By now, there's mountains of depressing evidence that in the Bush administration, ideology always trumps science.

Nowhere does this seem more cruelly short-sighted than in the administration's approach to AIDS. I've written here before about the government's insistence that any groups that receive federal funds have to formally oppose prostitution.

Here's one more disheartening report: after a year-long investigation, the Center for Public Integrity, a nonprofit based in Washington DC, has found that PEPFAR, the administration's $15 billion AIDS initiative, "has not worked out the way it was envisioned."

One of PEPFAR's most criticized aspects is the ABC approach for prevention: abstinence, be faithful and condoms. Neither abstinence nor being faithful is much of an option for a married woman whose husband is unfaithful, but let's not get bogged down by practical details.

The center's Consortium of Investigative Journalists filed two dozen Freedom of Information Act requests, FOIA lawsuits against the State Department, the U.S. Agency for International Development and the Department of Health and Human Services. After more than 100 interviews, examination of thousands of pages of documents and reporting on the ground in affected countries, they say that:

In fact, the actual prevention practices stress the "AB" messages — abstinence until marriage and being faithful to one partner. The "C" has moved to a small c, and the use of condoms is lumped into the category of "other preventions" that includes prevention of mother-to-child transmission, blood safety, safe medical injections and control of intravenous drug use.

It's nice to see that tomorrow, this ambitious project, dubbed "Divine intervention", is set to win the first prize in online and trade journals category from the Association of Health Care Journalists.

On another positive note, I mentioned before that Brazil had turned down money from the US rather than meet the ideological demands. Looks like even within this country, there's some rebellion afoot.

On March 5, Wisconsin turned down about $600,000 in federal "abstinence-only-before-marriage" funds because the money would have prevented programs from teaching kids about contraception or sexually transmitted diseases. California, Maine, New Jersey and Pennsylvania have also turned down the funds and another dozen are set to do the same, according to Madison's The Capital Times

Posted by Apoorva Mandavilli at 03:40 PM | Permalink | Comments (3)

People being treated for cancer often become anemic, meaning their blood oxygen levels fall too low, which is partly why they feel exhausted during treatment. To ease the anemia — and the fatigue — doctors prescribe erythropoietins, which stimulate the production of red blood cells.

On Friday, the Food and Drug Administration warned that these drugs, sold under the brand names Epogen, Procrit and Aranesp, are doing more harm than good in some cases. Doctors have apparently been over-prescribing the drugs, using them to reverse anemia, instead of just alleviating it enough to avoid blood transfusions.

The agency says that the drugs carry a higher risk of blood clots in the legs and the lungs, could make tumors grow faster, and could even cause people being treated for cancer to die more quickly. The drugs will now be sold with a black-box warning that highlights these risks.

Here's what I don't understand: we first reported on the risks with these drugs in 2003, when a couple of trials unexpectedly showed that people taking erythropoietin died faster than those taking the placebo.

We quoted experts who had found that many tumor cells have receptors for erythropoietin and that the cells grow faster in response to erythropoietin, and we reported — perhaps naively, in retrospect — that the mounting evidence might have an effect on how the drugs are prescribed.

As I said, that was in December 2003, more than three years ago.

Why has it taken so long for the FDA to act?

Posted by Apoorva Mandavilli at 03:27 PM | Permalink | Comments (3)