Wisdom Behind Eating with Your Hands

Eating food with the hands in today’s Western society can sometimes be perceived as being unhygienic, bad mannered and primitive.

However within Indian culture there is an old saying that,

” Eating food with your hands feeds not only the body but also the mind and the spirit”.

In the Big Brother series some years back, an English participant complained about an Indian participants use of her hands during food preparations and her eating habits, “They eat with their hands in India, don’t they? Or is that China? You don’t know where those hands have been.” 

Within many Indian households nowadays, the practice of eating food with the hands has been replaced with the use of cutlery.

Have you ever thought of why previous generations in India ate with the hands? There is a reason for their this. 

The practice of eating with the hands originated within Ayurvedic teachings. The Vedic people knew the power held in the hand.

The ancient native tradition of eating food with the hands is derived from the mudra practice.

Mudras are used during mediation and are prominent within the many classical forms of dance, such as Bharatnatyam\.

Our hands and feet are said to be the conduits of the five elements.

The Ayurvedic texts teach that each finger is an extension of one of the five elements. The thumb is agni (fire) (you might have seen children sucking their thumb, this is nature’s way of aiding the digestion in children at an age when they are unable to do an physical activity to aid the digestion), the forefinger is vayu (air), the middle finger is akash (ether – the tiny intercellular spaces in the human body), the ring finger is prithvi (earth) and the little finger is jal (water).

Each finger aids in the transformation of food, before it passes on to internal digestion.

Gathering the fingertips as they touch the food stimulates the five elements and invites Agni to bring forth the digestive juices.

As well as improving digestion the person becomes more conscious of the tastes, textures and smells of the foods they are eating, which all adds to the pleasure of eating.

You may have noticed that elders in the family hardly ever use utensils to measure all the different type of masala, and would instead prefer to use their hands to measure the quantity instead. As each handful is tailored to provide a suitable amount for the own body. Overall there are 6 main documented forms that the hands take when obtaining a measurement a certain type of food ranging from solid food to seeds, and flour.

Eating in Bangladesh Can be Dangerous

Food can just as easily kill as it keeps people alive, experts have learned in Bangladesh, where excessive use of pesticide, unregulated street food and lack of awareness about food safety sicken millions annually [ http://www.iphn.gov.bd/english/food.html].

Every day people are eating dangerous foods, which are triggering deadly diseases http://www.consumerbd.org ].

Children younger than five in Bangladesh are at the greatest risk from eating unsafe food, which causes at least 18 percent of deaths in that age group and 10 percent of adults’ deaths, according to a 2006 study cited by the US-based University of Minnesota’s Centre for Animal Health and Food Safety [ http://www.cahfs.umn.edu/appliedresearch/globalohimplement/CompellingStories/bangladesh-food-safety/index.htm ].

This trend has continued, and may worsen as urbanization strains clean water supply [ http://www.irinnews.org/report/95331/BANGLADESH-Dhaka-s-worrying-water-supply ] in  Dhaka.

On average,  most patients visit hospitals and clinics because of diarrhoea or cholera, which are often traced back to food or drink.

Pesticides and poor planning

Experts say the farm is one starting point for how food can turn fatal.

Many farmers in the country use an excessive amount of pesticide in agricultural products hoping to boost output, while ignoring the serious health impacts on consumers.

Despite repeated warnings [ http://www.irinnews.org/report/96223/BANGLADESH-Farmers-not-heeding-pesticide-warnings ] from the government about this issue, lack of coordination among public agencies has hampered effective controls, said a FAO advisor on food safety policies.

FAO is advocating a “farm to table” approach [ http://www.un.org/News/Press/docs/2003/sag124.doc.htm ] that addresses how food is grown or raised, to how it is collected, processed, packaged, sold and consumed.

Urban poor

In 2009, Bangladesh’s parliament passed the country’s first consumer protection law covering food safety and security. New standards included requiring food labels, creating safety testing standards, monitoring products for chemical and microbial hazards, and holding producers accountable by levying fines for violations.

This law joined several others aimed at regulating food quality: Bangladesh Pure Food Ordinance (1959), Fish and Fish Product Rules (1997) and the Radiation Protection Act (1987).

Safe and nutritious food for all is also guaranteed in the constitution – but on the streets, it is a different matter.

Street vendors operating small, unregulated carts feed millions of people daily, offering no guarantee of safety, with approximately one in six people becoming ill after eating out [ http://www.eminence-bd.org ].

This risk makes life even harder for slum dwellers who rely on street food for its ease and affordability. Health care is already a challenge for the slum population. This disease burden from unsafe food consumption adds up to their misery.

At least 5 percent of Bangladesh’s 170 million people live in illegal housing settlements [ http://www.unicef.org/sowc/files/SOWC_2012-Main_Report_EN_21Dec2011.pdf ]. According to a 2008 Asian Development Bank study, poor people in Bangladesh, particularly those in cities, find it difficult to prepare food at home as they spend so much time outside the home earning a living.

Many of them end up eating cheap ready-made meals of low quality purchased from small shops or street vendors.

Even though street food sales are illegal, and therefore unregulated, unofficial estimates hold that authorities tolerate about 200,000 food carts selling everything from samuchas – deep fried minced meat or vegetables wrapped in flour – to yogurt “lassi” drinks.

Profit at any cost

Vendors’ “philosophy of making profit at any cost” puts consumers at risk.

A common practice among food vendors is to spray fish, fruits and vegetables with chemical preservatives including formalin – a commercial solution of formaldehyde and water – to boost food’s lifespan and appearance.

Formaldehyde is typically used to preserve human corpses, as well as leather and textile products, said a medical doctor in the capital who has treated food poisoning.

The chemical’s short-term effects include: a burning sensation in the eyes, nose and throat; coughing; wheezing; nausea; and skin irritation. As for potential long-term health consequences, formaldehyde has been identified as a human carcinogen [ http://monographs.iarc.fr/ENG/Monographs/vol88/index.php].

A senior adviser at FAO in Bangladesh, said renal failure, cancer and liver damage – all potentially fatal – can be linked to the consumption of unsafe food, but the “extent of food-borne illness is yet unknown”. He predicted the situation will improve with more oversight.

But the private sector is hitting back.

It is using a special preservative detector machine to check food for formalin at its sourcing in order to make sure that its customers receive safe food [http://www.shwapno.com/about.php].

Customers can even check foods in some stores through a machine in order to detect formalin”.

Meanwhile, the local NGO Citizens Solidarity [ http://www.solidarity-bd.org ] recently sent a notice to the government requesting legal steps to force vendors to cease and desist unethical vending practices.

But even when vendors do not knowingly engage in unsafe food handling, their lack of knowledge, coupled with long work hours and their own precarious health, can sicken customers, according to a 2010 FAO-government initiative [ http://www.nfpcsp.org/agridrupal/sites/default/files/pR_7_of_04_Final_Techncial_Report_-_Approved.pdf ] to boost healthy street food.

The projects’ researchers tested 426 food samples from Dhaka vendors who had not undergone any food hygiene training and 135 from those who had. Samples from untrained vendors had almost uniformly “overwhelming” high bacteria counts, while results from trained vendors largely fell within international safety standards.

The researchers called on the government to develop a policy to “assist, maintain and control” street food vending.

Government efforts

The government is set to create the Bangladesh Food Safety and Quality Control Authority to boost control of street food and to criminalize unsafe food handling.

Under the National Food Safety and Quality Act 2013, this authority will be created within the next two months, said Ahmed Hossain Khan, director-general of the Directorate General of Food in the same ministry [ http://www.dgfood.gov.bd/index.php].

The draft act addresses weaknesses in the existing food safety regulatory system, including the scant enforcement of food control laws along the entire supply chain. It also introduces a national food-borne disease surveillance system and outlines an emergency response plan in case of a disease outbreak linked to food.

It has identified existing loopholes in our food safety system, and this act will help us radically improve our approach in food safety regulation.

But an associate professor at the Dhaka School of Economics, said regulatory policies alone have failed to solve the food safety problem, and that the government needs to examine the economic roots of unsafe food: the underclass of farmers responsible for feeding the country. One start, he suggested, is guaranteeing farmers fair prices, a longstanding grievance of producers who accuse middlemen traders and end consumers of profit gouging.

This may encourage farmers not to go for unethical practices up to a certain extent. But better agricultural extension services, easier access to information for farmers and strict regulatory measures are equally important.

The Asian Development Bank is supporting private agribusiness production facilities [ http://www.adb.org/projects/46904-014/details ] that will pay guaranteed prices to 50,000 contracted farmers.

But more is needed. The biggest challenge the country is facing in ensuring a meaningful food security for its.people is food safety.

The 2012 Global Hunger Index [ http://www.ifpri.org/publication/2012-global-hunger-index ] places the country’s hunger situation in an “alarming” range, with too few people being able to eat nutritious, life-sustaining food.

Pakistan’s Medical Schools – Where The Women Rule

by Rebecca Santana

In a lecture hall of one of Pakistan’s most prestigious medical schools, a handful of male students sits in the far top corner, clearly outnumbered by the rows and rows of female students listening intently to the doctor lecturing about insulin.

In a country better known for honor killings of women and low literacy rates for girls, Pakistan’s medical schools are a reflection of how women’s roles are evolving.

Women now make up the vast majority of students studying medicine, a gradual change that’s come about after a quota favoring male admittance into medical school was lifted in 1991.

The trend is a step forward for women in Pakistan, a largely conservative Muslim country. But there remain obstacles. Many women graduates don’t go on to work as doctors, largely because of pressure from family and society to get married and stop working – so much so that there are now concerns over the impact on the country’s health care system.

In Dow Medical College in Karachi, the female students said they are adamant they will work.

Standing in the school’s courtyard as fellow students – almost all of them women – gathered between classes, Ayesha Sultan described why she wants to become a doctor.

“I wanted to serve humanity, and I believe that I was born for this,” said Sultan, who is in her first year. “The women here are really striving hard to get a position, especially in this country where women’s discrimination is to the zenith, so I think that’s why you find a lot of women here.”

For years, a government-imposed quota mandated that 80 percent of the seats at medical schools went to men and 20 percent to women. Then the Supreme Court ruled that the quota was unconstitutional and that admission should be based solely on merit.

Now about 80 to 85 percent of Pakistan’s medical students are women, said the secretary general of the Pakistan Medical Association. Statistics show that at medical schools in some deeply conservative areas of the country such as Balochistan and Khyber Pakhtunkhwa, men still outnumber women.

But in Punjab and Sindh provinces, which turn out the vast bulk of medical students, the women dominate. At Dow, it is currently about 70 percent women to 30 percent men.

In comparison, about 47 percent of medical students in the U.S. are women, according to the Association of American Medical Colleges.

There are a number of different reasons why men don’t make the cut.

Medical school takes too long and is too difficult.

Boys have more freedom to leave the house than girls, so they have more distractions. Boys want a career path in business or IT that will make them more money and faster, in part because they need to earn money to raise families.

“In our society, girls are working harder. They are just more concentrated on their studies,” said Azhar. Boys also see how hard doctors have to work even after they get their degree. “They do not like to work hard as a matter of fact.”

Ammara Khan is fully prepared for the years that it will take to fulfill her dream of becoming a neurosurgeon. She decided she wanted to pursue neurosurgery after watching an operation while volunteering at the Aga Khan University Hospital in Karachi.

“It’s like an adrenaline rush, and I knew I wanted to be that and nothing else,” she said.

Still, medical officials and students acknowledge many women don’t go on to practice medicine.

At Dow, for example, just about all the male graduates work as doctors, but only an estimated half the women do, says Dr. Umar Farooq, the school’s pro-vice chancellor. Nationwide figures on how many women graduates forgo actual practice don’t exist, but despite years of increased women’s enrollment, the gender breakdown of doctors remains lopsided.

Of the 132,988 doctors registered with the Pakistan Medical and Dental Council, 58,789 are women. The number of female specialists is even smaller: 7,524 out of 28,686.

The pressure on women to get married, have kids and stay home to raise them is powerful.

The prestige of a medical degree gives a woman a boost in marriage prospects, so many parents push their daughters to enroll, many students and faculty said. Prospective in-laws like the idea of having a doctor in the family and want their sons to have an educated wife to ensure the grandchildren are educated as well.

But that doesn’t mean they want the woman to actually use her degree and take away from child-raising time.

“They want a doctor label but they don’t want it to go anywhere. They don’t think you’re a real person who might want to specialize or work on it,” said Beenish Ehsan, a student at Dow.

Her own family supports her completing the initial five years of medical college. But when she started talking about further studies for a specialization, they worried it would take away from her future family life.

“They’re like, `No, but you’ll take care of the house, won’t you?’” Ehsan said.

“You have to convince them,” she said, adding that too many women don’t push back against their families. “Sometimes girls give up too soon, I feel.”

There are also cultural impediments. Women who do work often don’t want to do so in rural areas far from their families or don’t want night shifts, given the country’s deteriorating law and order. Some male patients only want to be treated by men because they don’t want women touching them or because they perceive the men to be smarter and more qualified.

During the 2010 floods that devastated Pakistan, Dow wanted to send medical students to Sindh province to treat victims but were hindered by the school’s overwhelmingly female enrollment, admissions director said. The boys could go on their own for long stretches. The girls were also lobbying heavily to go, but the school decided to send them in teams on buses with chaperones out of concern for their safety. They would return home each evening, thus limiting how far they could travel.

“We are responsible for these girls. How can we send them out to these hard-hit areas?” she said. “These are the ground realities in our society.”

Amid concerns over the number of the doctors in the future, proposals are being touted to rebalance the student body. Masood said she would support some sort of gender bias in admissions to bring in more male students. The PMA has floated the idea of building a number of medical schools just for boys. Already there are five medical schools for women.

Among the students, some said a new quota was necessary. Others said it would be unfair.

“That would be injustice. Girls are studying harder,” said one male student, Aleem Uddin Khan, who said it took him two tries to get into Dow. “If we want the seats, we should study hard.”

The debate here echoes the “mommy wars” in the U.S., where women have been trying to figure out the balance between work and home life for years.

Midhat Lakhani, a Dow student, has only to look to her mother, who’s a doctor, to know it’s possible to pursue a career and have a family. Her mom took her postgraduate exams 15 days after giving birth to Midhat’s sister.

“You have to be supermom, obviously,” she said.

Stubbing Out Cigarettes for Good

By Richard A Daynard

Fewer than one in five American adults smoke, a share that’s plunged by about half since the 1960s — an achievement due, in some measure, to Dr. Koop’s antismoking crusade as surgeon general, from 1981 to 1989. Revelations in the 1990s about tobacco companies’ cover-up of smoking’s dangers also played a role. So have a host of other strategies that have included consumer taxes, minimum ages for cigarette purchases, restrictions on smoking in public spaces and programs to help people quit.

Continuing on the same path, with some luck, we might be able reduce the smoking rate a little more.

But that would still leave us with a profound public health tragedy: cigarettes continue to kill more than 400,000 Americans a year and cost untold billions in health care spending.

To its credit, the Food and Drug Administration has tried more aggressive approaches, including a recent effort to require hard-hitting graphic warnings on cigarette packages. That proposal, already the rule in dozens of countries, has been held up in United States federal courts over concerns that the ads might infringe on cigarette manufacturers’ First Amendment rights. But even if implemented, more scare tactics would not go far enough.

What we need is an all-out push to reduce smoking rates to well below 10 percent.

One involves federal action; the other, state or local action. Both are made possible by the Family Smoking Prevention and Tobacco Control Act, which President Obama signed in June 2009.

Under the Act, the F.D.A. has the power to establish tobacco product standards including “provisions, where appropriate, for nicotine yields of the product.” The only limitation on this power is that the F.D.A. may not require that nicotine yields be reduced to zero. The law calls on the F.D.A. to apply public health criteria — “the risks and benefits to the population as a whole” — in designing its regulations. It also encourages the F.D.A. to create tobacco standards that will help existing users stop smoking and decrease the risk that nonsmokers will start.

The F.D.A. would be well within its authority to require nicotine content to be below addictive levels — an idea that originated with a 1994 article in The New England Journal of Medicine urging a nonaddictive nicotine standard.

Cigarette makers would lobby hard to block such a standard. But if the F.D.A. insisted on the change, and cigarettes ceased to be addictive, ample evidence shows that most smokers would quit or switch to less toxic nicotine products. Current nonsmokers, moreover, would be far less likely to become addicted.

Another part of the act affirms the authority of states and municipal governments to prohibit the sale, distribution and possession of — and even access and exposure to — tobacco products by individuals of any age.

This provides an opportunity for states, counties and cities to adopt the Smokefree Generation, a proposal by A. J. Berrick, a mathematics professor in Singapore.

The idea is simple: no one born in or after 2000 can ever be sold cigarettes.

Under such legislation, which jurisdictions like the Australian state of Tasmania are considering, the vast majority of this cohort — the oldest are now 13 — would never begin smoking. It’s hard to imagine too many parents objecting, and it would be easy for retailers to enforce. In the United States, it would provide a useful focus for state and local public health officials to do something game-changing, rather than sitting on the sidelines waiting for Washington to act.

Critics will say that, even if a state or city passed such a law, would-be smokers could go to an adjoining one to buy cigarettes. But evidence suggests that border-crossing and smuggling would be minimal. States that have sharply raised their cigarette taxes, after all, have not only increased tax revenue but also reduced rates of smoking prevalence, even among nicotine addicts. Young people, who are generally not addicted (yet) and who tend not to have peers who smoke, are even less likely to chase cigarettes across state or county lines.

Some antismoking advocates who support existing approaches (smoking-cessation programs, higher taxes) fear that pushing for an “end game” — a smoking rate below 10 percent — is too ambitious. But then, banning smoking in restaurants, workplaces and bars was once seen as crazy, too. Sometimes, a little crazy goes a long way.

Richard A. Daynard is a professor of law at Northeastern University and president of itsPublic Health Advocacy Institute.

Purify Water the Old Desi Style

Copper vessels kill germs

Forget water purifiers (Aqua Guard / Pure it), and follow grandma’s age-old principle of storing water in copper tumblers to keep away diseases like typhoid, cholera, gastroenteritis and uncontrolled loose motions.

Thousands are spent on designer taps, water purifiers for safe gaurds, but the age old traditional copper vessels, utensils, taps, doors etc have now proved to be anti-bacteria which safe gaurds, this shows our ancestors knowledge of depth in every aspect of healthy living.

Water, if stored in copper vessels for about 24 hours, gets purified as the harmful bacteria present in it become inactivated or gets destroyed.

Copper attacks the DNA and other protein molecules present in the bacteria and causes them severe injury. This injury later leads to their death. For bacteria to die it takes about 24 hours.

For countries where pure drinking water is a dream in many localities and for a vast section of its people, this tradition of storing water in copper vessels reduces the chance of a number of infections, she pointed out.

The researchers tested the anti-bacterial effect of copper against bacteria like Salmonella Typhi, Salmonella typhimurium, Vibrio cholerae and E coli. They found that copper can kill these harmful pathogens present in contaminated water.

The copper vessel should be pure with at least 95 per cent copper and five per cent zinc. If the copper content is less than 95 per cent it will not kill the harmful pathogens. In the studies we have taken 99 per cent pure copper vessels.

http://www.dailymail.co.uk/health/article-1081359/Copper-door-handles-taps-kill-95-superbugs-hospitals.html

Copper Kills Salmonella, Other Microbes

http://www.foodsafetynews.com/2012/07/study-copper-kills-salmonella-other-microbes/#.UGMsdhf9hKM

Copper vessel keeps germs in water away 

Copper can destroy undesirable virus & bacteria. It is interesting that the Ayurveda new this, when bacteria were unknown to science! Ayurveda recommends storing water in Copper Vessels.

Ancient Egyptians used Copper Vessels to keep water fresh.

Even today, management of Siva temple at Rameswaram uses large sized Copper vessels to store water brought from river Ganges to offer to lord Siva. Water, stored thus, stays fresh for years together.

According to scientists, copper vessel can be the answer to kill the `E-Coli’ bacteria which causes food poisoning. British scientists are carrying out research on copper and concluded that copper ions kill these harmful bacteria, a capability not found in any other metals including gold.

It is interesting to see that a research group from Southampton University found that Coli 157 bacteria can live happily in stainless steel vessels for months together, while copper vessel at room temperature can kill them in just four hours. At 20 degree Centigrade, in the stainless steel vessel, those bacteria live for 34 days, while in brass vessel they live only for 4 days.

Thus if one uses copper vessels for storing water in factories, shops, hospitals, restaurants, we can get rid of the risk of these food poisoning bacteria. Though stainless steel is much used for its shine and cleanliness, the copper is more useful material for vessels.

Copper and Fertility

The advantages of drinking copper water was pointed out by Andrew Saul, Contributing Editor for the Journal of Orthomolecular Medicine, while speaking on fertility, conception & family planning. In his own words -”If you want to conceive, try having the man take mega doses of vitamin C for a few weeks prior. At least 6,000 milligrams a day, and as much as 20,000 mg/day guarantees very high sperm production. Divide the dose throughout the day for maximum effect. And that effect is what, exactly? More sperm, stronger sperm, and better swimming sperm all occurred, at even lower daily C doses, in a University of Texas.

Continued high doses of Zinc can produce a Copper deficiency & sometimes a Copper deficiency anemia. This is very easy to compensate for. To begin with, most Americans have copper water pipes in their homes. Drink a glass or two of cold water first out of the tap every morning and you’ll get copper. Secondly, eat more raisins and other Copper-high foods. Third, take a multiple vitamin (as you should be doing anyway) with Copper in it.

Finally, do what those sexpots in India have been doing for thousands of years. Buy a Copper metal cup, fill it with cold water at bedtime, and drink it first thing the next morning!!!

It is also seen that Copper water becomes “sharp” and gets readily absorbed by our body, reaches cells in about 45 minutes. Hence, it is generally recommended that after Ushapan (Drinking water in morning), one should give a gap of 45 minutes before taking tea or coffee. Copper water is also recommended to people suffering from vitiligo, where it helps formation of melanin. After starting on copper water, many do not need cold water to satisfy the thirst. With yoga, pranayama and other breathing techniques, senses become so sharp that taste and quality of water can be sensed adequately. Though copper water is slightly ionic, it does not cause gastric acidity to increase. On the other hand, due to increased Agni and digestion, acidity reduces.

In Medical First, a Baby With HIV is Deemed Cured

By Andrew Pollack & Donald Gl Mcneil, Jr

March 3, 2013/ NYT

Doctors announced on March 3, 2013, that a baby had been cured of an HIV infection for the first time, a startling development that could change how infected newborns are treated and sharply reduce the number of children living with the virus that causes AIDS.

The baby, born in rural Mississippi, was treated aggressively with antiretroviral drugs starting around 30 hours after birth, something that is not usually done. If further study shows this works in other babies, it will almost certainly be recommended globally. The United Nations estimates that 330,000 babies were newly infected in 2011, the most recent year for which there is data, and that more than three million children globally are living with H.I.V.

If the report is confirmed, the child born in Mississippi would be only the second well-documented case of a cure in the world. That could give a lift to research aimed at a cure, something that only a few years ago was thought to be virtually impossible, though some experts said the findings in the baby would probably not be relevant to adults.

The first person cured was Timothy Brown, known as the Berlin patient, a middle-aged man with leukemia who received a bone-marrow transplant from a donor genetically resistant to HIV infection.

Some outside experts, who have not yet heard all the details, said they needed convincing that the baby had truly been infected. If not, this would be a case of prevention, something already done for babies born to infected mothers.

The mother arrived at a rural hospital in the fall of 2010 already in labor and gave birth prematurely. She had not seen a doctor during the pregnancy and did not know she had HIV. When a test showed the mother might be infected, the hospital transferred the baby to the University of Mississippi Medical Center, where it arrived at about 30 hours old.

Dr. Hannah B. Gay, an associate professor of pediatrics, ordered two blood draws an hour apart to test for the presence of the virus’ RNA and DNA.

The tests found a level of virus at about 20,000 copies per milliliter, fairly low for a baby. But since tests so early in life were positive, it suggests the infection occurred in the womb rather than during delivery, Dr. Gay said.

Typically a newborn with an infected mother would be given one or two drugs as a prophylactic measure. But Dr. Gay said that based on her experience, she almost immediately used a three-drug regimen aimed at treatment, not prophylaxis, not even waiting for the test results confirming infection.

Virus levels rapidly declined with treatment and were undetectable by the time the baby was a month old. That remained the case until the baby was 18 months old, after which the mother stopped coming to the hospital and stopped giving the drugs.

When the mother and child returned five months later, Dr. Gay expected to see high viral loads in the baby. But the tests were negative.

Suspecting a laboratory error, she ordered more tests. “To my greater surprise, all of these came back negative,” Dr. Gay said.

Dr. Gay contacted Dr. Katherine Luzuriaga, an immunologist at the University of Massachusetts, who was working with Dr. Persaud and others on a project to document possible pediatric cures. The researchers, sponsored by amfAR, the Foundation for AIDS Research, put the baby through a battery of sophisticated tests. They found tiny amounts of some viral genetic material but no virus able to replicate, even lying dormant in so-called reservoirs in the body.

There have been scattered cases reported in the past, including one in The New England Journal of Medicine in 1995, of babies clearing the virus, even without treatment.

Those reports were greeted skeptically, particularly since testing methods were not very sophisticated back then. But those reports and this new one could suggest there is something different about babies’ immune systems, said Dr. Joseph McCune of the University of California, San Francisco.

One hypothesis is that the drugs killed off the virus before it could establish a hidden reservoir in the baby. One reason people cannot be cured now is that the virus hides in a dormant state, out of reach of existing drugs. When drug therapy is stopped, the virus can emerge from hiding.

“That goes along with the concept that, if you treat before the virus has had an opportunity to establish a large reservoir and before it can destroy the immune system, there’s a chance you can withdraw therapy and have no virus,” said Dr. Anthony S. Fauci, the director of the National Institute for Allergy and Infectious Diseases. Adults, however, typically do not know they are infected right as it happens, he said.

Dr. Steven Deeks, professor of medicine at the University of California, San Francisco, said if the reservoir never established itself, then he would not call it a true cure, though this was somewhat a matter of semantics. “Was there enough time for a latent reservoir, the true barrier to cure, to establish itself?” he said.

Still, he and others said, the results could lead to a new protocol for quickly testing and treating infants.

In the United States, transmission from mother to child is rare — several experts said there are only about 200 cases a year or even fewer — because infected mothers are generally treated during their pregnancies.

If the mother has been treated during pregnancy, babies are typically given six weeks of prophylactic treatment with one drug, AZT, while being tested for infection. In cases like the Mississippi one, where the mother was not treated during pregnancy, standards have been changing, but typically two drugs are used.

But women in many developing countries are less likely to be treated during pregnancy. And in South Africa and other African countries that lack sophisticated testing, babies born to infected mothers are often not tested until after six weeks, said Dr. Yvonne Bryson, chief of global pediatric infectious disease at the University of California, Los Angeles.

Studies are being planned to see if early testing and aggressive treatment can work for other babies. While the bone marrow transplant that cured Mr. Brown is an arduous and life-threatening procedure, the Mississippi treatment is not and could become a new standard of care.

While it might be difficult for some poorer countries to do, treating for only a year or two would be cost effective, “sparing the kid a lifetime of antiretroviral therapy,” said Rowena Johnston, director of research at amfAR.

 

Doctors Paid Depending on How Their Patients Fare

For Dr. Damian Folch, 59, is among thousands of physicians in Massachusetts whose pay depends on how their patients fare, not just on how many times they see them. If patients stay healthy and avoid costly medical care, he gets more money.

This simple shift in how healthcare is paid for — long seen as key to taming costs — has been occurring in pockets of the country. But nowhere is it happening more systematically than in Massachusetts, the state that blazed a trail in 2006 by guaranteeing its residents health insurance.

There have been few greater periods of change in American medical history … and this is the epicenter. It is striking how different Massachusetts is from the rest of the nation.

In the last three years, commercial insurers in the state have moved nearly 1 million patients into health plans that reward doctors and hospitals that control costs while improving quality.

About 180,000 Massachusetts seniors are on track to get care from physicians paid this way by Medicare through a new initiative included in the national health law.

And this summer, state lawmakers passed legislation aimed at moving 1.7 million government employees and Medicaid recipients into similar health plans.

Within a few years, close to half of the state’s 6.5 million residents could be in a health plan that pays for medical care in a fundamentally different way.

Massachusetts’ move to reshape how healthcare is financed is still in its infancy. And the state continues to have the nation’s highest medical costs, spending nearly 50% more per person than the national average.

That has fueled skepticism from conservatives who see too much government involvement and from liberals who say the state should more aggressively set medical prices.

But early research in Massachusetts suggests the approach may be slowing health spending. And medical providers, business leaders and elected officials are increasingly hopeful they are making headway.

The building block of the Massachusetts experiment is a contract between insurers and groups of doctors known as a global payment. In such contracts, physicians receive a budget to care for a cohort of patients. If doctors can care for their patients more economically, they keep a portion of the savings. If patient care exceeds the budget, they pay a penalty.

That is supposed to encourage physicians to keep their patients healthier and direct them to lower-cost hospitals and specialists.

If poorly designed, the arrangement can create a financial incentive to skimp on care. That perceived problem undermined earlier experiments with global payments and provoked a backlash against managed care in the 1990s.

In a key change, Blue Cross now links its contracts to dozens of quality metrics that track whether patients get the right screenings and exams, whether doctors and hospitals prescribe the correct drugs — even whether patients are satisfied with their care. That means a doctor who withholds care in hopes of saving money faces a penalty if patients suffer or are unhappy.

On a shelf in doctors’ offices are reams of spreadsheets, updated constantly, that outline how each of his patients is faring, which tests they have taken and which are due. With bonus payments from Blue Cross, they hire new aides and installed a new computer system to better track their patients.

Doctors also have to explain to patients why he wants them to get X-rays, eye exams and other routine care at the community hospital rather than at one of Boston’s famous teaching hospitals, where an MRI that normally runs about $1,100 can cost as much as $1,650.

Change has not come easily around the state, particularly for hospitals that depend on filling beds, not on keeping patients healthy enough to prevent hospitalizations.

Medical practices like Folch’s are already making significant strides, however.

Between 2008 and 2011, the percentage of Folch’s patients getting recommended colorectal cancer screenings increased from 61% to 82%. The share of patients with cardiovascular conditions managing their cholesterol jumped from 75% to 89%. And last year, all of Folch’s diabetic patients successfully managed their cholesterol and had their yearly diabetic eye exams.

“If he sees something he doesn’t like, he contacts me right away,” said Bill Wooster, a 59-year-old sales representative who began seeing Folch after having a stroke four years ago. “I’m his patient, but I feel like more of a friend.”

Although the cost savings were modest, healthcare spending increased more slowly for the Blue Cross medical practices compared with others. Patients were hospitalized less and used fewer expensive services like advanced imaging. These results suggest that global budgets with pay-for-performance can begin to slow underlying growth in medical spending while improving quality of care.

America is also trying a new system going by the name `New Current Procedural Terminology codes’ which entail that just about any practice can bill for coordinating the care of those discharged from a hospital or with multiple chronic conditions, even without having formally to transform into a patient-centered medical home or become part of an accountable care organization.

The American Medical Association created codes for transitional care management and complex chronic care coordination that have been in effect since Jan. 1. The hope of those who designed them, said chair of the AMA’s CPT Editorial Panel, is that some practices will use the codes as a means to finance a transition to become a patient-centered medical home, ACO or some other emerging delivery model. Other practices will be able to provide greater care coordination services without necessarily making significant transformations.

“This is a good opportunity for physician practices,” said vice president of revenue cycle coding with T-System, a company based in Dallas that works with medical practices on documentation and regulatory compliance issues. “These services are something physicians have been providing forever, but it was work that was unreimbursed. And there’s a lot of time involved in this type of work.”

The codes also may be used by practices participating in an ACO or medical home depending on insurer policies, although payment for these services most likely would be included in various bonus programs.

What the codes cover

The first step for practices, coding experts say, is to contact the various insurers to find out how they are responding to these new codes. Medicare will pay for transitional care management and expects to pay out about $600 million for practices to handle a patient’s move from a hospital to other settings in 2013. No additional money is on the table from Medicare for complex chronic care coordination, although that is expected to change. Commercial insurers are deciding which codes will be covered and how much money will be offered.

Commercial insurers are in the process of deciding which codes will be covered, and how much money will be offered.

The second step is to determine how to use the codes to make proper payment more likely.

For instance, the transitional care management codes should be used when a practice takes care of the issues of a patient returning home or going to another care setting from a hospital or skilled nursing facility. Both codes, 99496 and 99495, require a physician to have and document some kind of medical discussion, although not necessarily in person, with the patient or their caregiver within two business days of discharge.

The higher-level code, 99496, calls for a face-to-face visit within a week. For the lower-level code, 99495, the face-to-face visit may be within two weeks.The other set of new codes can be used for patients a physician or insurer considers in need of significant care coordination services outside of usual face-to-face visits. These services can be provided by a physician, but coding designers say they are a better fit for nurses or others staffers within their scope of practice. These codes cover designing care plans, linking patients with multiple medical professionals and community service agencies and organizing, and attending medical team conferences.

The code 99487 should be used if the patient is not actually seen by the physician, but instead if other practice staff spend an hour over a 30-day period on care coordination involving that patient. Code 99488 includes this hour of care coordination time and a face-to-face visit. Code 99489 should be used for 30-minute increments over the initial hour of care coordination.

Medicare considers these codes as bundled with other services, but commercial payers may cover them.

The key to the care coordination codes, consultants say, is to develop systems that track actual time spent.

A physician and medical practice staffers may spend 10 minutes coordinating a patient’s care one week and 15 minutes the next, but these codes are to be used only once per patient per month and are dependent on the total number of minutes spent on these activities over 30 days. Other evaluation and management services would be billed separately.

“Because it’s accumulated time over a month, it can be much harder to track,” said director of education with AAPC, an organization of professional coders.

Understanding how to use these codes properly is viewed as important even if local insurers are not on board, one consultant said.

“I would implement the codes and understand what it takes to bill them,” said Jim Watson, a director with SS&G Healthcare and a partner with Professional Business Consultants in Chicago who works with medical practices. “If insurers are not reimbursing them now, they probably will be in the future.”

The third step, coding experts say, is to have contacts with other parts of the health system to identify opportunities to provide these services. For example, strengthen links with local hospitals to make it more likely that a practice is notified when a patient is discharged. Consultants say most hospitals should be amenable, since improving transitions can reduce readmissions and Medicare penalties for having too many of them. Patients who are good candidates for complex chronic care coordination may be identified by the practice or an insurer.

“Find out what kind of care continuity programs they are working on,” Contreras said.

 

Potential Cure for HIV-AIDS

16 January 2013

In a breakthrough, Australian researchers claim to have discovered how to modify a protein in HIV which could lead to a potential cure for AIDS.

According to researcher Dr David Harrich, the protein can be modified so that, instead of replicating, it protects against the deadly infection.

“I consider that this is fighting fire with fire. What we’ve actually done is taken a normal virus protein that the virus needs to grow, and we’ve changed this protein, so that instead of assisting the virus, it actually impedes virus replication and does it quite strongly,” Dr Harrich said.

Dr Harrich added that modified protein cannot cure HIV but it has protected human cells from AIDS in the laboratory.

“This therapy is potentially a cure for AIDS. So it’s not a cure for HIV infection, but it potentially could end the disease,” he said.

Over 30,000 people have been diagnosed with HIV in Australia.

If clinical trials are successful, one treatment could be effective enough to replace the multiple therapies they currently need.

“Drug therapy targets individual enzymes or proteins and they have one drug, one protein,” Dr Harrich said.

He added that they have to take two or three drugs, so this would be a single agent that essentially has the same effect.

“So in that respect, this is a world-first agent that’s able to stop HIV with a single agent at multiple steps of the virus life-cycle,” Dr Harrich added.

He said that the new treatment has the potential to make big improvements in the quality of life for those carrying HIV. I think what people are looking for is basically a means to go on and live happy and productive lives with as little intrusion as possible.

Dr Harrich added that animal trials are due to start this year and early indications are positive.

Indian Surrogate Mothers Getting Popular

Surrogacy Rules Across World

Australia In most parts, commercial surrogacy is illegal. Where allowed, the surrogate mother is considered the legal mother.

India Commercial surrogacy began in 2002

Canada Illegal

Hungary Illegal

Japan Illegal

France Illegal

Israel State-controlled surrogacy

United Kingdom Legal since 2009

United States Most states have their own laws. Florida and California have more relaxed legislation.

***

India is now the baby hub of the Australasian world.

The Aussies are queueing up for a ‘made in India’ baby as surrogacy is illegal in most Australian states (in the few where commercial surrogacy is permitted, the law recognises the surrogate as the legal mother). This has led to many Australians heading to countries where they can rent a womb. India has become the destination of choice for fertility tourists: it’s cheap, has excellent doctors and, most importantly, has women ready to gestate a foetus to delivery for a price.

In fact, 1,500 children are born to parents across the world through a surrogate in India each year. And unofficial figures suggest that 179 babies were born to Australian parents last year in India.

The Australian High Commission in India has now acknowledged this and has set guidelines to assist its people in taking their babies home trouble-free. Many say this may well have come in the backdrop of improved ties between the two countries after the prime ministers’ summit here last month. It also evinces a new pragmatism on part of the Australians, although it raises serious questions of ethics.

The high commission’s website now has a special section for “children born through surrogacy arrangements in India”, in which it advises Australians to exercise extreme caution when opting to go the surrogacy route, given the laws back in Australia and the legal status of surrogacy in the country. Then it goes on to list, in painstaking detail, the steps that need to be taken for legalising the process. It states a large number of documents and tests, such as a DNA test for the parents in Australia and for the child in specific centres in Delhi and Mumbai. The result of the latter test is sent to Australia in order to be given final clearance. The website also details all the documents required to be procured and submitted. A list that includes no objection certificates from the surrogate mother, the doctor and the hospital, among other documents.

The web portal goes on to warn prospective parents that “Indian legislation in respect to surrogacy is limited and Indian laws are expected to change in response to the growing demand for surrogacy arrangements”. That the move to have a baby in India is fast gaining popularity in Australia can also be attributed to couples sharing their stories on social media networks and YouTube and urging other parents to try India for a hassle-free surrogate experience.

Surrogacy Australia, a non-profit association helping Australians with their surrogacy abroad, estimates an average 50 babies are born to Australian expatriates in India each year. It also points out that “the practice of paying an overseas surrogate carries a jail term of up to 10 years in some states in Australia.”

Surrogacy Laws India, a Delhi-based law firm specialising in surrogacy, emphasises that “international surrogacy involves bilateral issues, where the laws of both the nations have to be at par, or else the concerns and interests of parties involved will remain unresolved. Due regard must be given to such concerns in order to protect against the commercialisation of the human reproductive system, the exploitation of women and the commodification of children.”

Others are more hopeful. “We welcome the move of countries recognising surrogacy in India. This may well push our government to look at the Assisted Reproductive Technologies (ART) Bill, which has been with the law commission since 2010,” an Indian Council of Medical Research member said.

That aside, the need of the hour is for the state to implement safeguards against surrogacy becoming exploitative.

 

How Long You Live Depends Where You Live

How we live and die

We all know we are going to die, but how and when it happens depends largely on who we are and where we live.

We think we know the major risks – perhaps malaria or AIDS-related diseases in Africa, or stroke, cancer and heart disease in North America and Western Europe. But, in fact, patterns of mortality and morbidity are rapidly changing around the world.

This was the revelation of more than five years of data collection and analysis, which culminated in the recent publication of the Global Burden of Disease Study 2010. Led by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), the study involved 486 authors from 50 countries.

Peter Piot, the director of London’s School of Hygiene and Tropical Medicine, said the speed of change has taken researchers by surprise. “It’s going much faster than I think that we all thought. But there is also enormous diversity.”

Good and bad news
The study reveals that people can expect to live longer – in some cases, dramatically longer.

Overall life expectancy worldwide has increased by more than a decade since 1970. The Indian Ocean island nation of Maldives has shown the most striking improvement: a woman there in the 1970s lived on average to 51; now the average lifespan increased by three decades.

But there were also disappointments. The big one, said Chris Murray, IHME’s director, is that health gains have been uneven.

“These rapid transformations in health don’t seem to translate into a change in the leading causes of disease burden in sub-Saharan Africa. We have quantified considerable progress there. Child mortality rates are down quite substantially. There’s progress – especially since 2004 – in reducing HIV-related death. There’s progress in reducing malaria due to the scale-up of bed nets and artemisinin-combination therapy. But despite that progress, 65 to 70 percent of the burden of ill-health is still related to MDGs [Millennium Development Goals] four, five and six,” he said, referring to the MDGs to significantly reduce child mortality, improve maternal health, and combat HIV, malaria and other diseases by 2015.

The key is: let’s not assume that the MDGs, as they are now, will all be achieved by 2015, that we can drop that and then move on with a completely blank sheet. That would be a disaster. And that’s what’s in the pipeline.

Changing trends
The researchers noted a shift away from infectious diseases as a cause of death towards non-communicable diseases such as cancer, stroke and heart disease – often called “lifestyle” diseases. Among communicable diseases, only AIDS and, to a lesser extent, malaria have increased since 1990, primarily in sub-Saharan Africa.

Now only 25 percent of deaths globally are due to infectious diseases and maternal, neonatal and nutritional causes. More than 65 percent are due to non-communicable conditions, and just under 10 percent are related to injuries, the bulk of them happening on increasingly deadly roads in the world’s poorest places.

Countries in Africa are increasingly facing the dual burdenof fighting “old” as well as “new” diseases.

Two years ago, we looked at the data from Greater Accra [the capital area… which is about 90 percent urban now. And we realized that hypertension had moved to number two among the common causes of outpatient attendance and was a leading cause of death, which is different from the rest of the country. “And I was discussing with a colleague that we should start research into cardiovascular disease in low- and middle-income countries, and he was still saying, ‘Why on earth would you do that? It’s not a problem.’”

Data
Data-keeping has surfaced as one of the biggest challenges countries face in setting targets to reduce non-communicable diseases.

Only about two-thirds of the world’s countries have “vital” registration systems that record births and deaths sufficiently to estimate death rates from various causes. 74 countries lacked data on cause of death, while another 81 countries had only lower-quality data.

While researchers have, until now, only occasionally conducted such global disease burden studies, they hope to keep the database updated and freely available. They have also provided a set of interactive tools that present information by different categories, including region and population segment.