“It is time to sound the alarm,” said Dr. Judy Wasserheit, vice chair of the Department of Global Health at the University of Washington, who wrote the article with Dr. Gail Bolan of the U.S. Centers for Disease Control and Prevention and Dr. P. Frederick Sparling of the University of North Carolina School of Medicine, Chapel Hill.

Gonorrhea bacteria - Photo CDC

Gonorrhea is a sexually transmitted disease that can infect the genital tract, throat and anus.

There are more than 600,000 cases of gonorrhea a year in the U.S., making it one of the most common reportable infections in the country.

Untreated, gonorrhea can cause a number of serous complications, including infertility, a chronic painful pelvic condition in women called pelvic inflammatory disease, and ectopic pregnancy, a serious complication in which the fetus develops in the fallopian tube instead of the uterus.

In rare cases, the bacteria can travel through the bloodstream and infect joints, heart valves and the brain.

The bacteria that causes gonorrhea, Neisseria gonorrhoeae, has a history of quickly acquiring the ability to resist antibiotics. In the 1940s it became resistant to sulfa drugs, in the 1980s to penicillins and tetracyclines, and by 2007 to flouroquinolones.

Today, treatment with a class of antibiotics called cephalosporins is considered the most reliable option, but resistance to this class of drugs is on the rise both abroad and in the U.S., raising concerns that doctors here will soon begin seeing cases they cannot cure.

Untreatable cases have not yet been reported in the U.S., but they have appeared in Asia and Europe and a worrying number of strains in the U.S. are showing signs of resistance to cephalosporins.

Resistance to one of the cephalosporins has risen 17-fold in the U.S. over the past few years, Dr. Wasserheit and her colleagues write, increasing from just 0.1 percent of cases in 2006 to 1.7 percent in the first part of last year.

Resistance has been increasing even faster in the western U.S., reaching 3.6 percent of all cases last year and 4.7 percent of cases among men who have sex with men.

Although higher doses may overcome the ability of these strains to resist cephalosporins for a time, Dr. Wasserheit and her colleagues write, urgent action is needed now to prevent the spread of these strains and to develop new treatments.

“There is much to do, and the threat of untreatable gonorrhea is emerging rapidly,” they conclude.

 To learn more:

• Visit the National Library of Medicine’s Medline Plus information page on gonorrhea.

• Visit the Public Health – Seattle & King County’s page on Sexually Transmitted Infections.

Photo: Sigurd Decroos

The good news: Teen pregnancies are at their lowest rate in nearly 40 years, resulting in fewer abortions and births, according to data from the Guttmacher Institute, a research organization focused on sexual and reproductive health.

The report shows that about 7 percent of U.S. teen girls between the ages of 15 to 19 were pregnant in 2008 — a decline from the high of more than 11 percent in 1990.

Abortions among teen girls fell from a peak of more than 4 percent in 1988 to about 1.8 percent in 2008, the lastest year for which data is available.

The bad news: While overall rates have dropped, there is still a major gap among white, Hispanic and black teenagers. Non-Hispanic white teen pregnancy rates fell by 50 percent from their peak; Hispanic teen pregnancy rates, 37 percent; black teen pregnancy rates, 48 percent.

Yet, according to the report, “the abortion rate among black teenagers was four times the rate for non-Hispanic whites, while the rate among Hispanic teenagers was twice the rate for non-Hispanic white teenagers.”

“The disparity has pretty much been unchanged,” said Kathryn Kost, co-author of the report. “If you think of these rates as lines on a graph, they are all going down, but the distance between them is pretty much unchanged.”

Kost said the increase in contraceptive marketing has helped to reduce pregnancies, but Heather Boonstra, a senior public policy associate at Guttmacher said the cost of contraceptives continues to be a factor. Boonstra said increasing the age limit for dependent health care coverage to 26 will increase access to birth control for many teens.

“There’s plenty of evidence that shows that if you take away cost in the equation,there is going to be better contraceptive use, fewer unintended pregnancies, fewer abortions, better birth outcomes,” she said. “The health care reform law was not designed with teens in mind, but … the more parents that are insured, the more teens or their dependents are insured, so certainly that will help.”

Bill Albert, the chief program officer of The National Campaign to Prevent Teen and Unplanned Pregnancy, said the decreased rates are a sign of progress, but more remains to be done. He noted that three out of 10 girls are pregnant by the age of 20.  Among the campaign’s initiatives is one focused on the Latino community and a new website geared to educating young women about birth control.

“In a way the message is let’s celebrate today, and then get back to work this afternoon,” Albert said. “I think this underscores the need to continue to invest as the current admin has in proven efforts to prevent teen pregnancy.”

Photo by Sigurd Decroos of CobraSoft.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Sharon Reynolds
NCI Cancer Bulletin Staff Writer 

Prostate Cancer

New data from the Prostate, Lung, Colorectal and Ovarian (PLCO) randomized screening trial show that, after 13 years of follow up, men who underwent annual prostate cancer screening with prostate-specific antigen (PSA) testing and digital rectal examination (DRE) had a 12 percent higher incidence of prostate cancer than men in the control group but the same rate of death from the disease.

No evidence of a mortality benefit was seen in subgroups defined by age, the presence of other illnesses, or pre-trial PSA testing. The results were published January 6 in the Journal of the National Cancer Institute.

When the PLCO researchers published their initial prostate screening results in 2009, which also revealed no prostate cancer mortality or overall mortality benefit from annual screening, critics countered that participants had not been followed long enough to detect a difference in prostate cancer mortality, if one existed.

“The natural history of prostate cancer is so long that 10 to 15 years of follow up is usually the window we look for” when determining the effectiveness of a screening intervention, explained first author Dr. Gerald Andriole, who is chief urologic surgeon at the Siteman Cancer Center at Barnes-Jewish Hospital in St. Louis and the Washington University School of Medicine.

Overdiagnosis?

The persistent increase in incidence of prostate cancer in the screening arm of the study may indicate that regular screening can lead to overdiagnosis—finding tumors that never would have caused symptoms or death.

“Even if there was just a tiny mortality benefit [from prostate cancer screening], overdiagnosis wouldn’t be so bad if we didn’t hurt people. But we do hurt people by finding a lot of trivial cancers that are most often overtreated,” explained Dr. Andriole.

The PLCO began in 1993 and enrolled men through mid-2001. More than 38,000 men were randomly assigned to annual screening for 6 years (including DRE for the first 4 years and PSA testing for all 6), and the same number of men were assigned to usual care.

Because prostate cancer screening is so common, more than half of the participants in the control arm underwent at least one prostate cancer screening test outside the trial.

This contamination made it more difficult to determine whether annual testing affected mortality. However, “the level of screening in the intervention arm was substantially greater than that in the control arm throughout the trial screening period,” wrote the authors.

“Every time we screened [in the intervention arm] we got a bump of excess cases,” said Dr. Philip Prorok, a lead NCI investigator on the study. “What we can’t say for sure is whether we would have seen more of an effect on mortality had there been absolutely no screening in the control arm.”

Studies differ

Another recent large trial, called the European Randomized Study of Screening for Prostate Cancer, did report a mortality benefit for prostate cancer screening.

Although that trial had less contamination in the control arm, it had other limitations that could bias the results, such as differences in the treatments given to men in the screening and control arms.

To help reconcile the differing results from these two trials—the largest trials to date of organized prostate cancer screening—an effort is under way by the NCI-funded Cancer Intervention and Surveillance Modeling Network (CISNET) to use mathematical modeling to tease out how differences in the trial designs and populations may have contributed to the disparate trial results, explained Dr. Paul Pinsky, an NCI investigator on the PLCO trial and consultant to the CISNET project.

“Even though the results seem to be disparate, because one [trial] found a [statistically] significant protective effect [on prostate cancer mortality] and one didn’t, it could be because of the ways the trials were designed and carried out,” he said. The CISNET study began last year and is examining data from the two trials.

Men and their health providers agree that a more definitive answer is needed as doctors and policy makers seek to understand which, if any, men may benefit from routine prostate cancer screening.

In October 2011, the United States Preventive Services Task Force released new draft guidelines for prostate cancer screening for public comment.

The new draft guidelines, which are based in part on PLCO findings, recommend against routine PSA testing in men who do not have prostate cancer symptoms.

Some doctors think the new recommendations go too far in not accounting for the informed decisions of individual men.

“If prostate cancer constitutes a continuum of disease and its overdiagnosis and overtreatment are mainly limited to low-grade disease, then instead of completely eliminating the potential benefits of screening along with the risks, why not consider managing low-risk patients differently?” asked Drs. Robert Volk from the University of Texas M. D. Anderson Cancer Center and Andrew Wolf from the University of Virginia School of Medicine in a commentary published last month in JAMA.

Practice appears to be moving in this direction, with a greater emphasis on active surveillance instead of immediate treatment for some men who have prostate cancer that is thought to be at low risk of progressing.

A big advance, explained Dr. Andriole, would be the ability to predict, even before a biopsy, whether a man with an elevated PSA level is likely to have an aggressive versus a nonaggressive cancer.

“There’s a lot of effort now being put into this, and not just for prostate cancer, but for a lot of other cancer types as well,” added Dr. Prorok. “If we diagnose someone with symptoms, or you find something on a screening test, can we eventually find a way to determine for which individuals the cancers are in fact aggressive and need more aggressive treatment, versus some that need less aggressive treatment or don’t need any treatment at all?”

Researchers are looking for biomarkers, including genes and proteins, that may give clues to a cancer’s aggressiveness. “If we could selectively change our criteria for biopsy such that only men who are at high risk for aggressive cancer get biopsied, we might be able to substantially shift the overall risk/benefit [ratio] of screening,” said Dr. Andriole.

To learn more:

• Read the National Cancer Institute’s booklet: What You Need to Know About Prostate Cancer.

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

Supporters of the initiatives say these new services allow students to get good information about sex anonymously. But there are also those who oppose these initiatives, writes Hoffman.

…proponents of abstinence-based sexual education argue that these digital services presume that sexual activity among teenagers is the norm, and do not spend enough time on alternatives.

“They are only focusing on the risk-reduction model,” said Valerie Huber, executive director of the National Abstinence Education Association, which hopes to kick off its online service for teenagers next year.

Those who run digital programs say they simply want teens to have accurate information, to help them make good decisions. Even though popular culture is saturated with sex, facts and advice can be hard to find.

To learn more:

• Read Hoffman’s article Sex Education Gets Directly to Youths, via Text.

Some of the services discussed:

• ICYC – In Case You’re Curious

• Chicago’s The Sex-Ed Loop

• California’s The Hookup.

• SexEtc: www.sexetc.org

• National Abstinence Education Association: www.abstinenceassociation.org

Polyclinic introduces clinical research department with international HDL study

Seattle’s Polyclinic has launched a clinical research department with a study sponsored by Oxford University. The study, called REVEAL, will test whether new drug Anacetrapib can boost levels of the “good cholesterol” HDL in patients 50 years or older with a history of heart attack, coronary artery disease, or type I or II diabetes. “The only currently available therapy with an effect on HDL is niacin, which raises levels by 20% to 30% but can cause uncomfortable side effects,” the medical group says. Press Release.

Virginia Mason and Wenatchee Valley Medical Center to Begin Cardiac Affiliation

Virginia Mason and Wenatchee Valley Medical Center have formed a “cardiac affiliation” in which physicians from the two medical centers will collaborate on patient care and share best practices. Activities include:

• Weekly Grand Rounds
• Consultation on cases requiring technology and techniques not available in Wenatchee
• Development of cardiology order-sets and clinical protocols
• Weekly cardiac catheterization conferences and collaborative case reviews
• Shadowing opportunities
• Continuing medical education
• Site visits
• Community outreach events

To learn more read the full press release.

Merck for Mothers and PATH to collaborate on project to reduce maternal deaths

The pharmaceutical company Merck has awarded a grant to the Seattle global health non-profit PATH to “evaluate more than 30 promising technologies at various stages of development that address the two leading causes of maternal mortality—post-partum hemorrhage and preeclampsia—as well as family planning.”

The initiative is part of Merck’s “Merck for Mothers” program.

“The partnership, valued at $2.5 million and extending through Fall 2012, will integrate private- and public-sector expertise to help evaluate affordable and easy-to-use maternal health technologies that work in resource-poor settings.” Press Release.

PRESS RELEASE MATERIAL

Polyclinic introduces clinical research department with international HDL study

SEATTLE, Wash. – The Polyclinic is participating in a major international clinical research study aimed at raising HDL (good cholesterol) levels. As an entirely new department at The Polyclinic, clinical research opens up an additional arm of medicine for patients and physicians alike. The Polyclinic recognizes clinical research as an enhancement to its mission of providing high-quality, comprehensive, personalized health care.

“Patients who participate in clinical research studies are ultimately contributing to better health care,” said Polyclinic Chief Medical Officer Michael Tronolone, MD, MMM. “It leads to new discoveries that improve quality of life, and also the lives of future generations.”

Having grown significantly since its creation a year ago, the department aims to focus on research studies addressing significant unmet medical needs. Polyclinic physicians welcome the addition of the department, as it increases patients’ options for treatment and their ability to participate in research.

“Not all patients achieve optimum health with currently available medications,” said Dr. Tronolone. “The Polyclinic clinical research department can now play a part in improving outcomes.”

This international HDL study, now enrolling participants, will test whether new drug Anacetrapib can boost HDL levels in patients 50 years or older with a history of heart attack, coronary artery disease, or type I or II diabetes.

The study, entitled REVEAL and sponsored by Oxford University, will include 30,000 individuals worldwide with 180 sites in the United States.

The only currently available therapy with an effect on HDL is niacin, which raises levels by 20% to 30% but can cause uncomfortable side effects.

“Although we have excellent methods of treating heart disease, current therapies have plateaued and further progress is needed,” said Dr. Kier Huehnergarth, Polyclinic

cardiologist and principal investigator for the REVEAL study. “By participating in this research, The Polyclinic hopes to provide patients with even more protection against a future heart attack.”

Patients who qualify for this study will attend five clinic visits in the first year and biannual clinic visits thereafter. They will also receive a stipend for each visit as well as lab tests and study medication at no cost. The study will continue to enroll throughout the next several months.

The Polyclinic clinical research department studies are open to anyone who meets the criteria, regardless of their status as a Polyclinic patient. Other studies currently enrolling are focused on lupus, overactive bladder, nocturia (nighttime urination), and HIV. Each study is administered by a Polyclinic physician who acts as the principal investigator and is assisted by the staff of the research department.

For more information about the REVEAL study and other clinical research studies at The Polyclinic, or to find out if you qualify, visit www.polyclinic.com/clinical-research or call 206-860-5433.

# # #

PRESS RELEASE MATERIAL

Virginia Mason and Wenatchee Valley Medical Center to Begin Cardiac Affiliation

SEATTLE – (Dec. 5, 2011) – Virginia Mason and Wenatchee Valley Medical Center have entered into a new cardiac affiliation. This affiliation represents two outstanding health care organizations, who share similar values, formalizing a relationship to provide the residents of North Central Washington with access to high-quality, efficient and cost-effective health care. This is an opportunity for two like-minded organizations to further dedicate themselves to transforming health care, with a focus on improving the patient experience and value of care.

As part of the arrangement, physicians from Wenatchee Valley Medical Center and Virginia Mason will collaborate on numerous aspects of patient care and share best practices with one another. Some of the activities include:

• Weekly Grand Rounds
• Consultation on cases requiring technology and techniques not available in Wenatchee
• Development of cardiology order-sets and clinical protocols
• Weekly cardiac catheterization conferences and collaborative case reviews
• Shadowing opportunities
• Continuing medical education
• Site visits
• Community outreach events

“We look forward to this affiliation with Wenatchee Valley Medical Center, as our patients and providers throughout the state will ultimately benefit from what these exceptional organizations have to offer,” says Sarah Patterson, Virginia Mason executive vice president and chief operating officer. “Virginia Mason has served many eastern Washington patients over the years, and we are excited to build on this service as our partnership with WVMC takes shape.”

“This affiliation is a tremendous opportunity for Wenatchee Valley Medical Center and the patients it serves to have organized access to and interaction with a high quality health care organization that shares our values of patient-centered value-based care,” says Peter Rutherford, MD, CEO and Chairman of Wenatchee Valley Medical Center. “We will be able to learn from each other and improve patient care for all.”

# # #

PRESS RELEASE MATERIAL

Merck for Mothers and PATH Collaborate to Identify Innovations that Save Mothers’ Lives

Alliance is Key Step in Bringing Sustainable, Affordable Technologies to the Mothers Who Need Them Most

Whitehouse Station, N.J. and Seattle, W.A., December 5, 2011 – Merck (NYSE: MRK), known as MSD outside the United States and Canada, awarded a grant to PATH, a global health nonprofit, to identify game-changing technologies with potential to save the lives of women during pregnancy and childbirth in low-resource settings. Spearheaded by top scientists from Merck for Mothers and PATH, this unique alliance will evaluate more than 30 promising technologies at various stages of development that address the two leading causes of maternal mortality—post-partum hemorrhage and preeclampsia—as well as family planning. The partnership, valued at $2.5 million and extending through Fall 2012, will integrate private- and public-sector expertise to help evaluate affordable and easy-to-use maternal health technologies that work in resource-poor settings.

“PATH is excited to collaborate with Merck to make measurable reductions in maternal mortality,” said Dr. Michael J. Free, vice president and senior advisor for technologies, PATH. “Combining our capabilities will allow the most effective technologies to enter the market, without the usual barriers that come from the lack of private-sector incentives. This is an opportunity to advance needed technologies and make a great impact on maternal health around the world.”

“There are many promising, life-saving maternal health innovations that, left to current market forces, would not reach the mothers who need them, when they need them, at a price they can afford,” said Dr. Naveen Rao, who is leading Merck for Mothers. “By collaborating with PATH, which has deep expertise in developing solutions for the world’s greatest health problems, we will help bring important technologies to countries where women are dying at some of the highest rates.  By doing so, we will fulfill a key part of the commitment of Merck for Mothers to advance product development in post-partum hemorrhage, preeclampsia and family planning toward achieving United Nations’ Millennium Development Goal 5.”

Merck for Mothers is a new 10-year, half-billion-dollar initiative to create a world where no woman has to die from preventable complications of pregnancy and childbirth (merckformothers.com).  Drawing on the company’s history of discovering innovative, life-saving medicines and vaccines, Merck for Mothers will apply Merck’s scientific and business expertise—as well as its financial resources and experience in taking on tough global healthcare challenges—to reduce maternal mortality around the world.  As part of its focus, the program will seek to accelerate access to proven solutions; develop game-changing prevention, diagnostic and treatment technologies; and support public awareness, improved policies and broader private-sector engagement in the area of maternal health. The collaboration with PATH is a key step in Merck for Mothers’ rapid development of game-changing technologies in maternal health, and the company will leverage the learnings to build an investment strategy for accelerating the development of these technologies.

Researchers at Merck’s Development Center in Oss, Netherlands and PATH’s Technology Solutions Global Program in Seattle will work together to advance promising technologies in different stages of development, with an initial goal of identifying three to five maternal health breakthroughs in the next 12-18 months. The collaboration will evaluate technologies in the prevention, diagnostic and treatment areas for the different stages of pregnancy and childbirth and compare them across multiple parameters, such as commercialization potential, user and stakeholder acceptability and time to impact.

Potential technologies for assessment include:

• Treatments for the prevention of post-partum hemorrhage to assist women in the third stage of labor.

• Pre-natal preeclampsia screening tool to identify high risk women and significantly increase survival rates.

• Effective family planning interventions that are relatively easy to use to encourage higher adherence.

About Maternal Mortality

In the next decade, it is estimated that as many as three million women may die from complications of pregnancy and childbirth. The majority of these maternal deaths are preventable.

The United Nations’ Millennium Development Goals (MDGs) seek to address the world’s greatest development priorities, with MDG5 focused on reducing the maternal mortality ratio by 75 percent and creating universal access to reproductive health. However, several countries around the world run the risk of failing to meet this goal unless good-quality reproductive health services and well-timed interventions are supplied.

About PATH

PATH is an international nonprofit organization that transforms global health through innovation. PATH takes an entrepreneurial approach to developing and delivering high-impact, low-cost solutions, from lifesaving vaccines and devices to collaborative programs with communities. Through its work in more than 70 countries, PATH and its partners empower people to achieve their full potential. For more information, please visit www.path.org.

About Merck

Today’s Merck is a global healthcare leader working to help the world be well.  Merck is known as MSD outside the United States and Canada.  Through our prescription medicines, vaccines, biologic therapies, and consumer care and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions.  We also demonstrate our commitment to increasing access to healthcare through far-reaching policies, programs and partnerships.  For more information, visit www.merck.com and connect with us on Twitter, Facebook and YouTube.

Forward-Looking Statement

This news release includes “forward-looking statements” within the meaning of the safe harbor provisions of the United States Private Securities Litigation Reform Act of 1995. Such statements may include, but are not limited to, statements about the benefits of the merger between Merck and Schering-Plough, including future financial and operating results, the combined company’s plans, objectives, expectations and intentions and other statements that are not historical facts. Such statements are based upon the current beliefs and expectations of Merck’s management and are subject to significant risks and uncertainties. Actual results may differ from those set forth in the forward-looking statements.

The following factors, among others, could cause actual results to differ from those set forth in the forward-looking statements: the possibility that the expected synergies from the merger of Merck and Schering-Plough will not be realized, or will not be realized within the expected time period; the impact of pharmaceutical industry regulation and healthcare legislation; the risk that the businesses will not be integrated successfully; disruption from the merger making it more difficult to maintain business and operational relationships; Merck’s ability to accurately predict future market conditions; dependence on the effectiveness of Merck’s patents and other protections for innovative products; the risk of new and changing regulation and health policies in the United States and internationally and the exposure to litigation and/or regulatory actions.

Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events or otherwise. Additional factors that could cause results to differ materially from those described in the forward-looking statements can be found in Merck’s 2010 Annual Report on Form 10-K and the company’s other filings with the Securities and Exchange Commission (SEC) available at the SEC’s Internet site (www.sec.gov).