![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
brdgt
Oral Cancer in Men Associated With HPV
By NICHOLAS BAKALAR, The New York Times, May 13, 2008
The sexually transmitted virus called HPV, for human papillomavirus, is well known to lead to cervical cancer in women — which is why the federal government recommends that all girls be vaccinated for HPV at 11 or 12, before they become sexually active.
Now researchers are finding that many oral cancers in men are also associated with the virus.
A clinical trial testing therapies for advanced tongue and tonsil cancers has found that more than 40 percent of the tumors in men were infected with HPV. If there is good news in the finding, it is that these HPV-associated tumors were among the most responsive to treatment.
Of an estimated 28,900 cases of oral cancer a year, 18,550 are in men.
“The high risk of HPV-associated cancers in men suggests that vaccinating all adolescents is something that should strongly be considered,” said the lead researcher, Dr. Francis P. Worden, a clinical assistant professor of medicine at the University of Michigan.
HPV can enter the mouth during oral sex. A study published in February by researchers at Johns Hopkins estimated that 38 percent of oral squamous-cell cancers are HPV related, and suggested that their increasing number might be a result of changing sexual behaviors.
The new study, published in two papers in The Journal of Clinical Oncology, included 51 men and 15 women with cancers of the tonsils or the base of tongue. The researchers were able to examine biopsies of 42 of the subjects before treatment. After tests for HPV, the researchers found that 27 tumors, nearly two-thirds, were positive for the virus. Of the 51 men, researchers found 22 with HPV.
Other experts found the results interesting, but said it was unclear what they would mean for treatment. Finding the answer to that question is the next step, said to Dr. Maura L. Gillison, an associate professor of oncology at Johns Hopkins who was not involved in the study.
“Clearly,” Dr. Gillison added, “it should give people optimism that the vaccine that was approved largely for women and for cervical cancer could have broader implications, and also for other cancers that occur in both men and women. All of our clinical trials now will be designed for either HPV-positive or HPV-negative patients. Right now, these patients are treated the same way.”
All the patients in the study were initially treated with induction chemotherapy, that is, an initial course to shrink the tumor. Those whose tumors did not shrink by at least 50 percent, 12 patients, were then treated with surgery. Most of those did not survive their illness.
Of the remaining group, 49 of 54 responded to the next step, combined chemotherapy and radiation. In that group, 78 percent needed no surgery, and 70 percent survived more than four years. Of the 49, almost half, 24, were positive for HPV, and all but 3of those were men.
People with tumors with high HPV levels were significantly more likely to respond to treatment. They were also more likely to survive their cancer and to survive over all.
The researchers also tested these tumors for the presence of four genetic markers: EGFR, a cell receptor associated with various cancers; BCLXL, a repressor of cell death; and the tumor-suppressor proteins p53 and p16. The scientists found that these were also accurate predictors of the success or failure of the treatment. Women and smokers were less likely to be treated successfully.
“Patients who have HPV infections are at higher risk for these cancers,” Dr. Worden said. “But the good news is that if that’s the cause of their cancer, they’re more likely to survive treatment. We still don’t know what the ideal treatment regimens are. For example, these patients may benefit from less intense chemotherapy and radiation.”
Although the researchers acknowledge that the number of patients in their study was small, they conclude that especially in patients with HPV-positive tumors, chemotherapy followed by combined chemotherapy and radiation appears to be an effective treatment.
An author of the papers has an interest in a company that is developing an HPV detection method.
Global Update: Fake Malaria Drugs Emerging in Vulnerable Countries in Africa
By DONALD G. McNEIL Jr., The New York Times, May 13, 2008
Until recently, fake malaria drugs have been a problem largely confined to Southeast Asia, where a sampling two years ago found 53 percent of the drugs substandard, and drug experts said Asia was facing “an epidemic of counterfeits.”
A study released last week suggests that the epidemic is spreading to Africa, where the malaria burden is even greater, and the regulatory agencies are even weaker.
Tests on 195 packs of malaria drugs bought at private pharmacies found that 35 percent either did not contain enough active ingredient or did not dissolve quickly enough to work.
“The results are not happy reading for people taking these drugs,” said Richard Tren, director of Africa Fighting Malaria, a health advocacy group that sponsored the tests.
The samples were bought in six cities: Accra, Ghana; Dar es Salaam, Tanzania; Kampala, Uganda; Kigali, Rwanda; Lagos, Nigeria; and Nairobi, Kenya. The study was published in The Public Library of Science.
Moreover, a third of the packets tested contained just artemisinin, the newest antimalarial from China. Last year, to prevent artemisinin-resistant strains of malaria from developing, the World Health Organization asked all the world’s drug companies to stop selling it except in multidrug cocktails.
Nearly half the drugs that were made in Africa — assuming that their packaging was legitimate — failed the tests. So did a third of those made in Asia. None of the three samples of CoArtem, a multidrug cocktail made in Switzerland for global health agencies, failed.
For the Disabled, Age 18 Brings Difficult Choices
By MARC SANTORA, The New York Times, May 14, 2008
Outside Sam Stabiner’s room pumps the steady drone of ventilators, giving life to his neighbors breath by breath. Most are in their 80s and 90s, in the twilight of their years.
But Mr. Stabiner’s parents never imagined they would have to visit him in a place like this. On the eve of his 21st birthday, he is living in a Manhattan nursing home.
The Stabiners’ predicament, however, is far from unique. As medical advances have allowed patients who might have died as children to survive into adulthood, the patients are falling into a void in a health care system that has yet to develop institutions for the young and “medically fragile.”
Each year 500,000 youths in the United States with special health care needs resulting from ailments like congenital heart disease, cystic fibrosis, diabetes, renal disease and sickle cell turn 18, according to a survey conducted by the United States Department of Health and Human Services.
Many of these young people will transition to adulthood smoothly, but for the most seriously disabled, the options for care often prove limited. As a result, about 8,000 people under age 30 are among roughly 1.4 million nursing home residents, according to the Centers for Medicare and Medicaid Services.
“This is a problem that has gone largely unrecognized and is only going to grow,” said Dr. Edwin F. Simpser, the chief medical officer at St. Mary’s Healthcare System for Children, the largest provider of intensive rehabilitation and specialized care for severely ill and disabled children in New York.
At St. Mary’s alone there are some 200 children aging out of its program in the next few years. “We could be talking about 70 percent of those kids ending up in a nursing home if we don’t find an alternative,” he said.
While the situation is not confined to New York, it varies state by state. “The people we are talking about did not exist 50 years ago,” said Dr. Miriam Kaufman, founder of the Good 2 Go Transition Program at the Hospital for Sick Children in Toronto. “We simply don’t have a model for these children.”
As the children grow older, so do the parents, making intensive home care more difficult, if it was even possible to begin with.
At 15, Sam Stabiner was a picture of health, with a perfect attendance record at his school and a normal life.
Then the headaches started, growing mysteriously more severe until he had to be hospitalized, fell into a coma and barely survived what doctors now believe was a rare form of meningitis.
For the next five years, he received intensive care at St. Mary’s, which provides care for some 4,000 children through inpatient, home-care, and community-based programs. The demand on the institution is so great, it is planning a major expansion of its Queens center in coming months.
Mr. Stabiner made slow progress, using a wheelchair and with only limited use of his hands. He cannot communicate by speaking, but seems fully aware of his surroundings, smiling when happy and able to slap high five. Beyond the care at St. Mary’s, he attended classes at Public School 79 in Manhattan, which is for children with special needs. He will age out of that program next year, his parents said.
His care is complicated because he had a tracheotomy and needs assistance eating, via a feeding tube. While he has regained some motor skills, the continuing medical care required by the tracheotomy led to his being categorized as medically fragile.
Still, when he turned 18, his parents were shocked to learn how that categorization significantly limited the options for their son’s care.
Erroll Stabiner, 67, said he contacted 87 institutions across the city, the vast majority traditional nursing homes, and found only three that had clusters of young adults. All of those were far from his home and none were particularly appealing, leaving him to try to place his son at the Isabella campus at Audubon Avenue and 190th Street, which had no history of working with young adults.
The administration at Isabella’s was initially reluctant, but after executives at St. Mary’s pressed the case, officials at Isabella’s relented.
The setting that the young Mr. Stabiner left could hardly be more different from the one he entered.
At St. Mary’s, which was the first inpatient palliative care center for children in the country, there is one health worker for every four patients. The rooms are brightly painted, with separate areas for school, recreation and physical rehabilitation. There is an attempt to allow even the most severely disabled patients to develop a routine and build relationships.
Mr. Stabiner’s old room is right off one of the main playrooms, filled with games and toys.
Michael, 17, whose family did not want to give a last name, is now residing on the hall after a nearly fatal car crash left him with a severe head injury. While he has no feeding tube, Michael will also be aging out of St. Mary’s soon and his family could face a similar quandary.
The doctors and psychologists at St. Mary’s believe the group setting and the encouragement of other children with similar ailments help speed rehabilitation, or at least provide comfort, because they are reminders that the children are not alone.
At Isabella’s, Mr. Stabiner is often without any diversions. His parents, who visit six days a week, fear that he will feel isolated and have asked the nurses to put him out by their station so he can get more daily stimulation. To help make him feel young, the Stabiners bought him an array of T-shirts with smart-alecky sayings that make their son laugh.
Despite the doting of the nurses, there is no question that the parents feel something has been lost.
“When we found out Sam was aging out, we were devastated,” said his mother, Leslie Stabiner, 66. “It was very depressing to realize that in a city like New York there are just no facilities.”
And it was not just her son who missed the company. Mrs. Stabiner said she and her husband had developed friendships with other parents at St. Mary’s, some of whom are now facing a similar problem.
For instance, one of the children from their son’s floor at St. Mary’s, Justin, just moved into Isabella’s on the floor above his after the Stabiners told them about their experience.
Mark J. Kator, the chief executive officer of Isabella’s, said that having only one or two people as young as Mr. Stabiner in the 700-bed institution created obvious difficulties.
“It presents challenges in that we are responsible for creating an environment that is good for the patient,” he said. But despite their best efforts, he said, “we are not going to create a milieu that is best for them.”
The situation has propelled the administration at St. Mary’s to begin an aggressive effort to establish a clinical model for new institutions equipped to handle medically fragile children as they age out of existing programs.
“It’s something totally new, so part of it is just educating people about the situation,” Dr. Simpser said. “We may also need to push for specific legislation.”
He said that St. Mary’s officials were exploring the idea of establishing small institutions in homelike settings — with perhaps as few as six young adults — where there would be one or two health professionals on duty at all times.
But Dr. Simpser said that if his institution did not push patients out after they turned 18, it could no longer accept new patients.
“It is a terrible dilemma,” he said.
By NICHOLAS BAKALAR, The New York Times, May 13, 2008
The sexually transmitted virus called HPV, for human papillomavirus, is well known to lead to cervical cancer in women — which is why the federal government recommends that all girls be vaccinated for HPV at 11 or 12, before they become sexually active.
Now researchers are finding that many oral cancers in men are also associated with the virus.
A clinical trial testing therapies for advanced tongue and tonsil cancers has found that more than 40 percent of the tumors in men were infected with HPV. If there is good news in the finding, it is that these HPV-associated tumors were among the most responsive to treatment.
Of an estimated 28,900 cases of oral cancer a year, 18,550 are in men.
“The high risk of HPV-associated cancers in men suggests that vaccinating all adolescents is something that should strongly be considered,” said the lead researcher, Dr. Francis P. Worden, a clinical assistant professor of medicine at the University of Michigan.
HPV can enter the mouth during oral sex. A study published in February by researchers at Johns Hopkins estimated that 38 percent of oral squamous-cell cancers are HPV related, and suggested that their increasing number might be a result of changing sexual behaviors.
The new study, published in two papers in The Journal of Clinical Oncology, included 51 men and 15 women with cancers of the tonsils or the base of tongue. The researchers were able to examine biopsies of 42 of the subjects before treatment. After tests for HPV, the researchers found that 27 tumors, nearly two-thirds, were positive for the virus. Of the 51 men, researchers found 22 with HPV.
Other experts found the results interesting, but said it was unclear what they would mean for treatment. Finding the answer to that question is the next step, said to Dr. Maura L. Gillison, an associate professor of oncology at Johns Hopkins who was not involved in the study.
“Clearly,” Dr. Gillison added, “it should give people optimism that the vaccine that was approved largely for women and for cervical cancer could have broader implications, and also for other cancers that occur in both men and women. All of our clinical trials now will be designed for either HPV-positive or HPV-negative patients. Right now, these patients are treated the same way.”
All the patients in the study were initially treated with induction chemotherapy, that is, an initial course to shrink the tumor. Those whose tumors did not shrink by at least 50 percent, 12 patients, were then treated with surgery. Most of those did not survive their illness.
Of the remaining group, 49 of 54 responded to the next step, combined chemotherapy and radiation. In that group, 78 percent needed no surgery, and 70 percent survived more than four years. Of the 49, almost half, 24, were positive for HPV, and all but 3of those were men.
People with tumors with high HPV levels were significantly more likely to respond to treatment. They were also more likely to survive their cancer and to survive over all.
The researchers also tested these tumors for the presence of four genetic markers: EGFR, a cell receptor associated with various cancers; BCLXL, a repressor of cell death; and the tumor-suppressor proteins p53 and p16. The scientists found that these were also accurate predictors of the success or failure of the treatment. Women and smokers were less likely to be treated successfully.
“Patients who have HPV infections are at higher risk for these cancers,” Dr. Worden said. “But the good news is that if that’s the cause of their cancer, they’re more likely to survive treatment. We still don’t know what the ideal treatment regimens are. For example, these patients may benefit from less intense chemotherapy and radiation.”
Although the researchers acknowledge that the number of patients in their study was small, they conclude that especially in patients with HPV-positive tumors, chemotherapy followed by combined chemotherapy and radiation appears to be an effective treatment.
An author of the papers has an interest in a company that is developing an HPV detection method.
Global Update: Fake Malaria Drugs Emerging in Vulnerable Countries in Africa
By DONALD G. McNEIL Jr., The New York Times, May 13, 2008
Until recently, fake malaria drugs have been a problem largely confined to Southeast Asia, where a sampling two years ago found 53 percent of the drugs substandard, and drug experts said Asia was facing “an epidemic of counterfeits.”
A study released last week suggests that the epidemic is spreading to Africa, where the malaria burden is even greater, and the regulatory agencies are even weaker.
Tests on 195 packs of malaria drugs bought at private pharmacies found that 35 percent either did not contain enough active ingredient or did not dissolve quickly enough to work.
“The results are not happy reading for people taking these drugs,” said Richard Tren, director of Africa Fighting Malaria, a health advocacy group that sponsored the tests.
The samples were bought in six cities: Accra, Ghana; Dar es Salaam, Tanzania; Kampala, Uganda; Kigali, Rwanda; Lagos, Nigeria; and Nairobi, Kenya. The study was published in The Public Library of Science.
Moreover, a third of the packets tested contained just artemisinin, the newest antimalarial from China. Last year, to prevent artemisinin-resistant strains of malaria from developing, the World Health Organization asked all the world’s drug companies to stop selling it except in multidrug cocktails.
Nearly half the drugs that were made in Africa — assuming that their packaging was legitimate — failed the tests. So did a third of those made in Asia. None of the three samples of CoArtem, a multidrug cocktail made in Switzerland for global health agencies, failed.
For the Disabled, Age 18 Brings Difficult Choices
By MARC SANTORA, The New York Times, May 14, 2008
Outside Sam Stabiner’s room pumps the steady drone of ventilators, giving life to his neighbors breath by breath. Most are in their 80s and 90s, in the twilight of their years.
But Mr. Stabiner’s parents never imagined they would have to visit him in a place like this. On the eve of his 21st birthday, he is living in a Manhattan nursing home.
The Stabiners’ predicament, however, is far from unique. As medical advances have allowed patients who might have died as children to survive into adulthood, the patients are falling into a void in a health care system that has yet to develop institutions for the young and “medically fragile.”
Each year 500,000 youths in the United States with special health care needs resulting from ailments like congenital heart disease, cystic fibrosis, diabetes, renal disease and sickle cell turn 18, according to a survey conducted by the United States Department of Health and Human Services.
Many of these young people will transition to adulthood smoothly, but for the most seriously disabled, the options for care often prove limited. As a result, about 8,000 people under age 30 are among roughly 1.4 million nursing home residents, according to the Centers for Medicare and Medicaid Services.
“This is a problem that has gone largely unrecognized and is only going to grow,” said Dr. Edwin F. Simpser, the chief medical officer at St. Mary’s Healthcare System for Children, the largest provider of intensive rehabilitation and specialized care for severely ill and disabled children in New York.
At St. Mary’s alone there are some 200 children aging out of its program in the next few years. “We could be talking about 70 percent of those kids ending up in a nursing home if we don’t find an alternative,” he said.
While the situation is not confined to New York, it varies state by state. “The people we are talking about did not exist 50 years ago,” said Dr. Miriam Kaufman, founder of the Good 2 Go Transition Program at the Hospital for Sick Children in Toronto. “We simply don’t have a model for these children.”
As the children grow older, so do the parents, making intensive home care more difficult, if it was even possible to begin with.
At 15, Sam Stabiner was a picture of health, with a perfect attendance record at his school and a normal life.
Then the headaches started, growing mysteriously more severe until he had to be hospitalized, fell into a coma and barely survived what doctors now believe was a rare form of meningitis.
For the next five years, he received intensive care at St. Mary’s, which provides care for some 4,000 children through inpatient, home-care, and community-based programs. The demand on the institution is so great, it is planning a major expansion of its Queens center in coming months.
Mr. Stabiner made slow progress, using a wheelchair and with only limited use of his hands. He cannot communicate by speaking, but seems fully aware of his surroundings, smiling when happy and able to slap high five. Beyond the care at St. Mary’s, he attended classes at Public School 79 in Manhattan, which is for children with special needs. He will age out of that program next year, his parents said.
His care is complicated because he had a tracheotomy and needs assistance eating, via a feeding tube. While he has regained some motor skills, the continuing medical care required by the tracheotomy led to his being categorized as medically fragile.
Still, when he turned 18, his parents were shocked to learn how that categorization significantly limited the options for their son’s care.
Erroll Stabiner, 67, said he contacted 87 institutions across the city, the vast majority traditional nursing homes, and found only three that had clusters of young adults. All of those were far from his home and none were particularly appealing, leaving him to try to place his son at the Isabella campus at Audubon Avenue and 190th Street, which had no history of working with young adults.
The administration at Isabella’s was initially reluctant, but after executives at St. Mary’s pressed the case, officials at Isabella’s relented.
The setting that the young Mr. Stabiner left could hardly be more different from the one he entered.
At St. Mary’s, which was the first inpatient palliative care center for children in the country, there is one health worker for every four patients. The rooms are brightly painted, with separate areas for school, recreation and physical rehabilitation. There is an attempt to allow even the most severely disabled patients to develop a routine and build relationships.
Mr. Stabiner’s old room is right off one of the main playrooms, filled with games and toys.
Michael, 17, whose family did not want to give a last name, is now residing on the hall after a nearly fatal car crash left him with a severe head injury. While he has no feeding tube, Michael will also be aging out of St. Mary’s soon and his family could face a similar quandary.
The doctors and psychologists at St. Mary’s believe the group setting and the encouragement of other children with similar ailments help speed rehabilitation, or at least provide comfort, because they are reminders that the children are not alone.
At Isabella’s, Mr. Stabiner is often without any diversions. His parents, who visit six days a week, fear that he will feel isolated and have asked the nurses to put him out by their station so he can get more daily stimulation. To help make him feel young, the Stabiners bought him an array of T-shirts with smart-alecky sayings that make their son laugh.
Despite the doting of the nurses, there is no question that the parents feel something has been lost.
“When we found out Sam was aging out, we were devastated,” said his mother, Leslie Stabiner, 66. “It was very depressing to realize that in a city like New York there are just no facilities.”
And it was not just her son who missed the company. Mrs. Stabiner said she and her husband had developed friendships with other parents at St. Mary’s, some of whom are now facing a similar problem.
For instance, one of the children from their son’s floor at St. Mary’s, Justin, just moved into Isabella’s on the floor above his after the Stabiners told them about their experience.
Mark J. Kator, the chief executive officer of Isabella’s, said that having only one or two people as young as Mr. Stabiner in the 700-bed institution created obvious difficulties.
“It presents challenges in that we are responsible for creating an environment that is good for the patient,” he said. But despite their best efforts, he said, “we are not going to create a milieu that is best for them.”
The situation has propelled the administration at St. Mary’s to begin an aggressive effort to establish a clinical model for new institutions equipped to handle medically fragile children as they age out of existing programs.
“It’s something totally new, so part of it is just educating people about the situation,” Dr. Simpser said. “We may also need to push for specific legislation.”
He said that St. Mary’s officials were exploring the idea of establishing small institutions in homelike settings — with perhaps as few as six young adults — where there would be one or two health professionals on duty at all times.
But Dr. Simpser said that if his institution did not push patients out after they turned 18, it could no longer accept new patients.
“It is a terrible dilemma,” he said.
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
no subject
Date: 2008-05-14 05:00 pm (UTC)Turning 18 in Iowa for her meant that my parents actually had to hire a lawyer and take her to court and a judge had to sit there and tell them that they could keep custody of my sister. If she had said something wrong (which she's a weird little joker sometimes) they could have taken her away and made her a ward of the state.
I think that the way the system is- in short-completely screwed up. I could go on for hours, but I won't :)
no subject
Date: 2008-05-22 01:49 pm (UTC)It's such a fascinating and scary issue - like the article points out, this is sort of a new issue because many disabled children are living longer and because we have come so far in thinking about the disabled. Hopefully this will turn into an opportunity for devoted activists.
no subject
Date: 2008-05-22 01:59 pm (UTC)I'm making an attempt to actually start reading (and maybe *someday* blogging) on here...
anyways yeah. I actually find it a scary thing that so many more disabled children are living longer. Not that I don't want them to, but as their parents and guardians die, these people are being put into a system that's underfunded and a lot of people are simply unwilling to go into that kind of a field. Hardcore kudos to the people that do, but it's such hard stressful work for little pay and less gratitude.
Luckily, we have come very far in our thinking of the disabled, but in a lot of ways we're still backtracking. A lot of places still have segregated classrooms for disabled kids (even the ones that can function normally in a classroom setting) and it's hard to make teachers and students understand. It's even harder, I think, for teachers than students though because a lot of the burden is put on the teachers due to lack of funding for personal aides. It's a sick sad world.
Hopefully, you're right, and it will turn into an opportunity for activists :)
Cheers!
no subject
Date: 2008-05-14 05:45 pm (UTC)Those other two stories are just plain sad.
no subject
Date: 2008-05-15 12:56 pm (UTC)no subject
Date: 2008-05-15 06:04 pm (UTC)no subject
Date: 2008-05-15 06:24 pm (UTC)no subject
Date: 2008-05-15 06:28 pm (UTC)*headdesk*