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					                                                                                                                                                                                                                                            ARAB TIMES, TUESDAY, DECEMBER 29, 2009
HEALTH                                                                                                                                                                                                                                                                                             31



                  Health


     Thai-Cambodia border disease epicenter

New form of malaria
renders drug useless
Once curable diseases such as                feeding smugglers’ routes that snake
tuberculosis and malaria are rapid-          through Myanmar and into Laos,
ly mutating into aggressive strains          Thailand, Cambodia and Vietnam.
that resist drugs. The reason: The                        Counterfeits
misuse of the very drugs that were              The counterfeits, along with outdat-
supposed to save us has built up             ed drugs, are jumping continents. In
drug resistance worldwide. Second            Africa, where malaria is endemic in 45
in a five-part series. — Editor              countries, the fake drug industry is
              ❑     ❑    ❑                   thriving. A 2003 World Health
  By Margie Mason and Martha                 Organization survey found between 20
                                             percent and 90 percent of antimalarials
            Mendoza                          randomly purchased in seven African
                                             countries failed quality testing,
O     ’treng village does not look like
      the epicenter of anything.
   Just off a muddy, rutted-out road, it
                                             depending on the type of drug.
                                                WHO and Interpol formed a task
                                             force three years ago to try to stop
is nothing more than a handful of            counterfeiters, seizing millions of fake
Khmer-style bamboo huts perched              malaria, tuberculosis, HIV and other
crookedly on stilts, tucked among a          pills in Southeast Asia and Africa. But
tangle of cornfields once littered with      officials say the work is only as good
deadly land mines.                           as the countries’ legal systems.
   Yet this spot on the Thai-Cambodian          “One of the problems is that there’s
border is home to a form of malaria          not really any enforcement, so what
that keeps rendering one powerful drug       happens when they find a drug that’s
after another useless. This time, scien-     counterfeit or substandard?” says
tists have confirmed the first signs of      David Sintasath, a regional epidemiol-
resistance to the only affordable treat-     ogist at the nonprofit Malaria
ment left in the global medicine cabi-       Consortium in Bangkok. “The policy is
net for malaria: Artemisinin.                to take it away from them. That’s good        A grower holds a marijuana plant under a grow-light, in Seattle. The marijuana is distributed to members of a cooperative of medical patients who have received doctor’s author-
   If this drug should stop working,         until the next month when they get            ization to use the drug to treat their illness, such as AIDS and multiple sclerosis. Unlike several other states which permit marijuana sales to patients, Washington requires patients
there would be no good replacement to                                                                                                           to grow marijuana themselves or designate a caregiver to grow it for them. (AP)
                                             their next shipment, right?”
combat a disease that kills 1 million           Countless unlicensed shops in
people annually. As a result, interna-
tional medical leaders declared this
                                             Cambodia sell artesunate, a single-                                                                                                     ‘Legalization may up health care costs’
                                             drug therapy that has been banned in
year that resistant malaria here is a        the country. Artesunate, a modified

                                                                                                                                                States weigh marijuana reform
health emergency.                            version of artemisinin derived from a
   “This is not business as usual. It’s      Chinese herb, has been hailed as mira-
something really special, and it needs a     cle treatment worldwide because it
real concerted effort,” said Dr. Nick        works so well with so few side effects.
White, a malaria expert at Mahidol           But Cambodian surveys have shown                                                                   OLYMPIA, Washington, Dec 28, (AP):                 Bruce Mirken, spokesman for the                     themselves “if they believe we really will
University in Bangkok, who has spent         that many patients take artesunate                                                                 Washington is one of four states where             Marijuana Policy Project, a Washington,             make all that revenue, and even if we did,
decades trying to eradicate the disease      alone instead of mixing it with another                                                            measures to legalize and regulate marijua-         D.C.-based marijuana advocacy group.                will it be worth the suffering, the loss of
from Southeast Asia. “We know that           antimalarial drug, making it easier for                                                            na have been introduced, and about two             “There are some parts of the country where          opportunities, the chronic illness or death
children have been dying in Africa —         resistance to build.                                                                               dozen other states are considering bills           social attitudes are just a little more cau-        that would occur?”
millions of children have died over the         “The drug has been around for a                                                                 ranging from medical marijuana to decrim-          tious and conservative.”
past three decades — and a lot of those                                                                                                                                                                                                                                  Measure
                                             long time and misused for a long time,                                                             inalizing possession of small amounts of              Rep. Mary Lou Dickerson, a Seattle                  Legalization isn’t the only measure law-
deaths have been attributed to drug          and this is all encouraging the parasite                                                           the herb.                                          Democrat who is sponsoring the legaliza-
resistance. And we know that the drug                                                                                                                                                                                                                  makers across the country are weighing.
                                             to develop resistance,” says Dr. Delia                                                                “In terms of state legislatures, this is far    tion bill in Washington state, said that she        About two dozen states, including
resistance came from the same place.”        Bethell, of the U.S. Armed Forces                                                                  and away the most active year that we’ve           “wanted to start a strong conversation
   Malaria is just one of the leading                                                                                                                                                                                                                  Pennsylvania, New Jersey and Wisconsin,
                                             Research Institute of Medical Science,                                                             ever seen,” said Ethan Nadelmann, execu-           about the pros and cons of legalizing mari-         are considering bills ranging from medical
killer infectious diseases battling back     whose research has been at the fore-                                                               tive director of the New York-based Drug           juana.”
in a new and more deadly form, the AP                                                                                                                                                                                                                  marijuana to decriminalizing possession of
                                             front of identifying emerging resist-                                                              Policy Alliance, which supports reforming             Under her bill, marijuana would be sold          small amounts of marijuana, St. Pierre
found in a six-month look at the soar-       ance on the border.                                                                                marijuana laws.                                    in Washington state’s 160 state-run liquor
ing rates of drug resistance worldwide.                                                                                                                                                                                                                said. Washington state is among the states
                                                Back in western Cambodia a few                                                                     Nadelmann said that while legalization          stores, and customers, 21 and older, would          that are considering decriminalization,
After decades of the overuse and mis-        miles from O’treng village, shopkeep-                                                              efforts are not likely to get much traction in     pay a tax of 15 percent per gram. The
use of antibiotics, diseases like malar-                                                                                                                                                                                                               with a bill that would reclassify adult pos-
                                             er Nop Chen turns a flashlight on a                                                                state capitals anytime soon, the fact that         measure would dedicate most of the money            session of marijuana from a crime with jail
ia, tuberculosis and staph have started      glass case full of drugs he hawks from        An immigrant from Mexico holds her four              there is such an increase of activity “is ele-     raised for substance abuse prevention and
to mutate. The result: The drugs are                                                                                                                                                                                                                   time to a civil infraction with a $100 penal-
                                             inside his cramped roadside house. He         day-old son during a newborn care class              vating the level of public discourse on this       treatment, which is facing potential cuts in        ty.
slowly dying.                                digs through the many boxes and pro-          at a community health center for low-                issue and legitimizing it.”                        the state budget.
              Resistance                                                                   income patients in Aurora, Colorado. The                                                                                                                       Fourteen states, including Washington
                                             duces two different types of                                                                          “I would say that we are close to the tip-         Dickerson said the measure could even-           state, already have medical marijuana
   Already, The Associated Press             artemisinin-based antimalarials. Both         Metro Community Provider Network                     ping point,” he said. “At this point they are      tually bring in as much to state coffers as
                                                                                           (MCPN), which has 11 health centers in                                                                                                                      laws, and 13 have decriminalization laws
found, resistance to malaria has spread      lack the full amount of a second                                                                   still seen as symbolic bills to get the con-       alcohol does, more than $300 million a              on the books, St. Pierre said. About two
                                                                                           the Denver area, has seen a 138 percent
faster and wider than previously docu-       required medication, mefloquine, nec-         increase in patients during the last year of         versation going, but at least the conversa-        year.                                               dozen cities across the country, including
mented. Dr. White said virtually every       essary to treat the strain of malaria in      recession. Non-profit community health               tion can be a serious one.”                                           Revenue                          Seattle, make marijuana offenses a low
case of malaria he sees in western           the area and ward off more resistance.        centers such as MCPN could play a major                 Opponents of relaxing marijuana laws               “Our state is facing a huge financial            law-enforcement priority.
Cambodia is now resistant to drugs.             Cluster                                    role nationally if health care reform is             aren’t happy with any conversation on the          deficit and deficits are projected for a few           Marijuana advocates said that while
And in the Pailin area, patients given          But Nop Chen, a former Khmer               passed, with increased subsidies from                topic, other than keeping the drug illegal.        more years,” Dickerson said, referring to           increased activity in the statehouse is
artemisinin take twice as long as those      Rouge medic, points to a small                the federal government as well as millions              “There’s no upside to it in any manner
                                                                                           of newly-insured low-income citizens                                                                    the projected $2.6 billion hole lawmakers           heartening, change most likely will come
elsewhere to be clear of the parasite —      Cambodian seal on the boxes and says                                                               other than for those people who want to            will need to fill next year. “We need to look       at the ballot box through voter-driven ini-
84 hours instead of the typical 48, and      he feels confident the drugs are the real     seeking care. Health coverage for immi-
                                                                                           grants remains a contentious issue in the            smoke pot,” said Travis Kuykendall, head           at revenue and see what might be possi-             tiatives.
sometimes even 96.                           deal. Still, he acknowledges he is not                  reform debate. (AFP)                       of the West Texas High Intensity Drug-             ble.”                                                  “Inevitably, the politicians are going to
   Mosquitoes spread this resistant          licensed to sell the pills and he is                                                               Trafficking Area office in El Paso, Texas.            Allen St. Pierre, executive director of the      be behind the curve on this stuff,”
malaria quickly from shack to shack,         unsure where they originated.                                                                      “There’s nothing for society in it, there’s        National Organization for the Reform of             Nadelmann said, noting that almost all of
village to village, eventually country to       “I’m not concerned because it’s got                                                             nothing good for the country in it, there’s        Marijuana Laws, said that tough economic            the medical marijuana laws came about by
country.                                     the sticker and the stamp,” he says,                                                               nothing for the good of the economy in it.”        times across the country have lawmakers             initiative.
   And so O’treng, with its 45 poor          squinting at the Khmer script on the                                                                               Prosecution                        looking at everything, and may lead even               This month, a group campaigning to put
families, naked kids, skinny dogs and        labels. “Because of the logo, I trust it to                                                          Legalization bills were introduced in            more states to eventually consider the              a marijuana legalization measure before
boiling pots of rice, finds itself at the    not be fake; it was made in Cambodia.”                                                             California and Massachusetts earlier this          potential tax value of pot.                         California voters said it had enough signa-
epicenter of an increasingly desperate                                                                                                          year, and this month, New Hampshire and               “The bean counters are now reporting             tures to qualify for the 2010 ballot.
worldwide effort to stop a dangerous            Walk past O’treng’s cluster of sag-                                                             Washington state prefiled bills in advance         back to their elected officials how much               That proposal would legalize possession
new version of an old disease.               ging huts, cross another cornfield and                                                             of their legislative sessions that begin in        money is being left off the table,” he said,        of up to one ounce of marijuana for adults
                                             hike a twisted mile (1= kilometer) on a                                                            January. Marijuana is illegal under federal        adding that billions of dollars worth of pot        21 and older. Residents could cultivate
   Bundled in a threadbare batik             dirt track to a wooden shack where a                                                               law, but guidelines have been loosened on          is going untaxed.                                   marijuana gardens up to 25 square feet (2.3
sarong, 51-year-old Chhien Rern, one         string of smoke is curling through the                                                             federal prosecution of medical marijuana              Ron Brooks, president of the National            sq. meters). City and county governments
of O’treng’s sick residents, sweats and      wooden floor planks in a largely futile               Schiff                    Frieden
                                                                                                                                                under the Obama administration.                    Narcotics        Officers’     Associations’        would determine whether to permit and tax
shivers as a 103-degree fever rages          effort to keep mosquitoes away. It is                                                                Even so, marijuana reform legislation            Coalition, said that he feared that, if legal-      marijuana sales within their boundaries.
against the malaria parasites in her         here that skinny 13-year-old Hoeun                                                                 remains a tough sell in some places. In the        ized, marijuana would contribute to more            And in Nevada earlier this month, backers
bloodstream.                                 Hong Da wakes up on the floor nau-                      Health                                     South, for example, only Mississippi and           highway accidents and deaths, as well as a          of a move to legalize marijuana there filed
   Three days ago Chhien Rern started        seous and burning with fever.                                                                      North Carolina have decriminalization              potential increase in health care costs for         paperwork creating an advocacy group
feeling ill while looking for work in a         Hong Da recovered from malaria                                                                  laws on the books.                                 those who smoke it.                                 aimed at qualifying an initiative for the
neighboring district. So she did what        two months ago, but now the dizziness         Airbags not risk in pregnancy: For                     “It’s a social and cultural thing,” said            State lawmakers, he said, need to ask            2012 election.
most rural Cambodians do: She walked         and headaches are back. He has been           pregnant women involved in a traffic accident,
to a little shop and asked for malaria       sickened by the disease six or seven          the impact of an airbag does not seem to raise
medicine. With no prescription, she          times in his short life — too many to         the risks of most pregnancy complications, a         10 percent among women in crashes where no         weekly bulletin on illness and death. These            The biggest percentage of deaths was among
was handed a packet of pills; she is         remember. He knows that if he does            new study finds.                                     airbag deployed. (RTRS)                            overdose deaths have been on the rise nation-       middle-aged people 45 to 54 years old, who
                                                                                              Airbags, used along with seatbelts, are                             ❑     ❑     ❑                    wide since 1999.                                    accounted for 34 percent of overdose deaths.
unsure what they were.                       not get to a hospital soon, he could die.     known to cut car-crash victims’ risk of death
                                                With no new treatments in the                                                                   Most who OD took methadone: A recent                  To better understand which drugs are             Forty-five percent of people who died were on
   “After I took the drugs, I felt better                                                  and severe injury. However, concerns have                                                                                                                   Medicaid, translating to a 5.7-fold greater risk
for a while,” she says. “Then I got sick     pipeline, normally reserved scientists                                                             study of overdose deaths in Washington State       involved, as well as whether overdose deaths
                                                                                           been raised about the impact of an airbag on a                                                          are more common among poor people, the              of prescription opiate overdose death among
again.”                                      are quick to use words like “disaster”        pregnant woman’s abdomen; there have been,           due to prescription opiate drugs shows that
                                                                                                                                                most of these deaths involved methadone, and       researchers analyzed all prescription opioid        Medicaid clients.
   The headaches, chills and fever,          or “catastrophe” when asked what              for instance, case reports of uterine or placental                                                      overdose deaths in Washington between 2004             Studies have shown, noted the authors of the
                                             might happen if they do not contain the       rupture leading to pregnancy loss.                   that these overdoses were much more common
classic symptoms of malaria, wors-                                                                                                              among people on Medicaid.                          and 2007.                                           report, that people on Medicaid are twice as
ened. Chhien Rern’s daughter persuad-        disease that is ravaging young Hong              But until now, large-scale studies had been                                                                                                              likely as those on private insurance to be pre-
                                                                                           lacking.                                                Washington State has a particularly high rate      Nearly 60 percent of the 1,668 people who
ed her to take a motorbike taxi past         Da before it spreads to Africa. There,                                                             of poisonings with opiate drugs, according to      died from prescription opiate overdoses were        scribed opiates. And methadone, long used to
                                             malaria already kills an estimated               In the new study, researchers analyzed data                                                                                                              treat heroin addiction, is increasingly being
washed out bridges and flooded cul-                                                        on 3,348 collisions involving pregnant women         the report from state health officials and the     men, the report indicates. Methadone was the
verts to the nearest hospital in Pailin, a   2,000 kids every day.                                                                              Centers for Disease Control and Prevention         cause of death in 64 percent of these cases, fol-   prescribed as a cheap painkiller; prescriptions
                                                                                           in Washington State between 2002 and 2005.                                                                                                                  for this purpose rose more than 12-fold
dirty border town about 10 miles (16            For the past 50,000 years the malar-          They found that for most pregnancy compli-        (CDC) headed by its Commissioner Thomas            lowed by oxycodone (23 percent) and
                                                                                                                                                                                                                                                       between 1997 and 2006.
kilometers) from O’treng.                    ia parasite has been evolving, and            cations — including placental detachment from        R. Frieden which is published in the CDC’s         hydrocodone (14 percent).
                                                                                                                                                                                                                                                          “These findings highlight the prominence of
   Doctors say there is a good chance        migrating, alongside humans. It moves         the uterine wall, fetal distress and Cesarean                                                                                                               methadone in prescription opioid-related over-
that Chhien Rern was sold counterfeit        within the huts of O’treng, and into          delivery — there was no evidence of a higher                                                                                                                dose deaths and indicate that the Medicaid pop-
drugs.                                       neighboring towns when men like               risk for women whose crash had involved an                                                                                                                  ulation is at high risk,” the researchers write.
   People generate drug resistant            Hong Da’s father and older siblings           airbag deployment.                                                                                                                                             “Efforts to minimize this risk should focus
malaria when they take too little medi-      float from job to job.                           There was a higher rate of fetal death in                                                                                                                on assessing the patterns of opioid prescribing
                                                                                           accidents involving an airbag — 1 percent, ver-                                                                                                             to Medicaid enrollees and intervening with
cine, substandard medicine or — as is           Some work is close enough for them         sus 0.3 percent among women in accidents
                                             to return home at night, but other jobs                                                                                                                                                                   Medicaid enrollees who appear to be misusing
all too often the case around O’treng                                                      without an airbag deployment.                                                                                                                               these drugs,” they advise.
— counterfeit medicine with a pinch of       keep them away for stretches of time.            However, there were only two fetal deaths in                                                                                                                They also suggest that other states look at
the real stuff. Once established, the        They sleep in tight rows, sweating and        each group, and the small numbers make it dif-                                                                                                              trends in prescription opiate-related deaths,
drug-resistant malaria is spread by          weary, in disintegrating bamboo huts          ficult to draw conclusions, the researchers note                                                                                                            “especially among Medicaid clients.” (RTRS)
mosquitoes. So one person’s counter-         with workers who are also traveling,          in the journal Obstetrics & Gynecology.                                                                                                                                       ❑      ❑      ❑
feit medicine can eventually spawn           and possibly infected with malaria.              In the US, it’s estimated that nearly 33,000
widespread resistant disease.                   The concept of containing drug             pregnant women are involved in car crashes                                                                                                                  Combat vets risk high BP: Can the stress
                                                                                           each year. These accidents are a leading cause                                                                                                              of war cause high blood pressure? Military vet-
   Yet in most parts of the world, peo-      resistance has never been tried before.       of fetal death.                                                                                                                                             erans with repeated tours of combat duty are
ple routinely buy antimalarials over the     Scientists wonder: How do you control            Because airbags can help save lives, groups                                                                                                              more likely to have high blood pressure than
counter at local pharmacies and treat        the spread of a resistant parasite trans-     such as the American College of Obstetricians                                                                                                               non-combat veterans, US researchers have
themselves.                                  mitted by mosquitoes that bite people         and Gynecologists (ACOG) have long advised                                                                                                                  reported.
   A recent study out of neighboring         who live and work in infested jungle          pregnant women not to deactivate their vehicle                                                                                                                 Their study of 36,000 servicemen and
Laos found 88 percent of stores selling      areas, then scatter in all directions, all    airbags.                                                                                                                                                    women, including 8,800 veterans of Iraq and
artemisinin-based drugs, the same ones       the time?                                        The current findings support those recom-                                                                                                                Afghanistan, showed those with multiple com-
scientists are desperately trying to pre-       This area, the former stronghold of        mendations, said lead researcher Dr Melissa A.                                                                                                              bat exposures were 33 percent more likely than
                                             the murderous Khmer Rouge, has a              Schiff, a professor of epidemiology at the                                                                                                                  other military personnel to say they had high
serve, were actually peddling fakes.                                                       University of Washington School of Public                                                                                                                   blood pressure.
Worse, nearly 15 percent of the coun-        notorious history. Burmese migrant            Health in Seattle.                                                                                                                                             Service members who had personally wit-
terfeits were laced with small hints of      workers who once mined rubies and                She added, though, that the findings are                                                                                                                 nessed death due to war or disaster were 50
artemisinin, which could prompt              sapphires in these now deforested hills       “inconclusive” regarding both the risk of fetal                                                                                                             percent more likely to have high blood pres-
resistance. The researchers found indi-      are believed to have helped transport         death and the risk of preterm labor. The                                                                                                                    sure, Nisara Granado of the Naval Health
cations that some were made in China,                 Continued on Page 32                 researchers did find a higher rate of preterm        A woman receives an H1N1 flu nasal spray vaccination during a clinic at the Bill                       Research Center in San Diego, California and
                                                                                           delivery among women whose accidents                 Graham Civic Auditorium in San Francisco, California. The city had 16,000 doses of the                 colleagues reported in the journal
                                                                                           involved an airbag — nearly 16 percent, versus                         vaccine on hand for residents of the city. (AFP)                                     Hypertension. (RTRS)

				
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