Prescription Drugs and Industrial Chemicals Threaten the Great Lakes

By Brian Kemp
The Great Lakes have faced various threats for years, from industrial pollution to invasive species, but another challenge worries many researchers these days - the emerging chemical threat.

It's not just pesticides, as scientists are finding worrying levels of pharmaceutically active compounds such as anti-inflammatories, antibiotics, anti-epileptics, and beta blockers in lake water. As well, hormones, pesticides and alkylphenols have been identified as threats.

These products and medicines flushed down toilets and dumped into sinks are not stopped at water treatment plants, which are not geared to deal with them.

A new report prepared for the International Joint Commission by two Windsor, Ont., researchers has outlined the threats the chemicals pose. The International Joint Commission was formed by the U.S. and Canadian governments to find solutions to problems in the Great Lakes Basin.

The compounds "are receiving attention due to their potential adverse effects on animals and humans at low levels of exposure," said the report, co-authored by Merih Otker Uslu and Nihar Biswas of the University of Windsor. They sound a warning later in the report, which is a review of data collected from 2007-11.

UN urges more funds for HIV drugs

In India, the rate of new HIV infections fell by more than 50%, according to UNAids

The head of the agency, Michael Sidibe, said a new study showed it could reduce the risk of HIV transmission by 96%.

He said the challenge was to expand access to drugs, and deal with social factors which stigmatise the disease.

On Thursday, a UN report said there had been a nearly 25% decline in new HIV infections and a reduction in Aids-related deaths during the past decade.

It was published ahead of the 30th anniversary on Sunday of the first official report on Aids by the US Centers for Disease Control and Prevention.

The General Assembly is to meet at UN headquarters to discuss the epidemic next week, with 20 world leaders and more than 100 ministers expected to attend.

An estimated 34 million people were living with HIV at the end of 2010 and nearly 30 million have died from Aids-related causes since 1981, the report said.

'Shunned disease'

In the report published ahead of the anniversary, UNAids said the global rate of new HIV infections had declined by nearly 25% between 2001 and 2009.

Continue reading the main story30 years of HIV 5 June 1981: Center for Disease Control mentions a new virus in its weekly mortality report 1982: The term Aids (acquired immunodeficiency syndrome) first used 1984: Virus identified and named HIV 1985: Rock Hudson dies of Aids, teenage haemophiliac Ryan White expelled from school because infected through treatment 1987: First showing of Aids Memorial Quilt on National Mall in Washington DC 1991: Jeremy Irons wears red ribbon and basketball's Magic Johnson has the virus 1993: Philadelphia film wins two Oscars 2000: Infection rate in US among African Americans overtakes that in gay men 2011: Global death toll 22m, infections 60m How a red ribbon conquered the world'More money needed' for HIV cure In India, the rate of new HIV infections fell by more than 50% and in South Africa by more than 35%; both countries have the largest number of people living with HIV on their continents.

The report found that in the third decade of the epidemic, people were starting to adopt safer sexual behaviour, reflecting the impact of HIV prevention and awareness efforts. But there were still important gaps, it warned, with young men more likely to be informed about HIV prevention than young women.

There has also been significant progress in preventing new HIV infections among children as increasing numbers of mothers living with HIV have gained access to antiretroviral prophylaxis during pregnancy, delivery and breastfeeding.

About 6.6 million people in low- and middle-income countries were receiving antiretroviral drugs at the end of 2010, a nearly 22-fold increase since 2001.

"Thirty years ago this mystery disease was called a gay plague - it was a shunned disease, people were scared about each other," Mr Sidibe said. "Now it's a completely different world - we've been breaking the conspiracy of silence."

However, the report found that at the end of last year nearly nine million people who needed treatment were not getting it, and that treatment access for children was lower than for adults.

And while the rate of new HIV infections has declined globally, the total number of HIV infections remains high, at about 7,000 per day.

The report also noted that there had been an increase in the rate of new HIV infections in Eastern Europe and in the Middle East and North Africa, and that HIV was the leading cause of death among women of reproductive age.

'Game-changer'

UNAids also said that while funding for HIV treatments in low- and middle-income countries had risen 10-fold between 2001 and 2009, international resources had declined in 2010. Many states remain dependant on external financing.

Continue reading the main story“Start QuoteAccess to treatment will transform the Aids response in the next decade”

End QuoteMichael SidibeExecutive Director, UNAIDS "I am worried that international investments are falling at a time when the Aids response is delivering results for people," Mr Sidibe said. "If we do not invest now, we will have to pay several times more in the future."

He stressed the importance of a recent trial, which found that if a person living with HIV adhered to an effective antiretroviral regimen, the risk of transmitting the virus to their uninfected sexual partner could be reduced by 96%.

"Access to treatment will transform the Aids response in the next decade. We must invest in accelerating access and finding new treatment options.

"Antiretroviral therapy is a bigger game-changer than ever before - it not only stops people from dying, but also prevents transmission of HIV to women, men and children," he added.

Mr Sidibe said the challenge was to expand access to drugs, and deal with social factors that in some countries continue to stigmatise the disease and make women particularly vulnerable.

To do this, UNAids believes an investment of at least $22bn is needed by 2015, $6bn more than is available today. It estimates such funds would stop 12m new HIV infections and 7.4m Aids-related deaths by 2020.

US-Led Global War on Drugs a Failure: Report

A 19-member international panel has condemned the US-led "War on Drugs" campaign as a failure and has recommended major reforms of the global drug prohibition regime.

The Global Commission on Drug Policy report, released on Thursday, argues that the four-decades-long campaign has failed to make significant changes in the international drug scenario and has, in fact, devastating consequences on human societies across the world.

The term "War on Drugs" was first used by US President Richard Nixon on June 17, 1971 and was intended to define and reduce illicit drug trade globally. However, the new report points out that the result of this campaign has been nothing but a drastic increase in drug violence, especially in regions like Brazil and Mexico.

"Fifty years after the initiation of the UN Single Convention on Narcotic Drugs, and 40 years after President Nixon launched the US government's global war on drugs, fundamental reforms in national and global drug control policies are urgently needed," stated former president of Brazil Fernando Henrique Cardoso. "Let's start by treating drug addiction as a health issue, reducing drug demand through proven educational initiatives and legally regulating rather than criminalizing cannabis." 

Study calls for heart drugs at 55

The study says preventive treatments like cholesterol and blood pressure lowering drugs could be given to all people over 55 Continue reading the main storyRelated StoriesWaist fat 'increases heart risk'Tomato pill 'beats heart disease'Gum and heart link 'breakthrough' All those over 55 should be offered drugs to lower cholesterol and blood pressure, according to a new study.

The report says that when assessing the risk of heart problems, offering treatment to all over-55s had the same results as testing for cholesterol or blood pressure problems.

The authors also argue it would be more simpler and cost effective.

But the Department of Health says the focus of the study is too narrow and ignores other health problems.

Writing in the open access journal PLoS ONE the authors, from the Wolfson Institute at Barts and the London Medical School, said age was by far the biggest factor in assessing someone's risk of cardiovascular disease such as heart attack or stroke.

They compared the effects of two screening programmes on a theoretical population of 500,000 people.

The first approach used screening just by age, where, at the age of 55, people would be offered preventive treatment, regardless of whether they were at risk.

Continue reading the main story“Start QuoteThe policy of selecting people above a certain age is, in effect, selecting people at high risk. It recognises that age is by far the most important determinant of that risk with other factors adding little extra prognostic information”

End QuoteProfessor Sir Nicholas WaldDirector of the Wolfson Institute The second approach used existing screening methods, based on age and sex, and whether someone was a smoker or has high blood pressure or cholesterol.

They found that both approaches had an 84% detection rate, but that offering everyone preventive treatment at 55 would be more cost effective.

The two methods also had a broadly similar false-positive rate - in other words, using age alone would diagnose 24% of people as being at risk, when in fact they would not go on to develop heart problems.

Existing methods of screening identified 21% of false-positives.

If screening by age alone was introduced, the authors believe it could prevent as many as 100,000 heart attacks and strokes each year in England and Wales alone.

Professor Sir Nicholas Wald is the lead author of the report and Director of the Wolfson Institute.

He said: "This study shows that age screening for future cardiovascular disease is simpler than current assessments, with a similar screening performance and cost effectiveness. It also avoids the need for blood tests and medical examinations.

"With age screening, all individuals above a specified age would be offered preventive treatment. Everyone would benefit because, for blood pressure and cholesterol, the lower the better.

"The policy of selecting people above a certain age is, in effect, selecting people at high risk. It recognises that age is by far the most important determinant of that risk with other factors adding little extra prognostic information.

"Prevention is better than measurement. Identifying people at high risk of cardiovascular disease needs to be greatly simplified, enabling people to obtain easy access to preventive treatment from nurses and pharmacists as well as from doctors."

Drugs 'can prevent breast cancer'

Breast density could be a risk factor of breast cancer Women at high risk of developing breast cancer should be given preventative drugs, according to an international panel of cancer experts.

Writing in the Lancet Oncology, they said drugs such as tamoxifen could reduce the chances of developing breast cancer.

Such a policy would be similar to prescribing statins to patients at risk of heart disease, they suggest.

However, tamoxifen has been linked with womb cancer, blood clots and stroke.

In the UK, 46,000 women are diagnosed with breast cancer each year.

Two drugs, tamoxifen and raloxifene, have been approved in the US for the prevention of breast cancer. However, they are not available as a preventative measure in the UK.

Professor Jack Cuzick, who chaired the panel and is an epidemiologist at Queen Mary, University of London, told the BBC: "The two drugs should be approved in the UK. The evidence for them is overwhelming."

He estimates that for every 1000 women given tamoxifen there would be 20 fewer breast cancers, but there would also be three more womb cancers and six more cases of deep vein thrombosis.

To balance the risks, the panel agreed that women who had a greater than 4% chance of developing breast cancer in the next 10 years should be offered preventative therapy.

Predicting risk

In heart disease, there are well-known risk factors such as blood pressure and cholesterol, which can inform treatment.

The challenge for any preventative breast cancer treatment would be identifying similar "markers" of risk.

The panel suggests breast density. They say patients with more than 75% "dense breast tissue" had at least four times the risk of developing breast cancer than patients with mainly non-dense tissue.

Professor Cuzick said: "Increased breast density is one of the leading risk factors for breast cancer and early trial results suggest that where tamoxifen is shown to decrease density, the risk of cancer decreases.

"If this is confirmed in long-term studies, breast density could become a powerful way to identify high-risk women who could benefit from preventive treatments."

He suggests the risk of getting breast cancer should be determined during cancer screening.

Dr Lesley Walker, from Cancer Research UK, said: "Our scientists were behind some of the first trials showing the long term benefits of tamoxifen for preventing breast cancer in women with a greater than average risk of the disease.

"Being able to accurately predict breast cancer risk and who will respond to preventative drugs like these is a crucial step in ensuring women get the most suitable treatment."

Meg McArthur, senior policy officer at Breakthrough Breast Cancer said: "It is vital that we find effective ways to prevent breast cancer, especially in women with a high risk. However, as preventative therapy may have negative side effects it would not be appropriate for everyone.

"We welcome studies investigating the best treatments to be used for breast cancer prevention. It's also crucial to identify those at high-risk who would benefit the most from this form of therapy."

Fracture warning over bone drugs

Bisphosphonates slow down bone turnover US regulators are warning patients that drugs used to protect brittle bones may increase fracture risk in rare cases.

The Food and Drugs Administration (FDA) says all drugs in the bisphosphonate class must carry an alert on their label about this unusual side effect.

They say patients should keep taking the pills unless they are told by their doctor to stop.

In the UK, only one bisphosphonate drug - alendronate - carries the warning but regulators are reviewing this decision.

Continue reading the main storyRelated storiesBone drug linked to cancer risk Nearly three million people in the UK have osteoporosis, a condition that makes the bones brittle and causes about 230,000 fractures a year.

Bisphosphonates are given to more than half a million of these patients in a bid to strengthen their bones and reduce their risk of a fracture.

But experts are becoming increasingly concerned that the drugs may cause the very thing they are trying to prevent after finding a link between their use and an unusual type of leg fracture.

Continue reading the main story“Start QuoteAt present it is uncertain whether these fractures are directly related to treatment but an association has not been excluded”

End QuoteA spokesman for the National Osteoporosis Society The FDA says it is not clear whether bisphosphonates are the cause of these thigh bone breaks, but they are concerned enough to tell manufacturers to add warnings to medication packets.

FDA medical officer Theresa Kehoe said they would continue to monitor the safety of the drugs, adding: "In the interim, it's important for patients and health care professionals to have all the safety information available when determining the best course of treatment for osteoporosis."

The FDA says patients should keep taking their medication unless they are advised by their doctor to stop.

Under review

The UK's drug regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA), said it had begun to look at the possible increased risk of fractures in patients taking bisphosphonates in case it was an effect common to all members of that drug family, not just alendronate.

A spokeswoman said: "The committee will now review all available data thoroughly, including published data, non-clinical and clinical data, and post-marketing reports, to clarify whether atypical stress fractures are a class effect of bisphosphonates, and will assess their impact on the balance of risks and benefits of these medicines."

A spokesman for the National Osteoporosis Society said: "At present it is uncertain whether these fractures are directly related to treatment but an association has not been excluded.

"Bisphosphonates slow down the rate at which bone is destroyed and replaced, by reducing the activity of osteoclast cells that break down bone.

"Although this is a useful process to prevent bone loss and fractures, there are concerns that over a prolonged period of time, this may result in bones becoming 'older' and more brittle."

He said it should be remembered that these unusual fractures are rare and that in the vast majority of patients the benefits of treatment will far outweigh the risks.

A recent study, published last month in the British Medical Journal, linked bisphosphonate use to cancer of the gullet.