Medicine Card The Discovery Of Power Through The Ways Of Animal

BLANTYRE, Malawi (AP) -- Government fertilizer has made the difference between hunger and plenty for Rodrick Jesitala, a farmer and father of three in southern Malawi.

Thanks to fertilizer he couldn't afford without government help, Jesitala harvested enough corn to feed his family this year. A report released Friday praised Malawi's program, saying governments simply making agriculture a top priority and offering financial and other incentives to small farmers have seen some poor countries quickly move from importing food to producing surpluses.

In its report, ActionAid International ranked Malawi among the top five successful developing nations, with Brazil taking the lead, for cutting child malnutrition by 73 percent in six years.

"Who's Really Fighting Hunger" said Brazil succeeded at cutting child malnutrition by investing extensively in small-holder farmers and implementing strong social welfare policies.

In Malawi, the past two growing seasons have ended with impressive surpluses of the staple crop, corn. President Bingu wa Mutharika persisted with his program to help farmers buy fertilizer despite opposition from Western donor nations and agencies that see subsidies as contrary to free market principles.

During the 2008-09 growing season, the government spent $183 million on the farm subsidy program, which resulted in Malawi realizing a surplus of 1.3 million metric tons of maize. Under the program, a farming family gets two 50-kilogram bags of fertilizer and packets of seed.

Before he started using fertilizer, Jesitala harvested fewer than 15 bags of corn from his one-acre plot. This year, he harvested 40 bags, enough to feed his family for the year.

"We will also even sell some of the maize," he said.

Malawi, which has had acute food shortages in the past, has been a donor in recent times, giving 500 metric tons of corn each to Swaziland and Lesotho and selling some to Zimbabwe in the 2007-08 growing season. Talks are under way to sell to Kenya and Zimbabwe this year.

The World Food Program is warning that, because of drought, Malawians in some southern regions will need food aid this year despite the national surplus. But the Ministry of Agriculture and Food Security says there's enough stock to respond to any food emergency.

The U.N. Food and Agriculture Organization said in a report released Wednesday that the world's hungry reached 1.02 billion this year, attributing the steady rise in the number of undernourished people to governments reducing their spending on agriculture for more than a decade.

"It's the role of the state and not the level of wealth, that determines progress on hunger," said Anne Jellema, ActionAid's policy director.

"Every six seconds a child dies from hunger, but this scandal could easily be ended if all governments took determined action," said Jellema.

ActionAid's report ranks 29 developing and 22 developed nations to compare policies, laws and actions individual governments have taken with the aim of ending global hunger.

The report grades rich nations on the measures they have taken to end hunger such as how much agriculture aid they give or what they are doing to reverse the effects of climate change.

Luxembourg tops the list of 22 rich nations, followed by Finland and Ireland.

"Who's Really Fighting Hunger," ranks 51 countries where either ActionAid has a presence or have reliable data that makes comparisons possible. So, for example, Zimbabwe is not included because of doubts about data generated in that country.

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Maliti contributed from Nairobi, Kenya.

© 2009 The Associated Press.

WASHINGTON (AP) -- Scientists have grown a piece of heart muscle - and then watched it beat - by using stem cells from a mouse embryo, a big step toward one day repairing damage from heart attacks. Think of Dr. Kenneth Chien as a heart mechanic. "We're making a heart part and (eventually) we're going to put the part in," is how he describes the work by his team of Harvard and Massachusetts General Hospital researchers.

Lots of work remains before trying that dramatic an experiment in people. But regenerating damaged heart muscle is a holy grail in cardiac care.

Doctors today have lots of treatments to prevent a heart attack. But once one strikes, there's no way to restore the heart muscle it kills. Gradually the weakened heart quits pumping properly, leading to deadly heart failure.

Hence the focus on embryonic stem cells, master cells that can give rise to any tissue in the body. Until now, scientists haven't known how to coax those cells into producing pure cardiac muscle.

Instead, researchers have tried injecting heart attack survivors with mixes of different kinds of stem cells, next-generation types like those found in bone marrow. The idea: Perhaps once those cells were inside a damaged heart, ones capable of growing cardiac muscle would receive a "get to work" signal and take root. There's been little success so far.

The new research, published in Friday's edition of the journal Science, promises a more targeted approach.

"It's not the home run," cautioned Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, which is spending millions on research nationwide into cardiac regeneration. "But it's a major advance that's helping to move the field forward in a very significant way."

Embryonic stem cells give rise to more specialized organ-producing stem cells. The team from the Harvard Stem Cell Institute and Mass General recently discovered a master heart stem cell present in both human and mouse embryos.

But could they control it enough to make just the kind of heart cell they wanted to grow? They'd have to winnow out the daughter cell whose only job is to grow the muscle fibers of the ventricle, or pumping chamber.

Chien genetically engineered mice so that certain cells in the embryos' developing hearts would light either fluorescent red or green. As he watched the embryos grow, where the colors overlapped signaled developing heart muscle. Sure enough, when the team plucked out those cells, they were pure ventricle generators.

Next Harvard engineers pitched in with a special scaffolding. The team "seeded" the scaffolding with these ventricle stem cells, and a thin strip of mouse heart muscle grew right in the laboratory.

Not only that, it spontaneously beat, the team reported in Science and at a National Institutes of Health meeting this week on the state of cardiac regeneration.

"This looks like the kind of work a normal heart tissue strip would do," said Chien, director of Mass General's Cardiovascular Research Center. "We went from embryonic stem cells to an organ."

What next? This was not a fully developed piece of heart muscle but a thin strip. To be usable, it would have to be thicker, more three-dimensional, for more beating strength. It also needs a nourishing blood supply. So a next big challenge is pinpointing which daughter to those master heart stem cells will grow blood vessels.

The NIH's Nabel said the experiment also offers a possible new opportunity for cell therapy - that perhaps injecting the precise muscle-generating cell directly into a damaged heart would have a better chance of sticking and working.

The Harvard team wants both methods tried.

"We're not saying this is going to happen tomorrow," said Chien, who also is working on repeating the work with human cells. "I believe within five years," it might be ready to try with people.

© 2009 The Associated Press.

ATLANTA (AP) -- It was six months ago that scientists discovered an ominous new flu virus, touching off fears of a catastrophic global outbreak that could cause people to drop dead in the streets. Doomsday, of course, never came to pass.

Now that the initial scare over the swine flu has subsided, health officials warn we are not out of danger yet.

"We've got many, many months ahead of us where we don't know what will happen and we need to take the best steps we can to protect ourselves," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said last week. "Our biggest concern is that the virus could change, mutate to become more deadly."

With winter approaching, another fear is a one-two punch in which a resurgent swine flu batters young people before the vaccine is widely available, while the ordinary flu strikes the elderly. Also, emergency doctors are worried about the strain on ERs and hospitals.

To date, swine flu has hospitalized hundreds of thousands of people around the world and killed at least 4,500, including at least 600 in the United States. At least 81 U.S. children have died, including many who had no underlying health problems

The CDC was the first to identify the new flu. It was on April 15 and 17 that the agency determined that nasal samples from two children in Southern California contained a swine flu virus that had never been seen before. It was found to contain bits of bird and human flu.

At first the cases represented more of a scientific puzzle than a public health threat. The two children recovered, but investigators were perplexed by how they got it, since the two kids had not been in contact with each other or with pigs.

But within a week, the situation became more dramatic, when testing linked the two children and a handful of subsequent U.S. cases to hundreds of illnesses in Mexico City. Mexican authorities closed schools, museums, libraries and theaters to stop the spread of the disease as initial reports suggested it was killing as many as one in 15 of those infected - a horrifying death rate more than three times higher than the terrible flu pandemic of 1918-19.

A series of bad and good news followed. First, the bad: It quickly became clear that the virus was spreading not only in Mexico and border regions of the United States, but around the world. As health officials had long surmised, international air travel provided a rapid path to world contagion.

What's more, studies indicated the millions of seasonal flu shots administered the previous winter offered no protection against the unusual new virus.

But then came some good news:

-While the flu vaccine was no help, the antiviral medication Tamiflu reduced the severity of illness if taken right after symptoms appeared.

-People 55 and older, who suffer and die the most from seasonal flu each year, seemed mostly to be spared by the new virus. Scientists credited some immunity that they had perhaps picked up from exposure decades ago to a similar-enough virus or vaccine.

-Additional investigation in Mexico suggested that many people had suffered only mild illness. Those cases were not counted in initial reports, meaning the death rate was much, much lower than originally estimated.

In the United States, some of the initial response plans for the new swine flu, an H1N1 strain, envisioned "people dropping dead in the streets," recalled Dr. Beth Bell, a CDC epidemiologist who has been a leader in the agency's response.

The disease kept spreading, and eventually the World Health Organization declared it the first global flu pandemic in 40 years. But even before then, U.S. health officials had downgraded some of their prevention advice, such as the call for schools to shut down for two weeks if any students became infected.

"Overall, it's a fairly typical flu virus," Richard Webby, a prominent researcher at St. Jude Children's Research Hospital in Memphis, says now.

But this story is not over yet. There are still important unanswered questions.

Most health experts believe swine flu hits children and pregnant women harder than seasonal flu, but it's not clear how much harder because officials don't know exactly how many have caught the swine flu and had only mild symptoms.

A mutation of the virus seen in two Dutch patients last month at first seemed to indicate the bug might be getting more dangerous, but the patients recovered and no further problems were reported. Researchers are watching for more such changes.

Over the summer, new infections spread, often hitting kids' summer camps. That's unusual because seasonal flu usually disappears in summer. But it wasn't a shock, either, because summer spread had been seen in flu pandemics of the past, like one in 1957, said Dr. Arnold Monto, a University of Michigan flu expert.

Experts predicted, correctly, that infections would jump in August and September, when schools and universities opened for fall classes.

Now, manufacturers are cranking out vaccine as fast as they can around the world, and the early shipments are trickling out.

Some health officials have speculated the worst may already be over for some parts of the country, particularly the Northeast. If the fall vaccination campaigns are effective, swine flu's winter season may not be as bad as the spring.

However, some experts think things could get worse. Some believe swine flu will be the dominant virus, as it has been during the Southern Hemisphere's winter, just ending. Others worry about the double-flu scenario in which the novel H1N1 virus strikes the young and the ordinary flu socks the old.

In either case, hospitals could be swamped. That's been causing a lot of hand-wringing, with a poll of 1,000 emergency room doctors this week finding that 90 percent are worried about their hospitals' ability to handle extra patients.

Whatever happens, health officials say it's been a memorable experience.

"There is a certain sense of history unfolding," Bell said.

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On the Net:

World Health Organization swine flu site: http://www.who.int/csr/disease/swineflu/en/

U.S. Centers for Disease Control and Prevention swine flu site: http://www.cdc.gov/H1N1FLU/

© 2009 The Associated Press.

WASHINGTON (AP) -- The Food and Drug Administration announced plans Thursday to study the scope of problems connected with laser eye-correcting surgery, which include blurred vision and dry eyes.

The FDA says it will work with the National Eye Institute and the Department of Defense to determine the percentage of patients who experience negative side effects following surgery.

The first phase of the project is already under way, with plans for an online questionnaire to help patients gauge their quality of life following surgery, according to an FDA statement.

The project will also include a clinical trial tracking patients who undergo the procedure, which is expected to conclude by 2012.

"This study will enhance our understanding of the risks of Lasik and could lead to a reduction in patients who experience adverse effects," said Dr. Jeffrey Shuren, the acting head of FDA's medical device division.

An estimated 6 million Americans have undergone Lasik surgery, which permanently reshapes the cornea, a clear layer covering the eye. There are no guarantees of 20/20 vision and the long-term safety of the procedure is still unknown.

Ophthalmology societies report that about 95 percent of patients are satisfied with their new vision.

But a small number of patients have reported permanent damage to their eyes following the surgery, including double vision, dry eye and halos around objects at night.

The FDA agreed to look into the problems in 2008 after years of complaints. The agency said last summer it received 140 reports of Lasik-related problems between 1998 and 2006.

Lasik procedures have fallen off in the past year as consumers cut back on the pricey surgeries, which can cost between $1,500 and $5,000

Makers of Lasik lasers include Advanced Medical Optics Inc., Alcon Inc., and Bausch and Lomb.

Also on Thursday, the FDA announced warning letters sent to 17 Lasik surgery centers for inadequate adverse event reporting procedures. Regulators periodically send letters to facilities that don't follow federal guidelines for reporting patient complaints.

"The inspections did not identify problems with the use of the Lasik devices at these facilities," the FDA stated.

More inspections of Lasik centers are planned in coming months, according to the FDA release.

© 2009 The Associated Press.

LOS ANGELES (AP) -- A surprising number of frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives, two new federally funded studies reveal.

One found that putting nursing home residents with failing kidneys on dialysis didn't improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment.

Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible - more like the palliative care given to terminally ill cancer patients.

"We probably need to be offering a palliative care option to many more patients to make the last days of their lives as comfortable as possible," said Dr. Mark Zeidel of the Beth Israel Deaconess Medical Center in Boston, who was not involved in the studies.

Palliative care focuses on managing symptoms of a disease and a main goal is to relieve pain at the end of life.

End-of-life care became a divisive issue in the national health care reform debate this summer after one proposal included Medicare reimbursement for doctors who consult with patients on end-of-life counseling. Critics called the counseling "death panels" and a step toward euthanasia. The Obama administration denied those claims, yet has signaled the Medicare benefit will be dropped.

The new studies are published in Thursday's New England Journal of Medicine.

In one study, doctors looked at health records of 3,702 nursing home residents nationwide who started dialysis between 1998 and 2000. The average age was 73 and many had other health problems, including diabetes, heart disease and cancer.

Within the first year, 58 percent died and another 29 percent declined in their ability to do simple tasks such as walking, bathing and getting dressed.

Kidney dialysis helps remove waste from blood, and the vast majority of patients with kidney failure benefit. However, in the case of seniors with failing kidneys, it is less clear whether the benefit outweighs the burden.

The findings call into question the common practice of transporting dialysis patients near the end of life to dialysis centers several times a week and hooking them up to a machine for hours at a time.

"We may be overestimating the benefits of dialysis in some of these patients and downplaying the burdens," said lead author Dr. Manjula Kurella Tamura, a Stanford University kidney specialist.

The study did not include a comparison group of patients who didn't get dialysis, so it's unknown if more elderly are dying after starting dialysis than not. Kurella Tamura said there's no one-size-fits-all recommendation for which nursing home residents should go on dialysis, and she suggests patients talk with their doctors about realistic expectations.

The second study followed 323 people with advanced dementia from Boston-area nursing homes. Their average age was 85 and they could not recognize loved ones and were unable to talk or walk.

One out of four died within six months and half died during the 18 months they were followed. Nursing home residents with advanced dementia were more likely to die of pneumonia, fever and eating problems related to their dementia than from strokes or heart attacks.

During their final three months, 41 percent received aggressive care including being hospitalized and tube feeding. However, if the person making their medical decisions was aware of their poor prognosis, they were less likely to receive aggressive care near the end of life, the research found.

"We often temporarily inflict discomfort or pain on patients. We try to minimize it, but we accept it because we think the trade-off is curing or healing," said Dr. Greg Sachs of Indiana University School of Medicine.

In an accompanying editorial, Sachs recalled how his grandmother, who suffered from Alzheimer's and lived in a nursing home, was aggressively treated with antibiotics for every infection in her final months and had to be restrained. He said that people with dementia could benefit from hospice care inside a nursing home or in the community.

Sachs cited research that found nursing home residents who had hospice care during the last month of their life were half as likely to be hospitalized. What's keeping dementia nursing home patients from getting hospice care is that dementia is not widely recognized as a terminal illness. It's also harder to predict when a dementia patient has six months or less to live - a criteria for Medicare-paid hospice care.

The National Institutes of Health funded the studies. The dementia study was led by the Harvard-affiliated Hebrew Senior Life Institute for Aging Research in Boston. In the dialysis study, Kurella Tamura has received grant support from Amgen, which makes a drug for people with kidney disease undergoing dialysis.

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On the Net:

New England Journal, http://www.nejm.org

© 2009 The Associated Press.