The Bill & Melinda Gates Foundation’s Grand Challenges Explorations program announced last week that it awarded $100,000 grants to each of 81 scientific teams that had submitted unconventional, almost whacky-sounding ideas to improve health in developing countries.

Many wondered whether the program’s second round could generate the same creative idea-flow that characterized its first round, in which 104 scientists were funded last October including one fellow who plans to recruit mosquitoes into an air force of flying syringes that deliver vaccines rather than diseases.

It turned out to be no problem.

The program funded scientists from 17 countries whose ideas focused primarily on infectious disease treatment and prevention.

“Grand Challenges Explorations is our way to help inspire the bold ideas that could one day help transform global health,” said Tachi Yamada, president of the Foundation’s Global Health Program.

Among the compelling projects, Boitumelo Semete at the Council for Scientific and Industrial Research in South Africa will attempt to develop “sticky” nanoparticles that attach to tuberculosis-infected cells and slowly release anti-TB drugs.

Eric Lam at Rutgers will try to develop a tomato laced with antiviral drugs.

Thomas Baker at Penn State will try to infect malaria-carrying mosquitoes with a fungus that essentially gives them a head cold which, hopefully, suppresses their sense of smell and hence their ability to find human prey.

The winners were selected from more than 3,000 applicants.

The grantees are based at universities, research institutes, nonprofit organizations, and private companies in Africa, Asia, Australia, Europe, Latin America, and North America.

Applications for the next round of Grand Challenges Explorations are being accepted through May 28, 2009.

Routine preventive measures for kidney stones might someday include consumption of diet soda, especially the fruit-flavored ones, if the findings of a team led by Brian Eisner withstand further scrutiny.

The UCSF-based scientists proposed that surprising possibility at the recently concluded meetings of the American Urological Association.

Using ion chromatography, Eisner and colleagues measured the amount alkalis such as citrate and malate in 15 diet soda products. These 2 chemicals increase urine alkalinity and so create a milieu that inhibits formation and growth of kidney stones.

Diet Sunkist Orange and Diet 7-Up had the highest alkali content according to Eisner, and fruit-flavored concoctions in general contained much more of the good stuff than colas.

“It’s not clear how all of these products got their alkali,” Eisner told MedPageToday. “The drinks with the highest alkali in our study presumably got it from the orange or lemon-lime juices that were added to them.”

Diet Sunkist Orange had a total of 10.49 meq/L total alkali, mostly as the citrate. Diet 7-Up took second with 9.79 meq/L, all from the citrate.

The top 10 finishers were all fruit-flavored (orange, lemon-lime, etc.). Diet Squirt was tenth at 3.93 meq/L total alkali, an amount that was more than twice as high as the top-scoring cola-like beverage, which for the record was Diet Mug Root Beer, at 1.72 meq/L.

Eisner’s group limited its investigation to diet drinks because, according to Eisner, “we wanted to be able to recommend something that was healthier for our patients.

We didn’t feel as comfortable recommending something with a lot of sugar or calories in it.”

AUA spokesperson Anthony Smith said the study “suggests that people with stone disease who do not drink soda may benefit from moderate consumption.”

Aware of recent studies which showed that paying people to lose weight and quit smoking actually works, CIGNA and Merck have decided to launch a program that pays CIGNA beneficiaries to improve their diabetes control.

And if they happen to take Merck’s oral anti-diabetes medications during that effort, so much the better.

According to terms of the deal, CIGNA will review hemoglobin A1C results for enrollees who take oral hypoglycemic agents and if at the end of the year the values have improved, Merck will offer discounts on its entries in this field, Januvia and Janumet.

CIGNA will also review claims data for people taking the 2 drugs to determine whether they’re using them as prescribed by their physicians.

If they are, Merck will increase its discounts to CIGNA for these drugs even more.

CIGNA would then supposedly pass the savings along to its beneficiaries. 

“Merck (is) the first major pharmaceutical company to offer discounts on its oral anti-diabetic products, supporting CIGNA’s efforts to reduce A1C levels for individuals with diabetes, regardless of what medication they may be taking,” said Eric Elliott, president of CIGNA Pharmacy Management.

Januvia was approved by the FDA in 2006. Janumet made the grade in 2007. Annual sales for the two are in the $1.5 billion range, and some experts predict that number will triple in the next few years making these drugs world leaders in the growing market for oral antidiabetic therapy.

Come to think of it, why wouldn’t Merck throw tuppence at a program that hooks patients on its high-end drugs for the rest of their lives?

West Penn Allegheny Health System claims it’s losing its shirt because its larger rival, the University of Pittsburgh Medical Center has colluded with Highmark, the area’s leading private insurer to drive it out of business.

So it filed suit in federal court against both of ‘em.

West Penn’s accusations cite numerous activities since 2002 that ensured Highmark’s dominance while guaranteeing juicy payouts for UPMC.

“West Penn is running out of options,” Jan Jennings commented to the Pittsburgh Post Gazette. The CEO of American Healthcare Solutions added, “you don’t sue UPMC and Highmark, with the deep reserves of cash they both have, unless you’re desperate.”

UPMC released a statement saying it “unequivocally denies the allegations,” and that the filing is an attempt by West Penn Allegheny “to divert attention from (its) operating and financial difficulties.”

Last year, WPA took a $73 million write down caused by an overestimation of revenues derived from patient care. A month ago, the system reported operating losses of $9.1 million and a Q4 2008 net loss of $5.6 million.

Highmark officials announced they were “surprised and disappointed” by the lawsuit, while citing their recent$125 million loan to West Penn and multiple grants they provided to “strengthen (West Penn’s) administrative and information systems.”

West Penn claims the 2 organizations have “engaged in mutual back-scratching designed to preserve Highmark’s monopoly in health insurance and to permit UPMC to build a monopoly in sophisticated … health care in this region,” according to David McClenahan, its board chairman.

“I can’t judge the arguments. I just know these kinds of cases in general are very hard to prove,” Jennings opined.

The National Security Agency has been intercepting email messages and phone calls of American citizens in violation of the already broad legal limits imposed by Congress last year, according to government intelligence officials.

These officials indicate there has been significant and systemic, although possibly inadvertent “overcollection” of domestic communications involving people living in the US.

Last week the Justice Department acknowledged to the New York Times that, as part of a routine review of NSA operations, it “detected issues that raised concerns.”

Justice Department officials then “took comprehensive steps to correct the situation and bring the program into compliance” with the law and court orders, according to the statement.

The violations apparently began last July when Congress modified the law regarding government wiretapping powers on terrorism and spying suspects. The new spying framework apparently created implementation challenges and errors resulted.

The original law represented a triumph for the Bush administration, 3 years after his warrantless wiretapping program was outed in 2005.

After much wrangling in Congress, the original law permitted the NSA to collect, without court-approved warrants, gobs of international phone and email traffic as it passed across US telecom gateways, so long as the targets  were “reasonably believed” to be outside the US.

The modification was designed to assure the law wasn’t extended to US citizens but either something got lost in translation or NSA staffers ran into operational glitches making it difficult to distinguish domestic from international communications, or both.

The result was that the agency was targeting US citizens and domestic communications without warrants.

No one seems to know the scope of the problem, or if they do, no one’s talking.

It is not clear whether the NSA actively listened to conversations or read email from Americans, or whether it simply obtained access to them.

In the brains of patients with Alzheimer’s disease, A-beta proteins stick together to form plaques that are at least associated with, and may actually precipitate the clinical syndrome.

A-beta proteins are formed when enzymes known as secretases digest a larger protein known as amyloid precursor protein.

Knowing this, drug designers have tried to find something that inhibits the secretases, but so far the search has been fruitless.

Malcolm Leissring and a team at Mayo Clinic, Florida have taken a different approach. They searched for compounds that hasten the destruction A-beta proteins, and they may have hit paydirt.

In a report published in PLoS ONE, the scientists used in vitro procedures to isolate 2 chemicals that stimulate insulin-degrading enzyme or IDE, which chews up A-beta proteins faster than Owen and Jen’s white Lab Marley could dismantle a sofa.

Almost immediately after the chemicals were added to IDE, more than 99 percent of the A-beta was destroyed.
 
“This study describes the first examples of synthetic small-molecule activators of IDE, showing that activation of this enzyme is achievable,” Leissring told BurrillReport.

“If it is possible to generate drugs for human use that stimulate the activity of IDE, these agents might offer therapeutic benefit for treating and preventing Alzheimer’s disease.”
 
IDE is shaped like a clamshell that opens and shuts, like Pac-Man.

When IDE is open, A-beta fits snugly inside. The protease then closes like a Venus-fly trap and digests the A-beta.

IDE’s primary role is to digest excess insulin in the body, so small molecule activators like the ones uncovered by Leissring’s group might prove to be useful in managing diabetes one day as well.

The compounds are years away from human testing.

Data are filtering in on Massachusetts’ grand plan to extend health insurance coverage to virtually all Bay Staters. The good news is just about everyone’s covered. The bad news is just about everything else.

When it comes to controlling health care costs, the state’s performance has been abysmal. Experts recently predicted that the state will spend $600 million more in 2009 on health care than in 2006, a 42% bump.

Now comes troubling data on a measure of access to care, emergency room visit volume.

In theory, the state’s new law should cut the costly visits because more people have access to PCPs that can either treat health situations before they reach crisis proportions or prevent them altogether.

In fact, ER visits went up 7% and the cost per ER visit jumped 17% in Massachusetts between 2005 and 2007, according to data shared with the Boston Globe.

The fraction of ER visits for non-urgent matters that could have been handled by a PCP remained unchanged at an astonishingly high 47%.

Massachusetts officials said several more years were required before accurate assessments could be made regarding the impact of their law on access to care.

The law actually went into effect half-way through the data collection period used to make the conclusions above, so they may have a point there.

Still, many worry that simply extending health insurance coverage isn’t going to control costs or improve access. They say the state needs to beef up its PCP corps before the program can work.

“Just because you have insurance doesn’t mean there’s a [PCP] who can see you,” said Sandra Schneider, VP of the American College of Emergency Physicians. “I am not surprised that visits went up.”

Two years after the US put a man on the Moon, Richard Nixon announced a heady new goal: to cure cancer by 1976, America’s bicentennial.

That festival came and went, as did the Millennium, the next target date that had been set for eradicating the scourge.

Now the Big O, who can understate the word “understate,” has vowed to find a cure for cancer “in our time,” and people are starting to wonder if even that is possible.

In fact there’s been only a 5% drop in age-adjusted cancer death rates since 1950.

Over the same period, death rates from cardiac disease and pneumonia/flu dropped 64% and 58%, respectively.

Funding has not been the problem. The National Cancer Institute has burned through $105 billion since Nixon declared war.

That doesn’t count spending by other government agencies, universities, Big Pharma and philanthropies.

Is cancer that much of a bear, or are we making fundamental mistakes in prosecuting the war?

Probably both. Cancer is a bear, or more accurately a thousand different ursine species. Cancer of the breast has, at our current levels of understanding, remarkably little to do with, say, cancer of the kidney.

A common weak link shared by all cancers may indeed not exist and if not, we have a long way to go, indeed.

But it’s also true that our research agenda has been driven by fads: cancer viruses, vaccines, genomics and promoters, and in some cases advocacy groups have commandeered research agendas in pursuit of these fads to the detriment of all.

In addition, investment in basic research, the kind that can fundamentally change treatment approaches, tends to lose out to less risky applied research.

“That is the biggest threat,” Robert Young told the New York Times.

The Fox Chase Cancer Center oncologist explained that “every organization says, ‘Oh, we want to fund high-risk research.’ And I think they mean it. But they don’t do it.”

The Walt Disney Company wants a bigger piece of the action in the pre-teen boy market, so it hired an anthropologist to sort through the dresser drawers of a 12 year-old.

Venturing into territory never before seen by human eyes, much less smelled by human noses other than his mother’s who–let’s face it–had no choice, Kelly Peña eventually found a Black Sabbath T-shirt scrunched into a corner on the top shelf.

When confronted with the artifact, the boy confided that “wearing it makes me feel like I’m going to an R-rated movie.” 

Disney hopes these and other penetrating psychological insights into a most assuredly confused demographic can help it recreate a time when Davy Crockett drove millions of boy-dollars its way, while hopefully counteracting its reputation as a provider of girl-friendly fare like (ew!) Hannah Montana.

Early results of Peña’s work are apparent on Disney XD, a new cable channel and Web site featuring urban skateboard parks populated by unassuming, nonthreatening boys, and on its TV hit “Aaron Stone,” where one character is quite average as a basketball player.

Peña had suggested to producers that today’s boys relate with characters that are trying to grow and improve themselves. “Winning isn’t nearly as important to boys as Hollywood thinks,” she told the New York Times.

Boys in the 6 to 14 age range drive $50 billion in global sales per year, according to market researchers, but it’s a tough market to crack, a fact to which News Corporation can attest after its Fox Kids Network failed famously in the late 1990s. 

Despite Pena’s intrepid work to date, results have been modest. Disney XD has bumped its prime-time audience by 27% among kids between 6-14 years of age, but most of that has come from girls. Viewership among the boys is up 10%.

Just don’t tell that to the boys!

What a long, strange trip it’s been for Dendreon.

Three years ago, positive results from a trial of Provenge, its immune therapy drug for prostate cancer, prompted an FDA advisory panel to recommend that it be approved.

Instead, the FDA ordered another study.

Last fall, the company announced interim results of the second study which showed the treatment group had 22% fewer deaths, but the results were met with skepticism and the company was told to finish out the trial.

Well, final results are in and Dendreon shareholders are celebrating all the way to the bank.

Provenge extended survival in late-stage prostate cancer patients with no major side effects.

The company plans to seek FDA approval for the juice later this year.

Shares of the heavily shorted stock closed at $22.94, up 94% on the day of the announcement.

Just before that, there were 2 “sell” ratings and 5 “hold” ratings among the 7 analysts who follow the biotechnology company. One analyst had set a $1 price target.

Now the chatter is which company in Big Pharmaville will acquire Dendreon and for how much.

After all, the list of pharmaceutical companies facing declining sales, generic competition and withering pipelines is longer than the line outside the toilet in coach on a flight from Boston to San Fran.

“Provenge could be on the market by mid next year, (it) could be instantly accretive to earnings,” said Joe Pantginis, of Merriman Curhan Ford & Co.

And Dendreon maintains full worldwide distribution rights for Provenge, making it even more appealing as an acquisition target.

“There are very few unencumbered assets (like Dendreon) out there,” said a salivating Sven Borho.

He’s a portfolio manager for OrbiMed Advisors which holds a cool 2 million shares of Dendreon.