuban missile crisis, the cold war and the 9/11 attacks, complete with video of Osama bin Laden. “If you can’t stand the heat, get out of the kitchen,” the narrator intoned.

If that was supposed to bolster Mrs. Clinton’s argument that she is the better prepared to be president in a dangerous world, she sent the opposite message on Tuesday morning by declaring in an interview on ABC News that if Iran attacked Israel while she were president: “We would be able to totally obliterate them.”

By staying on the attack and not engaging Mr. Obama on the substance of issues like terrorism, the economy and how to organize an orderly exit from Iraq, Mrs. Clinton does more than just turn off voters who don’t like negative campaigning. She undercuts the rationale for her candidacy that led this page and others to support her: that she is more qualified, right now, to be president than Mr. Obama.

Mr. Obama is not blameless when it comes to the negative and vapid nature of this campaign. He is increasingly rising to Mrs. Clinton’s bait, undercutting his own claims that he is offering a higher more inclusive form of politics. When she criticized his comments about “bitter” voters, Mr. Obama mocked her as an Annie Oakley wannabe. All that does is remind Americans who are on the fence about his relative youth and inexperience.

No matter what the high-priced political operatives (from both camps) may think, it is not a disadvantage that Mr. Obama and Mrs. Clinton share many of the same essential values and sensible policy prescriptions. It is their strength, and they are doing their best to make voters forget it. And if they think that only Democrats are paying attention to this spectacle, they’re wrong.

After seven years of George W. Bush’s failed with-us-or-against-us presidency, all American voters deserve to hear a nuanced debate — right now and through the general campaign — about how each candidate will combat terrorism, protect civil liberties, address the housing crisis and end the war in Iraq.

It is getting to be time for the superdelegates to do what the Democrats had in mind when they created superdelegates: settle a bloody race that cannot be won at the ballot box. Mrs. Clinton once had a big lead among the party elders, but has been steadily losing it, in large part because of her negative campaign. If she is ever to have a hope of persuading these most loyal of Democrats to come back to her side, let alone win over the larger body of voters, she has to call off the dogs.

Orphans of the Empire

In the run-up to last week's controversial elections in Zimbabwe, The Lancet published two excellent articles about deteriorating health care and human rights conditions in the struggling Southern African nation. At this moment it looks like Robert Mugabe -- Zim's despotic leader since independence in 1980 -- has lost the election by a fairly substantial margin, but has thus far refused to drop out of the race. Both sides have floated allegations of vote tampering, and the election totals are perhaps close enough to warrant a second round of voting in a few weeks time. Whatever happens, let's hope that conditions begin to improve in Zimbabwe, where inflation has recently surpassed the 100,000% mark and infant mortality rates are the highest in the world.

Here are links to the two articles from The Lancet, and a third from the New York Times about the ongoing saga surrounding Bob Mugabe and these current elections.

//
Zimbabwe’s health-care system struggles on
To download:
http://www.scribd.com/doc/2436041/Lancet-Health-Care-and-Zimbabwe
//
Health and human rights under assault in Zimbabwe
To download:
http://www.scribd.com/doc/2436042/Lancet-Human-Rights-and-Zimbabwe
//
Mugabe Party Seems Poised to Fight for Presidency
//

In other -- far less important -- news, I still wish I could be more diligent about my writing. That's all for now.

A brief word about autism.

It has long been known that advancing maternal age is associated with an increased risk of genetic disorders in children. I haven't done enough research to tell you the precise mechanism(s) for this genetic degradation, but it seems clear that as eggs age their chromosomal material becomes less stable.

Similar studies on paternal age have been recently conducted, and the results have been surprisingly analogous: advanced paternal age is associated with an increased risk of Autism Spectrum Disorders (ASD). Researchers have even identified possible biological mechanisms, including de novo mutations associated with advancing age or alterations in genetic imprinting.

The most important important article on the subject can be found here on the Archives of General Psychiatry website.

It is important that this result be publicized as widely as possible for a number of reasons. Firstly, and most significantly, the number of autistic children is rising rapidly in the US and around the world. Secondly - and as a direct result of this unprecedented rise in ASD children - we have heard from an unfortunately large number of highly unscientific sources that regular childhood vaccinations might be contributing to the increasing number of autistic children. This unfounded concern has in turn led to a fewer parents immunizing their children, thus increasing the likelihood of an outbreak of measles or other traditionally childhood illness. There is absolutely no scientific evidence showing causal association between the measles-mumps-rubella vaccine (or the vaccine preservative thiomersal) and autism.

Hopefully as this finding - coupled with ongoing research in the field - is disseminated, it will finally convince parents and (malpractice-averse) physicians alike that Autism Spectrum Disorders are related to genetic mutations, most likely occurring during spermatogenesis.

My apologies if it feels like this post isn't fleshed out enough. I just wanted to get down some quick thoughts on the subject while it was on my mind. If you have any specific questions about the underlying science or research principles of anything you've read about, I would be happy to discuss them more thoroughly and/or in a way that doesn't rely on as much pre-existing understanding of medical biology. That's all for now.

Upgrade U

I'm still nursing this sore throat - my voice has that distinctively pubescent squeak to it - and I don't feel like I have much to contribute at the moment. So in lieu of my thoughts: here are a few items that are marginally more interesting than anything I have to say right now.

#1 An article in the American Journal of Epidemiology about how Cuba's economic crisis of the 1990's has led to dramatic country-wide decreases in cardiovascular disease and diabetes. More good analysis can be found here. One of the the less obvious corollarys of this article is that if we are to believe the papers' conclusions, we must also accept that obesity is not only a genetic condition. Instead, weight is the consequence of environmental and genetic interactions, and that environment - including diet and exercise - play large roles.

#2 There are some bad-ass surgeons living in Melborne, apparently. Five Australian surgeons at the Royal Melbourne Hospital removed this metal chair leg from a 20 year-old patient's eye socket, saving both the man's life and, miraculously, his eye - which had, I guess, been pushed aside at impact. The procedure was more than four hours long - including the reconstructive plastic surgery - and the guy walked out of the hospital 19 days later with 95% vision in the damaged eye. While I would still recommend not getting into brawls outside of nightclubs, it's pretty miraculous to think that modern medicine has developed the tools to repair such catastrophic injuries to the human body.

Isn't this a haunting image? Huh, I wonder if the radiologist saw the pathos.

#3 Gβ5-RGS complexes co-localize with mGluR6 in retinal ON-bipolar cells. Morgans C, Bearnot BI, et al. Coming soon to a copy of the European Journal of Neuroscience near you. Oh, you don't get that one? Neither does anybody. This was basic science research I did out at the Neurological Sciences Institute at OHSU in 2004 - but I'm really glad that they're finally getting around to publishing it. I feel like I did some mean confocal microscopy work that summer.

No, I'm sorry, you can't have these 30 seconds of your life back

Rad:
South Africa's National Braai Day. From the official website: "Our vision is to create a local day with the same festivities and impact as St Patrick’s Day in Ireland or the 4th July in America."

Not Rad:
Waking up with a terribly sore throat after manning the grill in the pouring rain for an entire afternoon.

Rad:
Getting confirmation that my final med school recommendation (of 8?! It's a little ridiculous, i know) is in the mail. I had almost given up on this final reference, but I'm pretty glad that I decided to wait it out.

Not Rad:
Announcement of the complete failure of Merck's HIV vaccine trial. One of the arms of this Phase II clinical trial was being conducted in SA. Hopefully this won't set off the same media firestorm that occurred when the recent microbicide trials were halted.

Sorry for the lame post. I think I'm just going to make myself some tea and call it a night. And thanks for all of the feedback about my post from a couple of days ago about my trip up to Zululand.

Come together, right now

Big ups to my brother, who was finally able to convince the two universities he's been attending to get their acts together and put something down in writing. It's been a real struggle for him to juggle his studies at Brown and RISD up until this point, but Andy has been committed to ensuring that other students that had similar interests wouldn't have to jump through the same hoops as he did. From the article about the official launch of the dual-degree program in the ProJo:

Andrew Bearnot, 21, a fourth-year student studying materials engineering at Brown and glass at RISD, said he was initially met with resistance when he tried to pursue joint degrees at the schools. He will finish his major at RISD in May and return to Brown next fall for his final, fifth year.

“The logistics were tight,” said Bearnot, who applied to RISD after having already begun his studies at Brown. “When I started at Brown, I knew I’d study math, science or engineering in a liberal-arts setting, but I also knew I had a fine-art interest and background in craft.”

Officials at the schools say they want to make it easier for students such as Bearnot to pursue interdisciplinary studies, although they anticipate the program will be small. Only about 10 students will be accepted the first year, and about 20 in subsequent years.

full text here

Also: I'm a big fan of Joba.

Big and Bigger

Tonight the Yankees are starting a late-season series against the Red Sox at Fenway Park.

Six hours earlier - right here in sunny Durban, South Africa - India will face off against Pakistan in the first round of the cricket Twenty20 World Cup.

Which of these sporting events do you think has a larger audience worldwide? If only New York City and Boston were competing nuclear states, then we might have a chance in the ratings. Connecticut doesn't really have the same ring as Kashmir though, does it?

Prevent Defense

Big news from the HIV prevention community! The AIDS Vaccine Advocacy Coalition (AVAC) is very committed to this cause - as you might be able to guess from their name - but have yet to demonstrate any real success (they supported the failed microbicide trials in South Africa last year) . There are a few phase II clinical trials of HIV vaccines taking place in different parts of Sub-Saharan Africa; I imagine this money from Bill and Melinda will help to finance strategic scale-up and distribution of the drug if the studies prove to be successful. Unfortunately, the studies won't be completed until at least 2008 or 2009. Here's to hoping it all works out!

from The Lancet Blog:

US$14 million grant for HIV prevention campaign

Thursday August 23rd 2007

The AIDS Vaccine Advocacy Coalition is launching a new organization to promote the development of a wide variety of HIV prevention strategies, including microbicides and oral preventive drugs.

The launch of the new organization, called The HIV Prevention Research Advocacy Network, was announced by AVAC Tuesdsy, Aug 21 in Seattle at the AIDS Vaccine 2007 conference.

The initiative will be funded by five-year, US$14 million grant from the Bill & Melinda Gates Foundation

According to the press release announcing the network’s launch, the organization will:

•Develop international advocacy partnerships that support both the needs of communities involved in research and a global advocacy movement for HIV prevention research.

• Translate complex scientific ideas to communities AND translate community needs and perceptions to the scientific community.

• Work to hold both research agencies and advocates accountable for accelerating ethical prevention research and development.

• Help ensure that communities, policymakers, and civil society have realistic expectations about HIV prevention research and specific clinical trials.

• Work closely with other groups conducting HIV prevention research advocacy, including microbicide advocacy groups.

AVAC also released it annual report, which provides an overview of the state of HIV vaccine research today. Of particular interest is a section that looks at the slow uptake of both male circumcision as an HIV prevention strategy and the vaccine for human papilloma Virus (HPV). These case studies, the report argues, holds lessons for those seeking to implement other prevention strategies.

To visit AVAC site and download the new report go to: http://www.avac.org/

To visit the AIDS Vaccine 2007 conference website go to: www.hivvaccineenterprise.org/conference/index.html

By Michael McCarthy

The Godfathers (of Soul and Opera, respectively)

An inspired duet performed by two larger-than-life musicians who recently passed away: James Brown and Luciano Pavarotti. They perform Mr. Brown's misogynist classic, "It's a Man's World" - but totally rock out. This is really the only acceptable way to listen to Opera. Here's the video:



And a signature I'm Obviously On Drugs moment from JB at the very end of the clip:

James Brown: Thank you! Gratzie!
Interviwer: How did it feel to sing with Pavarotti?
James Brown: I FEEL GOOD!

Slip-N-Slide

Here are a few slides from a presentation I'm putting together for work next week. The PEPFAR-sponsored organization I'm working for here is holding orientations for staff from HIV clinics all over the greater Durban area - including several of the largest townships. (a brief aside: they call it 'orientating' in SA like it's going out of style.)

We've invited nurses, doctors, HIV counselors, and clerks/data entry from each of these sites to come by and hear about the comprehensive HIV care support we're providing for each of their clinics. I've been put in charge of presenting a fair amount of the material, including an overview of the South African National Strategic Plan on HIV/AIDS. I've written about this exciting, if somewhat controversial, document before, but for those who weren't reading my blog back then - it is the South African government's attempt to piece together a comprehensive national strategy to combat the HIV/AIDS pandemic.

My presentation certainly isn't finished yet, but I thought you guys might be curious to read about some of the goals and details of this landmark document. (Please note: The figures from the 'Implications' slides rely on some very sketchy epidemiological modeling on my part. Don't hold it against me too much; the numbers would be pretty scary regardless of model.)

I think I'm in love...

…with Maya Arulpragasamalbum. Ms. Arulpragasamalbum – or M.I.A. as she is known to a small, but quickly growing, group of fans worldwide – just released her third studio album, Kala. Put simply, I think this album is extra ordinary. And I don’t necessarily mean that it’s my absolute favorite (although I have been listening it fairly consistently for the past 5 days), but MIA is many steps ahead of your average emcee as far as never failing to deliver a large dose her unique perspective on the world. I won’t walk you through her history, because it’s already been written up by far more capable journalists than I could ever pretend to be. (This write-up and this other review are great paces to look for her inspiring backstory.) The conflict that fuels this album so passionately seems to be the very real conflict (never more so to me, in fact) between the richest and poorest people in the world. Her vision doesn’t necessarily subscribe to a particular solution to the problem (sorry Jeffrey Sachs and Paul Collier), but she does a great job of capturing the complexity of it all.

Her beats borrow heavily from her Subcontinental roots, and she knows how to sing a catchy, if occasionally pitchy, hook. Some of the instrumentation here blows my mind; I’m pretty sure that she managed to get her hands on one of those cheap plastic toys that I hear kids blowing into on the streets of the Townships. The whole album is peppered with references to cheap weapons (20 Dollars) and full of jarring sounds; the sound of a window being broken on one of the tracks was so realistic that I turned off my stereo three times in a row to make sure that one was stealing cars on my street and there are gun claps that violently interrupt an otherwise beautiful chorus.

Oh, and her collabo with Timbaland is out of this world. He still can't rap, but more than makes up for it with his unsurpassed Production. You see, this is why I can’t be a record reviewer; I’m not a player/ I just Talent Crush a lot. Also, I try to insert way too many pieces of information parenthetically.

But isn’t she one sexy artist/activist?

More on HIV Denialism

Here's an interesting article on the history of several HIV Denial movements during the past few years, as pointed out to me by one of my favorite Science Bloggers. It's an interesting story from a historical point of view, and the article makes several strong points against the real public health dangers of these opinions being voiced.

It's called HIV Denial in the Internet Era and can be found here.

Here's the opening paragraph as a teaser. Scary isn't it? :

It may seem remarkable that, 23 years after the identification of the human immunodeficiency virus (HIV), there is still denial that the virus is the cause of acquired immune deficiency syndrome (AIDS). This denial was highlighted on an international level in 2000, when South African president Thabo Mbeki convened a group of panelists to discuss the cause of AIDS, acknowledging that he remained unconvinced that HIV was the cause [1]. His ideas were derived at least partly from material he found on the Internet [2]. Though Mbeki agreed later that year to step back from the debate [3], he subsequently suggested a re-analysis of health spending with a decreased emphasis on HIV/AIDS [4].

From the 3rd SA Aids Conference - Day 1

I've been to so many exciting sessions at the AIDS conference over the past few days. I can barely figure out how best to summarize all of the information that I think you guys might find interesting. Maybe I'll just do it one day at a time and post the write-ups and I finish them. And let me preface all of my observations about the conference with the following: Listening to very smart and extremely passionate people discussing the complex issues at the intersection of science, research, public health, politics, and activism over the past three days has been quite an inspiring experience for me.

Tuesday afternoon I attended a panel discussion focusing on HIV prevention. There were scientists from many of the exciting prevention studies, including those focusing on a new generation of antiretrovial drug-containing microbicides, pre-exposure vaccines, and the African circumcision trials.

One topic that both speakers and audience members at the talk came back to on several occasions was actively keeping an eye towards eventual implementation of an intervention, even during the randomized trial phases of research. Long lags between the release of positive results from a study and the post-trial access to a given intervention was seen as a shortcoming of the scientific process. And while some of the scientists asserted that it wasn’t their job to implement, they still conceded that they would like to see improvement in this area as well.

This session also was my first exposure to Dr. Salim Karim (he pronounces is Slim, which then rhymes with Karim), who is one of the world's foremost experts on HIV prevention in South Africa. He comes across as extremely smart, well-spoken, and generally captivated the audience with everything he had to say. He has also written (along with his wife, who is also a HIV researcher and also sat on prevention panel) a comprehensive textbook about HIV in South Africa, focusing on wide-ranging topics from basic science to medicine, sociology, economics and politics. Intrestingly, Slim has a faculty appointment at the Mailman School of Public Health at Columbia University.

Next was the Conference's Opening Ceremony. There was some singing and dancing - staples of any event taking place in KwaZulu Natal - followed by a series of plenary speeches. Some of the talks were dull, but Graça Machel, Nelson Mandela's wife, gave an impassioned speech about combating stigma on individual and national levels.

Finally, South African Vice President, Phumzile Mlambo-Ngcuka, took her turn at the podium. The South African government is currently patting themselves on the back for having developed and ratified a very ambitious nation-wide strategic plan on HIV/AIDS for the next five years. The plan calls for a 50% reduction in new infections and ensuring ARV access to a full 80% of those with CD4 counts below 200 by the year 2011. And while many congratulate the South African government for taking such a dramatic stance, there is an equally vocal group noting that the proposed goals can not be bet without a major overhaul of the health system.

The Vice President also included a controversial rant against the organizers of the conference, for refusing to give Minister of Health, Manto Tshabalala-Msimang, a more prominent role in the conference. It was sort of political nonsense, but here's a link to a New York Times article about the episode. It should also be noted that the spurned Health Minister drew international condemnation at last year's world AIDS conference in Toronto for promoting garlic and beetroot as treatments for HIV while conference attendees booed her and exited the auditorium she was speaking in.

And so ended my first day at the SA Aids Conference. I attended a full day's session on Wednesday and am planning on heading down to the conference center to catch tomorrow mornings' talks and poster presentations. I'll try to write up any interesting findings as soon as possible. Hope you guys learned something interesting, and I'll talk to you soon.

Where the streets have no name. Or two names, oftentimes.

From the front page of the New York Times website this morning: Where the Road to Renaming Does Not Run Smooth.

This article addresses a hotly debated topic here in Durban - the renaming of many major roads to honor the architects of the New South Africa. These changes, while originating from a very reasonable and progressive premise, have made it exceedingly difficult at times for a newly initiated Durbanite to navigate the streets of the city. As you can see from the picture above, some of the old street names have temporarily been struck through with a red line, while other street signs with outdated names have been removed entirely - further complicating things.

Unfortunately, I don't really have time to share supplementary commentary at the moment; I have to finish up this work before I can head out to the Northern 'Berg for a weekend of camping and hiking with friends. But please take a look at the article if you get a chance, and I'll contribute my personal experiences and observations about this issue when I get back into town on Sunday.

In taking a look at posts from the recent past, it looks conspicuously like I've been shilling for the Times these past few weeks. I would be more apologetic, but I think it's just that NYT is one of my main sources of news here - and there has been a real wealth of interesting articles for me to share with you guys as of late.

Alright, I'm out of here; catch you all later.

I'm not a player, I just crush a lot

Oh yeah - I meant to mention this before, but it entirely slipped my mind. My homeboy, Dr. Atul Gawande, is a guest columnist over at the New York Times this month. I know I've waxed poetic about the many virtues of his writing in previous posts, but these editorial pieces that he's writing for the Times in May - while perhaps not as thorough or gripping as his other, longer works I've read - are smart, imminently digestible, and contain many interesting insights into the health care crisis in America.

Unfortunately, some of these articles are behind the ever-irritating Times Select paywall - but I'll take a look around and see if they are being published elsewhere. In the meantime, let me know if you'd like to get your hands on these editorials - and I would be happy to send them your way. The titles and brief descriptions of his writings so far are posted below for you to take a look at.

Rethinking Old Age
We don’t much talk about getting more control over our lives in nursing homes. And that’s a problem.

Let’s Talk About Sex
The four facts everyone needs to know about sex and contraception.

Doctors, Drugs And the Poor
The practice of medicine comes with certain moral obligations. The same goes for the manufacture of pharmaceuticals.

Bad Medicine, Sneaking In
Medicine’ s success and affordability critically depend on materials and distribution from around the globe. Yet market forces aren’t weeding out the shady operators.

Curing The System
It is possible to alter our health care system surgically enough to minimize harm while still channeling us onto a path out of our misery.

Can This Patient Be Saved?
Our health care system has eroded badly, but it has not collapsed. So we do nothing.

The Power Of Negative Thinking
We Americans believe instinctively in the power of positive thinking. But the real key is looking for, and sometimes expecting, failure.

Stranger Than Fiction

I had been hearing rumors about this story for the past few weeks, but it was only over the weekend that I saw the first written confirmations in the mainstream media. As a disclaimer, my source at St. Mary's Hospital on the outskirts of Druban tells me that this problem is not as widespread as these articles might have you believe.

And now - without further contextualization - a distinctly South African story of crime and drug use (from AFP.com):

S.African criminals steal anti-AIDS drugs to smoke with marijuana

Wed May 16, 3:29 PM ET

South African criminals are rumoured to be robbing AIDS patients of lifesaving anti-retroviral (ARV) medicines to smoke with marijuana for a better high, a local hospital said Wednesday.

St Mary's hospital in Durban in the eastern KwaZulu-Natal province said patients and staff have reported ARV's being stolen for this purpose.

"The community outreach co-ordinator of our ARV programme did confirm ... that on average twice a month she receives reports from patients that their anti-retrovirals have been stolen, either at knifepoint or snatched from their hands," hospital chief executive Dr Douglas Ross said in a statement.

AIDS lobby group, the Treatment Action Campaign (TAC), has warned against smoking Stocrin, part of a triple therapy cocktail given to patients, and reported to be the drug being being abused.

Stocrin was a "very toxic drug", TAC spokeswoman Lerato Maloka told AFP.

"Stocrin affects the central nervous system, it is recommended that people who have depression or psychotic illness shouldn't take Stocrin as it will make the condition worse," she said.

People using the drug could experience side effects like dizziness, nightmares and hallucination.

"People of all ages are stealing it (Stocrin) from patients and smoking it together with dagga," The Saturday Star quoted community worker Nancy Sias as saying.

"They say it gives them a better high than Mandrax and it makes them feel dizzy, weird and have wonderful dreams."

Ross said the hospital was encouraging patients to conceal their medicines in public to minimize the risk of theft.

"We have replaced the medication of those whose medication was apparently stolen."


For more coverage, here is a link to an article in this week's Mail and Guardian:
Thugs smoking antiretrovirals 'with dagga'

Where science and public health do not intersect.

From a recently published article in the always excellent British medical journal Lancet:

“Infants who were breastfed but also received solids (generally home-prepared cereal or commercial infant porridges) any time after birth, were nearly 11 times more likely to acquire [HIV] infection than were exclusively breastfed children.”

Coovadia HM et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding: the first six months of life. Lancet 2007 [in press].

///

This article was written by Coovadia et al, a group based right here in Durban at the Nelson Mandela School of Medicine. This highly-relevant issue of whether children of HIV-infected mothers should or should not breastfeed is very interesting one both from a scientific and a public health standpoint.

It is counterintuitive for many (including myself) to imagine that an HIV-negative baby should be fed the virus-containing milk of its mother. Breastfeeding is well demonstrated to protect against a range of illness, but it is risky because of the opportunity for HIV transmission from an infected mother to her baby. However, the data from this extensive study shows that if the infant is fed EXCLUSIVELY breastmilk - and does not have any formula or other solid food - for the first 6 months of life, the practice of breastfeeding is very safe and greatly reduces the probability that the baby will become HIV-positive. The underlying science of this has to do with the fact that babies' digestive systems are unable to handle most other foods at this early developmental stage, leading to small lesions or gaps in the GI mucosa which leads to increased transmission of the virus when the baby consumes breast milk with a positive viral load.

However, the public health policies that will emerge from this finding are ambiguous at best. Working mothers, especially in the developing world, can't always make time to feed their babies on regular schedules. These women tend to work long shifts, travel great distances between home and work using public transportation, and often rely on other family members to help provide care for their children. Complicating this matter even further, baby formula is prohibitively expensive. The end result is that it is most convenient for mothers to feed their infants a mixture of breast milk along with other available foods in these resource-limited settings, dramatically increasing the likelihood that the child will become positive within the first six months of life.

Stopping the spread of HIV from mother to child is exceedingly important (for a whole host of reasons that I shouldn’t get into here), yet how can South Africa or the World Health Organization advise mothers in impoverished settings around the world to do what is essentially impossible? While the science underlying this paper is very strong, it is far less obvious to me – as well as to other members of the HIV/AIDS research community – what public health guidelines should arise from these findings.

A triumverate of sorts

Three of my idols (well, more like two idols and one guy I simply find hilarious - I leave you to figure out who's who) were profiled in the New York Times this week.

First was an article on Atul Gawande, a surgeon at Brigham and Women's Hospital and assistant professor at the Harvard School of public health. He is also a gifted writer; having written extensively on medicine and public health for The New Yorker and is about to come out with his second book, Better: A Surgeon's Notes on Performance. (If you have never read a piece by him before, I suggest reading "Piecework: Medicine's Money Problem," a 4,000 word essay on the U.S. health system's fiscal underpinning that's classic Gawande.)

Second was an article on Timbaland, a famous American Hip Hop producer, who has just released an album entilted "Timbaland Presents Shock Value." Of additional interest to me, the profile was penned by Kelefa Sanneh - one of my favorite music writer on the Times staff.

And the final article I'd like to highlight was about the new season of the HBO show Entourage, which centers on the lives of a fictional movie star and his group of childhood friends (including his failing actor of a half-brother, his friend-cum-manager, Eric and Turtle - a third friend whose job description seems to involve equal parts "hanging out" and "spending his friends' money). And while the article was mostly a puff piece to hype the this upcoming season, there is are several paragraphs extolling the virtues of the character played by Jeremy Piven, who is always angry, mostly misogynistic, and unfailingly hilarious.

Life is South Africa is continuing to roll along, but it's been nice to spend a few moments thinking about parts of my life in the States that make me smile. If you're interested in the articles, the links are below. Have a Happy Easter weekend, and I'm sure you'll be hearing more from me quite soon. Now that I'm living in my own place and have access to internet at home, I have even fewer excuses to not post consistently.

Article on Atul Gawande

Article on Timbaland

Article on Entourage and Jeremy Piven