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L.A. Times, NYT Opinion Pieces Discuss International Women's Health Issues
The Los Angeles Times and the New York Times recently published opinion pieces examining issues related to international women"s health. Summaries appear below.~ Michelle Goldberg, Los Angeles Times: The solution to addressing issues of over-population and under-population in various parts of the world is "giving women more control over their fertility and their lives," Goldberg, author of "The Means of Reproduction: Sex, Power and the Future of the World," writes in a Times opinion piece. Goldberg says that both problems are "symptoms of countries" failures to meet women"s needs." Citing United Nations data, Goldberg writes that the world"s population is growing at an "unsustainable" rate of 78 million people annually, and it will probably continue to increase by 70 million or 75 million annually through 2020. Almost all of that growth will occur in developing countries, she says. "The ethical and effective way to counter rapid population growth is to bolster women"s rights and improve their access to family planning," as well as access to education, Goldberg writes, adding that "study after study has found that girls who go to school marry later and have fewer, healthier children." Meanwhile, some developed countries -- including Japan, Russia, Italy and Spain -- are seeing a decline in birth rates, a fact that some social conservatives are using "to argue for restrictions on women"s rights." According to Goldberg, "Fertility is reaching dangerously low levels in countries where social attitudes and institutions haven"t caught up with women"s desire to combine work and family. When faced with men who are unwilling to share domestic burdens, inflexible workplaces and day-care shortages, many women respond by having fewer children." However, "when societies make it possible for women to combine having children with pursuing their other ambitions, fertility rates are fine," Goldberg says. She adds, "Give women freedom and support, and they will find reproductive equilibrium, so that when societies do shrink or grow, they do so in a manageable way" (Goldberg, Los Angeles Times, 5/17).~ Nicholas Kristof, New York Times: About 500,000 women "die annually from complications related to pregnancy or childbirth without attracting much interest because the victims are typically among the most voiceless people in the world: impoverished, rural, uneducated and female," Kristof writes in a Times opinion piece. He adds, "It"s no mystery how to save the lives of pregnant women; what"s lacking is the will and res." Kristof writes that Sierra Leone, which has the highest maternal mortality rate in the world, "is now making progress with the help of the United Nations Population Fund." Former President George W. Bush cut off U.S. funding for UNFPA, but President Obama has restored the funding. Kristof adds that a bill (H.R. 1410) that would "establish American leadership in this area ... has attracted pathetically little attention." He continues that if the lives of women in West Africa "were a priority, there would be many simple ways to keep them alive," such as providing them with bed nets to help protect against malaria or iron tablets to fight anemia at a cost of "just a few dollars" (Kristof, New York Times, 5/17).

New Figures Reveal Ethnic Minorities Are Not Aware Of Their Cancer Risk
Despite growing evidence that cancer is becoming more prevalent amongst ethnic minority groups, news figures out today at the start of Ethnic Minority Cancer Awareness Week show that cancer awareness levels are critically low amongst this cohort.
News of the day
WHO, UNICEF Say Vitamin A, Deworming Interventions Safe, In Response To Alleged Deaths, Sickness In Bangladesh
The WHO and UNICEF on Tuesday said that vitamin A supplements and deworming tablets are safe, after two deaths and the "sickness of hundreds" were alleged among the children who received the interventions during a nationwide campaign in Bangladesh, Bernama.com reports (Bernama.com, 6/9).
Diagnostics

Genetic Testing May Be Valuable In Treating Colorectal Cancer

For the 29,000 patients in the United States with metastatic colorectal cancer, chemotherapy with irinotecan is a standard treatment that has been shown to improve survival. But for more than one in 10 of these patients, a variation in their DNA means that this treatment could result in a severe reduction in their white blood cell count, leading to a high risk of bacterial infection and possible subsequent death. A new genetic test can identify those with the variation in order to lower the treatment dose - however, it has been unclear whether the testing is worthwhile. A new cost-effectiveness study led by scientists at Weill Cornell Medical College has determined that so-called pretreatment pharmacogenetic testing is only beneficial if dose-reduced treatment is shown to be nearly as effective as the full dose. If the lower dose is as effective, the test could prevent many cases of severe neutropenia, an abnormally low count of an important type of white blood cells known as neutrophils. It would also mean better life expectancy and lower cost of care. The study appears online in the journal Cancer and is expected in print in the Sept. 1 issue. "Pharmacogenetic testing is a relatively new treatment innovation that may prove to be a valuable tool for clinicians as they develop personalized treatments for cancer patients to minimize side effects while maintaining outcomes," says lead author Dr. Heather Taffet Gold, assistant professor in the Division of Health Policy in the Department of Public Health at Weill Cornell Medical College. "Our study points to significant potential benefits for pretreatment pharmacogenetic testing for metastatic colorectal cancer, but remains to be verified by clinical research." The study used a computer simulation model that follows hypothetical patients treated with the FOLFIRI (5-fluorouracil/leucovorin with irinotecan) chemotherapy regimen for metastatic colorectal cancer. The model assumed that under usual care, patients received a full dose of irinotecan. With genetic testing, irinotecan dosage was reduced 25 percent in individuals identified using the genetic test as having the UGT1A1*28 variant allele. The dose reduction is specified in the Food and Drug Administration-approved drug label to minimize cases of neutropenia. Dr. Bruce Schackman, senior author of the study, says, "Cost-effectiveness evaluations of pharmacogenetic tests can provide important insights into both the clinical and economic value of these new treatment paradigms, but few of these types of studies have been conducted. Importantly, these studies also allow us to define in economic terms the value of additional comparative effectiveness research. In this case, we"ve determined that further research of up to $22 million should be conducted to study the risks and benefits of dose reductions based on the results of the genetic test." Dr. Schackman is associate professor of public health and chief of the Division of Health Policy in the Department of Public Health at Weill Cornell Medical College. "This study is an important example of how the combined use of cost-effectiveness analysis and pharmacogenetic testing can improve treatment outcomes," says Dr. Alvin I. Mushlin, Professor and Chairman of the Weill Cornell Department of Public Health. "Both methods are becoming increasingly integral to the advancement of evidence-based medicine." Additional co-authors include Drs. Michael J. Hall of Fox Chase Cancer Center in Philadelphia and Victoria Blinder of Memorial Sloan-Kettering Cancer Center in New York. The study received support from the American Cancer Society and the Agency for Healthcare Research and Quality (AHRQ) via Weill Cornell"s Center for Education and Research on Therapeutics (CERT). Andrew Klein New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College


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