Friday, January 4, 2008

A new study amongst doctors in the United States on the use of placebos—pills with no medical effect—shows that almost half of the questioned practitioners prescribe placebos, most of them within the last year.

The majority of 466 faculty physicians at Chicago-area medical schools interviewed by a research group of the University of Chicago stated that placebos are useful to calm a patient down or to respond to demands for medication that the doctor disagrees with, i.e. “to get the patient to stop complaining”.

96 percent of the physicians surveyed believe that placebos can have therapeutic effects. Close to 40 percent stated that placebos could benefit patents physiologically as well as mentally.

Twelve percent of surveyed physicians think that placebos should be banned from clinical practice. Among the doctors who prescribed them, one in five said they outright lied to patients by claiming a placebo was medication. But more often the physicians came up with ways to explain like that “this may help you but I’m not sure how it works.”

The American Medical Association (AMA), the largest association of U.S. doctors and medical students, tells its members that “[p]hysicians may use placebos for diagnosis or treatment only if the patient is informed of and agrees to its use.” The research, published in Journal of General Internal Medicine this week, is the first major U.S. study of doctors on the use of placebos since 1979.

Thursday, December 18, 2008

A team of eight transplant surgeons in Cleveland Clinic in Ohio, USA, led by reconstructive surgeon Dr. Maria Siemionow, age 58, have successfully performed the first almost total face transplant in the US, and the fourth globally, on a woman so horribly disfigured due to trauma, that cost her an eye. Two weeks ago Dr. Siemionow, in a 23-hour marathon surgery, replaced 80 percent of her face, by transplanting or grafting bone, nerve, blood vessels, muscles and skin harvested from a female donor’s cadaver.

The Clinic surgeons, in Wednesday’s news conference, described the details of the transplant but upon request, the team did not publish her name, age and cause of injury nor the donor’s identity. The patient’s family desired the reason for her transplant to remain confidential. The Los Angeles Times reported that the patient “had no upper jaw, nose, cheeks or lower eyelids and was unable to eat, talk, smile, smell or breathe on her own.” The clinic’s dermatology and plastic surgery chair, Francis Papay, described the nine hours phase of the procedure: “We transferred the skin, all the facial muscles in the upper face and mid-face, the upper lip, all of the nose, most of the sinuses around the nose, the upper jaw including the teeth, the facial nerve.” Thereafter, another team spent three hours sewing the woman’s blood vessels to that of the donor’s face to restore blood circulation, making the graft a success.

The New York Times reported that “three partial face transplants have been performed since 2005, two in France and one in China, all using facial tissue from a dead donor with permission from their families.” “Only the forehead, upper eyelids, lower lip, lower teeth and jaw are hers, the rest of her face comes from a cadaver; she could not eat on her own or breathe without a hole in her windpipe. About 77 square inches of tissue were transplanted from the donor,” it further described the details of the medical marvel. The patient, however, must take lifetime immunosuppressive drugs, also called antirejection drugs, which do not guarantee success. The transplant team said that in case of failure, it would replace the part with a skin graft taken from her own body.

Dr. Bohdan Pomahac, a Brigham and Women’s Hospital surgeon praised the recent medical development. “There are patients who can benefit tremendously from this. It’s great that it happened,” he said.

Leading bioethicist Arthur Caplan of the University of Pennsylvania withheld judgment on the Cleveland transplant amid grave concerns on the post-operation results. “The biggest ethical problem is dealing with failure — if your face rejects. It would be a living hell. If your face is falling off and you can’t eat and you can’t breathe and you’re suffering in a terrible manner that can’t be reversed, you need to put on the table assistance in dying. There are patients who can benefit tremendously from this. It’s great that it happened,” he said.

Dr Alex Clarke, of the Royal Free Hospital had praised the Clinic for its contribution to medicine. “It is a real step forward for people who have severe disfigurement and this operation has been done by a team who have really prepared and worked towards this for a number of years. These transplants have proven that the technical difficulties can be overcome and psychologically the patients are doing well. They have all have reacted positively and have begun to do things they were not able to before. All the things people thought were barriers to this kind of operations have been overcome,” she said.

The first partial face transplant surgery on a living human was performed on Isabelle Dinoire on November 27 2005, when she was 38, by Professor Bernard Devauchelle, assisted by Professor Jean-Michel Dubernard in Amiens, France. Her Labrador dog mauled her in May 2005. A triangle of face tissue including the nose and mouth was taken from a brain-dead female donor and grafted onto the patient. Scientists elsewhere have performed scalp and ear transplants. However, the claim is the first for a mouth and nose transplant. Experts say the mouth and nose are the most difficult parts of the face to transplant.

In 2004, the same Cleveland Clinic, became the first institution to approve this surgery and test it on cadavers. In October 2006, surgeon Peter Butler at London‘s Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out a full face transplant. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six month intervals. In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after having received what his doctors call the worlds first successful full face transplant.

Ethical concerns, psychological impact, problems relating to immunosuppression and consequences of technical failure have prevented teams from performing face transplant operations in the past, even though it has been technically possible to carry out such procedures for years.

Mr Iain Hutchison, of Barts and the London Hospital, warned of several problems with face transplants, such as blood vessels in the donated tissue clotting and immunosuppressants failing or increasing the patient’s risk of cancer. He also pointed out ethical issues with the fact that the procedure requires a “beating heart donor”. The transplant is carried out while the donor is brain dead, but still alive by use of a ventilator.

According to Stephen Wigmore, chair of British Transplantation Society’s ethics committee, it is unknown to what extent facial expressions will function in the long term. He said that it is not certain whether a patient could be left worse off in the case of a face transplant failing.

Mr Michael Earley, a member of the Royal College of Surgeon‘s facial transplantation working party, commented that if successful, the transplant would be “a major breakthrough in facial reconstruction” and “a major step forward for the facially disfigured.”

In Wednesday’s conference, Siemionow said “we know that there are so many patients there in their homes where they are hiding from society because they are afraid to walk to the grocery stores, they are afraid to go the the street.” “Our patient was called names and was humiliated. We very much hope that for this very special group of patients there is a hope that someday they will be able to go comfortably from their houses and enjoy the things we take for granted,” she added.

In response to the medical breakthrough, a British medical group led by Royal Free Hospital’s lead surgeon Dr Peter Butler, said they will finish the world’s first full face transplant within a year. “We hope to make an announcement about a full-face operation in the next 12 months. This latest operation shows how facial transplantation can help a particular group of the most severely facially injured people. These are people who would otherwise live a terrible twilight life, shut away from public gaze,” he said.

Tuesday, January 29, 2008

Mauritanian refugees stuck in Senegal for nearly two decades after fleeing ethnic clashes in their home country have begun returning to Mauritania under a U.N.-sponsored program. But many do not want to return.

There were goodbye ceremonies and welcoming ceremonies attended by officials on both sides of the Senegal River as more than 100 former refugees were ferried on motorized pirogues.

A spokesman for the United Nations refugee agency, Alphonse Munyaneza, explained international funding will help pay for resettlement.

“Each refugee returning back to Mauritania will receive a piece of land equivalent to 140 square meters for establishing a house. UNHCR and the government of Mauritania will provide construction material so that they can build a house,” explained Munyaneza. “We will provide three months of food ration. We will provide a tent also.”

Mauritanian refugee children broke out in song and laughter when officials arrived at their camps close to the border to get the process going.

There are more than 20,000 Mauritanian refugees in Senegal. Officials say the return program will extend over 18 months.

One of those happy to go is Haddy Sy. She says she left Mauritania after she was beaten up. This took place during a wave of ethnic violence that began in Arab Moor-dominated Mauritania in 1989 and escalated into border clashes, forcing tens of thousands of black, mostly ethnic Fula, Mauritanians into exile.

In the late 1990s, more than 30,000 refugees returned by their own means and some U.N. assistance.

Sy says she is leaving behind many good things in Senegal, including a peaceful setting, but that she is still happy to return to her home country.

Since taking office last year, the government of the elected, post-coup President Sidi Ould Cheikh Abdallahi has been making efforts to bring home the refugees, including several thousand more in Mali.

But many in Senegal do not want to return home, like Yaraah Sow, who lives in the Dagana refugee camp about 400 kilometers northwest of Dakar.

He says he is still very bitter about what happened nearly 20 years ago. He said his father, who was a civil servant, was attacked by a mob and died of internal bleeding at the gates of a hospital after doctors refused to treat him.

Sow accuses the military of seizing all his family’s property. He says that two of his younger brothers died on the trip to Senegal. He says his children are now going to school and that they are better off in Senegal.

One of the refugee leaders, Mohamed Ali Sow, who left when he was 10, says he is studying at a university in Senegal to become a lawyer to defend the rights of chased out Mauritanians.

He says the return program has been rushed, because he says people who had their property seized, houses burned, and jobs taken away, should have guarantees these will be restored. He says until then, he does not think it is wise to go back.

Monday, March 20, 2006

Buffalo, New York —On Saturday March 18, citizens in Buffalo demonstrated to make their voices be heard. The protest mounted by people opposed to the Elmwood Village Hotel proposal took place on the proposed site at Forest and Elmwood Avenues.

The Elmwood Village Hotel is a 72-room, seven-million-dollar hotel proposed by Savarino Construction Services Corporation. The hotel would require the demolition of at least five buildings (1109-1121 Elmwood), which house several shops and residents. Karl Frizlen, an architect with Frizlen Group, designed the hotel. Although the properties are “under contract,” it is still unknown if Savarino Construction actually owns the buildings. It is believed that Hans Mobius, a resident of Clarence, New York and former Buffalo Mayorial candidate, is still the owner. The hotel is expected to be a franchise of the Wyndham Hotels group.

Despite the cold weather, at least 40 people showed up to walk the picket line for 2 two hours.

Clarence Carnahan, a Buffalo resident, supplied signs that citizens could use during the protest. Some of the signs said, ‘No vacancy, No hotel,’ ‘No tell hotel,’ ‘Hans off’ and ‘Our neighborhood, our choice, no hotel.’

“The concern is they are going to tear down established businesses that have been here for years,” said Charles Leist, a protester.

“We’re fighting to the bitter end. We’re hoping that we can squelch this. We don’t think we can, but we’re going down kicking and screaming,” said Patty Morris, co-owner with Nancy Pollina of Don Apparel at 1119 Elmwood. Don Apparel is a vintage clothing and collectible shop and has been at the same location for nearly 14 years.

The city’s Common Council is expected to vote on the proposal on Tuesday, March 21, 2006 at 2:00 PM in Council Chambers, on 13th floor in City Hall.

The Planning Board is expected to vote on the proposal on Tuesday, March 28, at 8:00 AM in room 902 on the 9th floor of City Hall.

Even if the Common Council approves the proposal, the Planning board will get the final say in the matter.

So far, no other protests are scheduled. Organizers say they will wait until the Common Council votes before organizing any more protests.

Tuesday, January 30, 2007

This Monday Hewlett-Packard is to announce that it is expanding its partnership with SAP. The partnership will be working with NetWeaver around several new services. The company is also expected to mention about its new enterprise solutions that are currently in development.

Hewlett-Packard will offer its clients services for upgrading servers, storage and NetWeaver – SAP’s application builder platform meant for integrating business processes throughout different systems. Among other services that the company is going to provide comprise assessment, governance and some architecture services for R3.

The manager of Worldwide Packaged Applications for Enterprise Applications Services at HP Services Consulting & Integration, Tim Treat, stated that the company first of all looks at servers, storage and management and only afterwards it makes a proposal regarding the things that are to be updated. He mentioned that when Hewlett-Packard will work on upgrading servers and management, it will turn its attention towards Intel.

After performing all the upgrades, the company is going to offer its clientele a variety of services package options that are related to NetWeaver. The services offered by Hewlett-Packard will include: enabling the service, design and implementation, application development and management.

Tim Treat said that adaptive infrastructure is one of the company’s new things that are to come. Recently the company’s clients have put in place enough hardware capacity and infrastructure with the goal of supporting peak or quarter-end processes. However, a big amount of that capacity is unused till peak times. This is why Hewlett-Packard looks forward to bring solutions that are to allow users pay for the things they really use.

Treat also outlined the fact that, besides its new services, the company is to announce business-process consulting together with IDS Scheer – software and consulting company, which is one of the leading providers of Business Process Management and IT solutions.