Popular new approach slow down the spread of HIV : US Study

In recent months, public health officials around the country have started using a popular new method to prevent the spread of HIV called “test and treat.” But a USC study advises that this approach could be counter productive.

The new strategy calls for universal HIV testing of sexually active adolescents and adults as part of routine health screenings, followed by immediate drug therapy for all who test positive for the virus – instead of waiting until their immune system is more compromised.

Public health officials nationwide have embraced the strategy, as it’s been shown to substantially reduce the number of HIV cases and resulting deaths from AIDS. Some experts suggest “test and treat” could even eradicate HIV.


But USC researchers from the Schaeffer Center for Health Policy and Economics say their mathematical models indicate the need for caution.

The models predicted that if the “test and treat” strategy were applied for ten years, the prevalence of multi-drug resistant HIV strains would nearly double, from 4.79 percent to 9.1 percent, says Neeraj Sood, an associate professor at the Schaeffer Center.

“That is a worry because if you have multi-drug resistant HIV, then treatment for HIV is less effective for you,” Sood says, adding that the uncertainty of how new strains may evolve and whether new drugs can be developed to battle them remains unknown.

Sood advises a more cautious approach, in which public health officials would continue with aggressive HIV testing, but postpone early-stage treatment of the virus.

The study showed this more modest strategy offers an almost 18 percent reduction of HIV infections, without the increase in drug-resistant HIV strains.

“So you’re getting half the short term benefits,” he says, “but you’re hedging your long term bets.”

The USC researchers said their study also calls into question the claim that “test and treat” could eradicate HIV.

Under a best case scenario, “test and treat” would generate about a 34 percent reduction in new infections and a 19 percent drop in the number of deaths over ten years, says Sood. “Sizeable benefits, but not close to eradicating the disease.”

Sood says he and his team of researchers based their assessment on mathematical models that focused on LA County’s population of sexually active gay men, which accounts for 82 percent of all county residents infected with HIV/AIDS.
Source: SCPR

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The Public Health Crisis Hiding in Our Food


If you have high blood pressure, you’re in good company. Hypertension afflicts 67 million Americans, including nearly two-thirds of people over age 60. But it isn’t an inevitable part of the aging process. It’s better to think of it as chronic sodium intoxication. And, as an important new study from Britain shows, there’s a way to prevent the problem — and to save many, many lives.

A lifetime of consuming too much sodium (mostly in the form of sodium chloride, or table salt) raises blood pressure, and high blood pressure kills and disables people by triggering strokes and heart attacks. In the United States, according to best estimates, excess sodium is killing between 40,000 and 90,000 people and running up to $20 billion in medical costs a year.

Americans on average take in about 3,300 milligrams of sodium per day, but experts recommend less than 2,300 milligrams — and less than 1,500 milligrams for people over age 50, black people, or those who already have hypertension, diabetes or kidney disease, which adds up to a majority of American adults. Either target is far below where most Americans are now.

The reason that nearly everyone eats way too much sodium is that our food is loaded with it, and often where we don’t taste or expect it. Of course ham and canned soup are full of salt, but so are many foods that are surprising: A blueberry muffin can have more than double the salt of a serving of potato chips. Even healthy-sounding food can pack heavy sodium loads. Two slices of whole wheat bread can have nearly 400 milligrams of sodium, as can two tablespoons of fat-free salad dressing. Eight ounces of V8 vegetable juice contains well over 500 milligrams. Many restaurant entrees have far more sodium than is recommended for an entire day. Applebee’s lemon shrimp fettuccine, at 5,100 milligrams, has more than twice as much.

Doctors warn people with high blood pressure to go on a low-salt diet, but that’s virtually impossible in today’s world, because nearly 80 percent of the sodium that Americans eat comes in packaged and restaurant food (whether it’s a bagel, a sandwich or a steak dinner). You can’t take it out. And nearly everyone, not just people with hypertension puzzling over food labels, should be taking in less sodium. The only way to prevent millions of Americans from developing high blood pressure is for companies and restaurants to stop loading up their food with sodium.

Health experts have been asking the food industry to do that for decades. It’s not easy, but it isn’t impossible either. Sure, we all like the taste of salt, but there is much that food companies can do without driving away customers. Often they add sodium for leavening or food texture rather than taste, when replacement ingredients are available. And sodium levels in similar popular foods made by different manufacturers often vary two- or threefold (for example, a slice of pizza can pack anywhere from between 370 and 730 milligrams), which suggests that many manufacturers can cut sodium levels in their foods sharply without hurting taste. When salt levels in food drop, people’s preference for salt also shifts down, so no one would notice a gradual reduction in sodium across all foods.

That’s exactly what Britain’s Food Standards Agency has done. It divided processed food into different categories, set salt-reduction targets in each category and then asked companies to meet those targets over time. And as they did that, from 2001 to 2011, sodium consumption by the British fell 15 percent.

The new study shows that this drop in salt intake has been accompanied by a substantial reduction in average blood pressure, a 40 percent drop in deaths from heart attacks and a 42 percent decline in deaths from stroke.

A few scientific critics have been arguing for years that reducing salt intake is risky because it might paradoxically increase mortality in some people receiving aggressive treatment for congestive heart failure, but the British data show at a national level what smaller studies project — that when sodium levels in everyone’s food drop, so does the number of people dying from heart disease and stroke.

Lower smoking rates in Britain no doubt are helping as well, but as the authors of the study point out, the fall in mortality echoes the success of Japan and Finland in earlier decades, both of which reduced sodium consumption from sky-high levels with focused government efforts and saw huge drops in heart attacks and strokes.

Problem can be traced to industrialized food industry which had managed to mass produce inexpensive food attractively packaged with extended…

Health experts I listen to say we should avoid all processed foods, eat plenty of fresh veggies, enjoy moderate amounts of fruit, try to eat…

Here in the United States, in 2010, an Institute of Medicine panel was so troubled by salt-caused deaths that it called for mandatory federal standards for sodium in food. But the question of whether the Food and Drug Administration should regulate salt is more complicated than it might seem at first. As an expert once told me, you’re never going to ban pickles.

The only way to regulate that I can see is to set maximum sodium levels within many different food categories. But that could backfire if the levels are set high and then the companies already making food with sodium below those levels take the new limits as license to increase to the maximum amount of sodium permitted. I believe that in the end we will need a combination of mandated maximums and a coordinated voluntary sodium-reduction program like that in Britain. But the voluntary plan should come first, to see how much sodium levels can be reduced that way.

There is absolutely no reason we can’t do an initiative similar to Britain’s on this side of the Atlantic now. Over the last four years, the New York City health department has led the National Salt Reduction Initiative, a network of over 90 health departments and national organizations, including the American Medical Association, the American Heart Association, the American College of Cardiology and Consumers Union, working with food companies to voluntarily cut sodium, using Britain as a model.

Twenty-one companies, including food giants like Kraft, Unilever and Subway, and many others like Mars and Goya, have joined, putting less sodium in common products like processed cheese and canned beans. But far more food companies are ignoring it, and the initiative got no commitments at all in 18 of 62 packaged food categories.

A proposal as important to human life as this needs the stature and resources of the federal government to bring the rest of the food industry along. The F.D.A. has been developing a new plan for a voluntary, coordinated, national initiative. Unfortunately, even though it is voluntary, the food industry is fighting it, and the plan is stalled.

Many people are unnecessarily on kidney dialysis, in stroke rehabilitation centers and dying because we are failing to act. Even modest reductions in sodium in food could save tens of thousands of lives and billions in health care costs every year. No one likes government mandates these days. But it’s high time the federal government starts to fix this problem by at least leading a voluntary initiative that we know will save many lives.

Source: New york times

Helping Smokers Quit, or Not Start in the First Place

“Even 50 years after the first surgeon general’s report on smoking and health, we’re still finding out new ways that tobacco kills and maims people,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, recently told me. “It’s astonishing how bad it is.”

Dr. Frieden and public health specialists everywhere are seeking better ways to help the 44 million Americans who still smoke to quit and to keep young people from getting hooked on cigarettes. “Fewer than 2 percent of doctors smoke. Why can’t we get to that rate in society as a whole?” he wondered.

One reason: Smoking rates are highest among the poor, poorly educated and people with mental illness, populations hard to reach with educational messages and quit-smoking aids.

But when I mentioned to Dr. Frieden, a former New York City health commissioner, that the city’s streets are filled with young adult smokers who appear to be well educated and well dressed, he said television seems to have had an outsize influence.

Focus groups of white girls in New York private schools have suggested a “Sex in the City” effect, he said: Girls think smoking makes them look sexy. In the last two years, middle-aged men, too, have begun smoking in increasing numbers after a half-century decline. Dr. Frieden cited “Mad Men,” the popular TV series featuring admen in the early 1960s, when well over half of American men smoked.

Dr. Frieden said that an antismoking effort begun in 2008 by the World Health Organization “can make a huge difference in curbing smoking, and we should fully implement what we know works.” The program is called Mpower:

M stands for monitoring tobacco use and the effectiveness of prevention programs like antismoking videos on YouTube.

P for protecting people from secondhand smoke. Half the country still lacks laws mandating smoke-free public places. The latest national health survey found that about half of children from nonsmoking households have metabolites of tobacco in their blood, Dr. Frieden said.

O for offering help to the 70 percent of smokers who say they would like to quit. “Tobacco use remains egregiously undertreated in health care settings,” Dr. Helene M. Cole, associate editor of JAMA, The Journal of the American Medical Association, and Dr. Michael C. Fiore, a professor of medicine at the University of Wisconsin, wrote this month in the journal.

Medical aids for quitting smoking, which can triple the likelihood of success, should become available, without a co-pay, to many more people under the Affordable Care Act, Dr. Frieden said.

W for warning about smoking hazards through larger and more graphic messages on cigarette packs and paid advertising on radio and television.

E for enforcing bans on tobacco marketing, advertising, promotion and sponsorships. In bodegas throughout the country, Dr. Frieden said, “tobacco ads are used as wallpaper.” Smoking is freely depicted in movies and popular TV shows.

R for raising taxes, which studies have shown is the single most effective way to reduce smoking in the population, especially among teens.

“A higher cigarette tax is not a regressive tax, because it would help poor people even more than the well-to-do,” Dr. Frieden noted. President Obama has proposed an additional 94-cent-per-pack tax on cigarettes, which would yield $80 billion to fund universal prekindergarten.

Smokers ready to quit can choose from among a cornucopia of aids as wide-ranging as nicotine substitutes, low-dose antidepressants, hypnosis and acupuncture. While none by itself has a high rate of success, different methods have proved effective for different people. Many former smokers required several attempts before they managed to quit for good.

But quitting smoking does not necessarily require assistance. As two public health specialists, Andrea L. Smith and Simon Chapman at the University of Sydney in Australia, have pointed out, “The vast majority of quitters do so unaided.” A Gallup Poll conducted last year in the United States found that “only 8 percent of ex-smokers attributed their success to [nicotine replacement therapy] patches, gum or prescribed drugs,” these experts noted. “In contrast, 48 percent attributed their success to quitting ‘cold turkey’ and 8 percent to willpower, commitment or ‘mind over matter’.”

They added, “For many smokers, having a reason to quit (a why) was more important than having a method to quit (a how).”

For my husband, who smoked a pack a day for 50 years, the “why” was his distress at seeing two beautiful young nieces smoking; he made a pact with them to quit if they would, and he followed through.

Techniques that can help people trying to quit when troubled by the urge to smoke include waiting 10 minutes and distracting yourself; avoiding situations you associate with smoking, at least until you have become a committed ex-smoker; using stress reducers like physical activity, yoga, deep breathing, muscle relaxation and self-hypnosis; seeking moral support from a nonsmoking friend, family member or online stop-smoking program; and oral distractions like chewing sugarless gum or raw vegetables.

Electronic cigarettes are being promoted by some as a way to resist the real thing. E-cigarettes, invented in 2003 by a Chinese pharmacist, contain liquid nicotine that is heated to produce a vapor, not smoke. More than 200 brands are now on the market; they combine nicotine with flavorings like chocolate and tobacco.

But their contents are not regulated, and their long-term safety has not been established. In one study, 30 percent were found to produce known carcinogens. Dr. Frieden said that while e-cigarettes “have the potential to help some people quit,” the method would backfire “if it gets kids to start smoking, gets smokers who would have quit to continue to smoke, gets ex-smokers to go back to smoking, or re-glamorizes smoking.”

Nearly two million children in American middle and high schools have already used e-cigarettes, Dr. Frieden said. In an editorial in the Canadian Medical Association Journal last year, Dr. Matthew B. Stanbrook, an assistant professor of medicine at the University of Toronto, suggested that fruit-flavored e-cigarettes and endorsements by movie stars could lure teens who would not otherwise smoke into acquiring a nicotine habit.

A survey in 2011 of 75,643 South Korean youths in grades 7 through 12 by researchers at the University of California, San Francisco, revealed that four of five e-cigarette users also smoked tobacco. It could happen here: Stanton A. Glantz, the study’s senior author and a professor of medicine at the university, described e-cigarettes as “a new route to nicotine addiction for kids.”

Source: New York Times