Safe Food Handling; What You Need To Know

 

Study Points to Potential Treatment for Sickle Cell Disease

       Scientists corrected sickle cell disease in adult laboratory mice by activating production of a special blood protein normally produced only before birth. The approach may lead to new treatments for people with the blood disorder.

Sickle cell disease is caused by an abnormality in hemoglobin, the protein in red blood cells that carries oxygen throughout the body. About 100,000 Americans live with sickle cell disease. It is most prevalent in people of African, Hispanic, Mediterranean and Middle Eastern descent.

People with sickle cell disease have 2 copies of an altered hemoglobin gene. The defective protein that results changes shape after releasing its oxygen. This causes red blood cells to become stiff, misshapen and sticky. These sickle-shaped cells slow blood flow to tissues, resulting in organ damage.

There is no widely available cure for sickle cell disease. Bone marrow transplants have cured some patients. However, the treatment poses several risks, and most patients don’t have relatives who can donate compatible, healthy bone marrow.

Past studies have shown that an elevated level of a form of hemoglobin called fetal hemoglobin reduces the tendency of sickle hemoglobin to change the shape of red blood cells. Production of fetal hemoglobin normally predominates before birth but turns off as adult hemoglobin takes over. A drug called hydroxyurea can boost production of fetal hemoglobin and reduce the complications of sickle cell disease. However, not all patients respond well to this medication, and adverse side effects are a concern.

A research team led by Dr. Stuart Orkin set out to explore a more targeted approach to raising fetal hemoglobin by blocking production of a protein called BCL11A. The team—at Harvard Medical School, Children’s Hospital of Boston and the Howard Hughes Medical Institute, Boston—had previously demonstrated that BCL11A suppresses the production of fetal hemoglobin soon after birth. Their work was funded by NIH’s National Heart, Lung and Blood Institute (NHLBI), National Cancer Institute (NCI) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The study appeared in the October 13, 2011, online edition of Science.

The scientists used a genetic technique to inactivate the gene for BCL11A in mice with sickle cell disease. Without BCL11A, the mice continued to produce fetal hemoglobin. Sickled cells were absent in the mice, as were their disease symptoms. Other aspects of blood production appeared to be unaffected.

“This study provides the first proof of principle that BCL11A might serve as a target for treating sickle cell disease and related blood disorders such as the thalassemias,” Orkin says. More research is needed, however, before such therapies can be tested in people.

Commonly used three-drug regimen for idiopathic pulmonary fibrosis found harmful

 

NIH stops one treatment arm of trial; other two treatments to continue

The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, has stopped one arm of a three arm multi-center, clinical trial studying treatments for the lung-scarring disease idiopathic pulmonary fibrosis (IPF) for safety concerns. The trial found that people with IPF receiving a currently used triple-drug therapy consisting of prednisone, azathioprine, and N-acetylcysteine (NAC) had worse outcomes than those who received placebos or inactive substances.

"These findings underscore why treatments must be evaluated in a rigorous manner," said Susan B. Shurin, M.D., acting director of the NHLBI. "This combination therapy is widely used in patients with IPF, but has not previously been studied in direct comparison to a placebo for all three drugs."

The interim results from this study showed that compared to placebo, those assigned to triple therapy had greater mortality (11 percent versus 1 percent), more hospitalizations (29 percent versus 8 percent), and more serious adverse events (31 percent versus 9 percent) and also had no difference in lung function test changes. Participants randomly assigned to the triple- therapy arm also remained on their assigned treatment at a much lower rate (78 percent adherence versus 98 percent adherence).

"Anyone on some combination of these medications with questions or concerns should consult with their health care provider and not simply stop taking the drugs," said Ganesh Raghu, M.D., professor of medicine at the University of Washington, Seattle and a co-chair of this IPF study. "It is important to realize that these results definitively apply only to patients with well-defined IPF and not to people taking a combination of these drugs for other lung diseases or conditions."

The other two study arms, or intervention groups, of this IPF trial comparing NAC alone to placebo alone will continue. In stopping this part of the trial, the NHLBI accepted the recommendation of the Data and Safety Monitoring Board (DSMB) – an independent advisory group of experts in lung disease, biostatistics, medical ethics, and clinical trial design. The DSMB has been monitoring the study since it began.

This study, called PANTHER-IPF (Prednisone, Azathioprine, and N-acetylcysteine: A Study that Evaluates Response in Idiopathic Pulmonary Fibrosis) was designed and conducted by the Idiopathic Pulmonary Fibrosis Clinical Research Network, funded by the NHLBI. The PANTHER-IPF study was designed to evaluate whether this commonly used triple-therapy regimen could slow disease progression and improve lung function in people with moderate IPF.

PANTHER-IPF was the first study in IPF comparing the effectiveness of this combined treatment to a placebo for all three drugs. Each participant had a one in three chance of being randomized to receive the triple drug regimen, NAC alone, or placebo for a period of up to 60 weeks.

"We will continue to analyze the data to try to understand why this particular combination may be detrimental in people with IPF," said Fernando Martinez, M.D., professor of medicine, University of Michigan, Ann Arbor and co-chair of the PANTHER-IPF study. "The results are not explained by any differences between the two groups before the treatments started."

IPF is a progressive and currently incurable disease characterized by the buildup of fibrous scar tissue within the lungs. This accumulation of scar tissue leads to breathing difficulties, coughing, chest pain, and fatigue. Approximately 200,000 people in the United States have IPF. The cause or causes of IPF remain unknown; as a result treatment options remain limited. PANTHER-IPF began enrollment in October 2009.

The study had enrolled 238 of a planned 390 participants prior to the stop announcement. Participants ranged from 48 to 85 years of age, with an average age of 68. The placebo and NAC arms will continue enrolling and following their participants, and this part of the PANTHER-IPF study is expected to be completed by late 2013.

In addition to NIH funding, the Cowlin Family Fund at Chicago Community Trust provided financial support for this study. Zambon donated the NAC and matching placebo; the prednisone, azathioprine, and their matching placebos were purchased using study funds.

Find more information about this clinical trial at http://clinicaltrials.gov/ct2/show/NCT00650091 To arrange an interview with an NHLBI spokesperson, please contact the NHLBI Communications Office at (301) 496-4236 ornhlbi_news@nhlbi.nih.gov.

Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online atwww.nhlbi.nih.gov.

Prostate Cancer Risk from Vitamin E Supplements

A new study found that vitamin E, once thought to reduce the risk of prostate cancer, may actually increase the risk.

A prostate cancer cell. Image by Anne Weston. All rights reserved by Wellcome Images.

Prostate cancer is the second most common type of cancer in American men. Their current lifetime risk of prostate cancer is 16%. In 2011, there will be an estimated 241,000 new cases of prostate cancer and 34,000 deaths from the disease nationwide

Some early research had suggested that selenium or vitamin E might reduce the risk of developing prostate cancer. To investigate, NIH’s National Cancer Institute (NCI) and several other NIH components funded the Selenium and Vitamin E Cancer Prevention Trial (SELECT). The study began in 2001 and included over 35,000 men.

An initial report in 2008 found that regular intake of vitamin E, vitamin C or selenium does not reduce the risk of prostate cancer or other cancers in older men. The participants were told to stop taking their study supplements and, in 2010, the study sites were closed.

The SELECT researchers had seen a slight increase in prostate cancer risk with vitamin E that may have been due to chance. Over half of the study participants had consented to continue to have their health monitored via mail questionnaires. The researchers’ new analysis included this final data, which was collected through July 2011. Their report appeared on October 12, 2011, in the Journal of the American Medical Association.

The researchers found that men who took 400 international units (I.U.) of vitamin E daily had more prostate cancers than men who took a placebo. For every 1,000 men, there were 76 prostate cancers over a 7-year period among those who took vitamin E supplements vs. 65 in those taking placebo—11 more cases of prostate cancer per 1,000 men. This represents a 17% increase in prostate cancers, a difference not likely due to chance.

The researchers don’t know why vitamin E increased risk instead of decreasing it. SELECT researchers are now measuring the amount of vitamin E, selenium and other nutrients in the blood of participants when they joined the trial to see if the effect of the supplements was affected by baseline levels of these micronutrients. Other researchers are looking at single-letter DNA variations called single nucleotide polymorphisms (SNPs) to see if genetic differences affect a man’s risk of developing prostate cancer while taking vitamin E.

“Based on these results and the results of large cardiovascular studies using vitamin E, there is no reason for men in the general population to take the dose of vitamin E used in SELECT, as the supplements have shown no benefit and some very real risks,” says Dr. Eric Klein, a study co-chair at the Cleveland Clinic. “For now, men who were part of SELECT should continue to see their primary care physician or urologist and bring these results to their attention for further consideration.” 

Do Baby Products Prevent SIDS? FDA Says No

The best thing you can do to lower the chance of Sudden Infant Death Syndrome (SIDS) is to place your baby on his or her back to sleep, with nothing else in the crib or bassinet.

That’s the recommendation of the Food and Drug Administration (FDA), which is working to prevent manufacturers of over-the-counter sleep products for babies from claiming that their use will prevent or lower the chance of SIDS. These products include infant positioners, mattresses, crib bedding, pillows, crib tents and baby monitors. Baby products that claim to cure, treat or prevent any condition are considered medical devices, and are subject to FDA regulations designed to protect consumers and patients.

The agency has never approved a product to prevent SIDS—the unexplained death of a baby younger than age 1—and is asking manufacturers to stop marketing their products with these claims until they have received FDA clearance or approval, or to change their labeling to remove all medical claims.

“These products are absolutely not necessary and they can be very dangerous,” says Susan Cummins, M.D., M.P.H., chief pediatric medical officer in FDA’s Center for Devices and Radiological Health.

Dangerous comforts

FDA is aware of 13 infant deaths in the past 13 years associated with sleep positioners, which are used to keep the baby in a desired position. The Consumer Product Safety Commission has received reports of babies found in hazardous positions after being placed in a positioner.

Other products can also be hazardous. Babies can slide down and be trapped by wedges designed to keep them on their back, says Cummins. Blankets, quilts, soft toys and pillow-like crib bedding can smother, she adds.

It’s a matter of A-B-C, says Cummins:

• Alone in their own bed. Don’t keep the infant in your bed next to you and risk that the baby will be accidentally suffocated if you roll over.
• Back to sleep—every sleep. “The safest way to put the baby to sleep is on his or her back every time,” says Cummins. “Do not put the baby on his side or on his stomach.”
  Since the national Back to Sleep campaign in 1994 urged parents to place babies on their backs, there has been a 60 percent reduction in SIDS, Cummins says.
• Crib. The baby should always be placed in a crib or bassinet to sleep.

Cummins describes the ideal sleep environment for an infant as being free of anything that could block the infant’s movement or breathing.  All that’s needed is a firm crib mattress and a tight-fitting sheet.

To parents who have visions of a crib filled with comforts, she says, “Though a crib full of plush toys and soft bedding may look appealing to you, it is hazardous for your baby during his or her first year of life.”

“Your baby will develop faster in that first year than any time after. Newborns can't even hold up their head, yet by their first birthday they are walking or nearly so,” says Cummins. “In between, your baby will learn to roll, sit, turn, crawl and even may start to climb!”

“So in that first year, your baby constantly and rapidly develops new skills, even in the crib during sleep time,” she says. “Make your baby’s crib a safe place to sleep and move, with nothing to get in the way.”

Safe Sleep Resources

FDA is starting a new website on SIDS prevention claims for parents, caregivers and manufacturers of sleep products for babies. Its purpose is to:

• inform parents and caregivers about the risks associated with over-the-counter products that claim to prevent SIDS.
• help manufacturers understand and comply with FDA laws and regulations governing medical devices, which are designed to protect consumers and patients.

The site also offers advice to parents on reducing the risk of SIDS and a list of “baby safe sleep” resources.

“The sleep environment is the one place where the baby is alone, so we want to make sure it’s safe,” says Cummins. And in this case, she says, less is more.

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

Organ Donation: Pass it On Give a Gift of Life

   A gift with a major impact—one that will long be remembered with gratitude—takes just a bit of preparation. When you become anorgan donor, you can save the lives of up to 8 people. And if you donate tissues like blood cells, bone or corneas, you can help even more.

Organ transplantation was once considered an experimental procedure with a low success rate. Many transplanted organs survived just a few days or weeks. But researchers have transformed transplant surgery from risky to routine. It’s now the treatment of choice for patients with end-stage organ disease. Each day, about 80 Americans receive a lifesaving organ transplant.

“The outcomes of transplantation are really so good these days that it truly makes a difference for the people who receive organ transplants,” says Dr. Sandy Feng, a transplant surgeon at the University of California, San Francisco. “The organs are clearly lifesaving.”

The problem now is that there aren’t enough organs to meet the demand. In early 2011, more than 110,000 people were on the nationwide waiting list for an organ. An average of nearly 20 of them dies each day while waiting.

The kidney is the most commonly transplanted organ. More than 16,000 kidney transplantations were performed in the U.S. last year. The wait, though, can be long. In February 2011, nearly 90,000 people were on the national waiting list for a kidney. Next most commonly transplanted is the liver, with more than 6,000 surgeries in 2010. That’s followed by the heart, lungs, pancreas and intestines.

You can donate some organs—like a kidney or part of your liver—while you’re still alive. You have 2 kidneys but really need only one. And the liver can re-grow if part of it is removed. But donating these organs requires major surgery, which carries risks. That’s why living donors are often family or friends of the transplant recipient.

Most organs, though, are donated after the donor has died. The organs must be recovered quickly after death to be usable. Many come from patients who’ve been hospitalized following an accident or stroke. Once all lifesaving efforts have failed and the patient is declared dead, then organ donation becomes a possibility.

“When a person dies, it can feel like a burden to a family to make decisions about organ donation,” says Feng. “So it would be a real gift to a family to indicate your decision to be an organ donor while you’re still alive, so they don’t have to make the decision for you.”

In addition to organs, you can donate tissues. One of the most commonly transplanted tissues is the cornea, the transparent covering over the eye. A transplanted cornea can restore sight to someone blinded by an accident, infection or disease. Donated skin tissue can be used as grafts for burn victims or for reconstruction after surgery. Donated bones can replace cancerous bones and help prevent amputation of an arm or leg. Donated veins can be used in cardiac bypass surgery.

NIH-funded scientists are exploring a variety of ways to improve organ transplantation. The biggest problem is that when an organ from one person is transplanted to another, the recipient’s immune system attacks the implant as though it’s a disease-causing microbe.

“We’d hit a home run if we could find a way to re-educate a person’s immune system so that it continues to fight infection just as effectively as ever but it didn’t recognize a transplanted organ as foreign. That’s called transplantation tolerance,” says Dr. Nancy Bridges, chief of the transplantation immunology branch at NIH.

To prevent organ rejection, recipients must take drugs, called immunosuppressants, usually for the rest of their lives. “Immunosuppressant drugs have revolutionized our ability to do organ transplantation over the last 30 years,” says Dr. Jerry Nepom, who heads an NIH-funded program called the Immune Tolerance Network. “But those 3 decades have also taught us that these immunosuppressants are not very selective, which is a big problem.”

Immunosuppressants knock down the entire immune system, so that the body has trouble fighting off infections. The drugs also boost the risk for cancer, especially skin cancer. In addition, over time, these potent drugs can damage the kidneys and raise the risk for diabetes, high blood pressure and cardiovascular disease.

“These medications are sort of a necessary evil. You can’t live without them, because you might reject your organ. But it’s difficult to live with them because they cause side effects that need to be managed,” says Feng.

If a patient stops taking immunosuppressants, the transplanted organ nearly always fails. But in very rare cases, people can go off their medications. Last year, NIH-funded scientists spotted a pattern of gene activity in patients who had successfully stopped taking their immunosuppressants after a kidney transplant. Other researchers are testing whether certain liver transplant patients could be weaned off their medications.

“Ultimately, it would be valuable if we could do a blood test to predict who could stop taking their drugs or maybe be on a lower dose,” says Bridges. “We have evidence that it might be possible, but we’re not there yet.”

In other studies, Nepom says, “we’re exploring how to get the recipient’s immune system in a receptive mode, so that it doesn’t become excited and angry when a transplanted organ comes into the body.” In one small clinical study, researchers gave a kidney recipient some of the donor’s bone marrow before surgery. Bone marrow produces cells that fight infection. The procedure created a hybrid immune system in the recipients that better tolerated the transplants. A few patients were able to go off their immunosuppressants within a year after surgery.

While some scientists continue to improve current methods, others are exploring completely new ideas. One cutting-edge approach is to create artificial transplants that won’t trigger an immune system attack. Although years of research will be needed to apply these emerging techniques, researchers have made progress toward engineering livers, lungs and other organs.

You can help reduce the need for donated organs in the first place by living well. Lower your risk of developing a long-term disease that could lead to organ failure by being physically active and eating a healthy diet rich with high-fiber foods, fruits and vegetables. Talk to your doctor about your weight, blood pressure and cholesterol. And while you’re taking these healthy steps, be sure to sign up to be an organ donor so you can help others as well. 

Recognizing Schizophrenia Seeking Clues to a Difficult Disorder

       What would it be like to hear voices or see people or things that aren’t really there? How would you feel if people seemed out to harm you, and you weren’t sure who to trust? Would you recognize that something was wrong?

Unfortunately, most people with schizophrenia are unaware that their symptoms are warning signs of a mental disorder. Their lives may be unraveling, yet they may believe that their experiences are normal. Or they may feel that they’re blessed or cursed with special insights that others can’t see.

Schizophrenia is a brain disorder that affects about 1 in 100 people. It affects men and women equally in all ethnic groups. Symptoms often start between ages 16 and 30 but most often between 18 and 22. It’s unusual to develop schizophrenia after age 45.

A few decades ago, researchers thought that schizophrenia was caused by inappropriate parenting. Now scientists recognize that a combination of genes and the environment are to blame.

“We know from studies of identical twins that when one twin has schizophrenia, the other twin has a 50% chance of having the disease, indicating that genes may account for half of the mechanisms involved in schizophrenia,” says Dr. José A. Apud, clinical director of the schizophrenia research program at NIH.

But since these twins are genetically the same, other factors must also contribute to schizophrenia. Some scientists have identified environmental factors that may play a role. But researchers don’t yet fully agree on whether or how these factors trigger the disease.

Several genes have been linked to schizophrenia. But each seems to have only a small effect on the chances of getting the disorder. “If we could understand the genes and mechanisms, we might be able to develop drugs that better target the disease,” says Apud.

Although schizophrenia has no cure, 2 main types of treatment can help. “The first line of treatment is always medication, especially antipsychotics,” says Apud. “Second, we use supportive types of psychotherapy and psychosocial treatments.” These can help with everyday living skills and possibly finding an appropriate job.

Patients often try different medications to see which work best. Some types of antipsychotics can cause weight gain, which can lead to diabetes or high cholesterol. Other types can cause a disorder where a person cannot control muscle movements. Despite these drawbacks, antipsychotics greatly improve the lives of most patients.

Problems arise when patients stop taking their medications, which is common. One NIH-funded study found that most patients stop taking antipsychotics within the first 18 months of treatment. “Because of problems with judgment and insight, they may not feel that they need treatment,” Apud says. “Side effects also play a major role in patients’ poor compliance with medications.”

People with schizophrenia often must rely on family or friends to get them into treatment. Caring for and supporting a family member with schizophrenia can be challenging. It may help to find a support group. Talking to others who care for people with schizophrenia may help your whole family.

Genes that Influence Blood Pressure

 

In one of the largest genomic studies ever, an international research consortium identified 29 genetic variations that influence blood pressure. More than half of these variants were previously unknown. The findings provide insights into the biology of blood pressure and may lead to new therapeutic strategies.

 

High blood pressure, or hypertension, affects over 1 billion people worldwide.

  It can damage the body in many ways over time, leading to heart  disease,        stroke, kidney failure and other health problems.

More than 230 researchers across 6 continents scanned the genomes of over 200,000 European people to identify genetic variants that influence systolic and diastolic blood pressure. They followed up by analyzing the genomes of 70,000 people of East Indian, South Asian and African ancestry. The study was funded by NIH’s National Heart, Lung and Blood Institute (NHLBI), National Institute on Aging (NIA) and National Human Genome Research Institute (NHGRI), among others. The results appeared in the September 11, 2011, issue of Nature.

The researchers discovered 16 previously unknown variations. Six were found in genes already suspected of regulating blood pressure. The remaining 10 were found in unexpected locations and provide new clues into how blood pressure is controlled. Individually, the genetic variations increased the risk of hypertension by only a tiny amount. However, for people with multiple variants, the effects were significant.

The researchers developed a blood pressure genetic risk score based on the 29 variants they found. Among people with the top 10% of genetic risk score, 29% had hypertension, compared with 16% of those in the lowest risk group. Higher genetic risk scores were associated with increased blood pressure across ethnic groups. The risk score was also a good indicator of hypertension complications, such as increased thickness of the heart chambers, heart failure, stroke and coronary artery disease.

“This is one of the most important studies of the genetics of high blood pressure to date and a significant step toward finding better therapies for it,” says NHLBI Acting Director Dr. Susan B. Shurin.

A related study by the research group, the International Consortium of Blood Pressure Genome-Wide Association Studies, appeared on the same day in Nature Genetics. This other genome-wide association study identified 4 new genetic regions associated with pulse pressure and 2 linked to mean arterial pressure. The influence of these variants on systolic and diastolic blood pressure turned out to be more complex than expected.

Taken together, these findings suggest new genetic pathways underlying blood pressure regulation. They will also likely open new doors to research into treating high blood pressure.

Community Immunity

How Vaccines Protect Us All

Parents know that kids are vulnerable to a host of infectious diseases. Research supported by NIH and others proves that the benefits of vaccines in preventing illness and death greatly outweigh the risks.

The list of childhood diseases can be overwhelming: measles, mumps, rubella, diphtheria, pertussis, polio, meningitis, influenza and rotavirus. In the era before vaccines, many children in the U.S. died or became disabled from these diseases. Many still do in countries and regions with lower vaccination rates.

With all the international travel in the world these days, it’s important to keep vaccines, or immunizations, up to date. Here’s just one example of what might happen if you don’t. By 2000, immunization had practically wiped out measles in the U.S. But a measles outbreak in 2005 was traced to one unvaccinated U.S. resident infected during a visit to Europe. The returning traveler infected American children who hadn’t been vaccinated because of safety concerns—despite study after study showing that childhood vaccines are safe and effective.

A major epidemic didn’t emerge that time. That’s because enough people in the surrounding communities had already been vaccinated against measles.

“The important concept,” says Dr. Marc Lipsitch of the Harvard School of Public Health, “is that vaccinating people protects not only them, but others in the community. If I’m protected, I can protect others.”

This type of protection is known as “community immunity” or “herd immunity.”  When enough of the community is immunized against a contagious disease, most other members are protected from infection because there’s little opportunity for the disease to spread.

Newborns, pregnant women or people whose immune systems are weakened may not be eligible for certain vaccines. Yet even they will get some protection because the spread of contagious disease is contained.

“Epidemiologists think of infections as chain reactions, whose speed depends on contagiousness,” says Lipsitch. “The more contagious the disease, the more vaccination is required. The data tells us that herd immunity works.”

Using mathematical formulas and computer programs, NIH-funded scientists like Lipsitch have developed models to determine what proportion of the population has to be vaccinated to eliminate the spread of disease. As one example, a worldwide vaccination campaign completely eliminated, or eradicated, smallpox in the 1970s. So many people were immunized that the virus couldn’t sustain itself.

More recently, infant vaccination against Haemophilus influenzae type b (Hib, which can cause meningitis) lowered the risk of disease in the whole population. Before the vaccine, Hib struck about 1 in 200 children younger than age 5. It killed many and often left survivors with permanent brain damage. After the Hib vaccine was introduced in the mid-1980s, the incidence of Hib dropped by 99%.

“Infectious disease eradication is possible,” says Lipsitch. Even when a disease—such as measles or Hib— hasn’t been completely wiped out, immunizations can reduce disease transmission, so that epidemics become less frequent.

When parents choose to immunize, they’re helping more than their own. Make sure your child’s immunizations are up to date. And talk with your child’s doctor if you have any concerns about vaccine safety.

Inefficient developing world stoves contribute to 2 million deaths a year

 

International effort could reduce death toll, deforestation, NIH scientists say

An international effort to replace smoky, inefficient household stoves that people commonly use in lower and middle income countries with clean, affordable, fuel efficient stoves could save nearly 2 million lives each year, according to experts from the National Institutes of Health.

In a commentary in Science, the NIH scientists noted that indoor air pollution from such inefficient stoves affects about 3 billion people—nearly half the world's population. In addition to respiratory disease caused by smoke, the fuel needed by inefficient stoves leads to—deforestation, and environmental degradation.

"Many people in developed countries don't realize that smoke from indoor cooking fires is a terrible scourge upon the health of a large number of people," said Francis Collins, M.D., Ph.D, director of the National Institutes of Health and an author of the study. "International efforts to combat this scourge are now beginning. The NIH's role is to support the research that will determine the most efficient, cost effective means to do so while safe guarding human health."

The study authors stated that nearly half the world's population uses biomass (wood, crop residues, charcoal or dung) or coal as fuel for cooking and heating. "The primitive fires typically fill homes with dense smoke, blackening walls and ceilings and sickening those within."

Other authors of the study were William J. Martin II, M.D., associate director for prevention research and health promotion at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Roger I. Glass, M.D., Ph.D., director of the Fogarty International Center, and John M. Balbus, senior advisor for public health, National Institute of Environmental Health Sciences.

Women and children are at greatest risk for the adverse health effects posed by inefficient stoves, the study authors wrote. Men tend to leave home during the day, but women and children remain. As a result, women and children have many of the same disease risks as do people who smoke tobacco. These risks include pneumonia, lung cancer and chronic obstructive pulmonary disease.

In many societies, women and girls typically gather fuel for the stoves. Fuel gathering is time-consuming and, because they must often walk several miles from the safety of their home communities, these women and girls are at increased risk for gender-based violence.

"By freeing up time, efficient stoves can even expand the opportunities for education and economic development of women and girls in these impoverished areas," the scientists wrote.

The study authors cited a recent report by the World Bank, which noted that, in addition to improving public health, clean, efficient stoves could have benefits to the environment and the climate, by reducing carbon dioxide emissions.

In recognition of the problem, the United Nations launched the Global Alliance for Clean Cookstoves. A public-private partnership, the alliance seeks to create a global market for clean and efficient cookstoves and fuels in the developing world. The alliance’s target is "100 by 20," which stands for the adoption of clean, efficient stoves and fuels by 100 million homes by the year 2020, with eventual worldwide adoption. The authors noted that the U.S. government has committed more than $50 million to the effort, including about $25 million in research funds for the NIH.

To succeed, strategies for replacing the world's inefficient biomass stoves with clean, efficient stoves must be market driven, the researchers added. So that cleaner stoves will be accepted, they must meet the needs of those who will use them.

"Promoting sustained changes in the way food is cooked to reduce [indoor air pollution] requires a fundamental understanding of traditions, social interactions, and family dynamics, which differ widely across cultures," the authors wrote. "Successful implementation invariably involves women in stove design, training, use in the home, and follow-up in the community."

Local manufacture of new stoves would have the added benefit of stimulating local economic development.

Educating people about the health risks of the stoves would also increase demand, as potential users understand that the initial expense of a more efficient stove would have health benefits in the long run, the authors wrote. Governmental subsidies to help the poorest people purchase the stoves would provide additional incentive, as would efforts to informal local peoples that the new stoves would cut household fuel costs.

The authors also called for more research on the potential health benefits of cleaner, more efficient stoves. It is not precisely known how much emissions must be reduced to produce health benefits. For example, preliminary data from one study suggest that reducing exposure to emissions by 90 percent is needed to substantially reduce the risk of pneumonia, and reducing exposure by 50 percent is required to modestly reduce the risk. Similarly, such studies could confirm the link between indoor air pollution and suspected health risks such as low birth weight, cataracts, cardiovascular disease, asthma, and tuberculosis.

The authors noted, however, that programs to replace inefficient stoves are already under way and that these programs have been undertaken without advance research into their potential benefits. Along with research to determine the amount of reduction in indoor air pollution needed to be effective, programs are also needed to evaluate the potential benefits of programs now under way.

The authors estimated the costs of a research program to on health and indoor air pollution to range from $150 million to $200 million. Although these costs might seem high, the authors wrote, they are typical of the costs of research investments needed to combat leading worldwide causes of death.

"The challenges are great, but the potential to use a relatively low cost intervention to save millions of lives, improve the environment, and encourage economic development is compelling," the researchers concluded.

Fogarty, the international component of the NIH, addresses global health challenges through innovative and collaborative research and training programs and supports and advances the NIH mission through international partnerships. For more information, visit: www.fic.nih.gov.

The National Institute of Environmental Health Sciences supports research to understand the effects of the environment on human health and is part of NIH. For more information on environmental health topics, visit our Web site at http://www.niehs.nih.gov.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute's Web site athttp://www.nichd.nih.gov/.