Wake Up, Philippines!

Top health stories of 2008

Posted in Health, What/How/Why/Where/When by Erineus on March 3, 2009

AN APPLE A DAY By TYRONE M. REYES, M.D. Updated March 03, 2009 12:00 AM


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Last year’s top health stories are a reminder that so much of health and medicine seems to reside stubbornly in the details. For example, blood sugar control as a general proposition in diabetes isn’t a bit problematic. But sorting out just how low it should go, in which patients, and by what means — that’s difficult. Clinical trial results in 2008 steered patients and doctors away from an all-out approach that emphasizes super low levels toward a well-rounded one that takes into account cardiovascular risk factors. Similarly, we know that controlling high blood pressure is important, but clinical trial results in 2008 laid to rest some old theories by showing that this is also true for people ages 80 and older. I’m just as enthusiastic as anyone about advances in stem cell research and genomics. But it gives you a sense of the complexities and the long road ahead if basics such as blood sugar and blood pressure control are still being worked out.

Blood Sugar: How Low Should It Go?

People with type 2 diabetes are encouraged to keep their blood sugar levels low, and the usual goal is a glycated hemoglobin (HbA1c) level of seven percent or lower (the percentage of “sugary” hemoglobin is a good way to assess blood sugar levels over time, rather than depending on the snapshots of single blood sugar measurements). But is seven percent ambitious enough? Results from three clinical trials last year showed that the single-minded pursuit of low blood sugar levels is probably not the best approach to type 2 diabetes, particularly in people ages 60 and older.

The ACCORD trial got the most attention because it was stopped early after an interim analysis found that more people in the intensive treatment group (an HbA1C goal of below six percent) had died than those with more conventional blood sugar goals (between 7 and 7.9 percent).

The blood sugar goal was more relaxed (6.5 percent) in another trial, and the intensive treatment group did have fewer deaths and heart attacks than the conventional treatment group, but the difference wasn’t statistically significant. A third trial, a Danish study called Steno-2, tested a more holistic approach: the 6.5 percent goal along with targets for lower total cholesterol, triglycerides, and blood pressure. It worked to slice heart attacks and other cardiovascular “events” in half.

But it’s important to stress that people with diabetes should continue strict blood sugar control. Data show that it lowers the risk of kidney disorders, eye diseases, and other problems related to damage of small blood vessel (microvascular disease).In fact, a British report last year suggested that tight control may bring about changes at the cellular level that create a “legacy effect”: protection from vascular problems that extend years to decades, after blood sugar was tamped down.

But last year’s bumper crop of diabetes research has shown that it’s unwise to be overzealous about blood sugar lowering — moderation in all things! — and certainly not without also attending to risk factors like high blood pressure and cholesterol.

80 Ain’t Old

Doctors used to be taught that high blood pressure was a blessing in old age because the extra oomph pushed blood through narrow, atherosclerotic arteries. But the age limit for controlling high blood pressure — usually with medications — has crept up as research results have shown that it prevents strokes, heart attacks, and heart failure in the old and young alike.

Last year, results from the Hypertension in the Very Elderly Trial (HYVET) topped off that trend by showing that even in an age group once viewed as being extremely old — those 80 and older — reining in high blood pressure pays off. After two years, the treated group in the study had lower rates of heart failure, strokes, and overall mortality. The HYVET study subjects were noted to be healthier than the usual average group of 80-plusers. HYVET is one more evidence that the age for effective medical intervention — be it pills, surgery, or devices — is getting older and older.

iPS: What These Stem Cells Might Do For You

Last year, several research groups discovered ways to genetically tinker with adult cells so they look and behave like stem cells from embryos. These reprogrammed cells — called induced pluripotent stem cells (iPS) cells — have given researchers another source of stem cells besides embryos. One catch: The retroviruses and two of the genes used to create iPS cells could turn them cancerous. For that reason and others, scientists don’t want to abandon embryonic stem cell research, but iPS cells do eliminate many of the ethical issues dogging stem cell research because embryos aren’t involved. They could also make immunological rejection a moot point because with iPS cell therapy, the patient’s own cells would be used.

Important iPS findings popped up left and right last year. Skin cells from two older patients with amyotrophic lateral sclerosis (Lou Gehrig’s disease) were transformed into iPS cells and then coaxed into becoming neurons and other cells that might be used to treat the disease. Insulin-producing pancreatic cells were made from iPS cells that came from human skin. Harvard researchers created several lines of iPS cells from patients with genetically based diseases like Parkinson’s and Huntington’s. And as 2008 was ending, two research teams reported that they had created iPS cells without retroviruses or the two cancer-causing genes, another step forward toward the day when stem cell therapy will leave the lab and enter the clinic.

Seeing Right Through You And Its Dangers

A half-dozen imaging technologies allow doctors to see what’s going on inside the body. The workhorse, though, is computed tomography (CT), which uses a computer to assemble multiple cross-sectional x-rays into remarkably detailed pictures. The basic technology is nothing new — it’s been around for more than 30 years — but a new generation of machines, called multidetector CT scanners, is making the pictures even faster and incredibly sharp.

Speedy CT scanners are proving to be especially valuable in hospital emergency departments, where time is of the essence. It’s now routine at many modern hospitals for patients with chest pain to get a CT scan of their coronary arteries to see if they are diseased. Depending on the result, hospitalizations may be avoided. CT scans are also a mainstay of emergency departments; by some estimates, doctors now order more than a hundred thousand CT scans in the Philippines last year, double the number ordered a decade ago.

But are we going to pay a price for all these pictures? The radiation from CT scans is much higher than from traditional imaging tests. Starting in 2007, researchers at Columbia University in New York have published several provocative papers about the cancers that these CT scans may cause. According to their projections, the current exposure to CT scans might be responsible for between 1.5 percent and two percent of all cancers a few decades from now (it takes years for the cancers to develop).

There are, however, several technical adjustments to the CT scans that can lower the per-scan dose quite a bit. Still, scans are often repeated for no good reason; doctors need to eliminate those unnecessary do-overs. And using other imaging tests when possible could reduce radiation exposure.

Gene Tests: Progress And Pandora’s Box

Genetic tests might take some of the guesswork out of medicine. Someday, the results may be used to predict the diseases you are most at risk for, so you could adopt the most effective prevention behaviors. Other tests will be used to guide treatment. Genetic tests are already used in the prescription of some expensive cancer drugs, such as trastuzumab (Herceptin) for breast cancer.

Last year, personalized medicine (or pharmacogenomics, as it is sometimes called if drug choices are involved) inched closer to becoming part of everyday medicine. Doctors have started to order gene tests to assess how sensitive people are to warfarin (Coumadin), the anti-blood clotting drug — although doubts linger about how useful such tests will be. Researchers reported that heart-failure patients with a certain genetic profile responded well to a specific beta blocker. And results from a substudy of a large blood pressure trial traced differences in the response to diuretic drugs back to a particular gene.

Meanwhile, many direct-to-the-consumer genetic tests have hit the market. Other companies are also now selling genome scans. These commercial tests have raised concern in the medical and scientific communities. Will they be done correctly? And if they are, at this stage, their predictive powers may be oversold, unduly scaring some while giving false assurances to others. Moreover, for many people, something as simple as a waist size may be just as informative as a genome scan, and the take-home message would be the same: Lose weight, exercise, and eat more fruits and vegetables!

View previous articles of this column.

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European Union backs Reproductive Health bill, warns vs rapid population growth

Posted in Abortion, Congress, Contraception, Family Planning, Legislation, Reproductive Health by Erineus on March 3, 2009

By Jose Rodel Clapano Updated March 04, 2009 12:00 AM

MANILA, Philippines – The European Union (EU) has expressed its full support for the Reproductive Health (RH) bill.

In a speech delivered at a recent forum on Reproductive Health, Ambassador Alistair MacDonald, head of the Delegation of the European Commission in the Philippines, said the RH bill will enhance the anti-poverty and pro-development policy framework in the country.

MacDonald reiterated EU’s statement during last year’s Philippine Development Forum that the “continued rapid population growth in the Philippines is draining health and economic resources and slowing down economic growth.”

He said rapid population growth in the country also “threatens the sustainability of rural livelihoods and is inexorably destroying the remaining natural forest and marine habitats.”

The EU also stated “the poor are paying the highest price, both individually and collectively.”

“The European Union therefore calls for the effective implementation of a comprehensive national family planning policy, promoting access to family planning methods,” the EU further said.

MacDonald lauded Congress for preparing legislation that would enhance anti-poverty and pro-development efforts.

“In conclusion, therefore, I would like to put on record that I applaud the effort of legislators in the House and the Senate to prepare legislation intended to enhance the anti-poverty and pro-development policy framework in the Philippines, through a modern legal framework for Reproductive Health, and I wish you every success in your endeavors,” MacDonald said.

MacDonald said the European Commission has been, for many years, supportive of the fight against poverty in the country.

MacDonald pointed out that the EC’s current program in the country is largely concentrated on the health sector.

MacDonald cited a few “striking examples“ of grim statistics to present the social, developmental and personal consequences of the absence of an effective framework for reproductive health in the Philippines.

“It seems to me extremely unlikely that the Philippines will be able to meet its commitment under the MDGs (Millennium Development Goals) under the present policy,” he added.

He pointed out that latest estimates suggest that of a total of 3.6 million pregnancies in the Philippines in 2007, just over half (1.9 million) were “unplanned” – and one quarter of these (500,000) ended in abortions.

MacDonald said that in the Soviet Union in the 1950s, abortion was considered to be a cheap form of contraception.

“Yet here in the Philippines in the 21st century, these high (if often invisible) rates of abortion are a direct and ineluctable consequence of the unavailability of modern methods of contraception.”

Does this mean that those who argue against the Reproductive Health bill are arguing in favor of abortion? Of course not, of course this is not their intention, and nothing could be further from their minds. – With Pia Lee-Brago

View previous articles from this author.

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Island craze

Posted in DOT, Tourism, Travel by Erineus on March 3, 2009

Updated March 01, 2009 12:00 AM

MANILA, Philippines – As a country composed of 7,107 islands, sometimes we don’t really realize that here in the Philippines we are all truly islanders. Tropical weather? Check. Coconut and palm trees? Check. White-sand beaches? Check. But have you been to all of them… in a single day?

The M/S 7107 Island Cruise Ship does just that. It’s island hopping taken to a whole new level. And with the “Fly and Cruise, Pay Later” package, you don’t have to worry about finding your local paradise — right now.

Operating the 5,113-ton vessel is 7107 Islands Shipping Corporation. The ship has 137 fully air-conditioned cabins, with hot and cold showers, TVs and DVD players. It also has a swimming pool where guests are invited to relax and swim while gazing at the islands passing by (yes, islands and not buildings, for a change), enjoying a nice cool cocktail drink by the pool bar while having a deep-tissue massage on the sundeck with only the sound of waves and ocean breeze to rejuvenate you. The ship also has three function rooms named after the islands of Coron, Boracay, and Puerto Galera. Its capacity is good for only 350 people, so you can rent the whole ship for a great time with family, colleagues and friends. Share intimate and unforgettable moments with loved ones against a backdrop of Coron Island, with its majestic limestone cliffs and intricate rock formations; or view the spectacular sunset of Boracay island, watching the island come alive along the shoreline.

The best part of all is that the cruise takes you into the very heart of the Calamianes where a pontoon brings you to the islands of Ditaytayan, Malcapuya, Panlaitan and other island destinations. These lesser-known islands are virtually untouched, and totally beautiful. These are the destinations of tomorrow and only the M/S 7107 Islands Cruise Ship can bring you there in style. Escape into these islands for a romantic dinner, a sunset cocktail, or a snorkeling trip with family. The waters are so clean and pure that it’s easy to see the flourishing coral reefs from the pontoon.

Ditaytayan Island is a 96-hectare island made up mostly of powder-white sand and lush forests, reminiscent of Boracay back in the ‘80s. It has long swirling sand bars on both ends and at the center is a huge sand bar overlooking the sunrise and sunset. It is a secret paradise that soon will be transformed to the next party island with artists’ villages and boutique resorts.

Malcapuya is another haven. With monkeys swinging overhead, and wild ducks and dugong swimming around, it’s a back-to-nature haven, though the cove and nipa huts are where guests prefer to take their siesta.

Panlaitan is another island near the famous Black Island and its shipwreck sites. It is located at the other side of Busuanga. Panlaitan has a long stretch of white sand beach and the coral is so near the shore that snorkeling is not even necessary: you can see the marine life from above the water. Dibotunay is nearby and also a fantastic place for a picnic while sunbathing or swimming.

Aside from the islands mentioned above, guests can island-hop to other nearby islands such as Banana Island, Malaroyroy, Cheron, and so on.

These islands are what inspired British novelist Alex Garland to write The Beach; and the World War II wrecks submerged in the waters along with the abundance of endemic and exotic marine life are the reasons Jacques Cousteau kept returning for his dives. Hailed by National Geographic as having the best beaches in the world and Forbes magazine as one of the best dive sites in the world, it beats the Bahamas by a long run.

The island craze? It’s only just begun.

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For more inquiries and bookings please visit www.7107islandscruise.net or call (+632) 887 7107. E-mail reservations@7107islandscruise.net if you can’t wait to begin the cruise.

http://www.philstar.com/Article.aspx?articleId=444345&publicationSubCategoryId=87