Sunday, July 31, 2011
Friday, July 15, 2011
Sunday, June 26, 2011
Samba Samba
3rd class of samba today... it's so much fun!! prolly due to such a dramatic instructor... hahah!! next week will be e last lesson of level 1, am going up to level 2 the week after. *grins*
will be so busy wth work, sch and current dance class with BDD and new class with Groove School.. superbly happy about it. at least, i'm able to get things off my mind when i'm busy or doing some stuff i'm so in love with. =) i've been postponing my dance classes for 10 years... reminded by my instructor she started learning @ Mandarin Hotel from our director... 10 LONG YEARS!! can't imagine it's that fast!!! and NO WAY i'm gonna let my dance wait for me again!!!
Belly dance, you're my next target.. after my groupon with Groove Sch *winks*
Anyway, it's still @ BDD studio, same as my current samba class. ^_^
will be so busy wth work, sch and current dance class with BDD and new class with Groove School.. superbly happy about it. at least, i'm able to get things off my mind when i'm busy or doing some stuff i'm so in love with. =) i've been postponing my dance classes for 10 years... reminded by my instructor she started learning @ Mandarin Hotel from our director... 10 LONG YEARS!! can't imagine it's that fast!!! and NO WAY i'm gonna let my dance wait for me again!!!
Belly dance, you're my next target.. after my groupon with Groove Sch *winks*
Anyway, it's still @ BDD studio, same as my current samba class. ^_^
Tuesday, June 07, 2011
Drowning Doesn’t Look Like Drowning
The new captain jumped from the deck, fully dressed, and sprinted through the water. A former lifeguard, he kept his eyes on his victim as he headed straight for the couple swimming between their anchored sportfisher and the beach. “I think he thinks you’re drowning,” the husband said to his wife. They had been splashing each other and she had screamed but now they were just standing, neck-deep on the sand bar. “We’re fine, what is he doing?” she asked, a little annoyed. “We’re fine!” the husband yelled, waving him off, but his captain kept swimming hard. ”Move!” he barked as he sprinted between the stunned owners. Directly behind them, not ten feet away, their nine-year-old daughter was drowning. Safely above the surface in the arms of the captain, she burst into tears, “Daddy!”
How did this captain know – from fifty feet away – what the father couldn’t recognize from just ten? Drowning is not the violent, splashing, call for help that most people expect. The captain was trained to recognize drowning by experts and years of experience. The father, on the other hand, had learned what drowning looks like by watching television. If you spend time on or near the water (hint: that’s all of us) then you should make sure that you and your crew knows what to look for whenever people enter the water. Until she cried a tearful, “Daddy,” she hadn’t made a sound. As a former Coast Guard rescue swimmer, I wasn’t surprised at all by this story. Drowning is almost always a deceptively quiet event. The waving, splashing, and yelling that dramatic conditioning (television) prepares us to look for, is rarely seen in real life.
The Instinctive Drowning Response – so named by Francesco A. Pia, Ph.D., is what people do to avoid actual or perceived suffocation in the water. And it does not look like most people expect. There is very little splashing, no waving, and no yelling or calls for help of any kind. To get an idea of just how quiet and undramatic from the surface drowning can be, consider this: It is the number two cause of accidental death in children, age 15 and under (just behind vehicle accidents) – of the approximately 750 children who will drown next year, about 375 of them will do so within 25 yards of a parent or other adult. In ten percent of those drownings, the adult will actually watch them do it, having no idea it is happening (source: CDC). Drowning does not look like drowning – Dr. Pia, in an article in the Coast Guard’s On Scene Magazine, described the instinctive drowning response like this:
1.Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.
2.Drowning people’s mouths alternately sink below and reappear above the surface of the water. The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.
3.Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
4.Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
5.From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.
This doesn’t mean that a person that is yelling for help and thrashing isn’t in real trouble – they are experiencing aquatic distress. Not always present before the instinctive drowning response, aquatic distress doesn’t last long – but unlike true drowning, these victims can still assist in their own rescue. They can grab lifelines, throw rings, etc.
Look for these other signs of drowning when persons are in the water:
- Head low in the water, mouth at water level
- Head tilted back with mouth open
- Eyes glassy and empty, unable to focus
- Eyes closed
- Hair over forehead or eyes
- Not using legs – Vertical
- Hyperventilating or gasping
- Trying to swim in a particular direction but not making headway
- Trying to roll over on the back
- Appear to be climbing an invisible ladder.
So if a crew member falls overboard and everything looks OK – don’t be too sure. Sometimes the most common indication that someone is drowning is that they don’t look like they’re drowning. They may just look like they are treading water and looking up at the deck. One way to be sure? Ask them, “Are you alright?” If they can answer at all – they probably are. If they return a blank stare, you may have less than 30 seconds to get to them. And parents – children playing in the water make noise. When they get quiet, you get to them and find out why.
How did this captain know – from fifty feet away – what the father couldn’t recognize from just ten? Drowning is not the violent, splashing, call for help that most people expect. The captain was trained to recognize drowning by experts and years of experience. The father, on the other hand, had learned what drowning looks like by watching television. If you spend time on or near the water (hint: that’s all of us) then you should make sure that you and your crew knows what to look for whenever people enter the water. Until she cried a tearful, “Daddy,” she hadn’t made a sound. As a former Coast Guard rescue swimmer, I wasn’t surprised at all by this story. Drowning is almost always a deceptively quiet event. The waving, splashing, and yelling that dramatic conditioning (television) prepares us to look for, is rarely seen in real life.
The Instinctive Drowning Response – so named by Francesco A. Pia, Ph.D., is what people do to avoid actual or perceived suffocation in the water. And it does not look like most people expect. There is very little splashing, no waving, and no yelling or calls for help of any kind. To get an idea of just how quiet and undramatic from the surface drowning can be, consider this: It is the number two cause of accidental death in children, age 15 and under (just behind vehicle accidents) – of the approximately 750 children who will drown next year, about 375 of them will do so within 25 yards of a parent or other adult. In ten percent of those drownings, the adult will actually watch them do it, having no idea it is happening (source: CDC). Drowning does not look like drowning – Dr. Pia, in an article in the Coast Guard’s On Scene Magazine, described the instinctive drowning response like this:
1.Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.
2.Drowning people’s mouths alternately sink below and reappear above the surface of the water. The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.
3.Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
4.Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
5.From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.
This doesn’t mean that a person that is yelling for help and thrashing isn’t in real trouble – they are experiencing aquatic distress. Not always present before the instinctive drowning response, aquatic distress doesn’t last long – but unlike true drowning, these victims can still assist in their own rescue. They can grab lifelines, throw rings, etc.
Look for these other signs of drowning when persons are in the water:
- Head low in the water, mouth at water level
- Head tilted back with mouth open
- Eyes glassy and empty, unable to focus
- Eyes closed
- Hair over forehead or eyes
- Not using legs – Vertical
- Hyperventilating or gasping
- Trying to swim in a particular direction but not making headway
- Trying to roll over on the back
- Appear to be climbing an invisible ladder.
So if a crew member falls overboard and everything looks OK – don’t be too sure. Sometimes the most common indication that someone is drowning is that they don’t look like they’re drowning. They may just look like they are treading water and looking up at the deck. One way to be sure? Ask them, “Are you alright?” If they can answer at all – they probably are. If they return a blank stare, you may have less than 30 seconds to get to them. And parents – children playing in the water make noise. When they get quiet, you get to them and find out why.
Monday, May 23, 2011
gastric pain is acting up again... and the frequency interval is pretty close compared to previously.. dont wanna go back SGH cause it's so far from my place even though they've got e best gastroenterology dept.. or should i? on the other hand, i'm very sure that SGH's staff will schedule a scope for me immediately, but TTSH will rely on CT scan AGAIN!!! oh well, SGH then, in this case...i had bad experience with TTSH anyway...
Sunday, May 08, 2011
PAP returns to power with reduced mandate
As expected, the PAP won the 2011 general election though with a reduced mandate.
Though the PAP swept 81 out of 87 seats, its share of the popular vote slipped to 60.14 percent from 66.6 percent at the last election in 2006, its worst result since independence.
It also lost a GRC, and along with it 2 ministers and a potential Speaker of Parliament, for the first time since the system was introduced in 1988.
The Workers’ Party emerges as the strongest opposition party in Singapore, winning Aljunied GRC by a comfortable margin and increasing its percentage of votes in Hougang SMC.
The three NCMP seats are likely to go to Ms Lina Chiam (SPP), Mr Yee Jenn Jong (WP) and one candidate from WP’s losing team in East Coast GRC.
The biggest loser appears to be the Singapore People’s Party which lost all its contested seats, including Potong Pasir SMC and Bishan-Toa Payoh GRC.
The Singapore Democratic Party saw its percentage of votes improve, but was unable to win Holland-Bukit Timah GRC with its ‘A’ team polling a respectable 39.9 percent of the votes.
In spite fielding the largest slate of candidates among opposition parties, the National Solidarity Party lost all of them including Tampines GRC which was helmed by the unpopular PAP Housing Minister Mah Bow Tan.
The other parties all performed dismally including the newly formed Reform Party which was plagued by bitter in-fighting a few weeks before the election.
Despite optimism among netizens that a political tsunami may arrived, the PAP continues to maintain a stranglehold on power, retaining its two-third majority which will enable it to pass any bills and laws as and when it wishes.
The results of the election show that parties do have an impact on voters’ choices. The Workers’ Party managed to win at least 40 percent of the votes in all the seats it contested even with weak teams as compared to the other opposition parties.
As predicted earlier, the impact of the new media is limited though it may rise in future elections. Though the PAP has won the election, it has clearly weakened and the loss of a GRC may pave the way for more changes to come in Singapore’s new political landscape.
Though the PAP swept 81 out of 87 seats, its share of the popular vote slipped to 60.14 percent from 66.6 percent at the last election in 2006, its worst result since independence.
It also lost a GRC, and along with it 2 ministers and a potential Speaker of Parliament, for the first time since the system was introduced in 1988.
The Workers’ Party emerges as the strongest opposition party in Singapore, winning Aljunied GRC by a comfortable margin and increasing its percentage of votes in Hougang SMC.
The three NCMP seats are likely to go to Ms Lina Chiam (SPP), Mr Yee Jenn Jong (WP) and one candidate from WP’s losing team in East Coast GRC.
The biggest loser appears to be the Singapore People’s Party which lost all its contested seats, including Potong Pasir SMC and Bishan-Toa Payoh GRC.
The Singapore Democratic Party saw its percentage of votes improve, but was unable to win Holland-Bukit Timah GRC with its ‘A’ team polling a respectable 39.9 percent of the votes.
In spite fielding the largest slate of candidates among opposition parties, the National Solidarity Party lost all of them including Tampines GRC which was helmed by the unpopular PAP Housing Minister Mah Bow Tan.
The other parties all performed dismally including the newly formed Reform Party which was plagued by bitter in-fighting a few weeks before the election.
Despite optimism among netizens that a political tsunami may arrived, the PAP continues to maintain a stranglehold on power, retaining its two-third majority which will enable it to pass any bills and laws as and when it wishes.
The results of the election show that parties do have an impact on voters’ choices. The Workers’ Party managed to win at least 40 percent of the votes in all the seats it contested even with weak teams as compared to the other opposition parties.
As predicted earlier, the impact of the new media is limited though it may rise in future elections. Though the PAP has won the election, it has clearly weakened and the loss of a GRC may pave the way for more changes to come in Singapore’s new political landscape.
Monday, April 18, 2011
Top Alpha Female Characteristics
We're done with Alpha Male as of now (i'll write more if i feel like it which i simply don't feel like it today), here comes Alpha Female!!
Independence
The Alpha Female is fiercely independent and can take care of herself. She will not beg you for a diamond in order to impress her friends and family. She does not want to be tied down to anyone… unless it’s her HERO who has the courage to man up in the relationship and take the lead. She has no time for someone that she needs to mother.
Uniqueness
The Alpha Female has her own style… she is uniquely herself and is guided by her own rhythm. She follows the voice of her feelings – though she doesn’t neglect her sense of reason. She may even outright reject one or more social conventions – marriage, religion, government… nothing means more to her than HER ideas… she’s the top of the food chain in her world.
Strength
While she happily takes a more submissive role when dealing with a true MAN, she can hold her own in the boardroom or on the street. She commands the respect of other people and is selective about who she invites into her life. She has a pleasing personality. She is warm and friendly, but also strong when necessary.
Magnetism
She is dynamic, has presence and doesn’t blend in with the crowd. She’s charismatic and can work a room. You feel like she’s drawing you and everyone else into her web.
Self-Expression: Physical and Verbal
The Alpha Female is articulate and speaks with her mouth as well as with her eyes. She knows what she wants/feels/needs and she easily expresses those things. She lets you know how much she adores you or despises you… and sometimes, if she chooses… you can’t read her at all.
Assertiveness
This woman won’t be pushed around. She stands up for herself – quickly and succinctly putting people in their place if they try to disrespect her. The good news is that unlike other women, she’s easy-going and doesn’t throw tantrums, whine, bitch or nag. Her sense of reason doesn’t allow her to act like a child.
Confidence
Ms. Alpha Female is comfortable with herself. She loves her body and her brain and she works them out regularly. She knows her own value and sees that she’s beautiful from the inside out. She won’t settle for less than the absolute BEST in everything from men to career contracts.
Playfulness
This woman knows how to have FUN… especially with men. She is walking entertainment. She has a sense of humor and smiles and laughs at anything (including herself when appropriate). She sees the positive side of life and enjoys playing in it. She is the perfect complement to the sexy Alpha Male. And although she has no desire to be “caught”, her fun attitude that puts you at ease definitely makes her a “catch”.
Je Ne Sais Quoi
Mademoiselle Alpha Femme gives good conversation. She has many layers to her essence and more to talk about than Desperate Housewives or what “some girl said to me.” She has opinions, interests and passions which make her whole face light up when she speaks of them. You could talk to her all night without a dull moment.
Ambition
The Ambitious Alpha Chick is actively pursuing a dream or goal and is unconcerned with you making enough money to “provide for her”… she’s building her own empire.
Sex Appeal
All of the above alpha female characteristics make her sexy, but she has even more. She wears the things that make her look like a pretty woman. She moves her body in ways that make you think of sex. She flirts with you (in her own signature way). She’s your girly childhood buddy that you go on adventures with who often morphs into the vixen who gives you adventures in the bedroom. Her femininity makes you feel like a man. When you’re around her, you feel craziness rise in your body.
Independence
The Alpha Female is fiercely independent and can take care of herself. She will not beg you for a diamond in order to impress her friends and family. She does not want to be tied down to anyone… unless it’s her HERO who has the courage to man up in the relationship and take the lead. She has no time for someone that she needs to mother.
Uniqueness
The Alpha Female has her own style… she is uniquely herself and is guided by her own rhythm. She follows the voice of her feelings – though she doesn’t neglect her sense of reason. She may even outright reject one or more social conventions – marriage, religion, government… nothing means more to her than HER ideas… she’s the top of the food chain in her world.
Strength
While she happily takes a more submissive role when dealing with a true MAN, she can hold her own in the boardroom or on the street. She commands the respect of other people and is selective about who she invites into her life. She has a pleasing personality. She is warm and friendly, but also strong when necessary.
Magnetism
She is dynamic, has presence and doesn’t blend in with the crowd. She’s charismatic and can work a room. You feel like she’s drawing you and everyone else into her web.
Self-Expression: Physical and Verbal
The Alpha Female is articulate and speaks with her mouth as well as with her eyes. She knows what she wants/feels/needs and she easily expresses those things. She lets you know how much she adores you or despises you… and sometimes, if she chooses… you can’t read her at all.
Assertiveness
This woman won’t be pushed around. She stands up for herself – quickly and succinctly putting people in their place if they try to disrespect her. The good news is that unlike other women, she’s easy-going and doesn’t throw tantrums, whine, bitch or nag. Her sense of reason doesn’t allow her to act like a child.
Confidence
Ms. Alpha Female is comfortable with herself. She loves her body and her brain and she works them out regularly. She knows her own value and sees that she’s beautiful from the inside out. She won’t settle for less than the absolute BEST in everything from men to career contracts.
Playfulness
This woman knows how to have FUN… especially with men. She is walking entertainment. She has a sense of humor and smiles and laughs at anything (including herself when appropriate). She sees the positive side of life and enjoys playing in it. She is the perfect complement to the sexy Alpha Male. And although she has no desire to be “caught”, her fun attitude that puts you at ease definitely makes her a “catch”.
Je Ne Sais Quoi
Mademoiselle Alpha Femme gives good conversation. She has many layers to her essence and more to talk about than Desperate Housewives or what “some girl said to me.” She has opinions, interests and passions which make her whole face light up when she speaks of them. You could talk to her all night without a dull moment.
Ambition
The Ambitious Alpha Chick is actively pursuing a dream or goal and is unconcerned with you making enough money to “provide for her”… she’s building her own empire.
Sex Appeal
All of the above alpha female characteristics make her sexy, but she has even more. She wears the things that make her look like a pretty woman. She moves her body in ways that make you think of sex. She flirts with you (in her own signature way). She’s your girly childhood buddy that you go on adventures with who often morphs into the vixen who gives you adventures in the bedroom. Her femininity makes you feel like a man. When you’re around her, you feel craziness rise in your body.
Saturday, April 09, 2011
Special Report: When the drugs don't work
..LONDON (Reuters) - David Livermore is in a race against evolution. In his north London lab, he holds up an evil-smelling culture plate smeared with bacteria. This creamy-yellow growth is the enemy: a new strain of germs resistant to the most powerful antibiotics yet devised by humankind.
Out on the streets, Steve Owen is running the same race -- physically pounding the pavements to draw attention to the problem of drug-resistant infections.
Owen's father Donald died four years ago of multiple organ failure in a British hospital. He had checked in for a knee operation. But what he got was methicillin-resistant Staphylococcus aureus, commonly known as MRSA, a so-called "superbug" that all the drugs his doctors prescribed couldn't beat. After almost 18 months of severe pain, the infection got into his blood, overpowered his vital organs and killed him.
Owen and his wife Jules have pledged to run 12 big races in as many months, to raise funds for a charity that is working to fight MRSA. "It just shouldn't have happened," says Jules, as the pair nurse their own aching limbs after running a half-marathon. "It was his knee -- that's not something he should have died from."
Welcome to a world where the drugs don't work.
After Alexander Fleming's 1928 discovery of the first antibiotic, penicillin, we quickly came to assume we had the chemicals to beat bacteria. Sure, bugs evolve to develop resistance. But for decades scientists have managed to develop new medicines to stay at least one step ahead of an ever-mutating enemy.
Now, though, we may be running out of road. MRSA alone is estimated to kill around 19,000 people every year in the United States -- far more than HIV and AIDS -- and a similar number in Europe. Other drug-resistant superbugs are spreading. Cases of often fatal "extensively drug resistant" tuberculosis have mushroomed over the past few years. A new wave of "super superbugs" with a mutation called NDM 1, which first emerged in India, has now turned up all over the world, from Britain to New Zealand.
NDM 1 is what's growing on the plates that Livermore holds in his gloved hands. "You can't win against evolution," says the scientist, who spends his days tracking the emergence of superbugs in a national reference laboratory at Britain's Health Protection Agency. "All you can seek to do is to stay a jump ahead."
That's not happening now for a number of reasons. For a start, antibiotics are everywhere, giving bacteria countless opportunities to evolve escape routes. The drugs can be picked up, without prescription, for pennies in countries like Thailand, India and parts of Latin America. Even though their use is controlled in the west, the system encourages doctors to shoot the bugs first and ask questions later. Perhaps most worryingly, the world's top drug companies, faced with decreasing returns and ever more expensive and difficult science, have not only slowed their efforts to develop new antibiotics but have been quitting the field in droves.
Today, only two large companies - GlaxoSmithKline Plc and AstraZeneca Plc -- still have strong and active antibiotic research and development programs, according to the Infectious Diseases Society of America. Back in 1990, there were nearly 20.
That could have a profound impact on how we treat our sick. "If some of the most potent multi-resistant strains that we see now accumulate, then modern medicine -- from transplants to cancer treatment and even quite straightforward gut surgery, potentially becomes untenable," says Livermore. "You need the ability to treat infections in vulnerable patients. Lose that and a swathe of modern medicine becomes unstable."
Are we about to start going backwards, to a pre-antibiotic era in which things like hip replacements, chemotherapy and intensive care are simply impossible? It's a big enough fear for the World Health Organization to devote this year's World Health Day on April 7 to antimicrobial resistance in a bid to safeguard these drugs for future generations.
"Modern medicine can't function without effective antibiotics," says Derek Butler, chairman of the MRSA Action UK charity for which the Owens are raising money. "If we lose these magic bullets, medicine will be set back over 80 years.
RAT ON THE WARD
One aspect of the race against bugs has changed little since Fleming's time, or Florence Nightingale's before that. Hospital hygiene is the basic, unglamorous and underpaid work that forms the vital first-line of defense against pathogens. If it is done properly, it can ease the demand for drugs in the first place. Yet Steve Owen remembers his dad telling him he'd seen a rat running through his ward - a shock in a developed world hospital.
Bugs are no respecters of age. Donald Owen was 82 when the treatment for his knee problems ended up killing him. Susan Fallon's daughter Sammie was just 17 when she was admitted with flu-like symptoms to another British hospital in April 2008. Pretty, petite -- at only five feet tall she was "like a little doll", her mother says -- Sammie dreamed of being a professional photographer. When her hospital blood tests came back with worrying results, doctors ordered more, including a bone marrow biopsy. That led to a diagnosis of a rare blood disorder which required chemotherapy. She also picked up a superbug. Just over a month later, before any treatment had a chance to work, Sammie was dead.
The experience left her mother bereft, angry and with a fear of hospitals and the people who work in them. "I don't know which one came in without washing their hands and gave this bug to Sammie," she says. "But if I went into hospital now I'd be saying 'Wash your hands before you come near me' -- I'd be really vigilant."
In developed nations, a big push to improve hospital hygiene is starting to keep MRSA in check. At the same time, cheap international travel is breaking down the geographical barriers to infection. Medical progress is accelerating in places like India, China and Brazil, but often more swiftly than basic infection control in hospitals, Livermore says. "It's sexier to say you can do a kidney transplant, but it's not so sexy that infection control nurses go around and berate people for not washing their hands. And yet it may well be that the infection control nurse would save more lives than the renal surgeon."
The fact that the latest superbug -- NDM 1 stands for New Delhi metallo-beta-lactamase, an enzyme that gives bacteria multidrug resistance -- first emerged in India comes as little surprise to many microbiologists. Use of antibiotics is rampant and unregulated in a country with appalling sanitation, high rates of diarrheal disease and overcrowding -- ideal conditions for resistance to develop. A week-long course of antibiotics can cost as little as 30 or 40 U.S. cents from one of the thousands of chemist shops that all too often dispense poor advice along with their non-prescription drugs.
On top of this, even in the developed world, the antibiotics used today are "broad" products, whose blunderbuss approach can kill a wide range of bugs but also trigger knock-on problems. One reason for this is that for the first 48 hours, patients are effectively treated blind while lab staff go through the process of growing a culture sample to see just which microbe is to blame. In particular, Clostridium difficile infection has become a significant problem in hospitals because such broad-spectrum antibiotics damage gut flora, which creates an environment for it to flourish.
MEET THE FAMILY
Antibiotic-resistant bugs like MRSA and C. difficile tend to be picked up by patients in hospitals, but the risks are far broader than a hospital stay. Take the story of the 100 or so Swedes who went traveling to different parts of the world and were tracked by scientists to see what bugs they brought home. Of the eight who went to India, seven -- that's 88 percent -- came back with bacteria in their guts that were resistant to a whole class of antibiotics called cephalosporins. Not one of the people in the study had been in a doctor's clinic or hospital while they were there -- indicating the superbugs they picked up were freely circulating in the community.
What makes the NDM 1 enzyme so dangerous is not only its ability to outflank carbapenems, the most powerful class of antibiotic drugs, but also the company it keeps -- in tough bacteria already resistant to many other antibiotics. Despite being identified only three years ago, it has already been detected in a wide variety of bugs, including many familiar pathogens such as Escherichia coli, or E. coli. In contrast to so-called Gram-positive bacteria, like MRSA, these microscopic enemies are Gram-negative, meaning they have tougher outer membranes which block out many antibiotics, and an unnerving ability to pump out others, making them much harder to take on and beat.
Cases of bacteria producing NDM 1 have now been found and documented in two dozen countries from North America to Europe to New Zealand to China to Kenya.
Livermore's work shows only two or three remaining antibiotics can kill these bugs -- one is toxic, so doctors use it only in extreme cases; the second can't be used to treat urinary tract infections, one of the most common infections caused by E.coli; and the third is not available in many countries and is anyway susceptible to easily developed resistance.
What's more, no new drugs active against NDM 1-producing bacteria have yet reached even the Phase II stage of the three-step pipeline process of clinical trials needed for regulatory approval. That means any new drug to tackle NDM 1 is at least five or six years away.
Even more alarmingly, NDM 1 is no lone threat -- it comes as part of a family. Similar enzymes in the same class, known as carbapenemases, have been detected worldwide. Just this month, the Eurosurveillance journal of the European Center for Diseases Prevention and Control reported that four separate cases of a related strain had been found in Switzerland between May 2009 and November 2010. Three had come from Italy, one from Greece.
That suggests that NDM 1 and its kin are not, in fact, the ultimate "super superbugs" but rather just the tip of the iceberg. The WHO's Mario Raviglione, who is fronting its antimicrobial campaign, is particularly worried about "superbug" forms of tuberculosis -- a disease that earned the nickname of "white plague" during Victorian times in Britain because sufferers' skin tone turned so pale.
TB already kills around 5,000 people a day and cases of multidrug resistant TB are spreading fast, with about 440,000 new patients every year. Until now largely a disease of the marginalized and the poor, it's the sort of infection that mutates and could start killing more widely, regardless of its victims' wealth or home country.
"We're dealing here with a public health emergency of global proportion. If we don't do anything we're just going to see more and more," Raviglione says.
You might think all that adds up to a great business opportunity for the pharmaceuticals industry. But in the past 40 years only two new classes of antibiotics have won marketing approval, while the total number of antibacterial agents approved for sale has dived. Why are the drugs firms so quiet?
CINDERELLA BUSINESS
The European Medicines Agency is easy to miss among the imposing towers of London's Canary Wharf financial district. Yet alongside the U.S. Food and Drug Administration (FDA) in Washington, it is a pivotal gatekeeper to the west's flow of new drugs. Last December, outgoing Executive Director Thomas Lonngren sent invitations to a conference looking back on the watchdog's past decade of achievements, and the great and the good of the pharmaceuticals world turned out en masse.
If they had expected a celebration, they were misguided. Lonngren, a softly spoken Swedish pharmacist, berated the industry for its pitiful record of innovation, arguing that out of the estimated $85 billion spent globally each year on drug research and development, about $60 billion was effectively wasted on dead-end projects. Worse, he said, drug manufacturers were failing to put their research dollars into key areas of unmet medical need.
Nowhere was the shortfall more glaring than in antibiotics.
"We have more or less a gap of five years without research into new antibiotics," Lonngren complained. "It's an issue where commercial consideration doesn't really match the public health need." He went on to warn that, while it was not the job of regulators to tell commercial companies where to invest, they might in future need to advise politicians and the public at large about such research deficiencies.
Across the Atlantic, FDA Commissioner Margaret Hamburg shares his concerns. "We need new and better drugs …- and we need them now. Yet the R&D pipeline is distressingly low," she said in a speech to the National Press Club in Washington in October.
It wasn't always like this. For many years, making antibiotics was a bread-and-butter activity for the drugs industry. Today it has shrunk to a neglected Cinderella business -- complacent about past successes and reflecting the skewed economics that can drive pharmaceutical development.
Martin Mackay, a Scottish microbiologist who has worked for many of the world's top drugmakers and now heads up research at AstraZeneca, is better-placed than most to see the big picture. Back in the late 1970s he was a researcher at Beecham Pharmaceuticals -- now part of GlaxoSmithKline -- when many in the industry were checking off the fight against bacteria in the "Job Done" column. After all, doctors had a wide choice of effective treatments and all the drug companies needed to do was go out and sell them, and let the accounts department tot up the profits.
"Back then, there was a school of thought that said we had cracked the problem of bacterial diseases," Mackay says. "It looked a pretty good picture."
THE SUMS DON'T WORK
Today, it's very hard to make the commercial sums work. The drugs industry has seen dwindling returns on all its R&D in recent years, resulting in a wave of high-profile laboratory closures -- cost-cutting measures that have been cheered by the stock market. The payback on antibiotics has been even more dismal than in other diseases.
There are two main reasons for this. First and foremost antibiotics, when they work, tend to cure people. Patients take small quantities for several days, a few weeks at most. That's not a very attractive revenue flow. By contrast, a patient on a cholesterol-lowering heart medicine will keep using the pills, and contributing to drug industry profits, for the rest of his or her life. Second, even if a new antibiotic is approved for sale, its use is likely to be reserved for serious infections -- once again, minimizing the sales opportunity.
To cap it all, most existing antibiotics have been around for decades and are widely available as cheap generics, setting a very low bar for prices.
"If you are in the business of antibacterials, I think you just have to accept that is the way it is," says Mackay. "Will it be as profitable as a really great cardiovascular drug? Probably not."
So it should be no surprise that while the global market for all prescription drugs grew by more than 40 percent over the last five years, the value of sales of antibiotics shrank to $14.4 billion in 2010 from $16.1 billion in 2005. That figure is projected to fall to $12.0 billion in 2015 as some former blockbusters lose patent protection, according to consensus analyst forecasts compiled by Thomson Reuters Pharma.
Faced with such economic hurdles -- not to mention the daunting scientific difficulties of outwitting fast-mutating superbugs -- a long list of big drug companies have decided to end their antibiotic research, including Roche Holding AG, Bristol-Myers Squibb Co and Eli Lilly & Co.
AstraZeneca and GlaxoSmithKline -- and to a lesser extent Novartis AG, Merck & Co Inc and Pfizer Inc -- remain in the antibiotic space. But scientists like Livermore fear work in drug company labs is being disrupted by the upheaval now sweeping the industry, following a wave of mergers and acquisitions. That's diverting attention from the job at hand: battling the microscopic pathogens that are threatening the practice of modern medicine.
BARRIERS TO ENTRY
But the buck doesn't stop with Big Pharma. Despite urgings from officials at the FDA and its European equivalent for drug companies to do more, many in the industry believe that regulators are actually a large part of the problem.
David Shlaes, a 30-year industry veteran who now works as a consultant, has particularly harsh words for the FDA, accusing it of a "lurch into Neverland as far as antibiotics are concerned" in an open letter to U.S. Secretary of Health and Human Services Kathleen Sebelius in February.
The problem, as critics like Shlaes see it, is the increasingly onerous nature of clinical trials demanded by officialdom before an antibiotic can be approved for sale. Regulators have grown much more cautious about clearing new drugs in recent years: the situation is especially sensitive in the case of antibiotics, following a scandal over Sanofi-Aventis SA's Ketek, which was approved in 2004 but subsequently linked to a risk of liver damage.
The result is a belt-and-braces approach to testing new antibiotics that means experimental antibacterial drugs need more and much larger late-stage clinical studies, throwing up what senior Pfizer research executive Rod MacKenzie says is now the principal obstacle to antibiotic development for the handful of big players still left in the game.
"That's of course where the large bulk of our costs are -- in the late stage of development -- and so that really makes life very difficult," he says.
The pushback isn't just coming from the industry: Livermore is also convinced society needs to adjust its risk dial and make it easier for new antibiotics to win approval if it wants to secure a flow of future drugs. "As a result of seeking the perfect we risk squeezing out the good," he says. "It would introduce more risks -- but the biggest risk, looking forward, is that we are simply not going to get enough new antibiotics."
"PUSH-ME, PULL-YOU"
Experts from science and industry meet often in conferences to ponder the problem. One such get-together in a swanky hotel in central London this month had the catchy title "Superbugs and Superdrugs". Unfortunately, the bacteria right now are proving a lot more "super" than the medicines, the delegates agreed, and many pharmaceutical industry investors are losing their appetite for the fight.
Fixing the system, experts argue, will require a mixture of "push" and "pull" incentives - "push" measures to lower the cost of developing new antibiotics, and "pull" factors to increase the commercial rewards for successful products.
Adjusting the "pull" side of the equation may be the most controversial, since it effectively means offering a form of subsidy to drug companies. But the Infectious Diseases Society of America, which has called for a global commitment to develop 10 new antibiotics by 2020, believes stronger financial incentives are vital. Options include tax breaks, patent extensions or government commitments to buy future drugs. Some academics have also proposed more complex systems that would offer rewards based on how long a new product is on the market before resistance develops. The risk for taxpayers, of course, is that companies end up "gaming" any new reward system -- to the advantage of their shareholders but not necessarily society.
Ultimately, we may simply have to accept that antibiotics should no longer be cheap. Rather, they would become premium-priced products along the lines of targeted cancer therapies, which can cost tens of thousands of dollars a year for each patient. It would be a radical change, and price out many in the developing world, but a high price would, at least, have the advantage of deterring over-use and helping to fund research, particularly in more narrowly targeted drugs.
Changing the business model could also open the door to new approaches to treatment. There's certainly plenty of room for improvement, since the current diagnosis of bacterial infection by growing cultures hasn't changed fundamentally in decades. In the future, scientists hope rapid point-of-care diagnostic tests will allow them to identify their adversaries within hours, making treatment decisions quicker and allowing drug companies to conduct small, focused clinical trials targeting a narrow population group.
All promising ideas, but not much is happening yet. The WHO is working on a six-point plan to target health authorities, doctors and patients. Its main message: superbugs are not just a problem for the old and the sick -- this affects everyone.
Runner Steve Owen is the first to admit he finds the realities of what we face difficult to grasp. He knows that he lost his father because levels of hygiene in the hospital were too low. But why is the pace of drug development so slow? Why can't we do more to fix the problems that killed his dad?
"I've always thought that science would advance and keep up pace with the bugs, not that the bugs would get ahead of the expertise of the scientists," he says. "It's frightening."
Out on the streets, Steve Owen is running the same race -- physically pounding the pavements to draw attention to the problem of drug-resistant infections.
Owen's father Donald died four years ago of multiple organ failure in a British hospital. He had checked in for a knee operation. But what he got was methicillin-resistant Staphylococcus aureus, commonly known as MRSA, a so-called "superbug" that all the drugs his doctors prescribed couldn't beat. After almost 18 months of severe pain, the infection got into his blood, overpowered his vital organs and killed him.
Owen and his wife Jules have pledged to run 12 big races in as many months, to raise funds for a charity that is working to fight MRSA. "It just shouldn't have happened," says Jules, as the pair nurse their own aching limbs after running a half-marathon. "It was his knee -- that's not something he should have died from."
Welcome to a world where the drugs don't work.
After Alexander Fleming's 1928 discovery of the first antibiotic, penicillin, we quickly came to assume we had the chemicals to beat bacteria. Sure, bugs evolve to develop resistance. But for decades scientists have managed to develop new medicines to stay at least one step ahead of an ever-mutating enemy.
Now, though, we may be running out of road. MRSA alone is estimated to kill around 19,000 people every year in the United States -- far more than HIV and AIDS -- and a similar number in Europe. Other drug-resistant superbugs are spreading. Cases of often fatal "extensively drug resistant" tuberculosis have mushroomed over the past few years. A new wave of "super superbugs" with a mutation called NDM 1, which first emerged in India, has now turned up all over the world, from Britain to New Zealand.
NDM 1 is what's growing on the plates that Livermore holds in his gloved hands. "You can't win against evolution," says the scientist, who spends his days tracking the emergence of superbugs in a national reference laboratory at Britain's Health Protection Agency. "All you can seek to do is to stay a jump ahead."
That's not happening now for a number of reasons. For a start, antibiotics are everywhere, giving bacteria countless opportunities to evolve escape routes. The drugs can be picked up, without prescription, for pennies in countries like Thailand, India and parts of Latin America. Even though their use is controlled in the west, the system encourages doctors to shoot the bugs first and ask questions later. Perhaps most worryingly, the world's top drug companies, faced with decreasing returns and ever more expensive and difficult science, have not only slowed their efforts to develop new antibiotics but have been quitting the field in droves.
Today, only two large companies - GlaxoSmithKline Plc and AstraZeneca Plc -- still have strong and active antibiotic research and development programs, according to the Infectious Diseases Society of America. Back in 1990, there were nearly 20.
That could have a profound impact on how we treat our sick. "If some of the most potent multi-resistant strains that we see now accumulate, then modern medicine -- from transplants to cancer treatment and even quite straightforward gut surgery, potentially becomes untenable," says Livermore. "You need the ability to treat infections in vulnerable patients. Lose that and a swathe of modern medicine becomes unstable."
Are we about to start going backwards, to a pre-antibiotic era in which things like hip replacements, chemotherapy and intensive care are simply impossible? It's a big enough fear for the World Health Organization to devote this year's World Health Day on April 7 to antimicrobial resistance in a bid to safeguard these drugs for future generations.
"Modern medicine can't function without effective antibiotics," says Derek Butler, chairman of the MRSA Action UK charity for which the Owens are raising money. "If we lose these magic bullets, medicine will be set back over 80 years.
RAT ON THE WARD
One aspect of the race against bugs has changed little since Fleming's time, or Florence Nightingale's before that. Hospital hygiene is the basic, unglamorous and underpaid work that forms the vital first-line of defense against pathogens. If it is done properly, it can ease the demand for drugs in the first place. Yet Steve Owen remembers his dad telling him he'd seen a rat running through his ward - a shock in a developed world hospital.
Bugs are no respecters of age. Donald Owen was 82 when the treatment for his knee problems ended up killing him. Susan Fallon's daughter Sammie was just 17 when she was admitted with flu-like symptoms to another British hospital in April 2008. Pretty, petite -- at only five feet tall she was "like a little doll", her mother says -- Sammie dreamed of being a professional photographer. When her hospital blood tests came back with worrying results, doctors ordered more, including a bone marrow biopsy. That led to a diagnosis of a rare blood disorder which required chemotherapy. She also picked up a superbug. Just over a month later, before any treatment had a chance to work, Sammie was dead.
The experience left her mother bereft, angry and with a fear of hospitals and the people who work in them. "I don't know which one came in without washing their hands and gave this bug to Sammie," she says. "But if I went into hospital now I'd be saying 'Wash your hands before you come near me' -- I'd be really vigilant."
In developed nations, a big push to improve hospital hygiene is starting to keep MRSA in check. At the same time, cheap international travel is breaking down the geographical barriers to infection. Medical progress is accelerating in places like India, China and Brazil, but often more swiftly than basic infection control in hospitals, Livermore says. "It's sexier to say you can do a kidney transplant, but it's not so sexy that infection control nurses go around and berate people for not washing their hands. And yet it may well be that the infection control nurse would save more lives than the renal surgeon."
The fact that the latest superbug -- NDM 1 stands for New Delhi metallo-beta-lactamase, an enzyme that gives bacteria multidrug resistance -- first emerged in India comes as little surprise to many microbiologists. Use of antibiotics is rampant and unregulated in a country with appalling sanitation, high rates of diarrheal disease and overcrowding -- ideal conditions for resistance to develop. A week-long course of antibiotics can cost as little as 30 or 40 U.S. cents from one of the thousands of chemist shops that all too often dispense poor advice along with their non-prescription drugs.
On top of this, even in the developed world, the antibiotics used today are "broad" products, whose blunderbuss approach can kill a wide range of bugs but also trigger knock-on problems. One reason for this is that for the first 48 hours, patients are effectively treated blind while lab staff go through the process of growing a culture sample to see just which microbe is to blame. In particular, Clostridium difficile infection has become a significant problem in hospitals because such broad-spectrum antibiotics damage gut flora, which creates an environment for it to flourish.
MEET THE FAMILY
Antibiotic-resistant bugs like MRSA and C. difficile tend to be picked up by patients in hospitals, but the risks are far broader than a hospital stay. Take the story of the 100 or so Swedes who went traveling to different parts of the world and were tracked by scientists to see what bugs they brought home. Of the eight who went to India, seven -- that's 88 percent -- came back with bacteria in their guts that were resistant to a whole class of antibiotics called cephalosporins. Not one of the people in the study had been in a doctor's clinic or hospital while they were there -- indicating the superbugs they picked up were freely circulating in the community.
What makes the NDM 1 enzyme so dangerous is not only its ability to outflank carbapenems, the most powerful class of antibiotic drugs, but also the company it keeps -- in tough bacteria already resistant to many other antibiotics. Despite being identified only three years ago, it has already been detected in a wide variety of bugs, including many familiar pathogens such as Escherichia coli, or E. coli. In contrast to so-called Gram-positive bacteria, like MRSA, these microscopic enemies are Gram-negative, meaning they have tougher outer membranes which block out many antibiotics, and an unnerving ability to pump out others, making them much harder to take on and beat.
Cases of bacteria producing NDM 1 have now been found and documented in two dozen countries from North America to Europe to New Zealand to China to Kenya.
Livermore's work shows only two or three remaining antibiotics can kill these bugs -- one is toxic, so doctors use it only in extreme cases; the second can't be used to treat urinary tract infections, one of the most common infections caused by E.coli; and the third is not available in many countries and is anyway susceptible to easily developed resistance.
What's more, no new drugs active against NDM 1-producing bacteria have yet reached even the Phase II stage of the three-step pipeline process of clinical trials needed for regulatory approval. That means any new drug to tackle NDM 1 is at least five or six years away.
Even more alarmingly, NDM 1 is no lone threat -- it comes as part of a family. Similar enzymes in the same class, known as carbapenemases, have been detected worldwide. Just this month, the Eurosurveillance journal of the European Center for Diseases Prevention and Control reported that four separate cases of a related strain had been found in Switzerland between May 2009 and November 2010. Three had come from Italy, one from Greece.
That suggests that NDM 1 and its kin are not, in fact, the ultimate "super superbugs" but rather just the tip of the iceberg. The WHO's Mario Raviglione, who is fronting its antimicrobial campaign, is particularly worried about "superbug" forms of tuberculosis -- a disease that earned the nickname of "white plague" during Victorian times in Britain because sufferers' skin tone turned so pale.
TB already kills around 5,000 people a day and cases of multidrug resistant TB are spreading fast, with about 440,000 new patients every year. Until now largely a disease of the marginalized and the poor, it's the sort of infection that mutates and could start killing more widely, regardless of its victims' wealth or home country.
"We're dealing here with a public health emergency of global proportion. If we don't do anything we're just going to see more and more," Raviglione says.
You might think all that adds up to a great business opportunity for the pharmaceuticals industry. But in the past 40 years only two new classes of antibiotics have won marketing approval, while the total number of antibacterial agents approved for sale has dived. Why are the drugs firms so quiet?
CINDERELLA BUSINESS
The European Medicines Agency is easy to miss among the imposing towers of London's Canary Wharf financial district. Yet alongside the U.S. Food and Drug Administration (FDA) in Washington, it is a pivotal gatekeeper to the west's flow of new drugs. Last December, outgoing Executive Director Thomas Lonngren sent invitations to a conference looking back on the watchdog's past decade of achievements, and the great and the good of the pharmaceuticals world turned out en masse.
If they had expected a celebration, they were misguided. Lonngren, a softly spoken Swedish pharmacist, berated the industry for its pitiful record of innovation, arguing that out of the estimated $85 billion spent globally each year on drug research and development, about $60 billion was effectively wasted on dead-end projects. Worse, he said, drug manufacturers were failing to put their research dollars into key areas of unmet medical need.
Nowhere was the shortfall more glaring than in antibiotics.
"We have more or less a gap of five years without research into new antibiotics," Lonngren complained. "It's an issue where commercial consideration doesn't really match the public health need." He went on to warn that, while it was not the job of regulators to tell commercial companies where to invest, they might in future need to advise politicians and the public at large about such research deficiencies.
Across the Atlantic, FDA Commissioner Margaret Hamburg shares his concerns. "We need new and better drugs …- and we need them now. Yet the R&D pipeline is distressingly low," she said in a speech to the National Press Club in Washington in October.
It wasn't always like this. For many years, making antibiotics was a bread-and-butter activity for the drugs industry. Today it has shrunk to a neglected Cinderella business -- complacent about past successes and reflecting the skewed economics that can drive pharmaceutical development.
Martin Mackay, a Scottish microbiologist who has worked for many of the world's top drugmakers and now heads up research at AstraZeneca, is better-placed than most to see the big picture. Back in the late 1970s he was a researcher at Beecham Pharmaceuticals -- now part of GlaxoSmithKline -- when many in the industry were checking off the fight against bacteria in the "Job Done" column. After all, doctors had a wide choice of effective treatments and all the drug companies needed to do was go out and sell them, and let the accounts department tot up the profits.
"Back then, there was a school of thought that said we had cracked the problem of bacterial diseases," Mackay says. "It looked a pretty good picture."
THE SUMS DON'T WORK
Today, it's very hard to make the commercial sums work. The drugs industry has seen dwindling returns on all its R&D in recent years, resulting in a wave of high-profile laboratory closures -- cost-cutting measures that have been cheered by the stock market. The payback on antibiotics has been even more dismal than in other diseases.
There are two main reasons for this. First and foremost antibiotics, when they work, tend to cure people. Patients take small quantities for several days, a few weeks at most. That's not a very attractive revenue flow. By contrast, a patient on a cholesterol-lowering heart medicine will keep using the pills, and contributing to drug industry profits, for the rest of his or her life. Second, even if a new antibiotic is approved for sale, its use is likely to be reserved for serious infections -- once again, minimizing the sales opportunity.
To cap it all, most existing antibiotics have been around for decades and are widely available as cheap generics, setting a very low bar for prices.
"If you are in the business of antibacterials, I think you just have to accept that is the way it is," says Mackay. "Will it be as profitable as a really great cardiovascular drug? Probably not."
So it should be no surprise that while the global market for all prescription drugs grew by more than 40 percent over the last five years, the value of sales of antibiotics shrank to $14.4 billion in 2010 from $16.1 billion in 2005. That figure is projected to fall to $12.0 billion in 2015 as some former blockbusters lose patent protection, according to consensus analyst forecasts compiled by Thomson Reuters Pharma.
Faced with such economic hurdles -- not to mention the daunting scientific difficulties of outwitting fast-mutating superbugs -- a long list of big drug companies have decided to end their antibiotic research, including Roche Holding AG, Bristol-Myers Squibb Co and Eli Lilly & Co.
AstraZeneca and GlaxoSmithKline -- and to a lesser extent Novartis AG, Merck & Co Inc and Pfizer Inc -- remain in the antibiotic space. But scientists like Livermore fear work in drug company labs is being disrupted by the upheaval now sweeping the industry, following a wave of mergers and acquisitions. That's diverting attention from the job at hand: battling the microscopic pathogens that are threatening the practice of modern medicine.
BARRIERS TO ENTRY
But the buck doesn't stop with Big Pharma. Despite urgings from officials at the FDA and its European equivalent for drug companies to do more, many in the industry believe that regulators are actually a large part of the problem.
David Shlaes, a 30-year industry veteran who now works as a consultant, has particularly harsh words for the FDA, accusing it of a "lurch into Neverland as far as antibiotics are concerned" in an open letter to U.S. Secretary of Health and Human Services Kathleen Sebelius in February.
The problem, as critics like Shlaes see it, is the increasingly onerous nature of clinical trials demanded by officialdom before an antibiotic can be approved for sale. Regulators have grown much more cautious about clearing new drugs in recent years: the situation is especially sensitive in the case of antibiotics, following a scandal over Sanofi-Aventis SA's Ketek, which was approved in 2004 but subsequently linked to a risk of liver damage.
The result is a belt-and-braces approach to testing new antibiotics that means experimental antibacterial drugs need more and much larger late-stage clinical studies, throwing up what senior Pfizer research executive Rod MacKenzie says is now the principal obstacle to antibiotic development for the handful of big players still left in the game.
"That's of course where the large bulk of our costs are -- in the late stage of development -- and so that really makes life very difficult," he says.
The pushback isn't just coming from the industry: Livermore is also convinced society needs to adjust its risk dial and make it easier for new antibiotics to win approval if it wants to secure a flow of future drugs. "As a result of seeking the perfect we risk squeezing out the good," he says. "It would introduce more risks -- but the biggest risk, looking forward, is that we are simply not going to get enough new antibiotics."
"PUSH-ME, PULL-YOU"
Experts from science and industry meet often in conferences to ponder the problem. One such get-together in a swanky hotel in central London this month had the catchy title "Superbugs and Superdrugs". Unfortunately, the bacteria right now are proving a lot more "super" than the medicines, the delegates agreed, and many pharmaceutical industry investors are losing their appetite for the fight.
Fixing the system, experts argue, will require a mixture of "push" and "pull" incentives - "push" measures to lower the cost of developing new antibiotics, and "pull" factors to increase the commercial rewards for successful products.
Adjusting the "pull" side of the equation may be the most controversial, since it effectively means offering a form of subsidy to drug companies. But the Infectious Diseases Society of America, which has called for a global commitment to develop 10 new antibiotics by 2020, believes stronger financial incentives are vital. Options include tax breaks, patent extensions or government commitments to buy future drugs. Some academics have also proposed more complex systems that would offer rewards based on how long a new product is on the market before resistance develops. The risk for taxpayers, of course, is that companies end up "gaming" any new reward system -- to the advantage of their shareholders but not necessarily society.
Ultimately, we may simply have to accept that antibiotics should no longer be cheap. Rather, they would become premium-priced products along the lines of targeted cancer therapies, which can cost tens of thousands of dollars a year for each patient. It would be a radical change, and price out many in the developing world, but a high price would, at least, have the advantage of deterring over-use and helping to fund research, particularly in more narrowly targeted drugs.
Changing the business model could also open the door to new approaches to treatment. There's certainly plenty of room for improvement, since the current diagnosis of bacterial infection by growing cultures hasn't changed fundamentally in decades. In the future, scientists hope rapid point-of-care diagnostic tests will allow them to identify their adversaries within hours, making treatment decisions quicker and allowing drug companies to conduct small, focused clinical trials targeting a narrow population group.
All promising ideas, but not much is happening yet. The WHO is working on a six-point plan to target health authorities, doctors and patients. Its main message: superbugs are not just a problem for the old and the sick -- this affects everyone.
Runner Steve Owen is the first to admit he finds the realities of what we face difficult to grasp. He knows that he lost his father because levels of hygiene in the hospital were too low. But why is the pace of drug development so slow? Why can't we do more to fix the problems that killed his dad?
"I've always thought that science would advance and keep up pace with the bugs, not that the bugs would get ahead of the expertise of the scientists," he says. "It's frightening."
Tuesday, March 22, 2011
Alpha Male, Are You?
His attitude
The crowd follows him… and when they don’t follow, he doesn’t give a damn. He has his own style and frequently makes things stylish. He’s a little different… a tad mysterious… a little out of reach. He looks like a normal guy with a bit of “dangerous” mixed in for good measure.
His swagger and sex appeal around women
He has a walk that oozes SEX. He walks like he has a foot-long block of gold and diamonds between his legs and he’s not afraid to use it. He talks to women like they are “wo-man”… different than him, but still his worthy complement. He lets you know through his alpha male behavior and actions that he will DO YOU sooooo good… the best you ever had. (But of course, he has to believe that he will before he ever gets a chance to do it.)
His verbal play
He doesn’t let you win when he believes that he’s right. He will challenge you on the things you say and make you evaluate yourself. He gives you a run for your money in conversation. He’s not afraid to call you out. He doesn’t appease women and compliments flow to you only if they are completely deserved.
His charisma
He can talk to anyone. He has a big smile and a huge personality. He is spontaneous and likes to have a good time. His energy fills a room and he can rally a crowd to follow him. He can be serious, and in that seriousness, you see a hint of a softer side… but just a hint.
His leadership
He takes control of situations and is cordial, but you never know where you stand with him. He has a bit of a poker face. “Does he like me?” and “Does he think I’m interesting?” are floating through your mind as you stare into his eyes. He’s one step past friendly… he might smile a bit… but you’re simply not sure if he thinks you’re awesome or the suckiest person on earth.
His independence
He tells you exactly who he is and what he wants. He doesn’t have time to play games. He’s busy creating worlds and expanding his personal universe… whether at work or in other professional endeavors. He lets you know that you are a woman… and that you come SECOND to him and his goals… but he wants you by his side… he knows you have the power to bring out the best in him.
His persistence
He doesn’t let anyone tell him what he can or cannot do. He sometimes asks for what he wants and a lot of times he TAKES what he wants. That includes a phone number, a kiss, or more. He’s relentless in getting what he wants and he uses his whole bag of tricks to do it. A natural salesman… he’s always two steps ahead of you.
His honesty and dominating, deep stare
He has a no-nonsense way of communicating... blunt in his speech and doesn’t let you control him. He makes jokes that are a bit over your head and makes you wonder if he’s laughing with you or at you. His conversation leaves you wanting more… but you’re not sure why.
His easy-going, but sexually-charged vibe
He lets you know that he likes sex and will do it with you when HE’s ready. He is not concerned about whether or not you will “Let him”… he’s too busy deciding whether he “Wants to” or not. He doesn’t press for it, but he’s constantly leading you toward it… with the look in his eye, the raised eyebrow, the suggestions of sexy games like Strip Wii Bowling… he’s always leading you towards the bedroom. And you’re laughing and having a good time all the way there.
The crowd follows him… and when they don’t follow, he doesn’t give a damn. He has his own style and frequently makes things stylish. He’s a little different… a tad mysterious… a little out of reach. He looks like a normal guy with a bit of “dangerous” mixed in for good measure.
His swagger and sex appeal around women
He has a walk that oozes SEX. He walks like he has a foot-long block of gold and diamonds between his legs and he’s not afraid to use it. He talks to women like they are “wo-man”… different than him, but still his worthy complement. He lets you know through his alpha male behavior and actions that he will DO YOU sooooo good… the best you ever had. (But of course, he has to believe that he will before he ever gets a chance to do it.)
His verbal play
He doesn’t let you win when he believes that he’s right. He will challenge you on the things you say and make you evaluate yourself. He gives you a run for your money in conversation. He’s not afraid to call you out. He doesn’t appease women and compliments flow to you only if they are completely deserved.
His charisma
He can talk to anyone. He has a big smile and a huge personality. He is spontaneous and likes to have a good time. His energy fills a room and he can rally a crowd to follow him. He can be serious, and in that seriousness, you see a hint of a softer side… but just a hint.
His leadership
He takes control of situations and is cordial, but you never know where you stand with him. He has a bit of a poker face. “Does he like me?” and “Does he think I’m interesting?” are floating through your mind as you stare into his eyes. He’s one step past friendly… he might smile a bit… but you’re simply not sure if he thinks you’re awesome or the suckiest person on earth.
His independence
He tells you exactly who he is and what he wants. He doesn’t have time to play games. He’s busy creating worlds and expanding his personal universe… whether at work or in other professional endeavors. He lets you know that you are a woman… and that you come SECOND to him and his goals… but he wants you by his side… he knows you have the power to bring out the best in him.
His persistence
He doesn’t let anyone tell him what he can or cannot do. He sometimes asks for what he wants and a lot of times he TAKES what he wants. That includes a phone number, a kiss, or more. He’s relentless in getting what he wants and he uses his whole bag of tricks to do it. A natural salesman… he’s always two steps ahead of you.
His honesty and dominating, deep stare
He has a no-nonsense way of communicating... blunt in his speech and doesn’t let you control him. He makes jokes that are a bit over your head and makes you wonder if he’s laughing with you or at you. His conversation leaves you wanting more… but you’re not sure why.
His easy-going, but sexually-charged vibe
He lets you know that he likes sex and will do it with you when HE’s ready. He is not concerned about whether or not you will “Let him”… he’s too busy deciding whether he “Wants to” or not. He doesn’t press for it, but he’s constantly leading you toward it… with the look in his eye, the raised eyebrow, the suggestions of sexy games like Strip Wii Bowling… he’s always leading you towards the bedroom. And you’re laughing and having a good time all the way there.
Tuesday, March 15, 2011
Japan Quake May Have Shortened Earth Days, Moved Axis
The March 11, magnitude 9.0 earthquake in Japan may have shortened the length of each Earth day and shifted its axis. But don't worry—you won't notice the difference.
Using a United States Geological Survey estimate for how the fault responsible for the earthquake slipped, research scientist Richard Gross of NASA's Jet Propulsion Laboratory, Pasadena, Calif., applied a complex model to perform a preliminary theoretical calculation of how the Japan earthquake—the fifth largest since 1900—affected Earth's rotation. His calculations indicate that by changing the distribution of Earth's mass, the Japanese earthquake should have caused Earth to rotate a bit faster, shortening the length of the day by about 1.8 microseconds (a microsecond is one millionth of a second).
The calculations also show the Japan quake should have shifted the position of Earth's figure axis (the axis about which Earth's mass is balanced) by about 17 centimeters (6.5 inches), towards 133 degrees east longitude. Earth's figure axis should not be confused with its north-south axis; they are offset by about 10 meters (about 33 feet). This shift in Earth's figure axis will cause Earth to wobble a bit differently as it rotates, but it will not cause a shift of Earth's axis in space—only external forces such as the gravitational attraction of the sun, moon and planets can do that.
Both calculations will likely change as data on the quake are further refined.
In comparison, following last year's magnitude 8.8 earthquake in Chile, Gross estimated the Chile quake should have shortened the length of day by about 1.26 microseconds and shifted Earth's figure axis by about 8 centimeters (3 inches). A similar calculation performed after the 2004 magnitude 9.1 Sumatran earthquake revealed it should have shortened the length of day by 6.8 microseconds and shifted Earth's figure axis by about 7 centimeters, or 2.76 inches. How an individual earthquake affects Earth's rotation depends on its size (magnitude), location and the details of how the fault slipped.
Gross said that, in theory, anything that redistributes Earth's mass will change Earth's rotation.
"Earth's rotation changes all the time as a result of not only earthquakes, but also the much larger effects of changes in atmospheric winds and oceanic currents," he said. "Over the course of a year, the length of the day increases and decreases by about a millisecond, or about 550 times larger than the change caused by the Japanese earthquake. The position of Earth's figure axis also changes all the time, by about 1 meter (3.3 feet) over the course of a year, or about six times more than the change that should have been caused by the Japan quake."
Gross said that while we can measure the effects of the atmosphere and ocean on Earth's rotation, the effects of earthquakes, at least up until now, have been too small to measure. The computed change in the length of day caused by earthquakes is much smaller than the accuracy with which scientists can currently measure changes in the length of the day. However, since the position of the figure axis can be measured to an accuracy of about 5 centimeters (2 inches), the estimated 17-centimeter shift in the figure axis from the Japan quake may actually be large enough to observe if scientists can adequately remove the larger effects of the atmosphere and ocean from the Earth rotation measurements. He and other scientists will be investigating this as more data become available.
Gross said the changes in Earth's rotation and figure axis caused by earthquakes should not have any impacts on our daily lives. "These changes in Earth's rotation are perfectly natural and happen all the time," he said. "People shouldn't worry about them."
Alan Buis 818-354-0474
Jet Propulsion Laboratory, Pasadena, Calif.
Alan.buis@jpl.nasa.gov
2011-080
*Published on NASA official website on 14 March 2011
Using a United States Geological Survey estimate for how the fault responsible for the earthquake slipped, research scientist Richard Gross of NASA's Jet Propulsion Laboratory, Pasadena, Calif., applied a complex model to perform a preliminary theoretical calculation of how the Japan earthquake—the fifth largest since 1900—affected Earth's rotation. His calculations indicate that by changing the distribution of Earth's mass, the Japanese earthquake should have caused Earth to rotate a bit faster, shortening the length of the day by about 1.8 microseconds (a microsecond is one millionth of a second).
The calculations also show the Japan quake should have shifted the position of Earth's figure axis (the axis about which Earth's mass is balanced) by about 17 centimeters (6.5 inches), towards 133 degrees east longitude. Earth's figure axis should not be confused with its north-south axis; they are offset by about 10 meters (about 33 feet). This shift in Earth's figure axis will cause Earth to wobble a bit differently as it rotates, but it will not cause a shift of Earth's axis in space—only external forces such as the gravitational attraction of the sun, moon and planets can do that.
Both calculations will likely change as data on the quake are further refined.
In comparison, following last year's magnitude 8.8 earthquake in Chile, Gross estimated the Chile quake should have shortened the length of day by about 1.26 microseconds and shifted Earth's figure axis by about 8 centimeters (3 inches). A similar calculation performed after the 2004 magnitude 9.1 Sumatran earthquake revealed it should have shortened the length of day by 6.8 microseconds and shifted Earth's figure axis by about 7 centimeters, or 2.76 inches. How an individual earthquake affects Earth's rotation depends on its size (magnitude), location and the details of how the fault slipped.
Gross said that, in theory, anything that redistributes Earth's mass will change Earth's rotation.
"Earth's rotation changes all the time as a result of not only earthquakes, but also the much larger effects of changes in atmospheric winds and oceanic currents," he said. "Over the course of a year, the length of the day increases and decreases by about a millisecond, or about 550 times larger than the change caused by the Japanese earthquake. The position of Earth's figure axis also changes all the time, by about 1 meter (3.3 feet) over the course of a year, or about six times more than the change that should have been caused by the Japan quake."
Gross said that while we can measure the effects of the atmosphere and ocean on Earth's rotation, the effects of earthquakes, at least up until now, have been too small to measure. The computed change in the length of day caused by earthquakes is much smaller than the accuracy with which scientists can currently measure changes in the length of the day. However, since the position of the figure axis can be measured to an accuracy of about 5 centimeters (2 inches), the estimated 17-centimeter shift in the figure axis from the Japan quake may actually be large enough to observe if scientists can adequately remove the larger effects of the atmosphere and ocean from the Earth rotation measurements. He and other scientists will be investigating this as more data become available.
Gross said the changes in Earth's rotation and figure axis caused by earthquakes should not have any impacts on our daily lives. "These changes in Earth's rotation are perfectly natural and happen all the time," he said. "People shouldn't worry about them."
Alan Buis 818-354-0474
Jet Propulsion Laboratory, Pasadena, Calif.
Alan.buis@jpl.nasa.gov
2011-080
*Published on NASA official website on 14 March 2011
Saturday, March 12, 2011
Some random stuff...
I'm only speaking for women of my gen, and in general. If you feel offended in any way, do yourself a favour by getting outta here.
Seriously, I still dont understand the reason of having the majority whom don't enjoy and don't know how to give bjs... I've always thought that its in us, women. And how could we dislike the idea of giving?
Bj is something which can be learnt, either through friends, online, etc. But definitely, you cant fake enjoyment. If you don't like it, you will hate it more as you did more... unless, you gotta change the way of your thoughts. you gotta learn how to embrace the wonderful feeling.
I'm lazy to post how to give a good bj, so here's e link: Blowjob Tutorial
Enjoy & have fun!!
Seriously, I still dont understand the reason of having the majority whom don't enjoy and don't know how to give bjs... I've always thought that its in us, women. And how could we dislike the idea of giving?
Bj is something which can be learnt, either through friends, online, etc. But definitely, you cant fake enjoyment. If you don't like it, you will hate it more as you did more... unless, you gotta change the way of your thoughts. you gotta learn how to embrace the wonderful feeling.
I'm lazy to post how to give a good bj, so here's e link: Blowjob Tutorial
Enjoy & have fun!!
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