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AIDS Goal Missed, but Effort by U.N. Branch Is Praised
By LAWRENCE K. ALTMAN, The New York Times, November 29, 2005
The World Health Organization's failure to meet a goal of treating three million H.I.V.-infected people by the end of this year owes to inadequate international coordination and lack of national leadership, a group of leading advocates for AIDS patients said yesterday.
Although the health agency has said it cannot meet the goal, the advocacy group, the International Treatment Preparedness Coalition, credited it with bold efforts.
The world agency has missed its goal by more than a million, and millions more infected people urgently need treatment, the group said in a report.
W.H.O., a Geneva-based United Nations agency, helped show that antiretroviral treatment can be delivered effectively, extending the lives of hundreds of thousands of people, even in the poorest settings, the coalition said.
Still, efforts by the United Nations and nongovernmental groups are unevenly coordinated and would benefit from a more pragmatic strategy to meet their goals in treating the tens of millions of people in need of antiretroviral therapy, the report said.
Crucial to that strategy is "a much more systematic approach to setting goals, measuring progress, and assessing and addressing barriers" to providing AIDS treatment, the report said.
In citing a pledge by leaders of the Group of 8 countries to come as close as possible to providing universal access to AIDS treatment by 2010, the coalition said it would be a hollow promise unless governments and international agencies learned lessons from the World Health Organization's successes and failures.
More effective collaboration among agencies and groups within countries, eliminating existing bureaucratic barriers and providing more money will be vital to meeting the G-8 goal.
The more pragmatic approach recommended by the coalition includes country-specific strategies and goals with dedicated timelines and milestones as well as clear assignments of responsibility for specific tasks. Some financing agencies have taken steps toward that approach.
The coalition said its report was the first systematic analysis of efforts to scale up antiretroviral therapy based on the research of people living in communities in six of the countries most devastated by AIDS: the Dominican Republic, India, Kenya, Nigeria, Russia and South Africa.
The group found inadequate national leadership that failed to dedicate enough resources or mobilize government agencies; bureaucratic delays; procurement and logistic challenges; a global system that did not collaborate speedily and efficiently to address such bottlenecks; inadequate and uncertain financing levels; and pervasive stigmatization of people with H.I.V.
Critics say efforts to increase antiretroviral therapy will not be useful in the long-term if they fail to improve the countries' health infrastructures.
The report also criticized countries for missing opportunities to detect and treat tuberculosis and H.I.V., two diseases that are strongly related, and failing to establish coordinated health care systems.
The coalition said that President Bush's emergency plan for AIDS relief should deliver treatment to thousands more people within six months and cite specific examples of how it is building sustainable health care systems in its 15 target countries.
The coalition urged all countries that told W.H.O. they wanted to be part of its goal of treating three million people by now to provide detailed action plans to improve their future responses.
"National governments must be the primary engine for increasing access to care," the report said.
In Africa, the continent hardest hit by AIDS, countries need to live up to their commitment made in a declaration in 2001 to devote 15 percent of their budgets to addressing AIDS and other health priorities.
In challenging countries and agencies to abide by their pledges, the coalition said they could not set goals of improved access to treatment and then underfinance the response by billions of dollars.
Efforts should include more than technical support because the infected "people need to know how the drugs work, why adherence is important and the risks of resistance," Greg Gonsalves of the Gay Men's Health Crisis in New York, and an author of the report, told reporters in a telephone news conference.
In Russia, nongovernmental groups have made important contributions in programs to prevent H.I.V., and some have made innovative suggestions about how to scale up treatment, said Shona Schonning who represented a group of people living with AIDS.
Last week, the lower house of Russia's Parliament moved to impose greater control over charities and other private organizations. If the Russian crackdown affects groups that are supporting efforts to prevent and treat AIDS "it could be very damaging to scale up antiretroviral" programs, Ms. Schonning said in the news conference.
Coalition leaders said they planned to meet with government officials.
"The delivery of antiretroviral therapy will only be possible with a revolution in global public health, which makes primary care available to those who have never had it before," the report said, and success in AIDS "will pave the way for treatment of many other diseases that are now left untreated."
The report is available online at aidstreatmentaccess.org.
Rural Water Worries Persist After Chinese Chemical Spill
By JIM YARDLEY, The New York Times, November 27, 2005
SIFANTAI VILLAGE, China, Nov. 26 - Liu Shiying lifted the metal cover off the clay cistern in a corner of the bare kitchen and lowered a tin ladle into what remained of her water supply. Then she raised a scoop to her mouth.
"Do you think it smells?" she asked on Saturday, not taking a sip. "We're still drinking this. It is our only choice."
Ms. Liu lives in one of the dingy villages on the outskirts of Harbin, the provincial capital whose water supply had been shut off for four days to prevent contamination from a chemical spill that dumped a huge tide of pollution into the city's main water source, the Songhua River.
But on Saturday, as Harbin's four million residents learned that water would be restored by Sunday night, rural residents like Ms. Liu in the villages beside the Songhua got no such good news. Isolated and reachable only by rugged, dirt roads, these villages depend on underground wells or the river itself for drinking water. And as the pollution passed by, many villages never got the boxes of bottled water delivered to major cities like Harbin.
Environmental officials announced that the 50-mile slick of pollution had washed past Harbin by Saturday, clearing the way for officials to prepare to restart the water system. Prime Minister Wen Jiabao arrived in Harbin at midday to meet with city officials and to reassure local residents who had endured nearly a week with no running water.
[Later on Saturday, Mr. Wen issued an apology to Russia, into which the Songhua flows, for the spill, The Associated Press reported. The chemical slick is expected to reach there in about two weeks.]
Du Yuxin, the Communist Party secretary in Harbin, said the city had not received any reports of poisoning or other health-related problems from the spill, state news media reported. Mr. Du said local officials were consulting with China's Ministry of Construction to ensure that the system of underground water pipes could be safely reopened without risk of contamination. He predicted that water would be restored by 11 p.m. on Sunday.
"It is an urgent task to resume water supply," Mr. Du told the New China News Agency, "and we have been executing a detailed plan regarding resumption of water supply."
The pollution slick started on Nov. 13 after a petrochemical plant explosion spilled 100 tons of deadly benzene and nitrobenzene into the Songhua River. The factory is located in Jilin City, more than 200 miles upstream from Harbin, and the dangerous slick began steadily moving downstream. But factory executives and Jilin officials initially denied any pollution problems and waited for nearly a week to inform neighboring Heilongjiang Province, where Harbin is located.
Officials in Harbin also initially failed to inform residents of the pollution threat, announcing instead that the water system would be shut down for routine repairs. But that notice set off rising panic and wild rumors, including growing speculation that the local government had detected signs of an earthquake. Harbin officials responded with a new announcement confirming the chemical spill.
Environmental monitoring posts around Harbin found that pollution levels in Songhua had dropped almost to normal on Saturday as the slick moved past the city. But it is unclear whether the government plans extensive testing and cleanup efforts for the wells that supply the villages beside the river. Ms. Liu said the main well in Sifantai was about 100 yards from the Songhua. Several villagers said they were worried about contamination.
"We're concerned that we are so close to the river," said Tao Yunzhi, who lives in the village. "The polluted water gets in the well."
Ms. Liu said the local water had become cloudy in recent weeks and she could not tell whether it had changed, or become contaminated, as the pollution flowed by. On Friday, village officials finally turned off the faucets from the wells, but people continued drinking well water stored in pots and cisterns.
"No one was sending any water to us," Ms. Tao said. "We watched on television all the city people getting water delivered to their doors. Who cares about us village people?"
Really? The Claim: Green Tea Helps Prevent Cancer
By ANAHAD O'CONNOR, The New York Times, November 29, 2005
THE FACTS It has been called an herbal panacea, able to help people who drink it regularly to lose weight, lower their cholesterol and generally safeguard their health.
But when it comes to one of the most-cited benefits of green tea, its ability to fight cancer, studies have found plenty of promise and not a lot of evidence.
The promise, researchers say, stems from the tea's polyphenols, which are powerful antioxidants that studies have shown can inhibit the growth of cancer cells in animals. But the evidence has been sparse when researchers have tried to determine if the findings carry over into humans. Results so far are mixed, at best.
A study in The New England Journal of Medicine in 2001, for example, followed 26,311 residents of northern Japan for eight years and found no connection between the consumption of green tea and the rates of stomach cancer, the most common cancer in Japan.
In 2004, a study of breast cancer in 35,004 Japanese women had similar findings.
On the other hand, at least one study, in Los Angeles in 2003, found significantly lower rates of breast cancer among women who drank green tea.
But the evidence over all is such that the Food and Drug Administration refused this year to let green tea producers place statements about cancer-fighting properties on their packages.
The agency said a review of the research suggested that the claim was "highly unlikely."
THE BOTTOM LINE There is some evidence, but not much, that green tea lowers the risk of cancer.
Findings: The Grapefruit League
By BENEDICT CAREY, The New York Times, November 29, 2005
Athletes on a hot streak often describe warps in space-time that even Einstein did not anticipate: basketball hoops appearing as wide as hula-hoops, tennis balls that seem to move in slow motion, golf outings in which the cups seem as easy to hit as open manholes. "When you're hitting the ball, it comes at you looking like a grapefruit; when you're not, it looks like a black-eyed pea," the Red Sox slugger George Scott once said.
The changes in perception are apparently real, if sometimes exaggerated.
Psychologists at the University of Virginia recently set up tables at several softball fields in Charlottesville, offering free sports drinks to players who agreed to participate in a one-minute experiment. The athletes chose one of eight circles of different sizes on a poster - the one they thought was closest in size to the softball they played with, which was about four inches in diameter. The researchers then asked the players how many at-bats and hits they had had in games that day.
Sure enough, the better day a player had, on average, the bigger the ball looked. "Only people who hit .500 or more picked the largest size," said Jessica Witt, who published the findings in a paper, written with Dennis Proffitt, due to appear in the journal Psychological Science.
When performing, Ms. Witt said, people often seem to run a mental simulation of what they intend to do, in this case hit a ball. Hitting a few clean line drives could alter this simulation, in turn shaping perception of later pitches. Could imagining the hits do the same? "It's a very interesting question to look at," she said. "If you visualize hitting a ball, does it look bigger, and do you actually hit better?"
Vital Signs: Patterns: Research Finds Twins to Be the Slower Siblings
By NICHOLAS BAKALAR, The New York Times, November 29, 2005
Researchers in Scotland have found that twins have substantially lower I.Q.'s than their singleton siblings, based on a sampling of more than 10,000 Scottish children born in the 1950's.
The study, published online Nov. 18 in BMJ, the British Medical Journal, concludes that at least part of the explanation lies in the reduced prenatal growth and shorter gestation typical of twins.
The researchers identified a representative sample of children born in Aberdeen, Scotland, and attending primary school there in 1962.
The children were routinely given written tests of mental skills at the ages of 7 and 9, and the researchers then extracted age-standardized I.Q.'s from the results of those tests.
There were 9,832 singletons and 236 twins in the study, from 8,160 families.
As had been expected, the twins were born smaller and earlier in gestation, and they tended to be small even for their gestational age.
The researchers found that twins at age 7 had I.Q.'s an average of 6.6 points lower than those of their singleton brothers and sisters, and that by age 9 their average I.Q. was 6.9 points lower.
Sex, the number of siblings, the mother's age and the father's social class did not explain the difference. However, when the researchers adjusted for birth weight and gestational age, the differences in I.Q. were reduced substantially.
The authors acknowledge that their study is based on children born more than 50 years ago and that a study of children born more recently might produce different results.
Nevertheless, they write, even among children born more recently, "it seems very likely that there will still be differences in cognition between twins and singletons because of the shorter gestations and impaired fetal growth that affect some twins."
By LAWRENCE K. ALTMAN, The New York Times, November 29, 2005
The World Health Organization's failure to meet a goal of treating three million H.I.V.-infected people by the end of this year owes to inadequate international coordination and lack of national leadership, a group of leading advocates for AIDS patients said yesterday.
Although the health agency has said it cannot meet the goal, the advocacy group, the International Treatment Preparedness Coalition, credited it with bold efforts.
The world agency has missed its goal by more than a million, and millions more infected people urgently need treatment, the group said in a report.
W.H.O., a Geneva-based United Nations agency, helped show that antiretroviral treatment can be delivered effectively, extending the lives of hundreds of thousands of people, even in the poorest settings, the coalition said.
Still, efforts by the United Nations and nongovernmental groups are unevenly coordinated and would benefit from a more pragmatic strategy to meet their goals in treating the tens of millions of people in need of antiretroviral therapy, the report said.
Crucial to that strategy is "a much more systematic approach to setting goals, measuring progress, and assessing and addressing barriers" to providing AIDS treatment, the report said.
In citing a pledge by leaders of the Group of 8 countries to come as close as possible to providing universal access to AIDS treatment by 2010, the coalition said it would be a hollow promise unless governments and international agencies learned lessons from the World Health Organization's successes and failures.
More effective collaboration among agencies and groups within countries, eliminating existing bureaucratic barriers and providing more money will be vital to meeting the G-8 goal.
The more pragmatic approach recommended by the coalition includes country-specific strategies and goals with dedicated timelines and milestones as well as clear assignments of responsibility for specific tasks. Some financing agencies have taken steps toward that approach.
The coalition said its report was the first systematic analysis of efforts to scale up antiretroviral therapy based on the research of people living in communities in six of the countries most devastated by AIDS: the Dominican Republic, India, Kenya, Nigeria, Russia and South Africa.
The group found inadequate national leadership that failed to dedicate enough resources or mobilize government agencies; bureaucratic delays; procurement and logistic challenges; a global system that did not collaborate speedily and efficiently to address such bottlenecks; inadequate and uncertain financing levels; and pervasive stigmatization of people with H.I.V.
Critics say efforts to increase antiretroviral therapy will not be useful in the long-term if they fail to improve the countries' health infrastructures.
The report also criticized countries for missing opportunities to detect and treat tuberculosis and H.I.V., two diseases that are strongly related, and failing to establish coordinated health care systems.
The coalition said that President Bush's emergency plan for AIDS relief should deliver treatment to thousands more people within six months and cite specific examples of how it is building sustainable health care systems in its 15 target countries.
The coalition urged all countries that told W.H.O. they wanted to be part of its goal of treating three million people by now to provide detailed action plans to improve their future responses.
"National governments must be the primary engine for increasing access to care," the report said.
In Africa, the continent hardest hit by AIDS, countries need to live up to their commitment made in a declaration in 2001 to devote 15 percent of their budgets to addressing AIDS and other health priorities.
In challenging countries and agencies to abide by their pledges, the coalition said they could not set goals of improved access to treatment and then underfinance the response by billions of dollars.
Efforts should include more than technical support because the infected "people need to know how the drugs work, why adherence is important and the risks of resistance," Greg Gonsalves of the Gay Men's Health Crisis in New York, and an author of the report, told reporters in a telephone news conference.
In Russia, nongovernmental groups have made important contributions in programs to prevent H.I.V., and some have made innovative suggestions about how to scale up treatment, said Shona Schonning who represented a group of people living with AIDS.
Last week, the lower house of Russia's Parliament moved to impose greater control over charities and other private organizations. If the Russian crackdown affects groups that are supporting efforts to prevent and treat AIDS "it could be very damaging to scale up antiretroviral" programs, Ms. Schonning said in the news conference.
Coalition leaders said they planned to meet with government officials.
"The delivery of antiretroviral therapy will only be possible with a revolution in global public health, which makes primary care available to those who have never had it before," the report said, and success in AIDS "will pave the way for treatment of many other diseases that are now left untreated."
The report is available online at aidstreatmentaccess.org.
Rural Water Worries Persist After Chinese Chemical Spill
By JIM YARDLEY, The New York Times, November 27, 2005
SIFANTAI VILLAGE, China, Nov. 26 - Liu Shiying lifted the metal cover off the clay cistern in a corner of the bare kitchen and lowered a tin ladle into what remained of her water supply. Then she raised a scoop to her mouth.
"Do you think it smells?" she asked on Saturday, not taking a sip. "We're still drinking this. It is our only choice."
Ms. Liu lives in one of the dingy villages on the outskirts of Harbin, the provincial capital whose water supply had been shut off for four days to prevent contamination from a chemical spill that dumped a huge tide of pollution into the city's main water source, the Songhua River.
But on Saturday, as Harbin's four million residents learned that water would be restored by Sunday night, rural residents like Ms. Liu in the villages beside the Songhua got no such good news. Isolated and reachable only by rugged, dirt roads, these villages depend on underground wells or the river itself for drinking water. And as the pollution passed by, many villages never got the boxes of bottled water delivered to major cities like Harbin.
Environmental officials announced that the 50-mile slick of pollution had washed past Harbin by Saturday, clearing the way for officials to prepare to restart the water system. Prime Minister Wen Jiabao arrived in Harbin at midday to meet with city officials and to reassure local residents who had endured nearly a week with no running water.
[Later on Saturday, Mr. Wen issued an apology to Russia, into which the Songhua flows, for the spill, The Associated Press reported. The chemical slick is expected to reach there in about two weeks.]
Du Yuxin, the Communist Party secretary in Harbin, said the city had not received any reports of poisoning or other health-related problems from the spill, state news media reported. Mr. Du said local officials were consulting with China's Ministry of Construction to ensure that the system of underground water pipes could be safely reopened without risk of contamination. He predicted that water would be restored by 11 p.m. on Sunday.
"It is an urgent task to resume water supply," Mr. Du told the New China News Agency, "and we have been executing a detailed plan regarding resumption of water supply."
The pollution slick started on Nov. 13 after a petrochemical plant explosion spilled 100 tons of deadly benzene and nitrobenzene into the Songhua River. The factory is located in Jilin City, more than 200 miles upstream from Harbin, and the dangerous slick began steadily moving downstream. But factory executives and Jilin officials initially denied any pollution problems and waited for nearly a week to inform neighboring Heilongjiang Province, where Harbin is located.
Officials in Harbin also initially failed to inform residents of the pollution threat, announcing instead that the water system would be shut down for routine repairs. But that notice set off rising panic and wild rumors, including growing speculation that the local government had detected signs of an earthquake. Harbin officials responded with a new announcement confirming the chemical spill.
Environmental monitoring posts around Harbin found that pollution levels in Songhua had dropped almost to normal on Saturday as the slick moved past the city. But it is unclear whether the government plans extensive testing and cleanup efforts for the wells that supply the villages beside the river. Ms. Liu said the main well in Sifantai was about 100 yards from the Songhua. Several villagers said they were worried about contamination.
"We're concerned that we are so close to the river," said Tao Yunzhi, who lives in the village. "The polluted water gets in the well."
Ms. Liu said the local water had become cloudy in recent weeks and she could not tell whether it had changed, or become contaminated, as the pollution flowed by. On Friday, village officials finally turned off the faucets from the wells, but people continued drinking well water stored in pots and cisterns.
"No one was sending any water to us," Ms. Tao said. "We watched on television all the city people getting water delivered to their doors. Who cares about us village people?"
Really? The Claim: Green Tea Helps Prevent Cancer
By ANAHAD O'CONNOR, The New York Times, November 29, 2005
THE FACTS It has been called an herbal panacea, able to help people who drink it regularly to lose weight, lower their cholesterol and generally safeguard their health.
But when it comes to one of the most-cited benefits of green tea, its ability to fight cancer, studies have found plenty of promise and not a lot of evidence.
The promise, researchers say, stems from the tea's polyphenols, which are powerful antioxidants that studies have shown can inhibit the growth of cancer cells in animals. But the evidence has been sparse when researchers have tried to determine if the findings carry over into humans. Results so far are mixed, at best.
A study in The New England Journal of Medicine in 2001, for example, followed 26,311 residents of northern Japan for eight years and found no connection between the consumption of green tea and the rates of stomach cancer, the most common cancer in Japan.
In 2004, a study of breast cancer in 35,004 Japanese women had similar findings.
On the other hand, at least one study, in Los Angeles in 2003, found significantly lower rates of breast cancer among women who drank green tea.
But the evidence over all is such that the Food and Drug Administration refused this year to let green tea producers place statements about cancer-fighting properties on their packages.
The agency said a review of the research suggested that the claim was "highly unlikely."
THE BOTTOM LINE There is some evidence, but not much, that green tea lowers the risk of cancer.
Findings: The Grapefruit League
By BENEDICT CAREY, The New York Times, November 29, 2005
Athletes on a hot streak often describe warps in space-time that even Einstein did not anticipate: basketball hoops appearing as wide as hula-hoops, tennis balls that seem to move in slow motion, golf outings in which the cups seem as easy to hit as open manholes. "When you're hitting the ball, it comes at you looking like a grapefruit; when you're not, it looks like a black-eyed pea," the Red Sox slugger George Scott once said.
The changes in perception are apparently real, if sometimes exaggerated.
Psychologists at the University of Virginia recently set up tables at several softball fields in Charlottesville, offering free sports drinks to players who agreed to participate in a one-minute experiment. The athletes chose one of eight circles of different sizes on a poster - the one they thought was closest in size to the softball they played with, which was about four inches in diameter. The researchers then asked the players how many at-bats and hits they had had in games that day.
Sure enough, the better day a player had, on average, the bigger the ball looked. "Only people who hit .500 or more picked the largest size," said Jessica Witt, who published the findings in a paper, written with Dennis Proffitt, due to appear in the journal Psychological Science.
When performing, Ms. Witt said, people often seem to run a mental simulation of what they intend to do, in this case hit a ball. Hitting a few clean line drives could alter this simulation, in turn shaping perception of later pitches. Could imagining the hits do the same? "It's a very interesting question to look at," she said. "If you visualize hitting a ball, does it look bigger, and do you actually hit better?"
Vital Signs: Patterns: Research Finds Twins to Be the Slower Siblings
By NICHOLAS BAKALAR, The New York Times, November 29, 2005
Researchers in Scotland have found that twins have substantially lower I.Q.'s than their singleton siblings, based on a sampling of more than 10,000 Scottish children born in the 1950's.
The study, published online Nov. 18 in BMJ, the British Medical Journal, concludes that at least part of the explanation lies in the reduced prenatal growth and shorter gestation typical of twins.
The researchers identified a representative sample of children born in Aberdeen, Scotland, and attending primary school there in 1962.
The children were routinely given written tests of mental skills at the ages of 7 and 9, and the researchers then extracted age-standardized I.Q.'s from the results of those tests.
There were 9,832 singletons and 236 twins in the study, from 8,160 families.
As had been expected, the twins were born smaller and earlier in gestation, and they tended to be small even for their gestational age.
The researchers found that twins at age 7 had I.Q.'s an average of 6.6 points lower than those of their singleton brothers and sisters, and that by age 9 their average I.Q. was 6.9 points lower.
Sex, the number of siblings, the mother's age and the father's social class did not explain the difference. However, when the researchers adjusted for birth weight and gestational age, the differences in I.Q. were reduced substantially.
The authors acknowledge that their study is based on children born more than 50 years ago and that a study of children born more recently might produce different results.
Nevertheless, they write, even among children born more recently, "it seems very likely that there will still be differences in cognition between twins and singletons because of the shorter gestations and impaired fetal growth that affect some twins."
