Second man seems to be free of AIDS virus after transplant
By CARLA K. JOHNSON
AP Medical Writer
Tuesday, March 5
SEATTLE (AP) — A London man appears to be free of the AIDS virus after a stem cell transplant, the second success including the “Berlin patient,” doctors reported.
The therapy had an early success with Timothy Ray Brown, a U.S. man treated in Germany who is 12 years post-transplant and still free of HIV. Until now, Brown is the only person thought to have been cured of infection with HIV, the virus that causes AIDS.
Such transplants are dangerous and have failed in other patients. They’re also impractical to try to cure the millions already infected.
The latest case “shows the cure of Timothy Brown was not a fluke and can be recreated,” said Dr. Keith Jerome of Fred Hutchinson Cancer Research Center in Seattle who had no role. He added that it could lead to a simpler approach that could be used more widely.
The case was published online Monday by the journal Nature and will be presented at an HIV conference in Seattle.
The patient has not been identified. He was diagnosed with HIV in 2003 and started taking drugs to control the infection in 2012. It’s unclear why he waited that long. He developed Hodgkin lymphoma that year and agreed to a stem cell transplant to treat the cancer in 2016.
With the right kind of donor, his doctors figured, the London patient might get a bonus beyond treating his cancer: a possible HIV cure.
Doctors found a donor with a gene mutation that confers natural resistance to HIV. About 1 percent of people descended from northern Europeans have inherited the mutation from both parents and are immune to most HIV. The donor had this double copy of the mutation.
That was “an improbable event,” said lead researcher Ravindra Gupta of University College London. “That’s why this has not been observed more frequently.”
The transplant changed the London patient’s immune system, giving him the donor’s mutation and HIV resistance.
The patient voluntarily stopped taking HIV drugs to see if the virus would come back.
Usually, HIV patients expect to stay on daily pills for life to suppress the virus. When drugs are stopped, the virus roars back, usually in two to three weeks.
That didn’t happen with the London patient. There is still no trace of the virus after 18 months off the drugs.
Brown said he would like to meet the London patient and would encourage him to go public because “it’s been very useful for science and for giving hope to HIV-positive people, to people living with HIV,” he told The Associated Press Monday.
Stem cell transplants typically are harsh procedures which start with radiation or chemotherapy to damage the body’s existing immune system and make room for a new one. There are complications too. Brown had to have a second stem cell transplant when his leukemia returned.
Compared to Brown, the London patient had a less punishing form of chemotherapy to get ready for the transplant, didn’t have radiation and had only a mild reaction to the transplant.
Dr. Gero Hutter, the German doctor who treated Brown, called the new case “great news” and “one piece in the HIV cure puzzle.”
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
Opinion: High Time for Medicare-for-All
By Robert Weissman
Given America’s wealth, it would be hard to design a health care system that fails more completely than ours.
It’s time to get rid of our high-cost, low-performing system and replace it with something better.
The good news is, we already have the kernel of that system: Medicare. If we improve Medicare and expand it to cover all Americans, then we could simultaneously save money, give everyone better treatment and provide health care as a right. The even better news is that the public is fast rallying around the idea of improved and expanded Medicare-for-All — and the strongest and most detailed Medicare-for-All legislative proposal has just been introduced in the U.S. House of Representatives with a record level of support.
In the United States, we pay more — much more — for health care than other rich countries. We spend roughly twice what other rich countries spend on health care.
We pay more, but we get less — much less. Among rich countries, we do the worst job of providing health care coverage. Every day, 100 Americans die not from medical conditions but from a lack of treatment. They are killed by a heartless system that rations care based on ability to pay. Nothing like that happens in other rich countries.
Among rich countries, we have the greatest problem of under-insurance. One-third of adults report a cost-related access to health care problem in the past year. They stayed away from the doctor, or did not fill a prescription, or skipped a follow-up treatment. Cost-related barriers to care are five times worse in the United States than in the United Kingdom.
And we have some of the worst health outcomes. Our infant mortality rate is 25 percent higher than in Canada. It is practically triple the rate in Japan. We rank 43 among the world’s nations for life expectancy, behind Cuba, Costa Rica and Chile, among others.
We know we can do better, because Medicare already does better. And the new Medicare-for-All proposal introduced by Rep. Pramila Jayapal, D-Washington, not only would ensure every American was covered but it would improve on existing Medicare. The legislation would eliminate co-pays and deductibles, provide for dental care and cover long-term care, including nursing home care.
We can do all this at no additional cost compared to our current health care spending.
The largest savings from Medicare-for-All would come from eliminating needless and incredibly expensive bureaucracy. The key would be to move away from per-treatment billing. Instead, hospitals and other medical providers would receive an overall payment based on the patients they serve and the treatments they provide, and then they could get on with the business of providing care. The arrangement would be no different than the ways police stations or public libraries are funded; libraries don’t send a bill to the city treasurer each time a person checks out a book. The potential available savings are tremendous. Administrative costs consume an astounding 25 percent of U.S. hospital spending, for example, far above most comparable countries, due largely to the costs of billing.
Other massive savings could be obtained by empowering Medicare to negotiate the price of prescription drugs. Refusing to permit Big Pharma to set whatever prices it chooses and instead relying on price negotiations in a Medicare-for-All system could save $200 billion every single year.
There’s no reason the United States should tolerate a health care system that fails its purpose of provide health care to every person while practically bankrupting the nation and literally bankrupting half a million American families every year.
There’s no reason we should tolerate such a system, but there’s a reason, and only one reason, we do: the dominant political power of the health insurance, pharmaceutical and hospital industries. Big Pharma alone spends more on lobbying that any other industry, by far.
But all of the money from the insurance industry, the drug corporations and the for-profit hospitals can’t hold back the will of the people, if we are organized and mobilized. The Jayapal bill shows what we can do if we work off of Medicare and try to design a system that aims to advance health and deliver care, rather than increase corporate profits. It won’t be long before we win it.
ABOUT THE WRITER
Robert Weissman is the president of Public Citizen, a nonprofit consumer advocacy organization that champions the public interest in the halls of power. He wrote this for InsideSources.com.
America’s schools are crumbling – what will it take to fix them?
March 5, 2019
Author: Michael Addonizio, Professor of educational leadership and policy studies, Wayne State University
Disclosure statement: Michael Addonizio does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Partners: Wayne State University provides funding as a member of The Conversation US.
When I was asked to support a federal lawsuit that says Detroit’s deteriorating schools were having a negative impact on students’ ability to learn, the decision was a no-brainer.
Detroit’s schools are so old and raggedy that last year the city’s schools chief, Nikolai Vitti, ordered the water shut off across the district due to lead and copper risks from antiquated plumbing. By mid-September, elevated levels of copper and lead were confirmed in 57 of 86 schools tested.
Safe water isn’t the only problem in Detroit schools. A 2018 assessment found that it would cost about US$500 million to bring Detroit’s schools into a state of repair – a figure that could grow to $1.4 billion if the school district waits another five years to address the problems. A school board official concluded that the district would have to “pick and choose” which repairs to make because there isn’t enough money to make them all.
Even though a federal judge tossed out the lawsuit that I supported, the judge recognized how the deteriorating state of Detroit’s schools impact student learning. The central argument of the lawsuit is that children have a constitutional right to literacy, and that the state was violating that right by failing to provide enough resources for Detroit’s school system.
“The conditions and outcomes of Plaintiffs’ schools, as alleged, are nothing short of devastating,” U.S. District Court Judge Stephen J. Murphy III wrote. “When a child who could be taught to read goes untaught, the child suffers a lasting injury – and so does society.”
But Judge Murphy found that the “deplorable and unsafe conditions” that deny children access to literacy were not shown to stem from “irrational” decisions of the State. The case has been appealed to the U.S. 6th Circuit.
A nationwide problem
Detroit’s dilemma is not unique.
Before I became a professor of educational leadership and policy, I served as assistant state superintendent for research and policy in the Michigan Department of Education. I know a thing or two about how poor school facilities can have an effect on student learning. One recent study, for instance, found that in schools without air conditioning, for every one Fahrenheit degree increase in school year temperature, the amount learned that year goes down by 1 percent.
Crumbling schools can be found throughout the nation. These schools are disproportionately attended by low-income children of color. And it’s been that way for a while. For instance, a 1996 report by the General Accounting Office found that schools in “unsatisfactory physical and environmental condition” were “concentrated in central cities and serve large populations of poor or minority students.”
A 2014 Department of Education study found that it would cost about $197 billion to bring the nation’s deteriorating public schools into good condition.
The harshness of the conditions that have plagued the nation’s schools was captured in a case known as Williams v. California, a class action lawsuit that the ACLU filed in 2000 on behalf of California’s low-income students of color.
“The school has no air conditioning. On hot days classroom temperatures climb into the 90s,” the lawsuit stated in reference to the grim conditions at Luther Burbank middle school in San Francisco. “The school heating system does not work well. In winter, children often wear coats, hats, and gloves during class to keep warm.”
A similar situation happened in Baltimore’s public schools in January 2018, when the city’s schools were closed after parents and educators complained that students were being exposed to frigid conditions that the local teachers union described as “inhumane.”
A few years ago in the Yazoo County School District in Mississippi, the lights were so old at the high school that maintenance workers couldn’t find replacement bulbs when the lights went out.
In Philadelphia, the head of the teachers union recently described the current state of the city’s schools as “untenable.”
“From flaking lead paint, asbestos exposure, persistent rodent issues, the presence of mold, and even the lack of heat on bitterly cold days, educators and children in Philadelphia are learning and working in environmentally toxic facilities every day,” Jerry Jordan, president of the Philadelphia Federation of Teachers, wrote in a January op-ed.
Costs and consequences
Indeed, miserable conditions like these are not only hard on the children. They seriously impair school districts’ ability to retain their most valuable asset – their teachers. Teachers leave their jobs for a variety of reasons, but facility quality is a key factor.
Addressing the infrastructure needs of America’s public schools will be costly. However, continuing to ignore them would be even more costly. The educational impact of substandard facilities on students cannot be overstated. For example, at one elementary school in the Detroit “right to literacy” case that I supported, not a single sixth-grade student could read at a minimally proficient level. Perhaps poor facilities can’t be blamed entirely for the low reading ability at this particular school – but those conditions are still a potential factor.
Who should pay for it?
Funding for public education, including school facilities, is primarily a state and local matter. But while most states have tried to help poor local districts with basic operating expenses – such as paying teachers and buying supplies and materials – state support for school infrastructure has been much less reliable.
Local districts vary widely – usually along lines of race – in their ability to build or renovate schools. Property-poor districts, including most big city districts, are left behind.
Congress now has an opportunity to address this problem. The House has begun hearings on the Rebuild America’s School Act of 2019. Introduced by U.S. Rep. Bobby Scott, a Democrat from Virginia, the bill would invest $100 billion over 10 years in fixing America’s public schools.
Even for people who aren’t convinced that federal money should be spent on fixing America’s schools, there are other factors to consider when weighing the merits of the bill. For instance, the bill would create nearly 1.9 million jobs. This figure is based on an analysis that found 17,785 jobs are created for each $1 billion spent on construction. The estimate factors in an overall $107 billion investment when state and local resources are taken into account.
The $100 billion investment would also stimulate property values in communities where schools would be fixed. For all those reasons and more, passage of this bill should be a no-brainer.
Brian Jarvis: Across our state (Ohio) – I’m most familiar with school districts in our region (Dayton) – less affluent school districts receive significantly more total funding than do more affluent school districts (especially along lines of race). In every instance, combined funding of local + state + federal tax dollars received by less affluent school districts dwarfs that of more affluent districts. (Less affluent districts are subsidized by state & federal dollars up to 80%; more affluent districts are capped at 25%.) I’m unfamiliar with other states’ situations. But in this area of Ohio the excuse of a funding disparity (whether it be by affluence or race) has no substance.