Paying people to avoid sexually transmitted diseases effectively reduces their spread, according to a proof-of-concept study carried out by scientists at UC Berkeley, the Development Research Group at the World Bank and the Ifakara Health Institute in Tanzania.

The study involved young adults in southwestern Tanzania. Subjects were randomly assigned to a high-payment group, a low-payment group and no-payment control group. Participants in the high payment group received $20 every 4 months–up to $60–if they tested negative for STDs. Those in the low-payment group received half that amount.

Participants in all groups received individual counseling and could attend monthly group counseling sessions as well. Any participant that tested positive for an STD received free care for the condition.

By the end of the year, 9% of participants in the high-payment group had tested positive for an STD. That was significantly better than the 12% rate seen in both the control group and the low-payment group. The cash reward had the same impact in men and women. It had a more pronounced effect in people with lower incomes.

“For many of our study participants, $60 represented about one-fourth of their reported annual income, so it was a significant incentive,” says Will Dow, a study author and a health economist at Berkeley. “The question we tested is whether the cash reward was enough of an incentive to reduce risky behavior. The fact that disease prevalence decreased suggests the incentives worked.”

Participants were tested for chlamydia, gonorrhea and syphilis. HIV/AIDS status was not tested, but the same sexual behaviors that increase the risk of the STDs increase the risk of HIV.

Continuing a trend that began more than 2 decades ago, the death rate from cancer in the US dropped 1.3% year-over-year in 2010. It now stands at about 178 people per 100,000 per year.

The news is contained in a report prepared by epidemiologists at the American Cancer Society and published in CA: A Cancer Journal for Clinicians. The scientists estimate there will be about 1,530,000 new cancer cases in the US in 2010 (790,000 in men and 40,000 in women), and 569,000 deaths due to cancer (299,000 in men and 270,000 in women) in the US in 2010.

According to the report, cancer death rates have dropped 21% in men, and 12% in women since 1991. The report attributes the fall-off to fewer people smoking, improved treatment, and better screening.

In men, cancers of the prostate, lung, and colon will be the cause of 52% of all newly diagnosed cancers this year. Prostate cancer alone will cause 28% of these, and 90% of these cases will be discovered at local or regional stages, for which the five-year survival rate is nearly 100%.

In males who are less than 40 years of age, leukemia is the most common fatal cancer. In older men, lung cancer becomes the leading killer.
 
For women, cancers of the lung, breast and colon account for 52% of newly diagnosed cancer cases. Breast cancer alone will cause of 28% of all new cancers in women this year.

Leukemia is the leading cause of cancer death among women less than 20 years old. Breast cancer ranks first for those between the ages of 20 and 59. After that, lung cancer becomes the leading cause of cancer death.

Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. It will be responsible for 26% of all cancer deaths in women this year.

Almost 9 years after letters laced with weapons-grade anthrax spores killed 5 people and inflamed fears about bioterrorism, the US still relies on a single anthrax vaccine maker that uses expensive, impractical, decades-old technology.

The company is Emergent BioSolutions, and its BioThrax vaccine is its only product. Emergent has copped $1.4 billion in federal contracts for the vaccine in the last decade alone.

Twice before, the Feds tried to find cheaper anthrax vaccines and increase the number of vaccine suppliers. In 2004, it awarded an $877 million contract to VaxGen, but aggressive lobbying by Emergent and manufacturing problems at VaxGen forced the Feds to void that contract.

A second RFP that was released last year by Barda–the Biomedical Advanced Research and Development Authority–was halted after officials determined that no supplier could produce a vaccine quickly enough.

That was a setback for PharmAthene, a rival to Emergent. PharmAthene claims that heavy lobbying by Emergent scuttled what it thought was a sure win. Emergent spent $4 million in lobbying during 2009 to maintain its monopoly.

BioThrax requires the administration of 5 doses over 18 months, and costs the Feds $120 per person immunized. PharmAthene’s SparVax would cost $45 per person. That vaccine remains in testing, however. In fact, PharmAthene has no products on the market right now.

Barda is also hoping to lure some large consortiums into the field, including one involving Merck, GE and and the University of Pittsburgh, but they remain leery of the risks.

“The country needs an anthrax vaccine that requires fewer injections, produces fewer side effects and is made using modern techniques,” said former Sen. Bob Graham, who co-chaired a federal commission that questioned the nation’s bioterror readiness earlier this year.

UPDATE: At the time this post is being scheduled for publication, the Washington Post is reporting that Emergent BioSolutions will soon announce that it “received a contract worth up to $107 million to ready its anthrax vaccine for large-scale manufacture.

According to Emergent, the contract will pay for the company to develop and obtain regulatory approval for large-scale manufacture of BioThrax.

The award is based on an Emergent proposal that says the company can produce 26 million doses annually, a significant increase from the roughly 7 million to 9 million it generates today.”

Scientists at the Lawrence Livermore National Laboratory have developed a new tool that could help law enforcement authorities detect bioterrorism attacks, doctors in need of a rapid diagnostic tool for infectious diseases, and regulatory agencies responsible for food safety.

The device, blandly named the Microbial Detection Array, will be able to identify 2,000 viruses and 900 bacteria within 24 hours, according to officials at the lab.
 
“The ability to detect the major bacterial and viral components of any sample can be used in countless ways,” Tom Slezak, an associate program leader for Informatics at Lawrence Livermore National Laboratory told BurrillReport. “This is important because it fills a cost-performance gap that is relevant to many missions: biodefense, public health and product safety.”
 
If the cost of the array can be reduced, it could become a helpful tool for public health diagnostics, Slezak added. The array has the huge advantage of being able to detect a far wider range of viral and bacterial pathogens than the best available technology. That would be multiplex polymerase chain reaction or PCR, which is able to detect 50 organisms at one time.
 
The same benefits would apply to biodefense, where current systems are similarly designed to detect a much smaller set of high-risk pathogens. Not surprisingly, the US Department of Homeland Security is testing the array for its own use.
 
And there’s more: the Livermore group is now testing a new array that has probes covering 5,700 viruses and several thousand bacteria.

Approximately 3 million Americans consume unpasteurized milk each year. They believe “raw” milk contains enzymes, vitamins, beneficial bacteria and disease-fighting nutrients that are lost during pasteurization.

These beliefs persist despite the unanimous opinion of public health officials that the risks of unpasteurized milk outweigh any benefits, and that pasteurization—in which milk is heated to kill disease-causing bacteria—is by far the best way to assure milk is safe.

According to the CDC, there were 85 outbreaks of bacterial infections caused by raw milk consumption between 1998 and 2008. These outbreaks were associated with 1,614 reported cases of illness, 187 hospitalizations and 2 deaths. Deaths have also been caused by ingestion of fresh cheese made from raw milk, the CDC reports, especially the Queso Fresco cheeses which are favored by many Hispanic people.

Pregnant women, the elderly and children are particularly vulnerable to bacterial infections associated with raw milk, but healthy young adults can also be stricken.

The FDA bans interstate sales of unpasteurized milk for human consumption, but 28 states allow it to be sold, and others are considering doing so. These states impose their own laws regarding milk processing. Some require in addition that warning labels be affixed to milk containers.

In the aftermath of some recent outbreaks associated with unpasteurized milk, the FDA and CDC are ramping-up efforts to warn consumers about its dangers, and urging states to strengthen what regulatory controls they currently enforce. 

Pasteurization was widely adopted in the US around 1938. Before then, cow’s milk caused nearly 25% of all food- and water-borne disease outbreaks. “People don’t remember the bad old days,” Robert Tauxe, the CDC’s deputy director of food-borne and bacterial diseases division told the Wall Street Journal.

Two weeks ago, the prestigious medical journal Lancet retracted a 1998 article that purported to show a link between childhood vaccines and autism. The article stimulated a decade-long debate about vaccine safety, and the Lancet’s retraction effectively ended reasonable scientific discourse on the subject: the vaccines are safe.

Ten of 13 authors of the paper had issued a partial retraction 6 years ago, but the first author, Andrew Wakefield, did not. 

Wakefield’s study had focused on 12 children that had gastrointestinal problems. Eight had symptoms that their parents or a doctor thought were caused by the MMR vaccine, and 9 exhibited autistic behaviors.

That study triggered widespread concern that measles-mumps-rubella vaccine caused autism. Parents decided against immunizing their children as a result. Roughly 2.1% of US children weren’t immunized with the MMR vaccine in 2000, nearly triple the rate of 0.77% in 1995, according to a study in Pediatrics.

This occurred despite the publication of several subsequent studies which showed that vaccines were safe. The most notable among these were a 2004 review of the literature by the Institute of Medicine and a 2008 study by the CDC which looked specifically at children with GI problems.

“This retraction by the Lancet came far too late,” Paul Offit, chief of infectious diseases at Children’s Hospital of Philadelphia told the Wall Street Journal. “It’s very easy to scare people; it’s very hard to unscare them.”

The Lancet pulled the plug after a UK-based health care regulator concluded the Wakefield study was bogus. The General Medical Council’s report included allegations of ethical violations by some investigators, including “cherry-picking” children for the study, rather than taking kids as they presented randomly to the hospital, as had been implied in the paper.

Fully 8 years after the anthrax attacks of 2001 showed that bioterrorism can happen in the US, the nation remains woefully unprepared for a large-scale attack, according to a Congressional Commission.

The WMD Commission evaluated the government’s performance in 17 key areas. It nailed the White House and Congress with an “F” for not creating a rapid-response capability to handle disease outbreaks from bioterrorism, or providing adequate oversight of security and intelligence agencies.

As evidence, the Commission cited the government’s stuttering response to the swine flu epidemic. It pointed fingers at several administrations and branches of government.

In other news, the panel handed out “As” to government programs that secured dangerous viruses and bacteria, and to the Obama administration’s reorganization of the National Security Council so that it could handle other threats from weapons of mass destruction.

The Commission’s report cited in particular the White House’s efforts to strengthen international controls on nuclear technology and components.

“Each of the last three administrations has been slow to recognize and respond to the biothreat,” former senator Bob Graham (D-Fla.) told the Washington Post. Graham co-chaired the panel with former senator James M. Talent (R-Mo.). “We no longer have the luxury of a slow learning curve when we know al-Qaeda is interested in bioweapons.”

In his State of the Union address last month, President Obama revealed plans to fill many of the gaps that were identified by the Commission. In particular, he wants to improve the performance, scalability and flexibility of drug distribution systems.

According to White House spokesman Nick Shapiro, “the goal is a national capability for the rapid, reliable and affordable production of an array of medical countermeasures against public health threats.”

As scientists race to create an AIDS/HIV vaccine, few have asked whether people can be persuaded to take the jab in the event it someday becomes available.

To assess HIV vaccine acceptability among high-risk adults, Peter Newman and colleagues from the University of Toronto interviewed 1,164 adults that have visited sexually transmitted disease clinics, needle/syringe exchange programs, and community health/HIV prevention programs in Los Angeles.

During the interviews, participants were asked to rate the acceptability of eight hypothetical vaccines, which varied in their effectiveness, cost and side effect profile, and to discuss how each one would impact their use of condoms after receiving the vaccine.

The scientists found that many high-risk individuals would not accept the vaccine, no matter what its characteristics were. Vaccine effectiveness turned out to be the attribute most likely to drive vaccine acceptance, followed by side effects and out-of-pocket cost.

The scientists also found that nearly 10% of the at-risk adults in the study might be more prone to engage in unprotected sex after they were vaccinated. This is critical since initial HIV vaccines are probably going to be only partially effective in preventing HIV infection.
 
“Merely having a vaccine available doesn’t mean it gets to the people who need it—a fact that is evidenced by the issues we’re seeing now around H1N1 vaccines,” Newman told BurrillReport. “If we want HIV vaccines to be acceptable and accessible to people, we need to consider all of these factors before we have a safe and relatively effective vaccine on the market.”

Newman added that educational programs built to support any future HIV/AIDs vaccine would have to explain in lay terms how it worked and what scientists mean when talking about the efficacy of a vaccine.

Baby Boomers that are just now entering their sixties are likely to be more burdened by disabilities than their counterparts in earlier generations, according to UCLA scientists. If their projections prove accurate, it could have a devastating impact on the nation’s health system.

To reach these conclusions, Teresa Seeman and colleagues queried data from the National Health and Nutrition Examination Surveys (NHANES) for the years 1988 and 1999.

They looked at 4 areas: activities of daily living, like walking from room to room; instrumental activities like doing chores; functional limitations like kneeling or stooping; and mobility, which includes walking one-quarter mile without a rest.

The study focused on adults born between 1930 and 1944, because this group could offer the most insight into the problems that will be associated with Baby Boomers who are now entering their 60s.

The researchers found that between 1988 and 1999, disability among people in their sixties rose 40-70% percent in each of the 4 areas except functional limitations, even after controlling for socioeconomic characteristics, health status and weight.

The increases were pronounced in non-white people, a subset of the US population that is growing most rapidly and that is known to have a higher incidence of obesity and lower socioeconomic status. These factors are associated with an increased risk of functional limitations and disabilities.

“If this is true, it’s something we need to address,” Teresa Seeman, the study’s principal investigator told BurrillReport. “If this trend continues unchecked, it will put increasing pressure on our society to take care of these disabled individuals.”

The study will appear in the January issue of the American Journal of Public Health.

In the 15 years since cell phones first appeared on the scene, they have spread with astonishing speed and revolutionized communications on a global scale. But right around the time the Motorola Flip-phone was the rage, reports surfaced that cell phone use might be associated with brain cancer.

Since then, the majority of research on the subject has refuted this claim, as has the most recent publication on the matter by Isabelle Deltour of the Danish Cancer Society in Copenhagen, and her colleagues.

Deltour’s group looked at registry data from 4 Scandinavian countries between 1974 an 2003, a period encompassing the birth and growth of the technology.

They found that the incidence of the 2 major forms of brain cancer either remained stable, decreased, or continued the same slow rise that had been observed in the pre-cell phone era.

These findings are “consistent with mobile phone use having no observable effect on brain tumor incidence in this period,” they wrote in the Dec. 16 issue of the Journal of the National Cancer Institute.

The registry contained 59,984 glioma and meningioma cases had been diagnosed in people between the ages of 20 and 79 during the study period.

The incidence of glioma increased in men by 0.5% annually and in women by 0.2% annually during the study.

The incidence of meningioma increased 0.8% per year in men, on average.  In women, the incidence of meningioma rose by 2.9% per year from 1974 to 1987 (when cell phones began hitting the market), then dropped by 2.1% per year between 1987 and 1991, and then began rising again at a rate of 3.8%.

Most of that recent increase in meningioma incidence occurred in women who were at least 60 years old when they were diagnosed–an age group not likely to have been heavy cell-phone users back then.

The scientists could not exclude the possibility that very heavy cell-phone use could pose risks, or that a positive association may be present for very rare brain tumors.

Health and Human Services Secretary Kathleen Sebelius announced last week that she had ordered a complete review of the Feds’ ability to respond to emerging public health threats, bioterrorism and the like.

The news was prompted by the uneven performance of the government’s  swine flu vaccination program, which began delivering serious quantities of the jab right around the time the second wave of the outbreak began to subside.

“We’ll look for new technologies that will let us quickly produce countermeasures that are more dependable and more robust,” Sebelius told the AMA’s Third National Congress on Health System Readiness.

“Not just for flu and infectious diseases, but for all the public health threats we face.”

“Today, we face a wider range of public health threats than ever before in our history,” Sebelius told the crowd. “It could be anthrax delivered in an envelope. It could be a dirty bomb in a subway car. It could be a new strain of flu.”

“The countermeasure that saves the day during a quick-hitting public health emergency can take years to discover, develop, manufacture and distribute,” Sebelius continued. “We’ve often failed to make the kind of long-term investments in countermeasures that we need to stay safe.”

Referring to the H1N1 vaccine, which was produced far more slowly than officials predicted, Sebelius said “we were fighting (it) with vaccine technology from the 1950s…there was nothing we could do if vaccine grew slowly in eggs.

We could make deals with foreign vaccine producers ahead of time, but we (then) wouldn’t have as much control as if they were based in the US.”

Sebelius did point to some progress in this regard. She mentioned a new facility in Holly Springs, N.C. that can produce flu vaccine from cells in lieu of eggs, for example. That facility is being run by Novartis, which received nearly $400 million in seed funding from the Feds.

Microbiologists from the Food and Drug Administration may have found a new way to protect fruits and vegetables from contamination with Salmonella.

Eric Brown and colleagues at the FDA’s Center for Food Safety and Applied Nutrition have found that a particular group of naturally occurring bacteria that can wipe out the dreaded pathogen, at least in laboratory settings. 

“The beauty is that we take something alive and organic and put it back into the field, and by itself, it will kill other bacteria. We’re right on the edge of this,” Brown told scientists at conference on held last month in France.

What is more, the as-yet unclassified “good” bacteria can also destroy listeria and E. coli O15:H7, 2 other bacterial pathogens that frequently cause food-borne illnesses. The only bug that seems immune to the new hero is vibrio, the critter that contaminates oysters and other seafood.

Salmonella causes 1.4 million cases of food-borne illnesses and 500 deaths a year in the US, according to the CDC. Most people recover spontaneously from the infection, but the young, the elderly and people with weakened immune systems are susceptible to severe complications.

The bacterium used to be associated outbreaks of food-borne illnesses caused by eggs and poultry, but for unknown reasons, it has been found increasingly in association with outbreaks caused by fresh fruit and vegetables.

Last year, a salmonella outbreak was initially attributed to tomatoes, although tainted Mexican jalapeño peppers turned out to be the cause. The mistake cost the tomato industry $150 million, and consumer demand for tomatoes has still has not returned to pre-outbreak levels.

By the way, Brown’s “good” bacteria appear in early testing to cause humans no harm. Brown and his colleagues plan to test them on tomatoes grown in research settings during the winter. If that goes well, further testing in the field would follow.

The jig is up when it comes to juice. Public health officials long-ago identified sugary sodas as a causative factor behind the nation’s obesity epidemic, but fruit juice actually packs more calories per ounce than the vilified beverages themselves.

“It’s pretty much the same as sugar water,” said Charles Billington, an appetite researcher at the University of Minnesota. In the modern diet, “there’s no need for juice.”

A cup of fruit juice contains the sugar in 4-6 pieces of fresh fruit. A cup of OJ packs 112 calories, and the same amount of grape juice contains 152. A cup of Pepsi contains 100 calories.

Worse yet, the predominant sugar in these beverages is fructose—the sweetest of all simple carbohydrates. When fructose is consumed in frequent large boluses, it predisposes people to Type 2 diabetes and heart disease since under these circumstances, the liver converts fructose to fat.

In contrast, the fructose in whole fruit enters the body more slowly and in far lower amounts. This allows the liver to dispose of fructose in other, healthier ways.

Beyond this, calories consumed in liquid form don’t have high satiety value. People normally offset a healthy afternoon snack by eating less for dinner, but that doesn’t happen if the snack is juice.

The American Academy of Pediatrics was the first policy-making group to change its recommendations based on these realities. In 2001, it began recommending that kids between the ages of 1 and 6 years consume no more than one 4- to 6-ounce serving per day of juice.

The 2005 Federal government’s dietary guidelines suggest that fruit juice is a good source of potassium, but recommend that whole fruit be used to meet most recommended daily fruit servings.

Still, juice’s healthful aura is tough to penetrate. Frank Greer, who served on the American Academy of Pediatrics’ nutrition committee, said he “can’t imagine” the group would ever downgrade juice to the status of soda.

“It’s such a normal part of the American diet,” Greer told the LA Times. “A glass of fresh-squeezed orange juice for breakfast, my goodness!”

Comprehensive, school-based sex-education programs that teach teens about contraception and encourage them to delay sexual activity increase condom use and lower the risk of contracting sexually transmitted diseases including HIV, according to a panel appointed by the CDC.

But the panel concluded there isn’t enough evidence to endorse programs focused more narrowly on encouraging sexual abstinence until marriage.

The 15-member Task Force on Community Preventive Services reached these conclusions after reviewing 83 studies of such programs that were run between 1980 and 2007.

“Evidence and common sense have returned to public-health policy,” James Wagoner of Advocates for Youth told the Washington Post. “The report endorses a comprehensive approach to prevention that includes condoms and birth control. We should be spending taxpayer dollars only on evidence-based programs.”

Alas, 2 panelists, Irene Erickson of the Institute for Research and Evaluation and Danielle Ruedt of the Georgia Governor’s Office of Children and Families disputed these conclusions.

According to them, “the data indicated that many types of [comprehensive] programs do not work. Unfortunately, the report’s conclusion ignores these findings. This is misleading to policymakers who are seeking evidence-based programs, especially for schools.”

Answering these claims, panelist Randy Elder, who also works for the CDC, argued that the critics’ case was incorrect.

“Those points…reflect a misunderstanding of a systematic review process,” he said. “The whole point of what we are doing is to aggregate data from many studies that are critical to answering the question. What they were doing was chopping up the evidence into fine subsets to poke holes.”

Physicians have quipped for years that HMG CoA Reductase inhibitors—the cholesterol-busters better known as “statins,” ought to be put in the nation’s drinking water.

After all, they have an excellent safety profile, profoundly beneficial effects on serum cholesterol and cardiovascular mortality, and may even work against sepsis and prostate cancer.

The quip is likely to be heard even more nowadays, because a study by Meredith VanderMeer and colleagues from the Oregon Department of Public Health has shown that patients who were hospitalized for seasonal (not H1N1) flu–and who by coincidence were taking statins–had a lower risk of dying from the infection.

VanderMeer reported her team’s findings at the annual meeting of the Infectious Diseases Society of America.

In their study of 2,800 people hospitalized for flu complications, 801 patients were taking statins for high cholesterol at the time of admission. Only 17 of of them died in the hospital or within 30 days of discharge. In the remaining 1999 patients who were not taking statins, 64 died.

The difference in mortality, 2.1% vs. 3.2%, amounted to a statistically significant 54% reduction, and persisted after controlling for confounding factors such as age and the use of antiviral drugs.

Patients in the study were taking a variety of statins, including Crestor, Lescol, Lipitor, Mevacor, Pravachol, and Zocor. It was not clear whether any one of them was associated with more beneficial effects than the others.

The data for the study was pulled from the CDC’s Emerging Infections Program and covered the 2007-2008 influenza season (again, not H1N1).

According to VanderMeer, the link between statins and decreased seasonal flu mortality is not entirely surprising. Flu complications like pneumonia are caused by inflammation, and statins have anti-inflammatory effects.

VanderMeer suggested that a randomized controlled trial might help confirm her teams’ findings.

The Great Economic Crisis may not make front-page news with the regularity it did a year ago, but it continues to have a pernicious effect on the health of Americans, according to a survey carried out by the American Optometric Association.

The nationally representative survey of 1,000 adults showed that recession-related financial problems have prompted 36% of US citizens to cut back on doctor visits.

Sixty-three percent of the survey respondents have foregone visits to the dentist, whereas 59% and 52% have done the same for primary care physicians and eye doctors, respectively. Only 8% claimed they hadn’t changed their routine health-maintenance schedules at all.

The poor economy has hit Hispanics disproportionately, according to the survey. Nearly half (49 percent) of them said they’ve cut back on doctor visits, whereas 36% of blacks and 33% of whites had done the same.

Nearly 2/3 of Hispanics had bagged one or more dental visits, and 53% said they had been to see an eye doctor less often.

Women (38%) were more likely than men (32%) to forego a visit.

In rural areas, nearly 2/3 of respondents said they had reduced eye doctor visits, whereas only half of urban and suburban respondents had done so.

The survey findings “are very worrisome,” said David Cockrell, an optometrist and a trustee with the Association. “We know that many eye and vision problems have no obvious signs or symptoms, so early diagnosis and treatment are critical. This is true beyond just eye care. Health issues of any kind are not things that Americans should ignore.”

“The longer patients go between doctor visits, the greater the opportunity for additional health problems that ultimately can be much more expensive than routine checkups and early-stage treatment,” he added.