Anthony walks the streets of Philadelphia’s Kensington neighborhood looking for two competing things: His next heroin fix – and help in what he says is his struggle to end addiction.

He traces the habit to one fateful day.

“I shattered my leg and I was on oxycodone pain medication prescribed through my doctor,” recalls the 28-year-old, who asked for anonymity to share his story. “I withdrew so bad, a friend put me on heroin and it’s been a slippery slide for five years.”

He ended up in Kensington, a predominantly Hispanic neighborhood where drug users can find some of the cheapest and purest heroin in the country. The area is also home to unscrupulous healthcare providers who continue to over-prescribe opioid medications. 

Open drug use occurs within easy view of storefronts. Teenagers riding their bikes pass addicts in zombie-like states on the sidewalks and porches. Kensington is a destination for heroin users from afar. Many end up staying to feed their addiction.

“We have not only people from other parts of the state, we have people from other parts of the country who come here,” said Drug Enforcement Administration (DEA), Special Agent Patrick Trainor. “Unfortunately, it’s sparked a heroin tourism industry,”

The drug epidemic is not a new phenomenon for Kensington. For decades, it’s contended with addicts. More than half the population lives below the poverty line, 2.5 times the rate of the rest of Philadelphia. The wide availability of prescription opioids from healthcare providers, along with the influx of individuals from outside the community, has made matters dramatically worse.

In 2017, a deal was reached by city officials to clear out an open air heroin market known as El Campamento, or “The Tracks.”

It existed beneath sunken train tracks, hidden from street level. The property was riddled with syringes and all kinds of drug paraphernalia.

People in the area regularly died from drug overdoses. At times, 75 to 125 opioid addicts lived there in makeshift homes.

“It was contained,” said Councilwoman Maria Quinones Sanchez, who represents the Philadelphia district that includes Kensington. “But now it’s out in the open and people are kind of struggling about dealing with the problem. What are we going to do with it? Because this problem is not going to go away in the next six months or in the next year,” said Sanchez.

Pure Heroin Fills the Streets of Kensington

The attraction of Kensington is simple: cheap and powerful heroin primarily piped in by Mexico’s Sinaloa cartel. And in the streets of Kensington, drug dealers compete with one another to sell heroin, some laced with fentanyl, a synthetic opioid.

“In order to compete, you have to have the purest stuff on the street, we’ve seen purity levels in Philadelphia around 93% at times, and that’s street purity level,” said (Drug Enforcement Administration) DEA Special Agent in Charge Gary Tuggle. “So in order to compete with that, many groups have started to adulterate that 50% [of heroin] or so with fentanyl. Often not recognizing the fact that fentanyl is 80 to 100 times more powerful than morphine, 50 to 80 times more powerful than heroin.”

Davey, a 31-year-old heroin addict knows firsthand how strong, and dangerous, the fentanyl laced drug can be. “I had a good friend, the bag was empty, I scraped an empty bag for him, some grains, and just a tiny amount and he overdosed,” Davey said. “That’s just how powerful it is.”

Philadelphia recorded over 900 overdose deaths in 2016. Officials say the city is on track for at least 1,200 deaths in 2017. Overdoses are the number one cause of death in Philadelphia for every age group from 25 to 44, the number two cause from age 45 to 54, and the number three cause from age 55 to 64.

“It’s extraordinary to have an epidemic like this appear on leading causes of death,” said Dr. Thomas Farley, Philadelphia’s Health Commissioner. “The problem is not only not slowing down, but it’s accelerating. There are not enough beds for addicts he said.

“I lived through the worst drug epidemics in the country’s history. The post-Vietnam heroin epidemic, the crack cocaine epidemic of the ‘80s and early ‘90s and then there’s this particular opioid epidemic that dwarfs the other two,” Tuggle said.

“It has a feeder system to it that the others didn’t have. And that’s the misuse and abuse of prescription opioids,” Tuggle said.

“We still have a major focus on the enforcement piece, but we also engage with the community in prevention and education to try to drive down that insatiable demand for opioids that exists in this country,” said Tuggle. The engagement includes non-traditional partnerships within the public health sector such as treatment providers and medical examiners where they analyze data to assist in explaining the drug epidemic trends.

Councilwoman Sanchez wants all sectors working together to ensure those who understand what is happening are the ones leading the fight. “We now have to have the political will to sit all of those actors at the table and say, ‘OK, how do we work our way backwards,” she said.

The biggest obstacles are lack of treatment facilities and housing for addicts and others. Estimates suggest that 30,000 heroin addicts are in Philadelphia, currently, only half would have access to proper treatment.

“Not all people who are drug users have housing, and housing is often a part of treatment. It’s hard for people to get treatment if they are living on the street,” said Dr. Farley. 

A Community Connected beyond the Drug Epidemic

On a recent walk down Kensington Avenue, Sanchez recalls growing up in the neighborhood and her commitment to the people.

“All I see is people who survive despite circumstances that are sometimes created outside of their control, and those are the folks that I represent,” she said. “And so my job is to be the cheerleader for those folks who work really hard and despite all the situation, whether it’s the teacher, principal, the librarians, you know, the folks that are here.”

Convenience store owner Sam Kuttab said things have improved some. He plans to stay in Kensington.

“About 10 years ago we had a big fire here and the insurance company paid us good money,” Kuttab said. “We could have just taken the money and moved on. But we felt there is a community here, there’s a community here that really appreciated our services, and we appreciated them. So we put our money back into this neighborhood, and it’s paid off,” he said.

Officials recognize there are obstacles, but unless they do something impactful more people will die in Kensington and Philadelphia.
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President Trump’s opioid commission is calling for more federal funding to battle addiction and deadly opioid drug-related overdoses in the United States. More than 175 Americans are dying every day and the Trump administration has declared the opioid crisis a “public health emergency”. VOA’s Chris Simkins takes us to a hard hit Philadelphia neighborhood where the opioid epidemic is on open display.
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The World Health Organization reports the Saudi-led blockade of Yemen’s sea ports is hampering efforts to contain a diphtheria outbreak that, so far, has caused 197 cases of the disease, including 22 deaths.

Diphtheria has spread to 13 of Yemen’s 22 governorates, including the capital Sana’a, since the first case was detected less than two weeks ago.  World Health Organization spokesman Christian Lindmeier, says the Saudi blockade is hindering WHO’s ability to import the vaccines needed to keep the disease in check.

“There is still not even one dose of Tetanus-Diphtheria vaccine in the country for children above five years and young adults,” said Lindmeier. “Around 8.5 million doses are needed for three rounds of the vaccination campaign.” 

Diphtheria is an infectious bacterial disease.  It can cause severe breathing difficulties, suffocating its victims to death.  Lindmeier tells VOA diphtheria is a vaccine-preventable disease.

“So, what we did is, we had a vaccination campaign for children under five years,” said Lindmeier. “That was possible with the material which was available in country.  And, 1,000 doses of anti-toxins have reached Sana’a on Monday, just Monday 27th…These things are crucial, these things are important.”

Following an international outcry, Saudi Arabia has partially lifted the blockade.  As a consequence, Lindmeier says a ship carrying 33 tons of medical supplies, including surgical supply kits, infant incubators, and vaccine cold boxes is arriving in Hodeida port.

But, because of the long delay and closure of access, he says there is a big backlog of anti-diphtheria vaccines and other supplies stored in Djibouti and elsewhere waiting to get in.

 
…

Physical therapists can be a vital part of getting injured people back on their feet. But the therapy they recommend can sometimes be less than precise. Some new technology now being used in Italy could be a valuable tool for helping people recover from their injuries. VOA’s Kevin Enochs reports.
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The U.S. city of San Diego has opened the first of three large tents that together will house 700 homeless people in an effort to contain an outbreak of hepatitis A that is being spread among the homeless population.

About 20 people made the tent their temporary home Friday. The first tent erected will house 350 single men and women. The other two tents, which will open later this month, will be for families and veterans.

Bob McElroy of the Alpha Project, the nonprofit group that is operating the tent that opened Friday, said he expects the tent to be filled to capacity by the middle of next week.

City officials are using the tents as a way to get people off the streets where they have been living in such poor conditions that it has led to one of the worst outbreaks of hepatitis A in years. The disease, which is spread through feces, has left 20 people dead and sent hundreds to the hospital.

The new tents will provide a range of services to the homeless, including help with mental health issues, addiction and employment. The tent grounds also include portable showers and toilets.

The tents are not the first of their kind in the city. Officials had previously erected two large tents as winter shelters but took them down two years ago and moved the residents to a local shelter.
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TC Bell knows what life is like without health insurance after growing up with a mother who cobbled together care from a public health clinic, emergency room visits and off-the-books visits to a doctor they knew.

That memory makes Bell, of Denver, grateful for the coverage his two daughters have now under the Children’s Health Insurance Program — and concerned about its uncertain future in Congress.

“There’s an incredible security that I have with CHIP,” said Bell, 30, who has gone back to community college to reboot his life after working a series of low-paying jobs. “If my daughters get sick or seriously injured, we can take them to their doctor, rather than when I was growing and had to go through the emergency room. We always kept our fingers crossed back then.” 

Political stalemate

CHIP provides low-cost coverage to children in families that earn too much to qualify for Medicaid. But it has become caught up in a political stalemate over how to fund it. 

Congress failed to reauthorize the program before it expired in September. Several states are expected to deplete their remaining funds for it by next month. The uncertainty has left states scrambling — and causing worries for families that depend on the program.

“The fact that they want to play politics with our kids’ health care is appalling,” Bell said. “All we’re asking for is an investment, not a handout. CHIP was built for the working class.” 

Different situations for each states

Each state designs its own version of CHIP with different rules and coverage, so each faces a somewhat different situation. But Arizona, California, Colorado, Minnesota, Ohio, Oregon and the District of Columbia are among the first expected to exhaust their CHIP allotments.

“We’re seeing every month more and more states running out of their funding for their CHIP programs, so it’s becoming more of a national issue,” said Emily Piper, Minnesota’s human services commissioner.

Fresh federal money for CHIP, which was created in 1997, dried up Oct. 1. Legislation to extend the program for five more years passed the House earlier this month.

However, majority Republicans decided to pay for it partly by cutting a public health program created under former President Barack Obama’s health care law, and by raising Medicare premiums on upper-income recipients. Those provisions make the bill less palatable in the Senate. Senators have agreed on a bill extending the program for five more years but remain divided over how to pay for it. 

“Congress was really focused this summer on repealing and replacing the Affordable Care Act, and there wasn’t a lot of oxygen left in the room to talk about just about anything else in health and human services,” Piper said. 

Solution to be part of spending bill

Now Congress has turned its attention to its tax bill, she added. “The CHIP program has been a bipartisan program for a really long time, and it’s more to do with other priorities than, I think, to do with people not wanting to fund CHIP.”

An eventual fix is expected to be part of a huge year-end spending bill aimed at preventing a federal government shutdown, but that’s not guaranteed.

Now, with funds running out, states are struggling with what to tell families who rely on CHIP, said Samantha Artiga, an analyst with the Kaiser Family Foundation. 

“They’re really trying to hold off as long as possible or on providing any notice to families,” Artiga said. “They don’t want to create confusion or fear or instability for families who are covered under the program.”

Colorado isn’t waiting

Colorado isn’t holding off any longer. The Department of Health Care Policy and Financing, which administers the Child Health Plus program, Colorado’s version of CHIP, began sending letters to enrollees Monday advising them that they need to look at private insurance coverage options if Congress fails to act. Formal termination notices could go out in mid-December.

The department estimates that Colorado’s federal funding won’t last beyond Jan. 31. More than 75,000 children and 800 pregnant women in Colorado are enrolled in CHP Plus. 

States set their own eligibility rules for the program. Colorado covers children 18 or younger and pregnant women 19 and older when household income is no more than 260 percent of the federal poverty guideline; for example, a family of four with income of $63,960 or less.

In Minnesota, CHIP serves about 125,000 children. Since Minnesota provides CHIP coverage through its Medicaid program, it has been able to secure some temporary emergency federal funds and plans to keep those children covered even if it needs to use its own money. But without a congressional solution Minnesota would eventually have to cut off about 1,700 pregnant women and new mothers, Piper said.

Arizona was in danger of running out of money by mid-December, but Republican Gov. Doug Ducey’s administration came up with a complicated plan to shift some funding around to make CHIP last until March, said Christine Corieri, the governor’s health policy adviser.

“There’s a lot of things I think that we can argue about. There’s a lot of things that divide us,” Ducey said. “Taking care of these kids in this situation I think is something that should unite us.”

Delay tough on families

Arizona has about 74,000 children covered under Medicaid expansion and 23,000 under its CHIP program, known as KidsCare. Those include Corina Mejia’s two sons. 

Mejia, a single mother in Phoenix, works as a school community liaison officer. She has health insurance for herself through her job but needs KidsCare to make insuring her children affordable. Her older son, Isaiah, 11, has asthma and requires regular checkups and medication, while infant Jorge was born prematurely. Mejia said she doesn’t know what she’ll do if lawmakers keep balking.

“They need to put themselves in our position and have an open mind,” Mejia said. “A lot of us parents do work, but we just happen to not make enough to be able to provide the medically necessary needs that we have to provide for our children.”
…

The first birth as a result of a womb transplant in the United States has occurred in Texas, a milestone for the U.S. but one achieved several years ago in Sweden.

A woman who had been born without a uterus gave birth to the baby at Baylor University Medical Center in Dallas.

Hospital spokesman Craig Civale confirmed Friday that the birth had taken place, but said no other details are available. The hospital did not identify the woman, citing her privacy.

Baylor has had a study under way for several years to enroll up to 10 women for uterus transplants. In October 2016, the hospital said four women had received transplants but that three of the wombs had to be removed because of poor blood flow.

The hospital would give no further information on how many transplants have been performed since then. But Time magazine, which first reported the U.S. baby’s birth, says eight have been done in all, and that another woman is currently pregnant as a result.

A news conference was scheduled Monday to discuss the Dallas baby’s birth.

A doctor in Sweden, Mats Brannstrom, is the first in the world to deliver a baby as a result of a uterus transplant. As of last year, he had delivered five babies from women with donated wombs.

There have been at least 16 uterus transplants worldwide, including one in Cleveland from a deceased donor that had to be removed because of complications. Last month, Penn Medicine in Philadelphia announced that it also would start offering womb transplants.

Baylor transplants

Womb donors can be dead or alive, and the Baylor study aims to use some of both. The first four cases involved “altruistic” donors — unrelated and unknown to the recipients. The ones done in Sweden were from live donors, mostly from the recipients’ mother or a sister.

Doctors hope that womb transplants will enable as many as several thousand women born without a uterus to bear children. To be eligible for the Baylor study, women must be 20 to 35 years old and have healthy, normal ovaries. They will first have in vitro fertilization to retrieve and fertilize their eggs and produce embryos that can be frozen until they are ready to attempt pregnancy.

After the uterus transplant, the embryos can be thawed and implanted, at least a year after the transplant to make sure the womb is working well. A baby resulting from a uterine transplant would be delivered by cesarean section. The wombs are not intended to be permanent. Having one means a woman must take powerful drugs to prevent organ rejection, and the drugs pose long-term health risks, so the uterus would be removed after one or two successful pregnancies.

The American Society for Reproductive Medicine issued a statement Friday calling the Dallas birth “another important milestone in the history of reproductive medicine.”

For women born without a functioning uterus, “transplantation represents the only way they can carry a pregnancy,” the statement said. The group is convening experts to develop guidelines for programs that want to offer this service.
…

A dazzling discovery in northwestern China of hundreds of fossilized pterosaur eggs is providing fresh understanding of these flying reptiles that lived alongside the dinosaurs, including evidence that their babies were born flightless and needed parental care.

Scientists said Thursday that they had unearthed 215 eggs of the fish-eating Hamipterus tianshanensis — a species whose adults had a crest atop an elongated skull, pointy teeth and a wingspan of more than 11 feet (3.5 meters) — including 16 eggs containing partial embryonic remains.

Fossils of hundreds of male and female adult Hamipterus individuals were found alongside juveniles and eggs at the Xinjiang Uygur Autonomous Region site, making this Cretaceous Period species that lived 120 million years ago perhaps the best understood of all pterosaurs.

“We want to call this region ‘Pterosaur Eden,’ ” said paleontologist Shunxing Jiang of the Chinese Academy of Sciences’ Institute of Vertebrate Paleontology and Paleoanthropology.

Pterosaurs were Earth’s first flying vertebrates. Birds and bats appeared later.

Until now, no pterosaur eggs had been found with embryos preserved in three dimensions. Researchers think up to 300 eggs may be present at the Xinjiang Uygur site, some buried under the exposed fossils.

The embryonic bones indicated the hind legs of a baby Hamipterus developed more rapidly than crucial wing elements like the humerus bone, said paleontologist Alexander Kellner of Museu Nacional in Rio de Janeiro.

“Some birds can fly on the same day they break out from the egg, while some others will need a long period of parental care. Our conclusion is that a baby Hamipterus can walk but can’t fly,” Jiang said, an unexpected finding.

The researchers believe these pterosaurs lived in a bustling colony near a large freshwater lake. Kellner cited evidence that females gathered together to lay eggs in nesting colonies and returned over the years to the same nesting site.

They suspect the eggs and some juvenile and adult individuals were washed away from a nesting site in a storm and into the lake, where they were preserved and later fossilized.

The oblong eggs, up to about 3 inches (7.2 centimeters) long, were pliable with a thin, hard outer layer marked by cracking and crazing covering a thick membrane inner layer, resembling soft eggs of some modern snakes and lizards.

There had been a paucity of pterosaur eggs and embryos in the paleontological record because it is difficult for soft-shelled eggs to fossilize.

The research was published in the journal Science.
…

U.S. regulators have approved a first-of-a-kind test that looks for mutations in hundreds of cancer genes at once, giving a more complete picture of what’s driving a patient’s tumor and aiding efforts to match treatments to those flaws.

The U.S. Food and Drug Administration approved Foundation Medicine’s test for patients with advanced or widely spread cancers, and the Centers for Medicare and Medicaid Services proposed covering it.

The dual decisions, announced late Thursday, will make tumor-gene profiling available to far more cancer patients than the few who get it now, and lead more insurers to cover it.

“It’s essentially individualized, precision medicine,” said Dr. Kate Goodrich, chief medical officer for the Medicare oversight agency.

Currently, patients may get tested for individual genes if a drug is available to target those mutations. It’s a hit-and-miss approach that sometimes means multiple biopsies and wasted time. In lung cancer alone, for example, about half a dozen genes can be checked with individual tests to see if a particular drug is a good match.

The new FoundationOne CDx test can be used for any solid tumor such as prostate, breast or colon cancer, and surveys 324 genes plus other features that can help predict success with treatments that enlist the immune system.

“Instead of one or two, you have many” tests at once from a single tissue sample, said the FDA’s Dr. Jeffrey Shuren. The tests give better and more information to guide treatment and can help more patients find and enroll in studies of novel therapies, he said.

“This will be a sea change” for patients, said Dr. Richard Schilsky, chief medical officer of the American Society of Clinical Oncology, the association of doctors who treat the disease.

“On balance I think this is good,” but there is a risk that spotting a mutation will lead doctors and patients to try treatments that haven’t been proven to work in that situation and promote more off-label use of expensive drugs, he said.

A better outcome in those situations is to guide people into studies testing drugs that target those genes, Schilsky said.

Foundation Medicine, based in Cambridge, Massachusetts, and others have sold tumor profiling tests for several years under more lax rules governing lab-developed tests. But insurers have balked at paying for the tests, which cost around $6,000.

Now, the FDA’s approval gives assurance of quality, Shuren said, and the government’s proposed coverage for Medicare and other public insurance programs means private insurers will more likely follow.

Public comments on the coverage proposal will be taken for 30 days. A final decision is expected early next year followed by setting a price for reimbursement.

Coverage is proposed for patients with recurrent, widely spread or advanced cancers, in people who have decided with their doctors to seek further treatment and who have not previously had a gene sequencing test.

“A lot of these folks have run out of treatment options,” but the tests may point to something new that might help, Goodrich said.

The impact is expected to be greatest on lung cancer, since so many of those tumors are found at an advanced stage and multiple gene-targeting drugs are available to treat it.

Evidence isn’t strong enough to warrant using these gene profiling tests for earlier stages of cancer. Patients get standard, guideline-based care in those cases.

In mid-November, the FDA also approved a gene-profiling test developed by Memorial Sloan Kettering Cancer Center, but it’s used almost exclusively on patients at that cancer center and is not envisioned to be a widely available commercial test.

The federal decisions will make gene sequencing a more routine component of cancer care, “just like we normally look with a microscope” to classify the stage of a patient’s disease, said Dr. David Klimstra, pathology chief at the cancer center.

Another leader in this field, Caris Life Sciences, says it also intends to pursue FDA approval for its widely used tumor profiling test, sold now through lab certifications. It’s also working on a newer tool to profile tumor genes from a blood sample. Many companies already sell these so-called liquid biopsy tests, though none are FDA-approved yet.

This Associated Press series was produced in partnership with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
…

A new report issued on World AIDS Day finds more men than women are dying from AIDS because fewer men get tested for the fatal disease or have access to treatment.

The report finds men have, what it calls, a blind spot when it comes to getting tested for HIV, the virus that causes AIDS. And, if they do not know their HIV status, the report says men are unlikely to get treatment and will die.  

UNAIDS says this situation is particularly acute in sub-Saharan Africa, where men and boys living with HIV are 20 percent less likely than HIV-positive women and girls to know their status. The report says even larger numbers are less likely to seek treatment and warns that  people who are not being treated are more likely to transmit the AIDS virus.

While more women are likely to be living with HIV, more men are likely to die from this fatal disease, says Peter Ghys, the chief strategy officer at UNAIDS. He says the reason is that fewer men than women receive antiretroviral therapy – citing a figure of 47 percent for men compared to 60 percent for women.

“Then also once people are on treatment, we find that men are actually less likely to be fully observant or adherent to their treatment,” said Ghys. “And, so it results actually in a higher mortality of men living with HIV than women living with HIV. And so, about 58 percent of all the AIDS-related deaths that were observed in 2016 are occurring among men, even though there are more women living with HIV.” 

Global trends on the HIV/AIDS epidemic are generally positive. New data show AIDS-related deaths have declined by nearly half since a peak in 2005; but, the epidemic is far from over. UNAIDS reports nearly 2 million people worldwide became newly infected with HIV last year and more than one million people died from AIDS-related illnesses.

The report shows fewer men than women visit health care facilities and so are less likely to be diagnosed with life-threatening conditions. It says many men avoid getting tested because they fear being stigmatized by knowing their HIV status. Many others, it says refrain from receiving life-saving treatment because they believe they are invincible.

 

 
…

Friday marks World AIDS Day, and the World Health Organization is promoting a campaign of universal health coverage to help the 36.7 million people around the world living with HIV/AIDS. Gabrielle Weiss reports for VOA on the efforts of a Washington, D.C., clinic, Whitman Walker Health.
…

New, long-acting drugs may offer hope to millions of people who suffer from migraines. Studies of two of these medicines, given as shots every month or so, found they cut the frequency of the notoriously painful and disabling headaches.

The drugs are the first preventive medicines developed specifically for migraines. They work by interfering with a substance involved in modifying nerve signaling and progression of pain and symptoms.

“It’s a whole new direction” for treatment and an important advance for people who don’t want to take or aren’t helped by the daily pills sometimes used now to prevent recurrences, said Dr. Andrew Hershey, neurology chief at Cincinnati Children’s Hospital Medical Center.

He had no role in the research but has tested other migraine drugs and wrote a commentary published with the studies Wednesday by the New England Journal of Medicine.

Migraines plague more than a billion people worldwide, more than 38 million in the U.S. alone. They’re more severe than an ordinary headache — throbbing, squeezing pain and pressure, often accompanied by vision problems, sensitivity to light, noise or smells, and nausea. They can leave people unable to work or do simple things like cooking or even holding a conversation.

What studies show

One study tested erenumab, from Amgen and Novartis, in about 900 people who averaged eight migraines a month. Nearly half had already tried other preventive medicines.

For six months, they were given monthly shots into the abdomen of a high dose of the drug, a low dose or a dummy medicine. The number of days they suffered migraines each month dropped by three to four in the drug groups and nearly two in the placebo group. Half of the patients on the higher dose saw their migraine days cut at least in half.

“I very definitely benefited,” said Anne Vickers, who got the lower dose through one of the study leaders at Mercy Hospital St. Louis in Missouri.

“I can have anywhere from 15 to 18 headaches per month, and probably five of those days are migraines,” but that dropped 40 percent on the drug, she said. “I have three kids, so for me it meant having more days when I was able to live my everyday life, cook a meal at home, go to events at school.”

The second study tested fremanezumab, from Teva Pharmaceutical, for chronic migraines, defined as headaches on 15 or more days per month, at least eight of them migraines.

About 1,000 patients were given monthly shots for three months: One-third got the drug each time, another third got the drug the first time and then dummy shots the next two times, and the rest got dummy shots each time.

Monthly headache days dropped by four to five in the groups given the drug and by two to three for those given dummy treatments.

The caveats

Average reductions of one or two days a month are modest, but “there are some patients who have had a complete response — they become headache-free,” Hershey said.

No worrisome side effects emerged, but the studies were very short, so long-term safety and effectiveness are unknown.

The new drugs were not tested against existing ones, only placebo treatments.

Many study leaders work for or have other financial ties to the drugmakers, and the companies helped analyze results.

Biotech drugs like these tend to be very expensive, and if they’re approved, insurers may set big co-pays or require patients to try older medicines first, Hershey said. When the drugs did work, the benefit was seen right away, so there’s less financial risk in trying one or two doses.

“The patient will know quickly if this is a drug for them, and if not, move on to something else,” Hershey said.

Both drugs have been submitted to the U.S. Food and Drug Administration for approval. Eli Lilly and Co. and Alder Biopharmaceuticals also are testing similar drugs.
…

In a square in a poor eastern Tehran neighborhood known for its drug addicts and dealers, psychologist Atefeh Azimi draws another drop of blood from a worried passer-by’s finger.

 

She works on a nearby bench, where a sign next to her in English and in Farsi urges the public to receive free voluntary counseling and HIV testing.

 

But her worries, as well as those of her aid group called Reviving Values, are not confined these days just to those sharing needles to inject heroin that comes across the border from Afghanistan’s thriving opium trade.

 

Iran has seen a surge in the number of HIV infections spread by sex, especially among its youth. What’s more, authorities say many have no idea that they are infected.

 

That has led to growing uncomfortable questions in the Islamic Republic, where sex outside of marriage is prohibited and those who practice it can face arrest and severe punishment.

 

Some have dared challenge the long-standing taboos in Iran surrounding sex, speaking publicly about the need for safe sex, sex education and regular HIV testing.

 

“Everybody has a very bad attitude toward this disease,” said Mahboobeh Zeinali, an HIV-positive woman living in Tehran. “They even think if they wash their hand where I do they can be infected, but they can’t.”

 

According to government estimates, 66,000 people out of Iran’s 80 million people have HIV, though about 30,000 of them have no idea they have the virus. Iranian authorities blame that on how little general knowledge many have about the virus.

 

By comparison, in the United States, government statistics suggest 1.1 million people live with HIV, with one in seven not knowing it.

 

More than 50 percent of those with HIV in Iran are between 21 and 35, said Parvin Afsar Kazerouni, the head of the Health Ministry’s AIDS department. That’s despite that age group representing about 28 percent of Iran’s population as a whole.

 

The number of those infected through sex continues to rise.

 

“If we look at five or six years ago, the rate of infection through sex was around 16 or 17 percent, to 20 percent at the most. … Now it is up to 40 percent or even more in some provinces,” Dr. Mohammad Mahdi Gouya, Iran’s deputy health minister, told The Associated Press. “This is an alert for us, the people and the officials. They are addressing this issue very seriously.”

 

Societal mores play a part in the rise of HIV infections. As a Muslim country, Iranian clerics preach against sex outside of marriage and sex isn’t often discussed among children and parents. Schools offer little sexual education as well.

 

Sex outside of marriage is illegal and some have been prosecuted for merely shaking hands with a member of the opposite sex under Iran’s strict interpretation of Islamic law, or Shariah. However, police rarely interfere with young couples in Tehran walking hand-in-hand and whispering to each other.

 

The government blames drugs in part for the increase in HIV infections — though not those narcotics that are injected with a needle.

 

“Ecstasy drugs, synthetic addictive drugs and amphetamine combinations dramatically and abnormally raise sexual desire,” Gouya said.

 

Views on sex are also changing in Iran.

 

Previously, Iran allowed so-called “temporary marriages” or “sigheh” — a legal contract under Sharia law that allows a couple to share a hotel room or travel together, though it’s not publicly or officially backed by the government. The contracts last anything between several hours to a few years but are increasingly abandoned in mainstream life in most of the Muslim world.

 

Lately, Tehran has seen a quiet move toward so-called “white marriages,” or couples living together before being married even though it remains illegal.

 

Mohammad Mohammadi Golpayegani, Supreme Leader Ayatollah Ali Khamenei’s chief of staff, has criticized the practice, warning the “loose generation” that its offspring will “be illegitimate.”

 

Widespread access to satellite television, which in theory remains banned by authorities, also offers young Iranians access to images of Western culture, as does the internet.

 

About 60 percent of divorces across Iran come from those unhappy with sex in their marriages, said Mohammad Mahdi Labibi, a sociology professor at Tehran’s Azad University.

 

“When one of them is not satisfied, they will look for it outside their marriage,” in secret, Labibi said. Such “hidden sex increases the chance of being infected by any disease, including HIV.”

 

Prostitution also has been acknowledged by the government as a problem. Members of parliament have discussed the issue before, along with other “social problems,” according to Iranian media reports.

 

Today, Iran’s government treats some 10,000 people either infected with HIV or those with already developed AIDS, which weakens the immune system and gradually destroys the body’s ability to fight infections and certain cancers. It typically costs the government $16,000 a year to treat a patient, Gouya said.

 

Iranian society often ostracizes HIV-positive people, especially women.

 

“Most women here are in charge of their families, and unfortunately finding a job for them is very difficult,” said Najimeh Babagol, a psychologist who works with HIV-positive women. “Many of them get rejected went they reveal [they are HIV positive] at work. I can say this stigma and discrimination is the biggest problem they are facing.”

 

Khosro Mansourian, who leads the Reviving Values aid group, said sex education and better understanding can help solve that.

 

“Sex education should start from the kindergarten age,” he said. “Every child should have full knowledge about sexual characteristics so that they can protect themselves and especially learn they have the ability to say no.”

Gouya agrees that the young should have sex education.

 

“Our youth must learn about sexual issues in schools,” he said. “Prevention is much easier than treatment of AIDS.”

 

 
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NASA’s next mission to Mars in 2020 will feature a souped-up unmanned rover vehicle to search for signs of ancient microbial life in areas of the uninhabitable red planet.

The successor to the 2012 Curiosity rover, which could launch in July or August 2020, will be equipped with seven new instruments and re-designed wheels, NASA’s Jet Propulsion Laboratory (JPL) said.

The new vehicle will study the Mars terrain, above and below the surface, and collect soil and rock samples.

“What we learn from the samples collected during this mission has the potential to address whether we’re alone in the universe,” said Ken Farley, a JPL scientist with the Mars 2020 project.

JPL is also developing a new landing technology that will allow the rover to visit sites deemed too risky for Curiosity and shave miles off its journey.

NASA has successfully landed spacecraft on Mars seven times and is using the International Space Station to prepare for human missions to the moon and Mars.
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The significant progress made in recent decades against malaria is at risk, according to the World Health Organization. In its annual report looking at the global fight against the disease, the WHO says malaria cases are on the rise in several countries. More from Henry Ridgwell in London.
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Many countries are moving toward eliminating malaria, among them Madagascar, Senegal and Zimbabwe.

But a World Health Organization report warns that in other areas, progress has stalled. Malaria cases increased by more than 20 percent from 2015 to 2016 in eight African countries — including Rwanda, Nigeria and the Democratic Republic of Congo.

At the same time, funding for malaria prevention and treatment has leveled off, reaching $2.7 billion in 2016, less than half of the 2020 target.

“That amount of funding internationally has plateaued; possibly it has reached the realistic maximum now,” said David Conway, a professor from the London School of Hygiene and Tropical Medicine. “And it has always been assumed, indeed it has been important that countries themselves should commit to funding malaria control. And I think the big opportunity now is for those countries to step up and realize that this is good value.”

Overall, Africa continues to bear the highest burden of the disease, with approximately 401,000 deaths in 2016, a slight decrease from the previous year.

In addition to improving the coverage of existing methods of malaria prevention, the WHO calls for urgent investment in new tools.

“More research is needed to develop an effective malaria vaccine that could cover the populations that, at the moment, have high malaria rates and that, perhaps, do not use the available interventions even when they are being funded,” Conway said.

Several malaria vaccines are under development. The WHO is planning a major trial of the so-called RTS,S vaccine starting next year in Kenya, Ghana and Malawi.

However, its latest report warns the world is at a crossroads. Without better funding and more effective rollout of tools to tackle malaria, the progress made in recent decades could be undone.
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For fans of the yeti, newly published genetic research on purported specimens of the legendary apelike beast said to dwell in the Himalayan region may be too much to bear — literally.

Scientists said on Tuesday that genetic analysis of nine bone, tooth, skin, hair and fecal samples from museum and private collections attributed to the yeti, also called the Abominable Snowman, found that eight came from Asian black bears, Himalayan brown bears or Tibetan brown bears and one came from a dog.

“This strongly suggests that the yeti legend has a root in biological facts and that it has to do with bears that are living in the region today,” said biologist Charlotte Lindqvist of the University at Buffalo in New York and Nanyang Technological University, Singapore, who led the study published in the scientific journal Proceedings of the Royal Society B.

Lindqvist called the study the most rigorous analysis to date of purported yeti specimens. The researchers sequenced mitochondrial DNA — genetic material in structures within cells that was passed down from mothers — of purported yeti samples from Tibet, India and Nepal as well as from black, brown and polar bear populations.

The yeti is a creature of folklore in the Himalayan region that has become a part of Western popular culture. It is separate from North America’s Sasquatch and Big Foot folklore.

“I initially became involved in this study when I was contacted about a previous study that found two purported yeti samples to match genetically with an ancient, 120,000-year-old polar bear that I was doing research on,” Lindqvist said.

“But the data was very limited, and it made me suspicious about the speculation that the yeti legend represented some strange, hybrid bear roaming the Himalaya mountains. So, I agreed to follow up on this study with a more rigorous approach based on more genetic data from more purported yeti samples,” Lindqvist added.

Lindqvist said purported yeti samples came from places including the Messner Mountain Museum in Italy and were gathered by British independent television production company Icon Films.

While no actual yeti was identified, the DNA research shed light on bear populations in the region.

The brown bears roaming the high altitudes of the Tibetan Plateau and those in the western Himalayan mountains appear to belong to two separate bear populations separated from each other for thousands of years, despite their relative geographic proximity, Lindqvist said.
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The United Nations reports remarkable progress in containing the virus that causes AIDS. AIDS still kills, but in its latest report, UNAIDS said access to treatment has risen significantly. The UN’s goal is to end the pandemic by 2030. VOA’s Carol Pearson spoke to one of the world’s leading scientists about whether this can be done.
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It was a telling setting for a decision on whether post-traumatic stress disorder patients could use medical marijuana.

Against the backdrop of the nation’s largest Veterans Day parade, Democratic Gov. Andrew Cuomo announced this month he’d sign legislation making New York the latest in a fast-rising tide of states to OK therapeutic pot as a PTSD treatment, though it’s illegal under federal law and doesn’t boast extensive, conclusive medical research.

Twenty-eight states plus the District of Columbia now include PTSD in their medical marijuana programs, a tally that has more than doubled in the last two years, according to data compiled by the pro-legalization Marijuana Policy Project. A 29th state, Alaska, doesn’t incorporate PTSD in its medical marijuana program but allows everyone over 20 to buy pot legally.

The increase has come amid increasingly visible advocacy from veterans’ groups.

Retired Marine staff sergeant Mark DiPasquale says the drug freed him from the 17 opioids, anti-anxiety pills and other medications that were prescribed to him for migraines, post-traumatic stress and other injuries from service that included a hard helicopter landing in Iraq in 2005.

“I just felt like a zombie, and I wanted to hurt somebody,” says DiPasquale, a co-founder of the Rochester, New York-based Veterans Cannabis Collective Foundation. It aims to educate vets about the drug he pointedly calls by the scientific name cannabis.

DiPasquale pushed to extend New York’s nearly two-year-old medical marijuana program to include post-traumatic stress. He’d qualified because of other conditions but felt the drug ease his anxiety, sleeplessness and other PTSD symptoms and spur him to focus on wellness.

“Do I still have PTSD? Absolutely,” says DiPasquale, 42. But “I’m back to my old self. I love people again.”

Help for veterans

In a sign of how much the issue has taken hold among veterans, the 2.2-million-member American Legion began pressing the federal government this summer to let Department of Veterans Affairs doctors recommend medical marijuana where it’s legal . The Legion started advocating last year for easing federal constraints on medical pot research, a departure into drug policy for the nearly century-old organization.

“People ask, ‘Aren’t you the law-and-order group?’ Why, yes, we are,” Executive Director Verna Jones said at a Legion-arranged news conference early this month at the U.S. Capitol. But “when veterans come to us and say a particular treatment is working for them, we owe it to them to listen and to do scientific research required.”

Even Veterans Affairs Secretary Dr. David Shulkin recently said “there may be some evidence that this (medical marijuana) is beginning to be helpful,” while noting that his agency is barred from helping patients get the illegal drug. (A few prescription drugs containing a synthetic version of a key chemical in marijuana do have federal approval to treat chemotherapy-related nausea.)

Medical marijuana first became legal in 1996 in California for a wide range of conditions; New Mexico in 2009 became the first state specifically to include PTSD patients. States have signed on in growing numbers particularly since 2014.

“It’s quite a sea change,” says Michael Krawitz, a disabled Air Force veteran who now runs Veterans for Medical Cannabis Access, an Elliston, Virginia-based group that’s pursued the issue in many states.

Still, there remain questions and qualms _ some from veterans _ about advocating for medical marijuana as a treatment for PTSD.

It was stripped out of legislation that added six other diseases and syndromes to Georgia’s law that allows certain medical cannabis oils. The chairman of the New York Senate veterans’ affairs committee voted against adding PTSD to the state’s program, suggesting the drug might just mask their symptoms.

“The sooner we allow them to live and experience the kind of emotions we do, in an abstinence-based paradigm, the sooner that they are returning home,” said Sen. Thomas Croci, a Republican, former Navy intelligence officer and current reservist who served in Afghanistan.

The American Psychiatric Association says there’s not enough evidence now to support using pot to treat PTSD. The 82,000-member Vietnam Veterans of America group agrees.

“You wouldn’t have cancer treatments that aren’t approved done to yourself or your family members,” and marijuana should be subjected to the same scrutiny, says Dr. Thomas Berger, who heads VVA’s Veterans Health Council.

A federal science advisory panel’s recent assessment of two decades’ worth of studies found limited evidence that a synthetic chemical cousin of marijuana might help relieve PTSD, but also some data suggesting pot use could worsen symptoms.

Medical marijuana advocates note it’s been tough to get evidence when testing is complicated by pot’s legal status in the U.S.

A federally approved clinical trial of marijuana as a PTSD treatment for veterans is now underway in Phoenix, and results from the current phase could be ready to submit for publication in a couple of years, says one of the researchers, Dr. Suzanne Sisley.
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UNICEF’s Middle East director is calling Yemen one of the worst places on Earth to be a child and urging all involved in the fighting to let humanitarian aid keep coming in.

Geert Cappelaere told reporters in Amman, Jordan, Sunday that UNICEF was able to get nearly 2 million doses of vaccines delivered to Sana’a airport Saturday, but that such success should not be a “one-off.”

Cappelaere said far more supplies are needed and that ships carrying food, chlorine tables for drinking water, and treatments for diarrhea and cholera are on their way to the port of Hodeida.

“More than 11 million Yemeni children are today in acute need of humanitarian assistance. That’s almost every single Yemeni boy and girl,” Cappelaere said. “To all parties and all those with a heart for children, please take your responsibility now.”

He was talking about the responsibility for all those involved in Yemen to stop fighting and stop what he calls the war on children.

“Today we estimate that every 10 minutes, a child in Yemen is dying from preventable diseases,” he said.

The Saudi-led coalition trying to drive out Iranian-backed Houthi rebels from Sana’a promised last week to ease a blockade of the airport and Hodeida.

It shut down the facilities almost three weeks ago in response to a Houthi missile attack near the airport in Riyadh. The Saudis intercepted the missile.

Saudi Arabia blames the missile launch on Iran. Iran denies arming the Houthis.
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The United States is suffering through an unprecedented wave of opioid and prescription drug abuse. Every day, an average of 91 Americans die from an opioid-related overdose. A new study comparing two of the top medications for treating addiction found they were equally safe and effective in curtailing opioid use, relapse, treatment drop-out and overdose.  Faith Lapidus reports.
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Brazil’s President Michel Temer is recovering after undergoing a successful angioplasty in three coronary arteries.

The presidential palace said Saturday that at least one stent was implanted in the procedure late Friday. It said Temer was recuperating in a hospital in Sao Paulo.

The 77-year-old president was admitted to the hospital on Friday night to have a coronary catheter inserted. That’s typically a procedure to check for blockages in arteries.

Earlier this year, Temer was diagnosed with a partial coronary obstruction. His office had said he planned to treat it with aspirin and a low-fat diet.

Temer also underwent a urological exam on Friday. Last month, he had surgery to reduce the size of his prostate after doctors diagnosed a urological blockage.
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Chinese street barber Xiong Gaowu deftly scrapes a straight razor along the inside of his customer’s eyelid.

“You should be gentle, very, very gentle,” said Xiong, who performs traditional eyelid shaves at his roadside location in Chengdu, the capital of the southwestern province of Sichuan.

Customers swear by the practice of “blade wash eyes,” as it is known in Mandarin, saying they trust Xiong’s skill with the blade.

“No, it’s not dangerous,” said 68-year-old Zhang Tian. “My eyes feel refreshed after shaving and I feel comfortable.”

Xiong, 62, said he learned the technique in the 1980s and serves up to eight customers a week, charging 80 yuan ($12) per shave.

“It was difficult at the beginning, but it became a piece of cake afterwards,” he said.

Risk of infection

The technique appears to unblock moisturizing sebaceous glands along the rim of the eyelid, said Qu Chao, an opthalmologist who works at a nearby hospital in Chengdu.

“Patients will feel their eyes are dry and uncomfortable when the glands are blocked,” she said. “When he is shaving, it is most likely that he is shaving the openings of these glands.”

She said there was a risk of infection if the equipment was not sterilized.

“If he can properly sterilize the tools that he uses, I can still see there is a space for this technique to survive,” Qusaid.

Onlookers unsure

While customers insisted their eyes felt better after a shave, onlookers cringed at the sight of Xiong wielding his razor.

“I am afraid to do it,” said He Yiting, 27, who winced as she watched.
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Slowly but steadily, the consciousness about the need to protect and preserve the natural environment is rising all over the world. Grassroots initiatives get more coverage, and those involved in them say it feels good to be a part of a beneficial movement. VOA’s George Putic reports on two of the latest initiative in Indonesia.
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