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Ships are inadvertently carrying trillions of stowaways in the water held in their ballast tanks. When the water is pumped out, invasive species could be released into new environments. Disease-causing microbes could also be released, posing a risk to public health, according to an article in the May issue of Microbiology Today.

"There is no romantic adventure or skullduggery at work here," said Professor Fred Dobbs from Old Dominion University, Virginia, USA. Ships pump water in and out of ballast tanks to adjust the waterline and compensate for cargo loading, making the ship run as efficiently as possible. These tanks can hold thousands of tonnes of water. "Any organisms in the water are likely to be released when it is next pumped out."

Many non-native animals and plants have been taken to new environments and become invasive, threatening the survival of local species; some fundamentally alter the ecosystem. Zebra mussels were introduced in North America and the comb jelly in the Black Sea and both have had enormous ecological and economic impacts.

For more than 20 years we have known that a variety of large phytoplankton and protozoa are transported in this way, but we know very little about smaller microbes like bacteria and viruses. "It is inevitable that hundreds of trillions of micro-organisms enter a single ship's ballast tank during normal operations," said Professor Dobbs. The majority of these microbes are harmless, but some are a potential risk to public health.

"Vibrio cholerae, which causes cholera in humans, can be carried in ballast tanks," said Professor Dobbs. "There have been no known outbreaks of disease associated with ballasting activities, but the water is only sampled very rarely." Other disease-causing microbes in the tanks include Cryptosporidium parvum and Giardia duodenalis, which cause stomach upsets.

Some people say microbes are present everywhere; they may be easily dispersed because they are so small. However, many experts believe micro-organisms have a "biogeography", a natural home, which means they could become invasive if moved and have a negative effect on different environments. There is some evidence for this argument: two phytoplankton species called diatoms were introduced to the English Channel from the North Pacific Ocean

The International Maritime Organisation, which sets rules and standards for the global shipping industry, has proposed an upper limit to the numbers of Vibrio cholerae, E. coli, and intestinal enterococci contained in discharged ballast water. A few ships are also using different treatments to reduce and even eliminate the microbes in their ballast water. "A number of techniques are being looked at for this purpose, from filtration to biocides, ultrasound to ultraviolet irradiation," said Professor Dobbs. "Our understanding of the issues involved will increase as more studies are carried out, particularly those employing the tools of modern molecular biology.

http://www.socgenmicrobiol.org.uk/

Life in outer space is an absolute certainty, and it is likely to be more familiar than we might think, according to an article in the May issue of Microbiology Today. Ever since the start of the space race we have sent more than just satellites and astronauts into space: spacecraft are not routinely decontaminated and are teeming with microbial life.

"Wherever man boldly goes his microbial fauna is sure to follow," said Lewis Dartnell, an astrobiologist at University College London. The Russian space station Mir was launched in 1986 and microbial studies investigated the diversity of bacteria living alongside the astronauts. In 1998, free-floating blobs of water found during a NASA mission to the station were analyzed and discovered to contain microbes including faecal bacteria like E. coli, plague bacterium-related species of Yersinia, and even what was suspected to be Legionella, as well as fungi, amoebae and protozoa.

"Preventing the spread of microbial life between worlds of the solar system has been a top priority for decades now," said Lewis. "This effort is known as planetary protection." Today's International Space Station (ISS) is much cleaner than Mir was 20 years ago, thanks to HEPA filters, weekly cleaning and biweekly disinfecting regimes. But inevitably, the ISS is still far from being bug-free; recent sampling revealed the bacterium Staphylococcus epidermidis surviving in different areas.

But it's not just planets we need to protect - astronauts are at increased risk of infection in space. Respiratory infections are common among astronauts and diseases occur in a quarter of space shuttle flights. "Prolonged exposure to cosmic radiation and microgravity is believed to have a negative effect on the immune system, and disease transmission is enhanced within the closed environment of recycled air and water," said Lewis Dartnell. Microbes also pose an increased risk of allergies, toxic air and water supply and even biodegradation of critical spacecraft components.

This week, the Phoenix lander touched down on Mars, hoping to take the first ever direct measurements of Martian water and organic molecules. "To guarantee the cleanliness of the robotic arm, it was enclosed in a biobarrier bag - effectively an interplanetary condom," said Lewis. But this will not be a feasible control measure for humans. "Humans and spaceships are inherently dirty and once we arrive to plant flags in the rusty soil our microbial entourage will begin leaking out onto Mars." What's more, microbes have an uncanny ability to survive as spores, resistant to heat, cold and radiation. "Once humans have visited Mars, we may never be certain that any biological discoveries weren't simply signs of our own dirty sleeves," said Lewis Dartnell.

In fact, we might actually need to take microbes on a manned mission to Mars. "For longer missions, it will not be possible to take sufficient supplies from Earth," said Lewis. "Scientists are developing ingenious life support systems relying on plants and micro-organisms to provide food, waste recycling and water purification." Of course, in this case, an outbreak of harmful microbes could crash life support systems as well as affecting the health of the crew, endangering the whole mission. "For better or worse, space bugs are here to stay."

http://www.socgenmicrobiol.org.uk/

Many long-term survivors of cancer are not receiving the necessary symptom management that they require to help them live with the consequences of their disease, its treatment, or both, according to a leading professor of palliative medicine.

Currently, there are approximately 25 million people around the world (10 million in the USA) living with cancer, and over 60% of adults newly diagnosed with cancer can expect to live at least five years or more. Marie Fallon, Professor of Palliative Medicine at the University of Edinburgh, says many of these patients are living in limbo with unmet needs that should be addressed urgently.

"Traditionally, palliative care has been aimed at one end of the spectrum where it is used to help patients near the end of their lives," she says. "However, there is an enormous population of long-term survivors of cancer, many of whom are living with a range of symptoms. Some of them will not know whether they are cured and whether the symptoms they are experiencing are treatment-related or whether they are related to recurrence of the disease that has not yet been diagnosed.

"These patients exist in a limbo. They fall between two stools: they have finished being treated by oncologists, but are not receiving the care and support from palliative care teams that patients at the end of life receive. Yet the impact of cancer and cancer treatment on the long-term health of survivors is substantial and many of them remain very symptomatic, with poor quality of life. Clearly a proportion will unfortunately be diagnosed with recurrent cancer at some point."

The problems cancer survivors face can include pain, sexual difficulties, troublesome lymphoedema (chronic swelling caused by the failure of lymph glands to drain properly, often triggered by surgery and radiotherapy), and psychosocial problems including depression and anxiety.

To highlight these "large gaps in patient care", Prof Fallon and John Smyth, Professor of Medical Oncology (also at the University of Edinburgh), have co-edited a special issue of the European Journal of Cancer on Palliative Care [1], timed to coincide with one of the world's largest cancer conferences, the American Society of Clinical Oncology (ASCO) conference, which starts tomorrow (Friday 30 May) in Chicago (USA).

The EJC is the official journal of ECCO - the European CanCer Organisation - and Prof Smyth is its editor-in-chief as well as being a past president of ECCO.

"We aim to use this special issue to bridge the gap between oncology and palliative care, and to encourage integration between the two disciplines," says Prof Fallon. "Collaborations and systems need to be developed to care for patients at all stages of their disease and not just those who have a formal diagnosis of recurrent or advanced cancer."

In their EJC joint paper, Profs Fallon and Smyth write: "We need to develop a particular supportive care model for sick patients and traditional palliative care expertise should feed into this model. Life and illness are a continuum and our patients do not always fit into well-defined boxes. As specialists, our challenge is to accommodate this continuum rather than restrict it."

Prof Smyth says: "Europe has led the way in the development of palliative care, which is now an increasing focus of attention in the USA." The EJC special issue on Palliative Care will be available at ASCO and Prof Smyth will be highlighting it in discussions at the conference.

Professor Alexander M.M. Eggermont, current ECCO president, commented: "This is an important special issue of the EJC, for everyone to read and discuss its content. To be cured from cancer, but living with symptoms that are related to often complex multidisciplinary treatments involving surgery, radiation therapy and chemotherapy is already difficult enough. To reintegrate into society, resuming work full or part-time adds to the complexities and socio-psychological pressure that an ever-increasing number of 'former-patients' have to deal with. All this must be looked into and will need special initiatives to deal with these special and unmet needs of this population. We better start tackling these issues now as they will only increase in number and magnitude."

http://www.ecco-org.eu/

Brand-name prescription drug makers in fiscal year 2007 reached 14 agreements with generic drug makers to delay market entry of generic medications, according to a report released on Wednesday by the Federal Trade Commission, Reuters reports (Bartz, Reuters, 5/23).

Drug makers are required to report such deals to FTC under the 2003 Medicare law (Rugaber, AP/Bergen Record, 5/26). The report did not name which drugs were affected by the deals.

According to the report, there were 33 deals made between brand-name and generic drug makers in FY 2007, and 14 of the agreements resolved patent litigation on more than 13 brand-name drugs. In all 14 of the deals, the generic drug maker received some kind of compensation to delay market entry of a generic version of a drug. In 11 of the agreements, the brand-name drug maker agreed not to sell its own generic version when its patents expired, and in three deals, there was a side agreement on an unrelated issue that was to the generic drug maker's advantage (Reuters, 5/23). The report found that the number of agreements blocking new generics in FY 2007 was the same as in FY 2006. There were three such deals in FY 2005.

FTC has said that so-called "pay-for-delay" settlements harm consumers. The commission has sued to block some of the deals but "has had limited success," according to the AP/Bergen Record. FTC also supports legislation that would ban such deals (AP/Bergen Record, 5/26). According to Reuters, "Neither the Senate bill to ban the deals nor its companion in the [House] has made much headway because of opposition from pharmaceutical companies and makers of generic medicines." Democratic presidential candidate Sen. Barack Obama (Ill.) is among 10 co-sponsors of the Senate bill.

FTC Commissioner John Leibowitz said, "What [the report] shows is that this problem is persistent," adding, "It's becoming the new way to do business. It means that consumers in need of affordable drugs are going to get generics later, not sooner" (Reuters, 5/23). However, pharmaceutical companies and some generic drug makers say that the agreements can reduce costly litigation and that some of the deals still allow generic manufacturers to introduce generic drugs before their patents expire (AP/Bergen Record, 5/26).

While mainstream news coverage is still a primary source of information for the latest in policy debates and the health care marketplace, online blogs have become a significant part of the media landscape, often presenting new perspectives on policy issues and drawing attention to under-reported topics.

To provide complete coverage of health policy issues, the Kaiser Daily Health Policy Report offers readers a window into the world of blogs in a new roundup of health policy-related blog posts. "Blog Watch," published on Tuesdays and Fridays, tracks a wide range of blogs, providing a brief description and relevant links for highlighted posts.

The American Prospect's Ezra Klein describes his experience using Google Health's new online personal health record.

Cato@Liberty Blog's Michael Cannon considers Republican and conservative support for Sen. Ron Wyden's (D-Ore.) Healthy Americans Act, which he compares to the Medicare Advantage program. Conn Carroll of The Foundry Blog offers a different take on Wyden's plan.

Trudy Lieberman at the Columbia Journalism Review's Campaign Desk Blog discusses other bloggers Jonathan Cohn and Klein's reactions to a series of interviews with various senators about health reform in The Hill.

Congressional Budget Office Director Peter Orszag provides a detailed overview of the methods behind CBO's new study on potential costs and benefits of increased health information technology adoption.

The Health Affairs Blog posted commentaries -- one by David Kindig and a second by Cathy Schoen -- on a paper in the May/June issue titled "Triple Aim: Improving the Individual Experience of Care; Improving the Health of Populations; and Reducing the Per Capita Costs of Care for Populations."

Health Beat's Maggie Mahar provides an overview of medical malpractice, including controversies over the cost of and incidence of malpractice, as well as reform efforts.

The Health Care Blog's Donald Johnson discusses a new bill that will allow the sale of low-cost, bare-bones health insurance policies in Florida.

Jason Shafrin of the Health Care Economist hosted the most recent edition of Health Wonk Review, a biweekly compendium of more than two dozen health policy, infrastructure, insurance, technology and managed care bloggers. A different participant's blog hosts each issue.

Lisa Kaplan Howe of Health Care For All links to a discussion of high deductible health plans and notes that the Massachusetts Health Insurance Connector excluded HDHPs from minimum coverage requirements.

Jane Sarasohn-Kahn blogs at Health Populi about a new Society of Actuaries study that finds pre-retirees and retirees cite paying for long-term care and inflation of health care costs as key concerns.

Joe Paduda of Managed Care Matters examines presumptive Republican presidential nominee Sen. John McCain's (Ariz.) health care plan and whether it could increase the number of uninsured residents by destabilizing the employer-based health care system. Robert Laszewski of Health Care Policy and Marketplace Review builds off of Paduda's post to argue that McCain's market-based plan reforms might work well for some voters, as long as advisers present certain changes carefully. Bob Vineyard of Insure Blog reacts to a Slate article and discusses McCain's proposal to allow individuals to purchase insurance across state lines. Peter Harbage from the Wonk Room Blog discusses a new Center for American Progress Action Fund paper about McCain's health care plan and administrative costs.

Joanne Kennen from the New America Foundation's New Health Dialogue reports on comments by presidential candidate health advisers and the Washington Post's David Broder on the candidates' plans and the prospects for a health reform debate. They spoke at a briefing for Kaiser Family Foundation media fellows and other journalists.

Jacob Goldstein from the Wall Street Journal's Health Blog reports on a statement from the Massachusetts Medical Society that it is suing the state over its physician ranking program.