New antibody design may pave way for treating diseases affecting the brain

Immunotherapy has proven to be effective against many serious diseases. But to treat diseases in the brain, the antibodies must first get past the obstacle of the blood-brain barrier. In a new study, a research group at Uppsala University describes their development of a new antibody design that increases brain uptake of antibodies almost 100-fold.

Immunotherapy entails treatment with antibodies; it is the fastest growing field in pharmaceutical development. In recent years, immunotherapy has successfully been used to treat cancer and rheumatoid arthritis, and the results of clinical studies look very promising for several other diseases. Antibodies are unique in that they can be modified to strongly bind to almost any disease-causing protein. In other words, major potential exists for new antibody-based medicines.

The problem with immunotherapy for diseases affecting the brain is that the brain is protected by a very tight layer of cells, called the blood-brain barrier. The blood-brain barrier effectively prevents large molecules, such as antibodies, from passing from the bloodstream into the brain. It has therefore been difficult to use immunotherapy to treat Alzheimer’s and Parkinson’s disease, which affect the brain, as well as cancerous tumours in the brain.

It has been known for a long time that some large proteins are actively transported across the blood-brain barrier. These include a protein called transferrin, whose primary task is to bind to iron in the blood and then transport it to the brain. The research group behind this new study has taken advantage of this process and modified the antibodies they want to transport into the brain using components that bind to the transferrin receptor. Then, like a Trojan horse, the receptor transports antibodies into the brain. The number of modifications to and placement of the antibodies have proven to be important factors for making this process as effective as possible.

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“We’ve placed them so that each antibody only binds with one modification at a time, despite being modified in two places. Our design thus doubles the chances of the antibody binding to the transferrin receptor compared with only one modification. We’ve successfully increased the amount of antibodies in the brain almost 100-fold, which is the largest uptake improvement that has ever been shown,” says Greta Hultqvist, researcher at the Department of Public Health and Caring Sciences at Uppsala University.

To try out the new format, researchers have used it on an antibody that binds to a protein involved in the course of Alzheimer’s disease. Without the modification, they could only detect very small quantities of antibody in the brain in a mouse model of Alzheimer’s disease, while they could detect high levels of the modified antibody in the same mice.

“From a long-term perspective, it’s likely that the new format can be used to effectively treat not only Alzheimer’s disease, but also other diseases affecting the brain,” says Dag Sehlin, researcher at the Department of Public Health and Caring Sciences at Uppsala University.

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Uppsala University

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Georgia Tech researchers find new way to improve treatment for inflammatory diseases

Is a treatment only making things better or maybe also making some things a little worse?

That can be a nagging question in some medical decisions, where side effects are possible. But researchers at the Georgia Institute of Technology have figured out a way to keep what helps, while blocking what harms, in a therapy to fight serious chronic inflammatory diseases.

It’s simple and works a little like a pacemaker: An implanted device electrically stimulates the vagus nerve, but, in addition, inhibits unwanted nerve activity in a targeted manner.

Forms of vagus nerve stimulation treatment have already been successfully tested in humans by private industry with the intent to market them to patients. But the innovation by Georgia Tech researchers of adding an inhibiting signal could increase the clinical efficacy and therapeutic benefit of existing treatments.

Temporarily snipping a nerve

“We use an electrode with a kilohertz frequency that blocks unwanted nerve conduction in addition to the electrode that stimulates nerve activity,” said principal investigator Robert Butera, a professor jointly appointed in Georgia Tech’s School of Electrical and Computer Engineering and the Wallace H. Coulter Dept. of Biomedical Engineering. “We’ve arranged the two near each other, so the blocking electrode forces the stimulation from the stimulating electrode to only go in one direction.”

The researchers’ innovation could theoretically by implemented relatively quickly by augmenting existing clinical devices. So far, tests in rats have returned very encouraging results, and they have been achieved without taking more drastic measures notable in other experiments to optimize this kind of treatment – such as a vagotomy, the cutting of part of the vagus.

“The original studies in animals on the anti-inflammatory benefits of vagus nerve stimulation resorted to nerve transections to achieve directional stimulation as well as boost effectiveness of nerve stimulation. But cutting the vagus is not clinically viable – due to the multitude of vital bodily functions it monitors and regulates. Our approach provides the same therapeutic benefit, but is also immediately reversible, controllable, and clinically feasible,” said lead researcher Yogi Patel, a bioengineering graduate student.

“We call it a virtual vagotomy,” Butera said.

Patel, Butera and former Georgia Tech researchers Tarun Saxena and Ravi V. Bellamkonda, published the results of their study in the journal Nature Scientific Reports on Thursday, January 5, 2016. The research was funded by the National Institutes of Health and the Ian’s Friends Foundation.

Vagus nerve: What is it?

To understand how this new bioelectronic fine-tuning works, let’s start with the vagus nerve itself.

It lies outside the spinal column and runs in two parts down the front of your neck on either side. It’s easy to forget about because, though it does help you feel some limited sensations like pain and heat from a handful of internal organs, those sensations are not as blatant and common as when you reach out and touch something with your hand.

Your voluntary, or somatic, nervous system is responsible for the reaching, touching, and feeling, and the vagus nerve belongs to your involuntary nervous system – actually called the autonomic nervous system. Though you may experience the effects less consciously, you couldn’t survive without a vagus.

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“The vagus nerve conveys an incredible amount of information related to the state and function of the visceral organs – your digestive tract, your heart, your lungs, information about the nutrients you eat – anything required for homeostasis (physiological balance),” Patel said.

The vagus nerve is the lifeline between the vital function control centers of your brain and your visceral organs, passing messages constantly between your hypothalamus and organs to control things like pulse and respiration, the lubrication of sinuses, and the limiting of immune response.

Inflammation: What role does the vagus nerve play?

That last one is where inflammation comes in. When the immune system becomes hyperactive, it can attack not just pathogens but also healthy tissue, as with patients suffering from diseases such as rheumatoid arthritis, irritable bowel syndrome or Crohn’s disease. Drug-based therapies often fail to significantly benefit them.

The two parts of the autonomic (involuntary) nervous system — the sympathetic and the parasympathetic — strongly influence your immune system. The vagus nerve belongs to the parasympathetic.

“It’s like a seesaw system. Your sympathetic nervous system helps kick the immune system on, and the parasympathetic nervous system tempers it,” Patel said.

Electrical stimulation is good: Any downsides?

Stimulating the vagus nerve supports that tempering effect, but it can also somewhat excite the part of the nervous system that stimulates the immune response, which is counterproductive.

“Every circuit has a path coming from the brain and one going to the brain, and when you stimulate electrically, you usually have no control over which one you get. You usually get both.” Patel said. These paths are often in the same nerve being stimulated.

The path leaving the brain and going toward other organs, called the efferent pathway, is the one to stimulate to help relieve chronic inflammatory conditions. The one going to the brain, called the afferent pathway, if stimulated, leads eventually to the hypothalamus, a pea-sized region in the center of the brain, which triggers a chain of hormonal responses, eventually releasing cytokines, messaging molecules that promote inflammation.

“You get a heightened inflammatory response when you stimulate the afferent pathways, which are actively conveying information about your internal state and trigger the immune system when necessary,” Patel said. “And if a patient is already in a hyperactive immune state, you don’t want to push that even more.”

“When chronically inflamed, the body essentially thinks it’s in attack mode the entire time,” Patel said. “So, the ability to dampen the loop that results in more and more cytokines being produced is one way to shut down that cyclic process of more and more inflammation.”

Stimulating downward (efferent), while blocking upward (afferent) vagus nerve activity keeps the good effect while preventing possible bad effects. In animals that received this treatment, blood tests showed that inflammation markedly decreased. Most importantly, this treatment can be turned on or off, and be tuned to the needs of each patient.

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Georgia Institute of Technology

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Older adults with arthritis need just 45 minutes of activity per week

Older adults who suffer from arthritis need to keep moving to be functionally independent. But in an examination of a goal that is daunting for most of this aging population, a new study found that performing even a third (45 minutes) of the recommended activity is beneficial, and those who did improved function in their lower arthritic limbs by 80 percent.
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New TSRI study sheds light on how the brain stores memories

A new study led by scientists at The Scripps Research Institute (TSRI) sheds light on how the brain stores memories. The research, published recently in the journal eLife, is the first to demonstrate that the same brain region can both motivate a learned behavior and suppress that same behavior.

“We behave the way we do in a specific situation because we have learned an association–a memory–tying an environmental cue to a behavior,” said Nobuyoshi Suto, TSRI Assistant Professor of Molecular and Cellular Neuroscience, who co-led the study with TSRI Professor Friedbert Weiss and Bruce Hope, a principal investigator at the National Institutes of Health’s National Institute on Drug Abuse. “This study provides causal evidence that one brain region can store different memories.”

Scientists know that our memories are stored in specific areas of the brain, but there has been some debate over whether a single brain region can store different memories that control opposing behavior. For example, can the same region store the meanings of red and green traffic lights–the memories that make a driver stop a car at a red light, then hit the gas pedal at a green light?

Suto’s research focuses specifically on the brain circuits that control motivation. In the new study, he and his colleagues set out to examine how rats learn to press levers to get sugar water–and where they store those motivational memories.

The researchers first trained the rats to press a lever to get sugar water. The researchers then trained the rats to recognize two colored lights: one signaling the availability of sugar reward, and the other signaling the omission of this reward. As a consequence, the animals learned to change their behavior in response to these cues: the cue signaling availability promoted the lever-pressing, while the cues signaling omission suppressed this reward-seeking behavior.

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Based on previous electrophysiology studies, Suto and his colleagues speculated that memories associated with these two lessons were both stored in a region of the brain called the infralimbic cortex.

“We’ve seen correlational evidence, where we see brain activity together with a behavior, and we connect the dots to say it must be this brain activity causing this behavior,” said Suto. “But such correlational evidence alone cannot establish the causality–proof that the specific brain activity is directly controlling the specific behavior.”

So scientists took their experiment a step further. Using a pharmacogenetics approach, the researchers selectively switched off specific groups of brain cells–called neural ensembles–that react to select cues signaling either reward availability or reward omission.

The experiments demonstrated that distinct neural ensembles in the same region directly controlled the promotion of reward-seeking or the suppression of that behavior. Without those neurons firing, the rats no longer performed the behavior motivated by the memories in those ensembles. At last, the scientists appeared to prove the causality.

Suto called the findings a step towards understanding how different memories are stored in the brain. He said the research could also be relevant for studying which neurons are activated to motivate–and prevent–drug relapse. He said he’d next like to look at what other regions in the brain these infralimbic cortex neurons may be communicating with. “Brain regions don’t exist in a vacuum,” he said. In addition, he also would like to determine the brain chemicals mediating the promotion or suppression of reward seeking.

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Powerful version of anti-inflammatory molecule may help protect vision in diabetic retinopathy

A more powerful version of an anti-inflammatory molecule already circulating in our blood may help protect our vision in the face of diabetes.

Diabetic retinopathy resulting from high circulating levels of glucose is the leading cause of blindness in adults. Now scientists have evidence that a man-made version of soluble gp130, or sgp130, that is 10 times more powerful than the natural one, may help avoid high levels of inflammation in the eye that occur in diabetes and avert the retinal destruction that typically follows.

“What we are trying to do is inhibit this pathway so there will be no more signaling,” said Dr. Shruti Sharma, vascular and endothelial biologist in the Center for Biotechnology and Genomic Medicine at the Medical College of Georgia at Augusta University.

Sharma is talking about the pro-inflammatory cascade that can result when high levels of glucose in the blood prompt high circulating levels of the immune-system driver IL-6. High circulating IL-6 has been found in the blood as well as the fluid portion of the eyes of patients with diabetic retinopathy. When circulating levels of IL-6 increase, so do levels of its receptor, IL-6R, which is required for IL-6 to be active.

These floating inflammation drivers enable something called trans-signaling – where receptors aren’t directly found on the affected cells themselves – and there is emerging evidence from Sharma’s lab and others that it’s a major player in inflammation-driven diseases like diabetic retinopathy, inflammatory bowel disease, even atherosclerosis.

In this case, the body appears to have a check system: Sgp130 also is traveling in the bloodstream where it can essentially trap the IL-6/IL-6 receptor complex and keep it from crossing cell membranes to promote inflammation. However, in the altered face of diabetes, apparently its action is not always sufficient.

That’s why Sharma’s new $1.5 million grant from the National Eye Institute is enabling the first attempt to target IL-6 trans-signaling in diabetic retinopathy with this synthetic, more powerful version of sgp130, called sgp130-Fc, which is already in clinical trials for Crohn’s disease and rheumatoid arthritis.

The MCG research team hopes its work in human serum and mouse models will lead to clinical trials of sgp130-Fc in diabetic retinopathy as well.

In fact, Sharma’s lab has early evidence in both human tissue and diabetic mice retinas that inhibiting this IL-6 trans-signaling significantly reduces the classic eye inflammation and the destruction that follows.

IL-6 receptors aren’t always circulating, rather sometimes can be found directly on cell membranes. On white blood cells, for example, Il-6 naturally binds to its receptor on the cell membrane; that binding recruits gp130, which is also attached to the membrane, to help send a signal for action. In fact, even when IL-6 and its receptor successfully bind in the bloodstream, they gain access and action in the eye by hooking up with gp130 in the membrane of the endothelial cells that line the eye’s microscopic vasculature.

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Endothelial cells, which are early targets in diabetic retinopathy, don’t have IL-6 receptors, which is where trans-signaling comes in, said Dr. Ashok Sharma, bioinformatics and genomics expert in the Center for Biotechnology and Genomic Medicine and a study co-investigator. He notes that it’s not yet clear whether endothelial cells, which line blood vessels throughout the body, have IL-6 receptors in other environs.

The new grant is enabling the MCG scientists to further explore in a mouse model of type 1 diabetes the effects of trans-signaling on the endothelial cells as well as pericytes in the eye. Pericytes are contractile cells that wrap around endothelial cells, enhancing the strength of the smallest blood vessels, like where the arterial system and venous system come together so oxygen- and nutrient-rich blood can nourish the eye then depleted blood can exit.

In diabetic retinopathy, pericytes are damaged and destroyed; blood vessels walls unnaturally thicken; and blood passageways narrow. Eventually, endothelial cells also die. The eyes will attempt to grow new blood vessels as a fix, but the new vessels are ultimately dysfunctional and leaky and instead further destroy vision.

The scientists also are looking to see if the powerful sgp130-Fc can help. In their mouse model of diabetic retinopathy, they are giving their drug both before the disease develops to better understand its impact, as well as later in the disease process, which is when patients might one day receive treatment. They are injecting it directly into the eye, as anti-vascular endothelial growth factor treatments today are given, as well as intravenously to look at the difference in impact.

Sophisticated technology, such as optical coherence tomography, is enabling the scientists to keep a real-time, non-invasive eye on the health of the retina as they work.

While there is evidence that trans-signaling always promotes inflammation, classic signaling with the receptor on the cell surface can turn inflammation up or down. Current diabetic retinopathy therapies include laser and anti-VEGF therapies that target dysfunctional blood vessels.

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Medical College of Georgia at Augusta University

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Bundled Payments Work, Study Finds, But HHS Nominee No Fan

A recent change in the way Medicare pays for joint replacements is saving millions of dollars annually — and could save billions — without impacting patient care, a new study has found. But the man Donald Trump has picked to be the secretary of Health and Human Services has vocally opposed the new mandatory payment program and is likely to revoke it.

Under the new program, Medicare effectively agrees to pay hospitals a set fee — a bundled payment — for all care related to hip or knee replacement surgery, from the time of the surgery until 90 days after. Traditionally hospitals collect payments for many components of care and rehabilitation individually.

Tom Price, the president elect’s HHS nominee, a congressman from Georgia and an orthopedic surgeon, has actively opposed the idea of mandating bundled payments for these orthopedic operations, calling it “experimenting with Americans’ health,” in a letter to the Medicare agency just last September. In addition, the agency which designed and implemented the experiment, the Center for Medicare and Medicaid Innovation, was created by the Affordable Care Act to devise new methods for encouraging cost-effective care. It will disappear if the act is repealed, as President-elect Trump has promised to do.

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The study appeared Tuesday in the Journal of the American Medical Association. Though one of its authors is Dr. Ezekiel Emanuel, a professor at the University of Pennsylvania who helped design the ACA, the research relies on Medicare claims data from 2008 through mid-2015, long before the presidential election.

Starting in April 2016, CMS required around 800 hospitals in 67 cities to use the bundled payment model for joint replacements and 90 days of care after the surgery as part of the Comprehensive Care for Joint Replacement program. The program had previously been road-tested on a smaller number of hospitals on a voluntary basis, which formed the focus of the research.

The study found that hospitals saved an average of 8 percent under the program, and some saved much more. Price has been skeptical that bundled payments did save money, but the researchers estimate that if every hospital used this model, it would save Medicare $2 billion annually.

The bundled payment program works like this: For some specific kinds of medical procedures, including joint replacements or some heart surgeries, the Centers for Medicare & Medicaid Services will add up the costs for the entire episode, from the hospital stay and medical supplies to the rehabilitation afterwards. If the total costs are below a target set by CMS, the hospital gets to keep the savings. If not, the hospital has to pay Medicare the difference. It’s supposed to incentivize more efficient spending and better care coordination between providers, so they can lower costs.

In practice, it seems to be working. Baptist Health System, a network of five hospitals in San Antonio, saved an average of $5,577 on each joint replacement without sacrificing the quality of care, according to the study. Baptist was an early adopter of bundled payments; it began experimenting with them in 2008. Over seven years, the hospital system has cut Medicare’s costs on knee replacements by almost 21 percent.

The savings came without impacting quality. Patients at Baptist Health System were just as likely to be readmitted to the hospital or end up in the emergency room as patients nationally. There was some indication that quality of care may be better, fewer patients under bundled payments had long, extended hospital stays.

In Price’s letter from September, he said that Medicare had exceeded its powers in imposing such bundled payments, which he said took decisions out of the hands of doctors and patients.

That doesn’t seem to be the case, according to Dr. Amol Navathe, an assistant professor of medicine and health policy at the University of Pennsylvania, and one of the authors of the JAMA study. Instead, Navathe and his colleagues suggest that the bundled payments actually fostered greater collaboration between surgeons, administrators and patients because programs could only succeed in saving money if physicians were engaged in creating standardized pathways for care.

For example, the Baptist Health System saved about 30 percent on implant costs, around $2,000 on each artificial joint, by using the least expensive medically equivalent implants as determined by the hospitals’ surgeons.

Usually, physicians are prevented from benefitting when hospitals save money because of anti-kickback laws. Waivers under bundled payment models mean surgeons can put in the time to find the best, most cost-effective implants, and share in some of that savings.

“It takes that extra level of effort and coordination, and proactively communicate with [patients],” Navathe said. “Preplanning, setting of expectations and communicating up-front is resource intensive, when they have the incentive to do that they were willing to expend the extra resources to make that happen.”

When bundles included care after a patient’s hospital stay, spending on rehabilitation went down 54 percent. That’s because hospitals took the time to match patients to the right level of care, Navathe said.

Patients who didn’t need to stay in a nursing home or rehab center were set up with home health care or physical therapy.

Price has objected to CMS making bundled payments mandatory, calling it an instance of federal overreach. But bundled payments only work if everyone has to participate, according to Darshak Sanghavi, the former director of prevention and population health at the Center for Medicare and Medicaid Innovation.

If hospitals can choose whether or not to participate, only the ones that are already delivering care efficiently –and coming in under CMS’s cost target — will use bundles and Medicare will constantly be paying out bonuses. The system needs to be mandatory, Sanghavi said, to pull in less efficient hospitals and give them incentive to change.

“Stopping the programs for ideological reasons I think impedes innovation in a way that is going to consign us to having really, really high costs of care that’s going to continue in the future,” Sanghavi said.

Bundled payments aren’t just for hip and knee replacements. On December 20, CMS announced it would expand mandatory bundled payments to treatments for heart attacks, bypass surgery and cardiac rehab beginning in July 2017. In its waning days, the Obama Administration is effectively throwing down the gauntlet to the incoming administration on bundled payments, one of its signature reforms.

Categories: Cost and Quality, Medicare, Syndicate, The Health Law

Tags: CMS, Payment Bundling, Repeal and Replace, Study

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Offering Syringes Along With Prayers, Churches Help IV Drug Users

FAYETTEVILLE, N.C. — When Gov. Pat McCrory signed legislation in July legalizing syringe exchange programs in North Carolina, James Sizemore rejoiced.

The pastor of a small church, Sizemore had — with the tacit approval of some, but not all, local law enforcement — been offering clean syringes to drug users to help them avoid contracting HIV and hepatitis C. Now he could do so without fear of arrest.

Sizemore, who in 2007 launched Radiant Church, an affiliate of the Church of God of Prophecy, has sought to alleviate the effects of drug addiction, work that he sees as a natural extension of his other pursuits: feeding, clothing and otherwise offering sustenance to his parishioners and others in need.

“It was never an issue of, ‘Is this the right thing to do spiritually, scripturally?’” Sizemore said of his efforts. “For us, it was the right thing to do … You can’t save somebody’s soul if they’re dead.”

Churches and other faith-based organizations have increasingly voiced approval of syringe exchange programs, sometimes launching their own. Their efforts have contributed to growing support for the programs, which the federal Centers for Disease Control and other health organizations see as a valuable tool in combating the opioid epidemic. Most programs include components such as education, treatment and testing for HIV and hepatitis C, which can be spread by sharing needles. Some also distribute naloxone to reverse overdoses.

The CDC offered further encouragement Nov. 29, reporting greater use of syringe exchanges by people who inject drugs. Even so, one-third of users cited in the CDC analysis reported in 2015 that they had shared a needle within the past year. Exchange programs allow drug users to turn in used syringes and get sterile ones.

While more than half of states have not explicitly authorized syringe exchange, Corey Davis with the Network for Public Health Law said that most have at minimum removed the prescription requirement for syringes. A number have “patchworks” of what’s permitted in terms of exchange and what’s not.

The North American Syringe Exchange Network, or NASEN, reports 228 syringe exchange programs operating in 35 states and Washington, D.C. But the number of programs is growing weekly in response to the rise in heroin overdose deaths across the country.

Neither NASEN nor the Harm Reduction Coalition has an estimate of the number of faith-based churches and organizations directly involved in syringe exchange, but momentum is clearly gathering. Church-based programs are operating in communities across the country, including Seattle; Cincinnati; Albany, N.Y.; and even in traditionally conservative southern states.

Institutions such as the United Methodist Church, Presbyterian Church (U.S.A.), United Church of Christ and National Council on Jewish Women have issued statements of support for syringe exchange.

“Ultimately, we want people to live without the burdens of addiction, but for many people the road to recovery is long and arduous, and protecting public health in the meantime is fundamental,” said Kara Gotsch, who until recently was director of advocacy for the Interfaith Criminal Justice Coalition.

Hillary Brownsmith researches and writes about faith-based harm reduction initiatives and helps run the Steady Collective, a mobile syringe exchange program in Asheville, N.C. The program is based at the Haywood Street Congregation, a United Methodist Church ministry, and has received funding from three other congregations.

Brownsmith has engaged ministers and churchgoers in theological conversations about reaching out to drug users, and said she’s received only positive feedback.

“I think the tide is definitely shifting,” she said, with church officials and congregants recognizing that syringe exchange is in keeping with soup kitchens, temporary shelters and other outreach ministries.

St. Paul’s Episcopal Church in Fayetteville, Arkansas, launched its syringe exchange program last November. Shelby Carrothers, a church member, saw the need for one while offering HIV testing during a weekly free hot meal. She discovered that most of the people being tested identified as IV drug users.

Carrothers said that while providing clean syringes is a critical service, “Almost equally important is that we provide a nonjudgmental space to talk about what they’re going through and answer questions that they might otherwise be afraid to ask.”

Sherman Terry, 40, is among those who’ve found help at St. Paul’s. A former IV drug user, he came for a hot meal and has received a lot more.

“Shelby, bless her heart …” Terry said during a recent Wednesday lunch at the church, recounting how Carrothers had introduced him to a variety of support services. No longer an IV drug user, Terry now advocates in the community for safe sex, clean needles, healthy living in general.

Each Wednesday, St. Paul’s Episcopal Church in Fayetteville, Ark. offers HIV testing and syringe exchange. (Taylor Sisk for KHN)

Each Wednesday, St. Paul’s Episcopal Church in Fayetteville, Ark. offers HIV testing and syringe exchange. (Taylor Sisk for KHN)

Carrothers distributes some 300 to 400 syringes each week. But the need to help IV drug users continues to mount. She’s now talking with a Lutheran church in Fayetteville and Episcopal churches in Little Rock about hosting exchanges.

In North Carolina, James Sizemore tells of his own circuitous route to harm-reduction advocacy.

President of his high school’s “Just Say No” club, Sizemore went from being a Duke Divinity School student to a cocaine mule, transporting kilos from Miami to North Carolina. For five years, he struggled with addiction. Once free of drugs, he found his way back to the pulpit.

Disenchanted with mainstream churches — which, he perceives, too often fail to embrace the marginalized members of their communities — Sizemore started his own, in a section of Fayetteville marked by poverty and drug use.

Syringe exchange fits into his church’s primary mission, tending to an array of immediate needs.

You can’t “preach salvation” to someone who’s in the throes of addiction, battling for their life, or turning tricks to feed their kids, Sizemore said. “They’re not interested in hearing anything about the spirit because they’re concerned about these issues first.”

“Slowly, but surely,” he said, “we established a good enough relationship in the neighborhood that they trusted us enough to care for them spiritually.”

Categories: Public Health, Syndicate

Tags: Community Health, Hepatitis, HIV/AIDS

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Pakistani city launches new polio campaign after rare strain found

By Gul Yousafzai
| QUETTA, Pakistan

Pakistan began a special five-day polio immunization campaign in the southwestern city of Quetta on Monday for children under five after a rare strain of the virus was found in sewage samples, officials said.

Local officials said they had recruited Muslim clerics to promote the immunizations for 400,000 children after past programs were met with resistance and even violence by extremists.

“The religious leaders were … asking the people to give their children anti-polio drops in their sermons in the mosques in rural areas of Baluchistan,” said Syed Faisal Ahmed, coordinator of the local Emergency Operation Centre.

Pakistan is one of just three countries in the world, along with Afghanistan and Nigeria, that have endemic polio, a once-common childhood virus that can cause paralysis or death.

Last year, Pakistan reported a record low of 19 cases, Ahmed said, with only one of them in Baluchistan province, of which Quetta is the capital.

The new campaign follows the detection of the rare Type 2 strain of polio in sewage samples taken by the World Health Organization in November, Ahmed said. The WHO reported the findings last week.

No cases of the Type 2 strain have been reported in humans in Quetta but it has been added to the vaccine as a precaution. The more common type of polio is Type 1, with no human cases of Type 2 reported for more than a decade.

“We have achieved major goals in combating polio disease, but still we have to strive more to declare Pakistan a polio-free country,” Ahmed said.

Immunization efforts have in the past been hampered by Islamist militants. Last January, a suicide bomber killed 15 people outside a vaccination center in Quetta in an attack claimed by the Pakistani Taliban and another militant group, Jundullah.

Militants in Pakistan have previously alleged the immunization campaigns are a cover for Western spies.

The doctor believed to have helped the CIA track down the deceased al Qaeda leader Osama bin Laden – architect of the 2001 attacks on the United States – has been accused of using a fake vaccination campaign to collect DNA samples.

Bin Laden was killed in a covert raid by U.S. special forces in 2011 in the Pakistani town of Abbottabad, where he was living, straining ties between the U.S. and Pakistan.

Pakistan sentenced him in 2012 to 33 years in jail on charges of belonging to militant group Lashkar-e-Islam, which he denies. That sentence was overturned but he remains in jail charged with murder relating to the death of a patient.

(Writing by Kay Johnson; editing by Richard Lough)


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Supervised injection site for addicts could save San Francisco money, lives

By Ronnie Cohen

(Reuters Health) – Addicts regularly use drugs on the streets of San Francisco, and some people there say giving addicts a safe, clean place to shoot up – and clean needles – could help curb overdose deaths and diseases.

But critics object to enabling addicts to shoot illegal drugs in a supervised injection facility in San Francisco – or anywhere in the U.S.

A new cost-benefit analysis in the Journal of Drug Issues makes the financial case for a supervised injection site. A 13-booth facility in San Francisco could save $3.5 million a year, mostly in reduced medical costs, the report calculates.

The estimate assumes San Francisco would open a center exactly like Insite – North America’s first legal supervised drug-injection site built in Vancouver, Canada in 2003. Insite serves an estimated 1,700 people a month.

An injection facility in San Francisco would save the life of one drug user who would otherwise die of an overdose every four years and would assist in getting 110 drug addicts medication-assisted treatment each year, the new study suggests.

In addition, it would prevent an average of 19 cases of hepatitis C and three cases of HIV infection a year and would reduce hospital stays for skin and soft-tissue infections related to needle use by 415 days a year.

“To me, it’s really a win-win for everyone,” senior author Alex Kral said in a phone interview. “It’s a win for the community to get people off the streets, and it’s a win for the people injecting drugs to be sure they can be as safe as possible.”

An epidemiologist, Kral directs the behavioral and urban health program at RTI International, a nonprofit research institute in San Francisco.

Propelled by prescription painkiller and heroin abuse, U.S. deaths from drug overdoses hit a record 47,055 in 2014, according to the Centers for Disease Control and Prevention. The study authors estimate the U.S. spends more than $6 billion a year covering the medical expenses of people who inject drugs.

“This is one way to reduce what is one of the biggest sources of mortality in the country,” Kral said.

“We’ve tried a lot of things in the last 50 years, and none of them have succeeded,” he said. “So why not try an innovative, evidence-based solution that’s working in upwards of a dozen countries?”

Since the first supervised injection facility opened in the Swiss city of Berne in 1986, nearly 100 similar facilities have opened in 66 cities across 11 countries. U.S. cities from Seattle to New York have considered installing drug-injection sites, but none have been able to clear the hurdles.

Kral and his team assumed it would cost $2 million to buy and renovate a site for a supervised injection facility in San Francisco and $2.6 million a year to operate it. For every dollar spent, $2.33 would be saved as a result of averted overdose deaths, reduced disease transmission and increased drug treatment, the researchers found.

They expect the savings would be greater in other cities where the number of overdose deaths is higher and real estate and operating costs might be lower. San Francisco already slashed heroin overdose deaths from 120 to 13 a year between 2000 and 2012 largely because of widespread distribution of naloxone, a drug that can prevent overdoses by blocking the effects of opioids.

A supervised injection facility would likely bring more financial and life-saving benefits to a city like Baltimore, which has a higher percentage of needle users dying of heroin overdoses, the authors write.

Susan Sherman is working on a similar cost-benefit analysis for an injection facility in Baltimore. A professor of health, behavior and society at Johns Hopkins University in Baltimore, Sherman was not involved with the current study.

People fear supervised injection sites, she said, because they believe the facilities could draw drug users to their neighborhoods. But the sites would be located in areas where addicts already live.

“We have neighborhoods in Baltimore where heroin is the biggest economy,” she said in a phone interview. “Having a place to go and not being on a dirty street corner is foundational for dignity and respect, which can transfer into other aspects of their lives.”

“Having a safe consumption space somewhere in the U.S. is going to happen,” Sherman said. “It’s close to reality in New York, Ithaca and Seattle.”

SOURCE: bit.ly/2iHEcYp Journal of Drug Issues, online December 13, 2016.


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Find cervical cancer early—get screened

About 12,000 women in the United States are diagnosed with cervical cancer every year. All women are at risk, but it occurs most often in women over 30. Fortunately, it’s one of the easiest female cancers to prevent. There are 2 screening tests to find cervical cancer early.

Medicare covers the HPV test and Pap tests every 24 months for all women and every 12 months if you’re at high risk. The CDC recommends getting regular pap tests starting at 21.

January is Cervical Health Awareness Month. Watch our Cervical Health Awareness Month video and visit our cervical & vaginal cancer screenings page to learn more about these tests.

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