Who said you can’t teach an old dog new tricks?

Japanese scientists have trained an 8-year-old Labrador retriever to detect colon cancer by sniffing samples of breath and stool from people. According to their findings in the journal Gut, the dog nailed the diagnosis 95% of the time on the breath test and 98% of the time on the stool test, a performance that compares favorably with colonoscopy, the expensive, distasteful state-of-the art for such matters. 

The Black Lab was trained at the St. Sugar Cancer Sniffing Dog Training Center in Chiba, Japan. After training was complete, a team led by Hideto Sonada presented the dog a series of 5 sample stations, one of which contained a specimen from a patient with colon cancer. The other 4 came either from volunteers with no history of cancer or patients with a past history of cancer.

Amazingly, the dog correctly identified the cancerous sample in 37 out of 38 stool tests, and in 33 out of 36 breath tests. It seemed to perform better in samples derived from patients that had early stage disease. The dog’s talents were unaffected by colonic polyps, inflammatory disease, cigarette smoking, or the presence of blood in the stool.

This performance is light-years better than widely-available colon cancer-screening procedures. For example, the fecal occult blood test picks-up early-stage cancer only about 10% of the time.

The results in this case were consistent with previous studies in which dogs could detect cancers of the bladder, breast and ovary, as well as melanomas. This dog’s particular skill at detecting early-stage cancer was unique, however. (more…)

The horrifying events of September 11, 2001 and the subsequent weaponized anthrax scare shook-up every American. Officials in charge of homeland defense were particularly shocked. Among other things, it dawned on them that our nation had no good way to defend itself against future bioterrorist attacks.

Soon thereafter, the Pentagon set aside $1 billion to develop treatments for soldiers and civilians who became infected in a bioterrorist attack. The funds went to something called the Transformational Medical Technologies program, which quickly disbursed them to more than 100 universities, drug companies and biotech companies.

The primary goal of the research spawned by these grants was to develop medicines that could neutralize bacteria and viruses that had been specially designed by terrorists to kill people and resist all known therapeutic agents. The infectious agents targeted by the scientists included Ebola, Marburg, Lassa, Sabia, Machupo and Junin.

But now, 5 years after the grants were disbursed, Pentagon officials are pretty much calling the program a bust. Just 2 experimental drugs have shown promise, and they are years away from clinical testing, let alone commercialization.

The major problem, it seems, is technical. It turns out to be easier to increase the lethality of a virus than it is to devise ways to fight it.

“The offensive capabilities outrun the defensive capabilities as the march of biology continues,’’ Richard Danzig, a former Navy secretary and bioterrorism expert said in an interview. “The theory behind [the program] was these same advances should empower the defenses,’’ he explained. “That intuition is worth exploring and investing in, but it is easier to conceive than to execute.’’

A secondary problem should have been anticipated by the Pentagon in advance: for ethical reasons, experimental treatments for nasty germs like these cannot be tested in human clinical trials, yet the FDA requires data from such trials before approving them. The work-around strategy is to test the agents on animals that have been genetically engineered so as to have traits that mimic what is seen in humans, but this process is time-consuming and expensive.

So What Will the Pentagon to Do?
Of course the Pentagon cannot walk away from the effort. The threat of bioterrorism remains. So it has set aside an additional $1 billion to develop fast, inexpensive ways to identify (rather than treat) weaponized versions of the germs mentioned above. In all likelihood, many of the same contractors will play a role in the new effort. (more…)

It’s easy to see how the error happened. It was an oversight, really, and nobody cares who was to blame. All that matters is that the error gets fixed so that hospitals can administer life-saving medications to sick kids. And the fix is trivially easy: change just 47 words in a 1,880 page document.

Alas, the error may not be fixed any time soon.

Why? The fix requires members of Congress to set aside their partisan bickering long enough to authorize it. The plight of desperately ill children and the specialty hospitals caring for them is, apparently, less important to our elected officials than scoring points in internecine warfare inside the Beltway.

Here’s What Happened: In those chaotic final days before President Obama signed the Affordable Care Act into law, several dozen Congressional staffers were struggling mightily to reconcile the House and Senate versions of the law. Versions were flying left and right, around the clock. Amid the furor, somebody unintentionally deleted verbiage in one small passage of the voluminous document that was intended to permit children’s hospitals continued access to a federal program that offered below-market prices on drugs used to treat rare, life-threatening conditions. The mistake was missed and eventually signed into law by Obama. As a result, 30 or so children’s hospitals that depended on the lifeline were cut-off from the funds.

“It was a drafting error,’’ a congressional aide familiar with the writing of the bill told the Boston Globe. “Everybody on every side of the issue thinks it should be fixed.’’

Soon after the mistake-containing law was signed, the House passed a bill, with bipartisan support, to correct it. But it still needed a thumbs-up from the Senate, which has become the US Government’s version of the La Brea Tar Pits.

According to the Globe, officials from Children’s Hospital Boston implored Massachusetts Democrat John Kerry to help fix the mistake.

Kerry and other Democrats in the Senate quickly attached the fix to a larger bill whose main focus was tax legislation. Republicans nixed the bill.

Hospital officials then approached the state’s other Senator, Republican Scott Brown, who introduced a simple, stand-alone bill to fix the error. In introducing his bill, Brown said, “There is no cause for delay . . . our nation’s children deserve that we come together and protect their access to medicines that will save their lives.’’

Brown got a handful of Republicans to sign on, so naturally not a single Democrat did the same. The Senate is controlled by Democrats for now, so Brown’s fix is unlikely to pass in the lame duck session. 

What Will Children’s Hospitals Do?-Well, they need to find other ways to cover at least some of the costs for those expensive drugs. Boston Children’s officials told the Globe that the drafting error will leave them short between $1.5 and $3 million per year. Across the nation’s specialty children’s hospitals, the annual shortfall approaches $100 million.

In the worst case, these hospitals might decide to curtail programs, or pass along some of the costs to patients including those who are uninsured and pay out of pocket.

Shameful.

To help offset a drop in Harvard University’s enormous endowment, Harvard Medical School has cut a deal with its affiliated teaching hospitals that calls for the hospitals to contribute $36 million to the school over the next 3 years.

The figure represents but a fraction of the medical school’s $580 million budget, but it may signify the onset of a new kind of relationship between the school and its affiliates.

Before the deal, Harvard was probably the only medical school in the country that didn’t derive financial support from its teaching hospitals. The school does not own its teaching hospitals, as do most others.

The peculiar arrangement means Harvard Medical School has been unusually dependent on government research funding and endowment income, which exhibit cyclical variations beyond the control of the school.

The ongoing worldwide financial crisis thus hit Harvard Medical hard: Harvard University’s endowment fell by 27%, to $26 billion during fiscal year 2009. That caused a 20% reduction in endowment income for the medical school.

In response, Harvard Medical School froze salaries and dropped 70 FTEs from its labor force via layoffs and early retirement in 2009. It expects to break even in the current fiscal year, but needs more money to expand programs and develop new ones so it can maintain its exalted status.

At a meeting last summer involving medical school dean Jeffrey Flier and teaching hospital execs, Massachusetts General Hospital CEO Peter Slavin said Flier “had to convince us this is the fairest thing to do.’’

Although the Harvard teaching hospitals are profitable, insurers, politicians and regulators are all pressuring them to cut costs.

In return for their largesse, the hospitals asked the medical school to handle physician promotions more quickly, among other things.

Has salt finally reached its moment of truth as a staple of Western diets? US government experts estimate we consume at least twice as much as the recommended daily allowance, and that across-the-board reductions in salt consumption could save 150,000 lives per year.

Numerous health officials, Michelle Obama and New York’s Mayor Michael Bloomberg have all recently urged food makers to cut out some salt in their food. The prestigious Institute of Medicine actually wants the feds to force food makers to do so.

But this isn’t going to be easy, and it may not be possible. Salt is a cheap way to create tastes and textures that consumers demand in their food, so doing without salt can lead to reduced profit and therefore, unhappy investors.

Take Kellogg’s Cheez-Its, for example. A cup of the iconic snack contains one third of the daily recommended amount of salt. Part of the salt load is sprinkled atop the orange squares to titillate the tongue at the moment of contact, that’s obvious.

But did you know Kellogg adds salt to the cheese itself in order to give Cheez-Its their memorable crunch? Or that the food maker adds salt to the dough to block a tangy taste that develops during fermentation?

In fact, in a recent demonstration for reporters, Kellogg created a batch of Cheez-Its leaving out most of the salt. The snack’s pleasing orange color faded to brown. They were sticky after being chewed, with the gruel caking onto teeth. And the taste became downright medicinal.

Similarly produced Corn Flakes tasted like brass, and the buttery flavor of Keebler Light Buttery Crackers (which in fact contain no butter), simply vanished.

“Salt changes the way that your tongue will taste the product,” Kellogg vice president and food scientist, John Kepplinger explained. “You make one little change and something that was a complementary flavor now starts to stand out and become objectionable.”

Preschool-age children adopted from foreign countries learn English in the same sequence as US-born babies do: they begin with single words and move to word combinations and complex grammar, according to Harvard scientists.

Psychologist Jesse Snedeker and colleagues reached this conclusion after videotaping language acquisition by 141 international adoptees and comparing these observations with those made involving younger US counterparts.

Thus after being in the US for a few months, a 3 ½ year-old adoptee might use word combinations like “Andy shoe,’’ just like an 18-month old US-born child. A year later, the now 4 ½ year-old adoptee might have progressed to “my red shoe,’’ just like a US toddler would have done.

“Because babies are immature in so many ways, it’s easy to assume their language is simple because their minds are simple,’’ Snedeker told the Boston Globe. Her research has shown that’s not the case.

Snedeker’s research has shown that the older adoptees are quicker at progressing through English language acquisition than US-born babies, but they progress through the same stages and make the same kinds of grammatical mistakes.

Thus it seems that humans “might need to learn words like ‘ball’ and ‘shelf’ before they can learn a word like ‘on’ ’’ and produce a sentence like “the ball is on the shelf,’’ Snedeker told the Globe.

The one exception, according to Snedeker, is that the older adoptees tend to be quicker in using words referring to time, the future and the past. So apparently there are at least some areas where cognitive maturity comes into play.

A new study has confirmed that bisphenol A leaches from those popular, colored plastic drinking bottles into people’s bodies.

A research team led by Karin Michels of the Harvard School of Public Health asked 77 students to consume beverages from stainless steel bottles for a week to rid themselves of BPA, which is normally cleared through the urine hours after consumption.

The students provided urine samples throughout the washout period and during the second week, when they consumed all liquids from polycarbonate bottles manufactured using BPA.

Week 2 specimens contained 69% more BPA than those from Week 1, and were equivalent to levels routinely observed in the general population. All other dietary habits were unchanged over the course of the study, leaving no doubt the BPA came from the bottles.

The study appears in Environmental Health Perspectives.

BPA makes those reusable plastic bottles more durable. It also prevents corrosion in the cans used for commercial soup and baby formula products.

Animal studies suggest that BPA causes developmental and endocrine problems. Recent human studies have linked urinary BPA concentrations to behavioral problems in children, reproductive problems, immune deficiency and an increased risk of diabetes and heart and liver problems.

Last year, amid growing concerns about its health effects, Canada proscribed the use of BPA in baby bottles.

The FDA says that BPA-laced products are safe, even for infants and children. In reaching that conclusion, it overruled its own advisory board which had chastised the agency for relying on industry-sponsored research in its analysis.

Steven Hentges, an American Chemistry Council official representing manufacturers, actually found the Harvard study results to be heartening.  To him, the study indicates “that even exclusive use of polycarbonate bottles does not lead to unusually high levels of bisphenol A in the urine.”

In 2006, Massachusetts enacted a law requiring that all residents obtain health insurance.

Ever since, developments there have been watched closely since what happens in the state might play out nationally should the Great American Health Care Do-Over include an individual mandate.

Unfortunately, the Bay State’s program has been plagued by unsustainable cost escalations since Day 1, and the situation has been exacerbated recently by recession-related budget shortfalls and rising unemployment.

It was a matter of time before cuts had to be made, and that happened yesterday when state policymakers announced they’re cutting $115 million, or 12% from the budget of Commonwealth Care, a centerpiece of the state’s initiative which subsidizes premiums for poor residents.

The cuts amount to a forced slowdown in Commonwealth Care enrollment. According to the Boston Globe, about 18,000 residents who qualify for subsidies but who have not designated a health plan will no longer be automatically enrolled in program.

Tentative cuts in dental coverage for 92,000 Commonwealth Care enrollees and health insurance for 28,000 legal immigrants have also been proposed, although these proposals  must be approved by governor Deval Patrick.

He has until Monday to decide.

Commonwealth Care currently has 177,000 members. It’s projected to have 212,000 by year end, 2010.

“No decision has been made’’ on the immigrant coverage issue, Leslie Kirwan, Patrick’s secretary of administration and finance told the Globe. “It’s certainly going to be at the top of the list’’ of items Patrick might restore to the budget, she added.

Leaders of Health Care for All, a Bay State consumer group, said the proposal would be tough on non-English-speaking residents who find it hard to navigate the complex enrollment process for Commonwealth Care.

“My concern is people will not get the care they need,’’ lamented the group’s representative, Lindsey Tucker to the Globe.

Biotech giant Genzyme has shuttered a drug production complex after discovering a virus in a bioreactor used to produce its best selling drugs, Cerezyme and Fabrazyme.

The virus, Vesivirus 2117, is not thought to harm humans, according to company officials. It does affect growth of the cells used to produce the drugs, however. The tainted plant will stay closed for at least 6 weeks while decontamination takes place.

For about 8,000 people worldwide, the drugs are life-savers, although the temporary interruption in production should not pose significant risks to them.

Cerezyme is used for Gaucher disease, a hereditary condition in which an inactive enzyme causes fats to accumulate in multiple organs. 

Fabrazyme is used to treat Fabry disease, another inherited enzyme deficiency that leads to fat build-ups in various organ systems as well.

As a result of the shutdown, Cerezyme patients could miss one or 2 treatments. Those taking Fabrazyme could miss up to 4 doses.

Patients usually receive IV infusions of the drugs every 2 weeks. Any missed doses will not result in significant health sequellae, since it takes more than a few missed treatments to result in significant reaccumulation of the fatty substances.

“It is not a life-and-death situation we’re dealing with here,’’ Henri Termeer, the company’s chief executive told the Boston Globe.

The production glitch will cost the company $200-$300 million in lost revenue, however. Last year, Cerezyme garnered $1.2 billion in revenue, about  a quarter of the company’s total. Fabrazyme generated $500 million.

“This is an unusual event, but they’ll solve it and go on,” Leerink Swann’s John Sullivan told the Globe. “Traditionally, in cases like these, you worry about a market share shift. With these products, that is not a consideration.’’

Massachusetts’ universal health care plan has increased the number of insured Bay State residents and caused the states’ already highest-in-the-nation health care costs to balloon 42% in just 3 years.

Now it’s time to pay the piper, and the Bay State’s Special Commission on the Health Care Payment System believes the way to do that is to implement a capitation model similar to the one that was ridiculed, then buried 15 years ago.

In proposing a system that establishes prospectively a single, comprehensive payment that covers all care for an entire year, Commissioners hope to discourage providers from offering unneeded tests and treatments, and encourage provider network development.

The networks would, they hope, more effectively manage care across the continuum of care and reduce errors in information handoffs.

The old fee-for-service system “has all the wrong incentives,” Dolores Mitchell, a Commission member told the Boston Globe. “People know the system has been dysfunctional for years.”

The Commission must still decide how quickly to implement the new payment mechanism, which necessitates a massive reorganization on the provider side, and how to split fees among PCPs, specialists and hospitals. That’s the La Brea of tar pits.

Capitation was popular during the heyday of managed care in the 1980s and early 1990s.

It caused many small practices to lose millions on very sick patients, and raised concern that physicians were denying patients necessary care in order to stay within budget.

Commissioners believe the state can overcome the former problem by setting aside a separate pool of funds for the very sick, or by insuring providers against large losses.

The denial of service issue, they hope, could be handled through close monitoring of the quality of care.