Friday, June 12, 2009

David Kessler "The End of Overeating."

David Kessler visits Google's Mountain View, CA headquarters to discuss his book "The End of Overeating." This event took place on May 28, 2009, as part of the Authors@Google series.

Before we can begin to address America's eating epidemic, we need to understand WHY we have such difficulty controlling what we eat. Kessler spent the past seven years meeting with top scientists, physicians, psychologists, and food industry insiders, and conducting his own research to reveal how specific foods produced by giant food corporations and restaurant chains ("Big Food") feed our desire to eat by stimulating the brain with an infinite variety of diabolical combinations of salt, fat and sugar. People of all ages are being set up for a lifetime of food obsession due to the ever-present availability of foods laden with salt, fat and sugar. It is no wonder that millions of Americans are gaining weight and getting sick. The End of Overeating provides a highly readable and indispensable picture of the problems we face and offers solutions for how to fight them and regain control.

David Kessler, MD, served as commissioner of the US Food and Drug Administration. Dr. Kessler, a pediatrician, has been dean of the medical schools at Yale and the UCSF. He is the father of two grown children and lives with his wife in California.

Thursday, June 11, 2009

Health Officials Declare Flu Pandemic

GENEVA -- The World Health Organization declared an H1N1 flu pandemic Thursday -- the first global flu epidemic in 41 years -- as infections in the United States, Europe, Australia, South America and elsewhere climbed to nearly 30,000 cases.

The long-awaited pandemic announcement is scientific confirmation that a new flu virus has emerged and is quickly circling the globe. WHO will now ask drugmakers to speed up production of an H1N1 flu vaccine. The declaration will also prompt governments to devote more money toward efforts to contain the virus.

WHO chief Dr. Margaret Chan made the announcement Thursday after the U.N. agency held an emergency meeting with flu experts. Dr. Chan said she was moving the world to phase 6 -- the agency's highest alert level -- which means a pandemic, or global epidemic, is under way.

"The world is moving into the early days of its first influenza pandemic in the 21st century," Dr. Chan told reporters. "The (H1N1 flu) virus is now unstoppable."

On Thursday, WHO said 74 countries had reported 28,774 cases of H1N1 flu, including 144 deaths. Chan described the virus as "moderate." According to WHO's pandemic criteria, a global outbreak has begun when a new flu virus begins spreading in two world regions.

The agency has stressed that most cases are mild and require no treatment, but the fear is that a rash of new infections could overwhelm hospitals and health authorities -- especially in poorer countries.

Still, about half of the people who have died from H1N1 flu were previously young and healthy -- people who are not usually susceptible to flu. H1N1 flu is also crowding out regular flu viruses. Both features are typical of pandemic flu viruses.

The last pandemic -- the Hong Kong flu of 1968 -- killed about 1 million people. Ordinary flu kills about 250,000 to 500,000 people each year.

H1N1 flu is also continuing to spread during the start of summer in the northern hemisphere. Normally, flu viruses disappear with warm weather, but H1N1 flu is proving to be resilient.

The decision might have been made much earlier if WHO had more accurate information about H1N1 flu's rising sweep through Europe. Dr. Chan said she called the emergency meeting with flu experts after concerns were raised that some countries like Britain were not accurately reporting their cases.
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After Thursday's meeting, Dr. Chan said the experts agreed there was wider spread of H1N1 flu than what was being reported.

Dr. Chan would not say which country tipped the world into the pandemic, but said all countries and experts were agreed that it was time to declare a global outbreak.

WHO said it was now recommending that flu vaccine makers start making H1N1 flu vaccine. Drug giant GlaxoSmithKline PLC said they could start large-scale production of pandemic vaccine in July but that it would take several months before large quantities would be available.

The pandemic declaration will require all countries, including the dozens that haven't yet reported any cases, to launch pandemic-prevention plans.

Peter Cordingley, a spokesman for the WHO based in Manila, noted that the term pandemic was "a measure of the spread of the virus, not the severity of the virus." The virus's effects are moderate at the moment, he noted. "But it's still going to infect an awful lot of people."

Nearly half the world's confirmed cases, or 13,217, are in the U.S., including 27 deaths, according to the WHO.

In Australia, the number of the new disease, also known as swine flu, has more than tripled in the past week, reaching 1,263 on Thursday, when three new cases were confirmed in the state of Tasmania. It recorded its first case of the disease on May 9.

"Australia catches our eye particularly not because of the number of cases but because of strong evidence of community transmission," particularly in the southern state of Victoria and its capital, Melbourne, said Mr. Cordingley. He said the WHO is also focusing on similar evidence in the U.K., Spain, Japan and Chile.

More than 1,000 Australia's swine flu cases are in Victoria, which has been hit by the cold temperatures and dry conditions that flu viruses thrive in.
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Victorians now account for around 3.6% of total confirmed cases globally, and authorities are struggling to understand exactly why the virus has taken such a hold in the state, Victoria's acting chief health officer, Rosemary Lester, said Thursday.

"Perhaps we may never have a definitive answer on that," Lester told Australian Broadcasting Corp. radio. "We do know that we have had an extensive testing regime so we have uncovered a lot of cases that were there to be uncovered. And because the disease is so mild in the majority of people, that allowed it to spread undetected," she said.

Cases detected so far have been relatively mild, with no deaths from the virus yet recorded in the country. The majority of sufferers in Australia have been aged between five and 18, but the virus continues to strike healthy adults including several professional Rugby League players who competed in an interstate match in Victoria's capital, Melbourne, last week.

Those players were quarantined from their clubs, and earlier this week, authorities canceled a major swim meet due to be held in Melbourne. Victoria is on a higher level of alert than other Australian states.

On the streets of Melbourne there is little evidence of major concern among the city's nearly four million residents. Shops, bars and cafes -- while affected by the economic slowdown -- are still busy, and the city's public transport has shown no signs of reduced patronage.

Schools in the nation are no longer being closed if a student is reported as having the virus, although authorities have requested that school aged children at risk from the virus stay home for seven days.

In contrast, Hong Kong's government on Thursday ordered the closure of all nurseries, kindergartens and primary schools for two weeks after a dozen students at one school tested positive for swine flu.

Australian health authorities have stopped testing every suspected case of the virus -- drawing some condemnation from critics -- and Victoria is now focusing treatment on those most vulnerable to viral infections, such as the very old or very young.

New York City health officials say three more people have died from swine flu, bringing the city's total to 15. One victim was a child under the age of 5, one was a person between 5 to 24 years old, and another was between 30 to 39 years old.

The city health department says a telephone poll of over 1,000 residents found nearly 7% had flu-like symptoms in April and May. That suggests more than half a million New Yorkers were ill.
—Lyndal McFarland in Melbourne, Peter Stein in Hong Kong and the Associated Press contributed to this article.

Monday, June 8, 2009

Swine Flu Is Way Worse Than Expected

When we began writing about the impending swine flu pandemic, many readers thought we were buying into some kind of government created panic. Our view was exactly the opposite: the government was understating the risks of swine flu, worried that a "panic" would hurt the economy. Mainstream media sources started by being "responsible" and under-reporting the risks in the US, bought into the panic for a week or so, then quietly dropped the story.

The story of swine flu has now effectively dropped out of public discussion. In fact, when it is discussed it usually as a critique of health authorities for needlessly creating a scare.

Once again, however, this is exactly backwards. Swine flu has not turned out to be a non-event. It is not more confined than intially feared. Indeed, the official risk models of swine flu dramatically underestimated how widespread it has become.

As the New York Times reports, two rival supercomputer teams made projections about the swine flu epidemic. One said that swine flu would hit 2,000 people by the end of May. Another said the number would be 25 percent higher: 2,500. (The innumerate editors of the New York Times call these estimate "surprisingly similar," but that's not important for now.)

In fact, the Centers for Disease Control and Prevention estimate that by the end of May there were upwards of 100,000 cases of swine flu in the country. So much for the models that told us the risks weren't so big.

Saturday, June 6, 2009

Chagas Disease: A Century Later

Chagas Disease: A Century Later

By Kara Rogers on Health

In 1909 Brazilian physician Carlos Chagas discovered American trypanosomiasis, better known as Chagas disease. In the 100 years since, there have been two drugs developed that can cure the disease and a lot learned about how it can be prevented. Yet, it affects between 8 and 11 million people in the Americas and Caribbean. So instead of celebrating a centennial marked by successful control or elimination of Chagas, researchers and public health officials are calling for assistance, especially increased government and private funding.

Chagas has fallen unceremoniously into the pile of neglected tropical diseases, a group of human afflictions that thrive in the poorest and most destitute rural and urban regions of the world. The urgency with which health organizations have had to respond to diseases like malaria and AIDS has overshadowed Chagas, which is endemic to Mexico and countries in Central and South America. There are roughly 50,000 new cases of Chagas diagnosed annually in these places, and at the rate that its incidence appears to be increasing, there is concern that in the Americas and Caribbean the disease actually may be as prevalent as or even more so than malaria.

Chagas is a vector-borne disease, and thus it involves a carrier (vector), a parasite, and a mechanism of transmission to humans. The carrier is a bloodsucking insect known as the kissing bug, or barber beetle, because its favorite place to bite an unsuspecting victim is the face. The kissing bug attacks at night and is most commonly found in poorly constructed or dilapidated houses that have cracks in their walls or roofs, which serve as entry points for the bugs. Trypanosomas cruzi.

The parasite that causes Chagas disease is Trypanosomas cruzi, a protozoan that has a flagellum to propel it from place to place. When a kissing bug bites its victim, it deposits the infectious parasite in its feces. The victim scratches the bite and rubs the feces into the wound, thereby facilitating the entry of the parasite into nearby cells. Once inside a cell, the parasite matures and multiplies. The organisms eventually burst out of the cell and into the bloodstream. They then travel to and infect various tissues, though they seem to have an affinity for muscle cells and neuroglia, cells that function to support neurons.

Chagas is a frightening and sometimes unpredictable disease. It is characterized by acute and chronic stages, both of which may be silent, meaning that obvious symptoms do not always manifest. Acute disease in which there are no or only very mild symptoms often goes undiagnosed and therefore untreated. As a result, the parasite remains in the body, setting the stage for chronic disease, which can take one or more decades to develop and is often fatal. Chronic disease often appears in the form of heart abnormalities, which may lead to sudden cardiac death or heart failure, or in the form of gastrointestinal disease, which arises due to the parasitic destruction of nerve cells.

Only two drugs—nifurtimox and benznidazole—are effective for the treatment of Chagas, and they are useful only in the acute stage of disease, when they can cure infection. If treatment is delayed or if infection persists, the chance for ridding the body completely of parasites drops significantly. More importantly, however, Chagas can be prevented in the first place. Improving the construction of houses, spraying insecticides, using bed nets, and improving basic hygiene can stop kissing bugs from getting into houses and transmitting the disease.

Prevention and proper treatment are the most practical ways to break the cycle of infection from insect to human to insect. These approaches also can reduce the likelihood that people migrating from one place to another will carry the parasite with them. But delivering the needed preventative, educational, and therapeutic resources to affected regions requires money and people. Researchers and health workers hope that their efforts this year will draw attention to Chagas. After all, a century has passed. Perhaps it is time to bring this otherwise preventable disease under control.