Global response to flu must change
'Evil' scientists, deadly viruses and terrorist plots are usually the
preserve of Hollywood blockbusters. But when it comes to pandemic
influenza, it is the stuff of real life.
As controversy about research into the H5N1 bird flu virus continues,
a new find argues for a complete overhaul of current approaches to
pandemic preparedness.To Pandemic or Not? Reconfiguring Global Responses
to Influenza, by Dr Paul Forster, investigates the H1N1 swine flu
pandemic of 2009-10 and sets out some vital lessons if we are to prepare
for pandemic influenza effectively, while avoiding confusing and costly
When the H1N1 outbreak in 2009-10 was milder than the World Health
Organisation had predicted, WHO was accused of colluding with the
pharmaceutical industry and national governments of squandering
billions.The Council of Europe said US$18 billion was wasted, and
branded WHO's actions "one of the greatest medical scandals of the
century". The event revealed weaknesses in the world's current
configuration of planning for and responding to pandemic influenza,
according to Dr Forster. Science, public health policy makers and the
worldwide public were confounded by the uncertainty, complexity and
politics of pandemic influenza and the high emotions it inspires. Amid
this confusion, the global and national institutions responsible for
protecting public health were shown to be over-reliant on a reductive,
science-led approach that prioritised a one-size-fits-all response, and
failed to address the needs and priorities of the world's poorest and
most vulnerable people.
Dr Forster suggests new ways to construct plural responses more
suited to tackling the globalised mix of politics, people and pathogens
that pandemics produce.
"Preparing for an influenza pandemic means preparing for surprises
and being ready to respond rapidly and flexibly under conditions of
uncertainty. If people across the globe are to be ready, plural and
diverse response pathways are required," said Dr Forster, an independent
development consultant and STEPS Centre researcher.
"The world would be better protected by a re-ordering of pandemic
preparedness and response efforts around the needs of the world's
poorest, most vulnerable, and most exposed people," he added.
A re-ordered response would allow the undue pre-eminence of
pharmaceuticals to be examined, and bring focus on the pressing need for
disease surveillance in animals, scrutiny of contemporary agricultural
practices and a broadening of research efforts. It might also refresh
the World Health Organisation's approach, which Dr Forster believes
supports an inflexible and narrow set of interests by default, rather
With most flu experts agreeing that it is not so much a question of
if, but rather when, a new pandemic will arrive, the sooner the lessons
of outbreaks such as that in 2009-10 can be learned, the better.
Mass migration exposes Indians to HIV
A view published on bmj.com exposes the true scale of HIV in India,
placing the majority of blame on mass migration.
The Times of India proposes that "mass migration is the greatest
threat to India's HIV control program" and asks how this can be
India's 2001 census showed that a third of the population are
migrants (up from 27.4 percent in 1991). And worryingly, India's
National AIDS Control Organisation (NACO) found that they have a 3.6
percent prevalence of HIV, 10 times that of the general population.
In the Indian state of Maharashtra, studies from 2009 showed that
18.6 percent of migrants had sexually transmitted infection symptoms, of
which 45 percent did not seek treatment. seventy six percent did not
even perceive any risk of HIV and as such, only 13 percent had been
tested for the infection.
India's health ministry fear HIV prevalence will worsen due to
migrants' "risky sexual behaviour", lack of social and economic security
and "risk taking activities". Plus a recent study found that migrants
were 1.68 times more likely to contract HIV than non-migrants.
Studies have shown that four times as many informal workers have
casual sexual partners or visit sex workers, compared with those who are
faithful to their spouses. Plus, only 25 percent of these workers use
condoms, compared to 42 percent by others. To combat this, NACO is
implementing a new migration policy covering the main railway stations
in India where migrants usually board long distance trains. The primary
focus is on informal labourers with a high prevalence of HIV. NACO hope
this program will help to interrupt the transmission from rural migrants
to high urban risk groups, but concludes that "language, cultural norms
and available timings for migrants to access services" may present a
Does power lead people to greater happiness?
How does being in a position of power at work, with friends, or in a
romantic relationship influence well-being? While we might like to
believe the stereotype that power leads to unhappiness or loneliness,
new research indicates that this stereotype is largely untrue: Being in
a position of power may actually make people happier.
Drawing on personality and power research, Yona Kifer of Tel Aviv
University in Israel and colleagues hypothesised that holding a position
of authority might enhance subjective well-being through an increased
feeling of authenticity.
The researchers predicted that because the powerful are able to
"navigate their lives in congruence with their internal desires and
inclinations," they feel as if they are acting more authentically - more
"themselves" - and thus are more content.
In their first experiment, the researchers surveyed over 350
participants to determine if internal feelings of power are associated
with subjective well-being in different contexts: at work, with friends,
or in romantic relationships.
The results indicated that people who feel powerful in any context
tend to be more content.
The most powerful people surveyed felt 16 percent more satisfied with
their lives than the least powerful people. This effect was most
pronounced in the workplace: Powerful employees were 26 percent more
satisfied with their jobs than their powerless colleagues. The
power-based discrepancy in happiness was smaller for friendships and
The researchers posit that this may be because friendships are
associated with a sense of community rather than hierarchy, and
therefore having power in this kind of relationship is less important.
In the second and third experiments, Kifer and colleagues examined
the causal relationship between power, feelings of authenticity, and
general well-being, by manipulating each of the factors independently.
The results revealed that being in a position of power causes people
to feel more authentic and "true to themselves" - that is, it allows
their actions to more closely reflect their beliefs and desires.
Feelings of authenticity, in turn, enhance subjective feelings of
well-being and happiness.
"By leading people to be true to their desires and inclinations - to
be authentic - power leads individuals to experience greater happiness,"
the researchers conclude.
Kifer and colleagues propose that future research into power
dynamics, happiness, and authenticity should focus on specific kinds of
power, both positive (such as charisma) and negative (such as
Together, these findings suggest that even the perception of having
power can lead people to live more authentic lives, thereby increasing
their happiness and well-being.
Modifying cells in the eye may restore vision
Doctors may one day treat some forms of blindness by altering the
genetic program of the light-sensing cells of the eye, according to
scientists at Washington University School of Medicine in St. Louis.
Working in mice with retinitis pigmentosa, a disease that causes
gradual blindness, the researchers reprogrammed the cells in the eye
that enable night vision.
The change made the cells more similar to other cells that provide
sight during daylight hours and prevented degeneration of the retina,
the light-sensing structure in the back of the eye. Scientists are now
conducting additional tests to confirm that the mice can still see.
"We think it may be significantly easier to preserve vision by
modifying existing cells in the eye than it would be to introduce new
stem cells," said senior author Joseph Corbo. "A diseased retina is not
a hospitable environment for transplanting stem cells."
The study is available in the early online edition of Proceedings of
the National Academy of Sciences.
Mutations in more than 200 genes have been linked to various forms of
Efforts are under-way to develop gene therapies for some of these
conditions.Rather than seek treatment tailored to individual mutations,
Corbo hopes to develop therapies that can alleviate many forms of visual
impairment. To make that possible, he studies the genetic factors that
allow cells in the developing eye to take on the specialised roles
necessary for vision.
The retina has two types of light-sensing cells or photoreceptors.
The rods provide night vision, and the cones sense light in the daytime
and detect fine visual details.In retinitis pigmentosa, the rods die
first, leaving patients unable to see at night. Daytime vision often
remains intact for some time until the cones also die.
Corbo and others have identified several genes that are active in
rods or in cones but not in both types of photoreceptors.
He wondered whether turning off a key gene that is activated only in
rods could protect the cells from the loss of vision characteristic of
'The question was, when retinitis pigmentosa is caused by a mutation
in a protein only active in rods, can we reduce or stop vision loss by
making the cells less rod-like?" he explains.
The new study focuses on a protein known as Nrl, which influences
development of photoreceptors.
Cells that make Nrl become rods, while cells that lack the protein
Turning off the Nrl gene in developing mice leads to a retina packed
with cone cells.
To see if this rod-to-cone change was possible in adult mice, Corbo
created a mouse model of retinitis pigmentosa with an Nrl gene that
could be switched on and off by scientists.
"In adult mice, switching off Nrl partially converts the rod cells
into cone cells," he says.
"Several months later, when the mutant mice normally had very little
vision left, we tested the function of their retina."The test showed a
healthier level of electrical activity in the retinas of mice that
lacked Nrl, suggesting that the mice could still see.
Corbo now is looking for other critical development factors that can
help scientists more fully transform adult rods into cones.
He notes that if complete conversion of rods to cones were possible,
this therapy could also be helpful for conditions where cone cells die
first, such as macular degeneration.
Small changes may equal a trip to the gym
New research suggests the health benefits of small amounts of
activity - even as small as one and two-minute increments that add up to
30 minutes per day - can be just as beneficial as longer bouts of
physical exercise achieved by a trip to the gym.
The nationally representative study of more than 6,000 American
adults shows that an active lifestyle approach, as opposed to structured
exercise, may be just as beneficial in improving health outcomes,
including preventing metabolic syndrome, high blood pressure, and high
"Our results suggest that engaging in an active lifestyle approach,
compared to a structured exercise approach, may be just as beneficial in
improving various health outcomes," said Paul Loprinzi, lead author of
"We encourage people to seek out opportunities to be active when the
choice is available. For example, rather than sitting while talking on
the phone, use this opportunity to get in some activity by pacing around
Perhaps just as importantly, the researchers found that 43 percent of
those who participated in the "short bouts" of exercise met physical
activity guidelines of 30 minutes day.
In comparison, less than 10 percent of those in the longer exercise
bouts met those federal guidelines for exercise.
Cardinal, who has studied the "lifestyle exercise" model for more
than 20 years, said one of the most common barriers people cite to
getting enough exercise is lack of time.
He said the results of this study are promising, and show that simply
building movement into everyday activities can have meaningful health
"This is a more natural way to exercise, just to walk more and move
around a bit more," Cardinal said. "We are designed by nature as beings
who are supposed to move.
People get it in their minds, if I don't get that 30 minutes, I might
as well not exercise at all.
Our results really challenge that perception and give people
meaningful, realistic options for meeting the physical activity
For example, Cardinal said instead of driving half a mile, try biking
or walking the same distance; instead of using a riding lawn mower, use
a push lawn mower.
Instead of sitting through TV commercials, try doing some sit-ups,
push-ups, or jumping jacks during the commercial breaks; and instead of
sitting and being a spectator at a child's sporting event, try walking
around during the halftime break.
The researchers said the participants in this study wore
accelerometers, which is an objective tool to measure physical activity.
Those who participated in the short bouts of activity could be moving as
few as one or two minutes at a time. The people in the "short bouts"
group had positive results in areas such as blood pressure, cholesterol,
metabolic syndrome, and waist circumference.
For instance, the study showed those in the shorter exercise group
who met physical activity guidelines had an 89 percent chance of not
having metabolic syndrome, compared to 87 percent for those meeting
guidelines using the structured exercise approach. Loprinzi said the one
area where small bursts of activity did not seem to equal the benefits
of longer, sustained exercise was in Body Mass Index, or BMI.
However, the researchers cautioned that these findings do not
necessarily mean that short bouts of activity do not help with weight
loss, especially since they did find a benefit on weight circumference.