Donald Trump"s homicidal healthcare bill will kill some, and enrich others | Adam Gaffney

Let us imagine that you would like to redistribute hundreds of billions of dollars from working class people to the rich, and wouldn’t hesitate to risk the lives of tens of thousands of people to do so. Well, as luck would have it, there is a bill— the “American Health Care Act” (AHCA)—that does precisely that.

On Thursday, it squeezed through the House of Representatives. Trumpcare – at least for the moment – has been triumphant.

Many of us thought – or hoped – that Paul Ryan’s bill was as good as dead on 24 March, when, in a pleasurable political moment (a rare event these days), he admitted he lacked the votes to push it through. But where there is a will to degrade the healthcare safety net, there is a way. And, to the House Republicans’ credit, they indeed found a way to ram this grotesquerie through.

To do so, the hard right had to compromise with the harder right, which made the current version of the AHCA fouler than the original.

The harder right found much to like about the original bill – like its historic gouging of Medicaid. The problem was that it left too much of the regulatory infrastructure of the Affordable Care Act (ACA) intact. Rules that insurers must cover 10 “essential health benefits” and cannot discriminate against those with pre-existing conditions? Eliminate those provisions, and let healthcare freedom reign.

The compromises worked. First, there was the MacArthur amendment, which permits states to redefine “essential health benefits” (this would allow insurers to exclude coverage of some types of healthcare, such as maternity care), or to allow insurers to charge people with pre-existing conditions higher premiums if they failed to maintain coverage.

Trump lauds House vote to repeal and replace Obamacare – video

As Timothy Jost noted on the Health Affairs blog, the latter provision “could effectively make coverage completely unaffordable to people with pre-existing conditions”, notwithstanding the clearly inadequate high-risk pools.

So far, so good.

However, in appeasing the harder right, the House leadership risked estranging the less hard right. But the latter proved to be a cheap date: they were bought off by the Upton amendment, added at the eleventh hour, which gave another $ 8bn to the fund theoretically designed to cover those left behind by the AHCA. Though this was a drop in the bucket relative to the size of the problem created by the AHCA, it brought just enough moderates back on board to secure a winning vote.

If the AHCA were signed into law by Trump – an unlikely but not impossible proposition given the headwinds it faces in the Senate – the negative impact on ordinary Americans would be enormous.

Given that the House GOP didn’t bother to wait for the Congressional Budget Office (CBO) score before voting, we don’t know just how bad it will be. But relying on the CBO’s initial estimates, we can say that the AHCA will, over a decade, reduce spending on Medicaid alone by more than $ 800bn.

Together with savings from having less adequate, skimpier insurance subsidies, these reductions will allow hundreds of billions of dollars to be channeled to the wealthy and corporations in the form of tax cuts.

US House passes Republican healthcare bill – video

By enriching the rich in this manner, the AHCA would leave an estimated 24 million more uninsured by 2028. Similar calculations have already been done, but it’s worth briefly revisiting the blood-arithmetic on this.

Colleagues of mine recently reported estimates, in the American Journal of Public Health, of how many newly insured people there would have to be to prevent one death per year. These estimates, which, being estimates, aren’t perfect, were based on five studies. The numbers ranged from 300 to 1,239 people.

If we were to pick a round number on the conservative end of that range – say 1,000 – we would estimate that stripping insurance from 24 million people would produce an estimated 24,000 additional deaths annually. That is 40% more than the sum total of all murders, estimated by the FBI at 14,429 for 2014 (using somewhat different numbers, Vox’s Julia Belluz makes this point and comes to the same figure).

Now, in all fairness to House Republicans, as a critical care physician, I too get blood on my hands when I go to work. The only difference is I can wash mine off.

Modern medicine saves lives, while stripping healthcare coverage from millions to fund tax breaks for millionaires takes lives. There’s no way around it, whatever some may tell themselves to help them sleep at night.

This, of course, raises an even larger issue, namely the injustices of the healthcare status quo, wherein 28 million remain uninsured and even more without adequate coverage – shortcomings that leave open the door to continued attack from the right.

This execrable, homicidal bill must obviously be stopped. But that’s not all we must do. The most enduring defense against the rightwing saboteurs is not continued championship of a flawed status quo, but instead the promise of a better tomorrow: healthcare for all, through a single-payer universal system. That alone will put an end to these deadly assaults on healthcare.

Donald Trump"s homicidal healthcare bill will kill some, and enrich others | Adam Gaffney

Could a new approach to kill cancer at nanoscale work?

In a small laboratory, not far from southern California’s Pacific coastline, Dmitri Lapotko is using lasers to conduct on-demand explosions on a scale almost infinitely small. These explosions are carefully designed to obliterate cancer cells at a nanoscale, with a level of efficiency and safety which far outmatches the current treatments of choice. The technology, pioneered by the company Masimo, is about to undergo clinical trials for both the diagnosis and treatment of cancer in the next few years. But the story of how the idea was first conceived originates from one of most defining moments of the 20^th century.

In the late 1980s, Lapotko was a laser weapons physicist for the Soviet Union, living and working in what is now Belarus. His particular expertise was in using airborn ultrasound to steer the laser beam of a weapon in the upper atmosphere, as the Soviets tried to match the threat of Ronald Reagan’s Strategic Defense Initiative, nicknamed ‘Star Wars.’

But with the end of the Berlin Wall and the subsequent disintegration of the Soviet Union, many weapons scientists found themselves left out in the cold, surplus to requirements and with few career prospects.

“This was a bitter time for many Soviet physicists,” Lapotko remembers. “We realised our work was not about science or the future, but politics.”

However just as many of the scientists involved in the Manhattan Project 40 years earlier subsequently turned to biomedical research, Lapotko decided to try and apply his knowledge of lasers to treat diseases at the cell level, and the biggest challenge of all, developing a novel means of detecting and treating cancer, initially in Belarus and then in the US.

“One of the biggest problems in cancer treatment is that we cannot detect micro tumours at the earliest stage and we often would not be able to remove them surgically without damaging nearby important cells and organs,” Lapotko says. “Currently, the minimal detectable tumours are already several millimetres big and by then the disease has developed.”

Nanoparticles: cancer cell surface. Photograph: Dmitri Lapotko

Chemotherapy and radiation therapy are not always effective because cancer cells continuously mutate and so rapidly develop resistance, requiring therapeutic doses which harm the patient in order to destroy them. “You can have an excellent drug today, but tomorrow it doesn’t work,” Lapotko says. “So I decided to base my approach on a way to detect and explode the cancer cell mechanically, something it cannot resist through its biological tricks. If you do this, there’s no biological way it can reassemble, revive or metastasise.”

Over the past two decades, researchers have sought to use nanoparticles, of sizes a thousand times smaller than a cancer cell, to deliver chemotherapy drugs specifically to the rogue cells themselves. This is done by exploiting some of the natural properties of tumours. Nanoparticles are injected into the bloodstream, attached with antibodies to recognise the cancer cell. Because aggressive cancer cells actively “eat” nanoparticles through the mechanism known as endocytosis, they end up self-assembling internal clusters of nanoparticles. This improves the toxicity problems of chemotherapy because large quantities of a drug can be delivered directly to the cancer without much harm to the surrounding healthy tissue. Gold nanoparticles are being used in this way in several ongoing clinical trials. However, even these therapeutic strategies still come up against the inevitable problem of cancers developing biological resistance to drugs.

Instead, Lapotko’s idea has been to combine biology and physics in an entirely new way. Once gold nanoparticle clusters are inside a cancer cell, they are exposed to a short laser pulse which the nanoparticles convert to heat, forming a vapour bubble which expands and collapses in nanoseconds, called a ‘plasmonic nanobubble.’ The mechanical impact of this nanobubble tears the cancer cell apart in an instantaneous explosion.

“The nature of this explosion is intracellular so the surrounding healthy cells or important organs are not damaged,” Lapotko says. “A cell residue is left but this cannot reassemble into new cancer cells. It’s very safe as the energy of the laser pulse required is a million times lower than the laser energy used in some surgeries.”

Cancer cell explosion. Photograph: Dmitri Lapotko

One of the common problems in cancer treatment is that when surgeons remove a tumour, they may leave residual tumours behind. “In many instances the cancer is in a part of the body where doctors are afraid to remove more than they think that have to,” says Masimo’s chief executive and founder Joe Kiani who is looking to bring Lapotko’s technology from academia to the clinic. “And when you leave some behind it metastasises. Recurrence and metastases are the main causes of death.”

But Lapotko’s technology can also be used to diagnose and eliminate before such remaining cells can grow into a far more dangerous and resistant recurrent tumour.

“We can administer nanoparticles one day prior to the surgery and after the surgeon removes the tumour, we apply the endoscope to the surgical bed,” Lapotko says. “If there are even single cancer cells left in the surgical margins, plasmonic nanobubbles are generated which produce a pressure pulse or acoustic pop which we can detect immediately in real-time with an ultrasound detector. And then we can use the mechanical impact of the same nanobubbles to destroy them.”

So far the technology has been tested on tumours in mice in a series of studies published by Nature Medicine and Nature Nanotechnology, with a dramatic improvement in survival rate and safety compared to existing treatments. The only limitation is for cancers deeper in the body where it is difficult to generate lethal plasmonic nanobubbles due to poor laser penetration into the deep tissue.

In these cases, Lapotko believes he can use the technology to improve the efficacy of the mainstream cancer therapy techniques. Radiotherapy works by disrupting the DNA helix in cancer cells, but by creating even small nanobubbles inside these cells beforehand, the DNA structure is already weakened, presensitising them so a far lower radiation dose can be administered to achieve the desired effect.

The first preclinical study of the anti-cancer technology ‘quadrapeutics’ found it to be 17 times more efficient than conventional chemoradiation therapy against aggressive, drug-resistant head and neck tumors. Photograph: Dimitri Lapotko/Rice University

Lapotko is well aware of some of the disappointment among clinicians regarding nanomedicine after many years of promise, but still no broadly available treatments for patients. “There are two main reasons why not much has reached the clinic yet,” he says. “A lot of the time nanoparticles are initially developed for non-medical use, for example the energy industry or the oil industry and then people start thinking about medical applications. So perhaps they’re not so effective as they’re not initially designed with cancer in mind. And then within nanomedicine, the mainstream ideas aim to improve drugs, either by making nanoparticles which are drugs by themselves or making nanoparticles to carry drugs. So in cancer, nanomedicine did not replace chemotherapy, it has just created an additional chemotherapy, and because of that it faces the same regulatory challenges as any other drug.”

It typically takes 10-25 years and a lot of investment for anything to pass from academic research to drug use in the clinic, a passage referred to by scientists as the ‘Valley of Death.’ But with no pharmaceutical involved, Masimo are hoping to fast-track the process. They have obtained a grant from the National Institute of Health for further testing and intend to pursue phase I and II clinical trials within the next few years, likely to be held in Europe.

“A lot of the time what is done in the world of medicine on a mouse, doesn’t work on a monkey never mind a human but the early results look great,” Kiani says. “If it all works, we’re probably four years away from a product. But if it all works, it could be a game changer.”

Could a new approach to kill cancer at nanoscale work?

Pregnancy sickness can kill – why are doctors so uninformed about it? | Caitlin Dean

During my first pregnancy, I fully expected to glow and bloom. I was going to eat healthy, organic food, and exercise to nurture the life growing inside me. I never imagined that by week 10 I would look up the number for an abortion clinic from a bed where I had been a prisoner for two months, bar the days spent in hospital on a drip. I suffer from hyperemesis gravidarum and for me pregnancy is life threatening.

Hyperemesis is not just normal waves of nausea and occasional vomiting that most women experience in early pregnancy. It is nausea so intense and all-consuming you feel like you’ve been poisoned. It is vomiting so relentlessly that your throat bleeds and your stomach muscles tear. It is a sense of smell so powerful and warped that your partner can’t come near enough to offer comfort without making you retch. I could not swallow my own saliva without puking it back up.

The long, dark days lying motionless in my bed with acid trickling from my mouth slowly turned into weeks and then months. I was wracked with guilt for taking medication and at the same time I fantasised about miscarrying or aborting my baby.

But when I sought help from doctors or support from friends I was met with scepticism and doubt. People thought that ginger, fresh air and a positive mental attitude was all I needed. Some people thought I was skiving off work or that because they had never heard of it, hyperemesis couldn’t possibly be a real condition.

When my GP took me off the medications the hospital had prescribed, saying “It’s normal, pull yourself together”, we seriously considered termination. I had come so far but still had so far to go. My husband worried that I might die and he felt helpless. But even an abortion seemed impossible; I couldn’t get out of bed to shower, let alone manage long car journeys for multiple appointments.

Unsurprisingly, the mental toll of hyperemesis can be profound. And yet much of the mental burden and suffering could be avoided. The physical symptoms are torturous but it is the loneliness and stigma that is so hard to bear. When a doctor or midwife simply believes what you’re saying, the first battle is won and the fight to survive the illness feels more achievable. Is it too much to ask to be believed?

Historically, hyperemesis was taken very seriously as it was the leading cause of death in early pregnancy. Before intravenous fluids and anti-sickness medication, the only effective treatment was abortion, which was generally fatal anyway. The death rate dropped with modern treatments but then came the psychodynamic era. Suddenly women were being accused of mentally rejecting the foetus and were subjected to barbaric “therapies” such as isolation and interrogation.

Incredibly, this was the mainstay of treatment in Europe until earlier this century and, despite a vast amount of scientific evidence showing it is not a psychological condition, the psychodynamic theories persist in public and healthcare opinion. In part, they prevail because we don’t yet know the precise biological cause of either morning sickness or hyperemesis gravidarum.

The thalidomide tragedy of the 1950s also casts a long, dark shadow over the condition and is the key reason doctors are fearful to prescribe in pregnancy. There is no cure for hyperemesis. What we have is a range of safe medications to manage the physical symptoms. Decades of safety data has shown they don’t harm the baby; in fact recent research found that not treating severe symptoms can be harmful. The old adage that “Baby will be fine, it takes what it needs” is simply not true. The only solution is education and awareness, but doctors have to want to learn about hyperemesis and its treatments in the first place.

It’s not all doom and gloom – dedicated hyperemesis day units are springing up across the UK

I consider myself one of the lucky ones. I don’t know how we got through it but we did. The moment I gave birth to my son it felt as though a 70kg rucksack of nausea and misery I’d been carrying for nine months was lifted off my back; it was euphoric. Many women aren’t as lucky and face little choice but to terminate their wanted pregnancies as the physical, mental and financial toll becomes a reality. For some women, it is simply a matter of life or death.

Access to treatment has thankfully improved this decade, and the condition is once again being recognised as the life-threatening pregnancy complication it is. Yet the stigma remains tenacious. My research with Plymouth University, published by the Midwives Information and Resource Service this week, looked at women’s experiences of treatment for hyperemesis across the UK over the past two years and found that, for more than half of women, accessing treatment was difficult.

Women’s symptoms were often dismissed or normalised, or the treatments for them were described, incorrectly, as risky. A mere 34% of women felt they were making informed decisions about their treatment and couples terminated based on misinformation about other options. Healthcare professionals can’t give the information that women need to give informed consent if they don’t know the information themselves, so again, education and awareness is the key.

It’s not all doom and gloom – dedicated hyperemesis day units are springing up across the UK and could offer a solution to some of the challenges faced by those affected by hyperemesis. Staff knowledge and understanding, information provision and overall satisfaction was found to be higher in such settings. Treatment can be fitted around family, work and childcare commitments and the number of treatment days were halved thereby reducing financial burdens and saving a lot of money for overstretched maternity units. It is likely that the very process of setting up a day unit ensures staff are educated about hyperemesis.

Ultimately, however, the drugs are the same whether they are given in hospital, day unit or by a GP. It’s when they are administered with compassion, knowledge and informed consent that they can really make a difference.

For more information about hyperemesis gravidarum, its treatments and to get support for someone suffering, there is a UK charity called Pregnancy Sickness Support

Pregnancy sickness can kill – why are doctors so uninformed about it? | Caitlin Dean

Bio-terrorism could kill 30 million people in a year, says Bill Gates – video

Bill Gates, the co-founder of Microsoft who has spent billions on philanthropic efforts over the past several decades, speaks at the Munich security conference on Sunday and says that the world must be on guard for bio-terrorism attacks. Telling the audience that “a synthetic version of the smallpox virus … or a super contagious and deadly strain of the flu” could kill more than 30 million people in a year, Gates says there is a “reasonable probability” that such an event could occur in the next 10 to 15 years

Bio-terrorism could kill 30 million people in a year, says Bill Gates – video

Will NHS transformation plans kill or cure the health service?

“Secret plans to change our NHS”: This is the allegation levelled at sustainability and transformation plans (STPs) – the government’s latest NHS reform initiative – by campaigning group 38 Degrees. Some politicians seem to agree, with former shadow health secretary Diane Abbott calling them “a dagger pointed at the heart of the NHS”.

Simon Stevens, the chief executive of NHS England, sees it differently: “Now is quite obviously the time to confront … the big local choices needed to improve health and care across England.” For him, STPs are a way of delivering the reforms he set out in the NHS Five Year Forward View (pdf) and the £22bn of efficiency savings he promised to the government, while maintaining or improving the quality of care.

As details of the STPs have been made public and the extent of the winter crisis in the NHS has become apparent, the debate about their role in the health service has become dangerously polarised. The question is whether these controversial plans will prove to be kill or cure. Based on a detailed analysis of all 44 plans, we at IPPR think the reality is probably more nuanced and complex than either side let on.

The IPPR’s STP finder tool gives a breakdown of the scale of the financial challenge facing each area, and outlines the changes each plan is expected to bring about.

On the one hand, it’s clear that some elements of the argument made by campaigning groups – for example, that the government is knowingly underfunding the health and care service – stack up. Our analysis shows that every STP area is forecast to be in deficit by 2020-21, and these deficits total more than £24bn. For Theresa May and (somewhat more reluctantly) Simon Stevens to suggest that this financial gap can be closed through reform alone is disingenuous to say the least.

On the other hand, campaigners are wrong to argue that the reform agenda is simply about delivering dangerous cuts. The NHS cannot stand still as the world transforms around it. Instead, it must respond to growing demographic pressures; new evidence about what works and what doesn’t; and cutting edge technologies that can transform health and care.

Hospital reconfigurations are a perfect example of the need for a more balanced discussion. Campaigning groups have raced to uncover “secret” plans to close local hospitals, arguing that these changes are evidence of the government’s deceit. And, they are right to highlight that these changes are afoot: our research finds that up to 44% of STPs include hospital closures or reconfigurations.

However, the potential benefits of these changes have gone largely unnoticed. There is strong evidence for some services, in particular A&E and specialist surgery (pdf), concentrating care in fewer locations. This can save lives by ensuring people have access to the most highly trained doctors and the best equipment. Likewise, there are many examples where treatment could be moved out of hospital all together, saving money but also improving outcomes: for example, only 7% of people say they would prefer to die in hospital with the vast majority opting for home.

This doesn’t mean that all the planned changes are justified, some are likely to be driven by the need to cut costs but many are not and should end up improving health outcomes over the coming years.

Likewise, the wider health and care reform agenda is yet to get a fair hearing, with a number of initiatives likely to result in better care, for example new “community care hubs”, which will bring together GPs, mental health services and social care at a local level; “a truly seven-day health service” with GPs opening on evenings and weekdays; and the adoption of new technology that allows people to receive support remotely.

STPs are an opportunity to deliver these reforms – which will help to transform the quality of care delivered up and down the country – ensuring that the NHS is fit for the 21st century. However, there is no doubt that the NHS will struggle to seize these opportunities without three key changes.

First, the government must recognise that the health and care system needs more funding both to manage the immediate pressures of the winter crisis but also to properly fund the reform agenda. A good start would be a rise in national insurance. This could raise up to a further £16bn over the next five years, dramatically closing the funding gap.

Second, the government – in particular Theresa May and Jeremy Hunt – must start supporting NHS leaders in making the case for reform, in particular controversial and little understood hospital reconfigurations. This will give local NHS leaders the political leadership they need to argue for their proposals locally.

Finally, once central government has helped local leaders win support for their reform plans, they must be given the tools to deliver these changes and allowed to get on with it. This may well mean giving NHS leaders real powers to intervene in their local area, as well as devolving functions currently undertaken by central government as has happened in Greater Manchester.

STPs are an opportunity rather than a risk for the NHS, but without these fundamental changes, it seems inevitable the NHS will remain a 20th century system in a 21st century world.

Harry Quilter-Pinner is a research fellow on public services at the IPPR thinktank. This is an edited version of an article on the IPPR blog and is part of a wider project on STPs.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Will NHS transformation plans kill or cure the health service?

Kill Infections Using This 7 Ingredient Master Tonic

Kill Infections Using This 7 Ingredient Master Tonic

"I want to kill these dogs": question of whether to cull strays divides Yangon

Zu May Naing was playing with her brother outside their house in Bago Region, close to Myanmar’s commercial capital of Yangon, last month when a pack of stray dogs rounded on the 18-month-old.

Her mother, San Thar Myint, found her lying prone on the ground, bleeding and in shock. “Her temperature was over 100 [degrees fahrenheit] before they got to the operation room,” she says.

At the nearest children’s hospital in Yangon, doctors performed surgery and injected the baby with the anti-rabies vaccine. It was the second time that week a child had come in with dog bites. A doctor who declines to be named (he is not authorised to speak to the press) says they see between two and five cases per week.

A few days later, Zu May Naing’s arm is swaddled in bandages at the wrist where the dog seized her in its jaws. A red-brown gash sweeps from her left eye across her cheek. Another droops from the corner of her bottom lip where it was torn off. She glances fitfully around the hospital ward.

“She can’t sleep well at night,” her mother says. “She wakes up suddenly. She’s still afraid.”

Like many parts of the developing world, Myanmar has lived with stray dogs for generations. More than six decades ago, travel writer Norman Lewis described the mutts of Mergui, a coastal city in the south, with unsparing vividness: “There are more dogs than humans; they are a slinking, evil breed, cursed with every conceivable affliction … Many were earless, partially blind and had paralysed or dislocated limbs.”

For now, there is no killing – just breeding

Ye Naung Thein

The situation has not improved – and is arguably most acute in Yangon, the country’s rapidly developing commercial capital with a population of some five million. It is overrun with strays; government estimates seen by the Guardian put the number at more than 120,000. Some are scrawny creatures, rib cages pressing against flea-bitten skin, tumours flapping as they nose through rubbish carts. Others are visibly well fed, their muscular tawny torsos straddling spindly legs.

After dark, when the traffic clears and the air cools, some neighbourhoods descend into a chorus of howling. Others face more niggling problems: in a recent post on the local Facebook group “Eliminate All Stray Dogs”, one resident claimed an unruly pack kept jumping on his car, destroying its windscreen wipers.

“They occupy the streets – especially at night,” Ye Naung Thein, a local administrator, says at his office in Mingalar Taung Nyunt township.

Zu May Naing was bitten on the face by a stray dog in Yangon. Photograph: Aung Naing Soe

For decades the government has sought to curb the ever-spiralling canine population with regular mass culls. But increased resistance from animal lovers has led authorities to take a different tack – much to the ire of people such as Ye Naung Thein.

Last July, he says, the Yangon City Development Committee (YCDC) – the city’s chief administrative body – banned the killing of all dogs in two areas: Sanchaung, and his neighbourhood, Mingalar Taung Nyunt.

It was a condition of an agreement signed last year with the global nonprofit Humane Society International (HSI) and the Bangkok-based Soi Dog Foundation, which are set to help Yangon authorities implement a project that would replace culling with a spay-and-neuter programme while also vaccinating dogs against rabies. Six months on, however, Ye Naung Thein has heard nothing about the plan; HSI says it is finalising a proposal.

“For now, there is no killing – just breeding,” he complains.

In the past month, two children have been bitten in his quarter alone – including four-year-old Thurein Lin. He and his mother, Zin Mar Min, were sitting at a teashop when one of the dogs milling around lunged for the boy, sinking its teeth into his skin. The same dog had bitten a different child earlier that day; the girl was in hospital for a week. The dog was later beaten to death.

“The residents are scared,” says Ye Naung Thein. “They are scared of sending their children on to the streets.”

The threat of rabies

As well as attacks, the dogs bring with them a graver threat: rabies. Invariably fatal once symptoms appear, the virus is now largely forgotten in the UK, though it was a real fear in the 19th century.

Today, it is Asia and Africa that bear the largest burden. The virus claims an estimated 50,000 lives a year, and Myanmar has the second-highest incidence of any country in south-east Asia with about 1,000 deaths per year, according to the World Health Organisation.

Last year, 41 patients with rabies were sent to Yangon General Hospital, the biggest in the city, according to its deputy medical superintendent Daw Khin Than Mon. But the overall number of victims is likely higher: “It’s hard to know the number of people bitten because people can go to the clinic or regional hospital,” she says.

In Yangon, once rabies patients are confined to the isolation ward in the hospital – a vast, colonial-era building with no air-con and sporadic fans – there’s not much else to be done. Most people die within a few days.

“It’s very depressing,” says one of the nurses, who asked not be named.

After dark some neighbourhoods descend into a chorus of howling. Photograph: Romeo Gacad/AFP/Getty Images

Yangon’s regular mass dog culls have involved municipal workers laying out poisoned meat; scooping up the corpses later. But this method is deeply divisive in the Buddhist-majority nation, where religious conviction strengthens a deep love for animals.

“I have a YCDC official friend who worked for the animal department,” says Ye Naung Thein. “I met with him a couple of months ago and he said he is happy now because he moved to another department and doesn’t need to do killing any more.

“I told him: ‘You are government staff and you’re doing the government’s work. Who said this is a sin?’ But he replied: ‘Buddha said he doesn’t like killing and this is the sin’.”

While allowing authorities to remove obviously rabid or sick animals, the culls did little to bring the population down or eliminate the virus. Animal experts and humane organisations say culling alone has never helped a city control its dog population.

“I mean, it’s just common sense,” says Rahul Sehgal, Asia director at HSI. “If you compare the statistics of rabies in a country that is undertaking culling over the years, you will hardly see any hint of reduction in the number of rabies cases.”

Indeed, studies show culls can actually worsen the problem by killing vaccinated animals, unsettling the population – leading to fights over territory – and keeping it young and more aggressive.

“What is happening is a kneejerk reaction,” says Sehgal. “It’s a symptom but we are not finding a cure.”

He advocates the “spay-neuter-release” strategy, which involves capturing animals, neutering and vaccinating them and letting them go in the exact place they were caught.

The method – which studies say have produced results in some cities, including Jaipur – is now enshrined in law in India and elsewhere. But it takes time to work.

“The dog population has existed for several decades,” says Sehgal. “You can’t bring it down in a couple of years – it’s not magic.”

Residents are still waiting for the launch of a ‘spay-and-neuter’ programme to control the stray dogs. Photograph: Aung Naing Soe

‘We just want killing’

In her spacious office in the downtown YCDC building, Dr Hla May Oo, assistant head of the veterinary and slaughterhouse department, pulls a black plastic blowpipe out of a cardboard box and puffs into the tube.

“Stray dogs are very difficult to catch so we use a traditional method,” she says, laughing.

The city authorities carried out their own spay-and-neuter plan in one township late last year, sending municipal workers out with blowpipes loaded with anaesthetic.

Hla May Oo claims workers vaccinated and sterilised more than 70% of strays – the minimum threshold animal experts say must be met for population control to be sustained. Plans are under way to extend the campaign, funded by donations, to another township this month.

In the meantime, the department has stopped culling except on special request, aside from the two townships involved in the HSI project where it is banned outright.

Hla May Oo, who has led the department since 1988, says she is caught in the middle of what some are calling a war between dog lovers and dog haters. “We are receiving a lot of complaint letters every day,” she admits.

Ye Naung Thein is skeptical about the plan, having seen similar projects fall by the wayside in recent years.

“In our situation, a lot of corruption is happening everywhere,” he says. “We don’t how the money comes and what it goes on … We objected to the [spay-and-neuter] plan because we knew they would not do any follow-up after the project. We just want killing.”

Even in places where anti-rabies spay-and-neuter plans have showed signs of success, including Bali and some Indian cities, the expense of the programmes and the sheer terror of rabies has led governments back to culling.

“I live in India, which has 35 million stray dogs,” says Sehgal of HSI. “A massive amount of money is needed to do this, and [implementation of spay-and-neuter] has been sporadic there … You work for a year, you stop for a year. By the time you are coming back to it, the dog population has multiplied again.”

But if the efforts are sustained, Sehgal says, “it just cannot fail.”

The thing about culling, by contrast, is that the results can be seen straight away. As San Thar Myint cradles her baby in the hospital ward, she is in no doubt about what she wants.

“I want to kill these dogs – I don’t want to look at them,” she says. “I want to say that villages and residential areas should not have dogs.”

Additional reporting by Cape Win Diamond and Aung Naing Soe

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"I want to kill these dogs": question of whether to cull strays divides Yangon

Use Soursop Leaves to Kill Cancer Cells

Use Soursop Leaves to Kill Cancer Cells

"Cold does kill": plunging UK temperatures prompt health warning

Low temperatures heralding the arrival of winter have prompted health officials to stress that cold weather can be fatal.

A widespread frost is expected and a new survey of highways bosses shows that councils have stockpiled 1.2m tonnes of salt to prepare for the months ahead.

Public Health England is advising people to prepare for the chilly snap, warning that “cold does kill”.

On Monday night most of England will see temperatures fall to -4C (24.8F), with London experiencing a potential low of -3C (26.6F).

A low of -5C (23F) is forecast for Scotland – but rural areas are likely to be even colder – while Northern Ireland will face temperatures of 0C (32F), with rural areas similarly expected to plummet lower.

Dr Angie Bone, from the extreme events team at PHE, said: “Cold does kill, even in places where the temperatures aren’t at their lowest. Now is the time to prepare for the cold weather forecast by the Met Office, and to think of those you know who are older, very young, or have pre-existing health conditions who are particularly vulnerable.”

Andy Page, the chief operational meteorologist at the Met Office, said: “High pressure will bring generally dry and settled conditions this week, with clear skies and light winds allowing a widespread frost to occur on Monday and Tuesday night.

“From Wednesday onwards, cloudier and slightly less cold conditions will arrive across northern England, therefore overnight frosts will become fewer and less severe in the north but cold weather may persist across the south where skies remain clearer.

“Looking ahead into December and beyond, there are indications that a cold start to winter is more likely than normal, but this doesn’t guarantee snow nor does it mean we won’t see spells of mild and wet weather at times.”

Meanwhile, the Local Government Association (LGA) annual winter readiness survey shows councils are well prepared for plummeting temperatures with a substantial stock of grit.

About half are at the limit of storage capacity, and the LGA said gritters will be out treating thousands of miles of roads whenever overnight temperatures drop below zero in the coming days.

Councillor Martin Tett, the LGA’s transport spokesman, said: “Councils are fully prepared to protect residents and minimise disruption … caused by the drop in temperatures. They are constantly monitoring up-to-the-minute weather reports to make sure they can stay one step ahead of the weather.

“We are well prepared for the cold, with 1.2m tonnes of salt stockpiled and a fleet of state-of-the-art gritters ready to be deployed.”

1 December marks the beginning of meteorological winter, which lasts until 1 February.

"Cold does kill": plunging UK temperatures prompt health warning

Alcohol-related cancer to kill 135,000 in England by 2035 – study

Alcohol-related cancers will cause about 135,000 deaths and cost the NHS £2bn over the next 20 years in England, unless concerted action is taken to highlight the dangers of drinking, health campaigners have warned.

Cancer Research UK, which commissioned Sheffield University to come up with the figures, said the government urgently needed to counter public ignorance about the link between drinking and cancer and introduce minimum unit pricing (MUP) to prevent the number of deaths reaching 7,100 a year by 2035.

The analysis also forecasts more than 1.2m hospital admissions for alcohol-related cancer over the next two decades.

Alison Cox, the director of prevention at Cancer Research UK, said: “These new figures reveal the devastating impact alcohol will have over the coming years. That’s why it’s hugely important the public are aware of the link between alcohol and cancer, and what they can do to improve their risk.

“If we are to change the nation’s drinking habits and try to mitigate the impact alcohol will have, then national health campaigns are needed to provide clear information about the health risks of drinking alcohol.”

The majority of alcohol-related cancer deaths in 2035 are expected to come from oesophageal cancer (3,697), followed by bowel (1,369), other mouth and throat cancers (887), breast (835) and liver cancer (333).

Alcohol-related cancer deaths

Earlier this year, the government lowered the officially advised maximum weekly alcohol consumption by men to 14 units, bringing it in line with the existing limit for women.

But it said that there was no safe level of drinking for either sex, warning that any amount of alcohol consumption increased the risk of developing a range of cancers.

England’s chief medical officer, Dame Sally Davies, has said she would like people to think about their increased risk of cancer each time they reach for a glass of wine.

However, Cancer Research UK and its partners in the Alcohol Health Alliance believe there is still more the government can do, including introducing a 50p minimum unit price for alcohol in England.

The analysis, published on Friday, found that a 50p minimum price per unit of alcohol could, over 20 years, reduce alcohol-related deaths in England by about 7,200, including about 670 cancer deaths. It would also reduce healthcare costs by £1.3bn, the research suggests.

Prof Sir Ian Gilmore, chair of the Alcohol Health Alliance, said: “It is clear from the report that MUP will save lives, including those lost to cancer, and ease the burden on our health service. Importantly, MUP will do this while leaving moderate drinkers and prices in pubs and bars unaffected.

“In addition, we need mandatory health information on the labels of all alcoholic products, informing the public of the link between alcohol and cancer, and the new low-risk drinking guidelines.

“The public have the right to know about how their drinking impacts their health, so that they are empowered to make informed choices.”

The research assumes drinking trends will follow those seen over the last 40 years and takes into account recent falls in alcohol consumption.

Caroline Moye, head of the World Cancer Research Fund, said 21,000 cancer cases a year could be avoided in the UK if no one drank.

“After not smoking and being a healthy weight, not drinking alcohol is the best thing people can do to help reduce their cancer risk,” she said.

Responding to the study, the Department of Health highlighted the guidelines on alcohol consumption.

Rosanna O’Connor, director of drugs, alcohol and tobacco at Public Health England, said: “Anyone can reduce their risk of cancer by making changes to their lifestyle: drinking less alcohol, eating a balanced diet, staying physically active and not smoking.

“The One You campaign run by Public Health England will help achieve these aims and lower the risk of cancer by enabling everyone to live a healthier life.”

The Home Office said it was reviewing minimum pricing and would be watching implementation in Scotland.

Alcohol-related cancer to kill 135,000 in England by 2035 – study

Tasmanian devil milk could kill golden staph and other antibiotic-resistant bugs

Milk from Tasmanian devils could kill antibiotic-resistant bacteria like golden staph and potentially combat the deadly facial tumour disease that has killed 80% of the wild devil population in the past 20 years.

According to research led by Sydney University PhD student Emma Peel, milk produced by the marsupials contains antimicrobial peptides called cathelicidins which had been tested as being effective against a number of pathogens, including methicillin-resistant Staphylococcus aureus, or golden staph.

“These peptides are killing superbugs, so there is potential for future development into antibiotics,” Peel told the ABC.

“That is the next step for our research, to see if these peptides have anti-cancer potential, if they are killing superbugs maybe they could kill the facial tumour.”

Peel said the tests were done with artificial peptides made by extracting the cathelicidin sequence from the devil’s genome.

The artificial peptides also tested as between three and six times more effective against some fungal infections than anti-fungal medication.

Milking the famously aggressive animals was a process to be undertaken “very, very carefully and with a lots of safety gear,” Peel said.

Androo Kelly, owner and director of Trowunna Wildlife park in northern Tasmania, which has bred 16 generations of devils, said it could be done but “I don’t think you would set up a dairy”.

He tried his hand at milking devils in the 1990s for an earlier series of research by University of Tasmania associate professor Menna Jones.

“The devils that we have, we have mothers with young that are also used to being handled, so it’s a simple thing that when the mothers are lactating you just squeeze the milk out,” he said. “It was more of a once off, it would not be a common practice.”

Kelly said the research answered the longstanding question of why young devils did not contract the highly contagious devil facial tumour disease from infected mothers. It also explained how the immature young, which are born at just 3mm long and mature in the pouch, survive without a mature immune system.

“I really believed that the solution to the devils disease was something within them … this is only further supporting that,” he said.

Devil facial tumour disease was first reported in 1996 and spread to cover 95% of Tasmania, prompting an international breeding program to save the animal.

Recent research found the carrion-eating marsupials had already evolved a degree of resistance to the disease, which is caused by two of only four strains of viral cancer to be found in the wild.

Researchers in Hobart have also developed a vaccine and begun releasing vaccinated devils into areas believed to be free of the disease.

Tasmanian devil milk could kill golden staph and other antibiotic-resistant bugs

My ‘insane’ Uncle Ed tried to kill Queen Victoria – he was treated with kindness | Penny Pepper

A young Queen Victoria rides out of the palace with her dashing husband. It’s June, and she is happy as the open carriage moves down Constitution Hill. Waiting on a grassy verge is a young man. Scarcely that – he’s a boy, just 18, with dark eyes and a baby face, short of stature and wearing a high top hat, as was fashionable in 1840. As the Queen draws closer he raises two pistols, determined to fire on the pregnant Victoria.

The young man is Edward Oxford, and he’s about to fulfil his dream of becoming notorious. Edward: my great, great, great uncle, who I fondly call Uncle Ed.

As ITV’s Victoria came to the season finale, I was relieved his story played out relatively true to what is known. Edward is described as “one of Cumberland’s creature’s”, part of the supposed Hanoverian plot against Victoria. But it is quickly revealed he is as a “half-witted pot boy from south of the river”, and that “the would-be assassin is completely insane”. Victoria wanted to hang him high, naturally.

Since unearthing this skeleton in my family closet, I feel a deep protectiveness – and relief that Edward’s attempted regicide came at a time when “lunatics” and the “criminally insane” were beginning to be treated more humanely.

Indicted for treason, he stood trial at the Old Bailey on 6 July 1840. If found guilty, he would hang, and his defence rested heavily on the ideas of being “innocent by reason of insanity”. The Old Bailey records of the trial are as full of intrigue and early Victorian melodrama as one could wish for, including the reading out of his notebooks, which exposed Uncle Ed’s pseudo-military fantasy society, Young England.

Reading through the statements and the endless legal ramblings, I find nuggets that allow me to unravel a sense of young Uncle Ed’s wayward personality. I follow a repeating echo, as I realise the case for his defence depends on making sure that he is insane. The records swiftly become a sensational feast of detail, especially where Edward’s father and grandfather are concerned. Both were known alcoholics. His grandad, John Oxford, described in one press report as a “black sailor of obscure origin”, died in Greenwich Naval hospital. At various times he believed he was the pope and other times St Peter.

Part of the Bedlam Exhibition held at the Wellcome Collection 2016. Photograph: Thomas SG Farnetti/Wellcome/Courtesy The Vacuum Cleaner and Hannah Hull

Edward’s father, George Oxford, is described as a “mulatto” and “the Tawny Beau” in press coverage. A keen indulger in laudanum, he was given to odd and violent outbursts, most often inflicted on his long-suffering wife, Edward’s mother, Hannah. There was also the time he brought the horse into the parlour for dinner …

It’s hard to know now if Edward shared this family “madness”, assuming you share the still-controversial belief in inherited mental ill-health. Endless witnesses reported his strange behaviour and mood swings. But Edward’s family and friends would have known that any exaggeration could only strengthen his claim to innocence.

Uncle Ed was found “innocent by reason of insanity”, suffering “a lesion of the will”. He was sentenced to be detained indefinitely at Bethlem Royal hospital – better known as Bedlam – in its latest home in Southwark. This was a time when pressure was growing for the proper care for the mentally ill, with supporters committed to the genuine idea of asylum and a removal of those individuals from prisons and the workhouse. This began with the County Asylums Act 1808.

Those with mental health issues are demonised, despised and disbelieved. They are too expensive for the welfare state

Edward flourished in this environment, and responded to regimes aiming for genuine care of the patient – “patient” at last replacing the earlier terms “lunatic”, “imbecile” and plain “inmate” – through the Lunacy Act of 1845. Edward’s frustrated intellect grasped all opportunities – he became a model patient, learning several languages fluently, finding skills as a painter, and becoming an unbeatable chess player. He thrived in that environment, when – as Mike Jay, co-curator of the Wellcome exhibition, Bedlam: The Asylum and Beyond – says in his recent Guardian piece: “The asylum became an emblem of social progress: a therapeutic community in which patients were to be treated with kindness.”

It’s tragic that there is very little sense of true asylum, of sanctuary, within today’s mental healthcare system. In the 20th century, care in the community made much of individuals’ rights to be looked after in their own homes (which, conveniently in the Thatcher era, was likely to be cheaper). Yet many within the mental health system – myself included – feel that the baby might have been thrown out with the bathwater. These days, those with mental health issues are demonised, despised and disbelieved. They are too expensive for the welfare state.

John O’Donoghue, author of the award-winning memoir Sectioned, is a veteran patient of the remnants of those old hospitals. As he says: “The closure of the old Victorian asylums has yielded mixed results … Yes, they could be places of neglect and abuse, patients left to rot … but they also afforded sanctuary, the kind of open-ended humane treatment modern practice seems to have great difficulty in providing.”

Since my own teenage years I’ve experienced ongoing mental distress, uneasily wearing many labels given and changed. Clinical depression. Anxiety disorder. Manic depression. Emotionally unstable disorder. When I read the details of Uncle Ed in all the literature, I wonder what his label would be now. Would it help him any more than “lesion of the will”? That he was troubled, unhappy and in emotional pain is clear, and yes, I sat tight-lipped ready in his defence as this final episode of Victoria unfolded. But this is a royal soap opera. Edward is the pot boy working-class “lunatic”.

One day I’ll tell his story. Bring him fully to life, track our shared heritage from the mysterious black sailor and take him wholly back into the family embrace – and celebrate his happy ending in Australia.

My ‘insane’ Uncle Ed tried to kill Queen Victoria – he was treated with kindness | Penny Pepper

Germ-Busting Drink – A Simple Homemade Remedy to Kill Sinus Infection

Sinus is normally caused by bacterial infections, it’s so common that according to statistics, researchers find that around 29.8 million adults experience sinusitis in 2010, and the number is upto 37 million on the latest statistics.

Good news is that you can feel free to take help of natural home remedies for sinus infection, they’re safe and easy to use.

Here is a drink you can make with the simple ingredients in your kitchen to kill the bacteria or virus thus curing your sinus infection naturally.

Ingredients:

• 1 lemon


• 1/4 cup of apple cider vinegar


• 1 teaspoon of cayenne pepper


• 1 tablespoon of honey


• 1/2 cup of water

How to Make:

Boil the water and add in apple cider vinegar.

Combine with the cayenne pepper and honey, stir well.

Add the juice of lemon finally. Stir the mixture well and store in fridge.

How to Use:

Keep consuming this drink 3-4 times a day until the sinuses clear up.

Why This Drink Helps:

Apple Cider Vinegar – With anti-vital, anti-fungal and anti-microbial properties, apple cider vinegar fights sinus effectively. Another simple way to use apple cider vinegar to against sinus infection is to add 2 tablespoon of apple cider vinegar into 8 oz of warm water, add honey to taste if you like. Drink this mixture and the sinus infection will vanish after some days.

Ginger – One of the most ancient ingredients that has been proven to be useful for lots of ailments, it’s also an effective agent that combat sinus infection as it kills bacteria and viruses that may resulted in sinus infection.

Cayenne Pepper – A spicy solution for sinus infection, functions to reduce inflammation and prevent infections. To treat a sinus infection, cayenne pepper can also be diluted in water and dipped on an ear swab and then swabed into nose.

Lemon – Rich in vitamin C, it boosts your immune system and also reduces inflammation of the mucous membranes.

Sources: healthylifetricks.com/ rapidhomeremedies.com

More Posts By Author Heidi Kristoffer:

Apple Cider Vinegar – How to Use it to Improve Your Health as Simple Remedies

DIY Kiwi Smoothie to Clean Your Body From Harmful Toxins

How to Make and Drink Raw Garlic Juice to Improve Your Health Naturally

Germ-Busting Drink – A Simple Homemade Remedy to Kill Sinus Infection

Your bra could kill you – and other breast cancer myths busted

A diagnosis of breast cancer can be frightening, and many of the known risk factors – genetics, ageing, being a woman – are beyond our control. That is why myths are attractive. They sell us the idea that there is something simple we can do to protect ourselves from cancer. We look at three of the most common myths.

Your bra could be killing you

The idea that wearing an underwired bra can cause breast cancer has been around since 1995, when Sydney Singer and Soma Grismaijer published their book Dressed to Kill, which claimed there was a link. The idea was revived last year when a practitioner of alternative medicine wrote an essay on Gwyneth Paltrow’s website, Goop. What these people have in common is that none of them is a cancer researcher or medical doctor.

Singer and Grismaijer’s “study” was not reviewed by medical experts and published in a respected journal, as is the norm for bona fide scientific discoveries. According to a version of their story now doing the rounds on Twitter, they interviewed more than 4,000American women and discovered that women who don’t wear bras have a “1 in 168 chance” of developing breast cancer, as opposed to a “3 in 4 chance for those who wear a bra 24 hours a day”.

Their explanation is that underwired bras block circulation of lymphatic fluid, causing breasts to swell with “toxins” (a word more associated with pseudoscience, in my experience, than genuine medical knowledge). It is unlikely, though, that that lymph fluid would be trapped by an underwire, because it doesn’t flow in that direction, and a properly fitting bra prevents breast ligaments from overstretching. Scientists have also criticised Dressed to Kill for not taking into account known risk factors for breast cancer, most notably obesity, which increases the likelihood a woman will wear a bra for longer periods.

A comprehensive 2014 study by the globally respected Fred Hutchinson Cancer Centre in Seattle found that no aspect of bra-wearing was associated with breast cancer risk, and Breast Cancer Now, Cancer Research UK, the American Cancer Society, and the US National Institutes of Health are just a few of the organisations that have stressed the lack of evidence that wearing bras increases cancer risk.

American obstetrician and gynae-cologist Dr Jennifer Gunter has described this myth as “cruel”, saying that it scares women and could cause women with a breast cancer diagnosis to blame themselves for wearing a bra. If you find your bra is painful, you should not panic that you have cancer, but you should head to the high street and get measured for a new bra.

Sweat-free armpits or healthy breasts? You have to choose

The idea that antiperspirants cause breast cancer is usually justified either by the idea that preventing underarm stickiness blocks “toxins” from being sweated out, or that the aluminium salts used to block the sweat glands are absorbed through the skin and trigger cancer. The source appears to be an email hoax which spread so quickly that cancer charity helplines were overwhelmed by anxious callers worried they had been doomed by their personal hygiene routines.

The vast majority of harmful substances in our bodies are flushed out by the liver and kidneys (which is why we drink lots of water when we are hungover), not sweated out through our armpits. Almost all the studies purporting to show that antiperspirants cause cancer are from a single laboratory, with Dr Philippa Darbre often the only named author. One of the studies that, at first glance, shows aluminium is present in breast tissue is, on a second look, inconclusive because the authors didn’t compare normal (non-cancerous) tissue. Unless there is significantly more of something in a tumour compared with normal tissue, it isn’t wise to speculate that it has a role in cancer.

A 2002 study published by the Journal of the National Cancer Institute studied 1,606 women and discovered there was no link between the use of antiperspirants and cancer. Another study, in 2006, compared women with and without breast cancer and found that 82% of women who were cancer-free had used antiperspirant whereas only 52% of the women with breast cancer had, which certainly doesn’t support the theory that antiperspirants increase cancer risk.

Mammograms emit cancer-causing radiation, or squeeze tumours so the cancer spreads

Finding breast cancer early reduces your risk of dying from it by up to 25% – which makes the myth that mammograms cause cancer, or make it spread, a particularly dangerous one. The consensus in the medical community is that the benefits of mammograms far outweigh any risk. An annual, 20-minute mammogram involves a tiny dose of radiation, less than a chest X-ray and nowhere near enough to increase the risk of developing a cancer. The process of metastasis, in which cells break off a tumour, spread, and settle in a different place in the body to create a secondary tumour, is biologically complex and can’t be caused by squeezing a tumour. Mammograms are frightening because of the potential that they will find a cancer – but the mantra that early detection saves lives is true and one of the reasons that what used to be a death sentence is now survived by eight out of every 10 women diagnosed with breast cancer.

If you are worried about cancer, you can find reliable information from NHS Choices, or the websites and helpline of registered cancer charities such as Cancer Research UK, the Irish Cancer Society or Macmillan Cancer Support. As always, speak to your GP if you have any concerns about your health.

• Naomi Elster is a writer and scientist researching for a PhD in cancer medicine at the Royal College of Surgeons, Ireland, supported by the Irish Cancer Society

Your bra could kill you – and other breast cancer myths busted