Results from a recent survey of European women with early breast cancer, presented for the first time at the European Society for Medical Oncology (ESMO) congress, show that the information needs of patients are not being met and that there is an unacceptably low level of patient involvement in potentially life-extending treatment decisions.  The survey revealed that older women, those with a low level of education and those without Internet access are particularly uninformed.

“Our survey shows that information provided to patients about adjuvant endocrine therapy is sub-optimal”, says GAEA steering committee member Yvonne Wengström, President of the European Oncology Nursing Society (EONS) from the Karolinska Institute, Stockholm, Sweden.  “Health professionals are a highly trusted source of information for patients yet the survey has shown that patients were not given comprehensive information about the rationale for treatment and the potential consequences of treatment.  Indeed many patients were not even told about the available treatment choices. The patients who took part in the survey told us that they want to have more information about treatment and especially side effects.”

The survey, part of The GAEA Initiative, involved 547 post-menopausal women with early breast cancer from nine European countries.  It was designed to find out women’s knowledge and understanding about adjuvant endocrine (hormone) therapy and their risk of recurrence, their involvement in treatment decision making and their information and support needs.  Adjuvant endocrine therapy is given after breast cancer surgery to reduce the risk of recurrence and is usually continued for at least five years.  There are different types of therapies available, each of which has a different risk-benefit profile for the patient. Patients need to know the purpose of adjuvant endocrine treatment and the different risk-benefit profiles of each therapy so that they can make an informed choice.

“As doctors we are clearly failing some patients by not involving them in the decision about starting adjuvant endocrine therapy and by not giving them the information they need to make these decisions”, says Dr Alberto Costa, Director of the European School of Oncology (ESO), Milan, Italy and GAEA steering committee member. “This is not effective medical practice.  On the basis of these findings, ESO will develop initiatives aimed at helping doctors hone their communication skills and become more effective in meeting patients’ needs.”

Only 22% of patients were fully or highly involved in the decision to start adjuvant endocrine therapy with the lowest levels of involvement found in women over the age of 60 years. Many of the women who took part in the survey were not satisfied with the degree to which they were involved in treatment decision making.

Not surprisingly, women who were the most actively involved in the decision to start hormone treatment were provided with more information on side effects and treatment duration compared to women who were not involved.  Actively involved patients also received more information on the benefits of taking long term adjuvant therapy and the risk of their breast cancer returning.

“We know from past experience that well informed and active patients get better treatment”, said Ingrid Kössler, President of Europa Donna - the European Breast Cancer Coalition.  “These results expose a clear knowledge divide among breast cancer patients. Better education begins with better communication, and we need to work harder to address this situation to meet the needs of older and less well-educated women.”

Reuters UK on Monday examined efforts by an HIV/AIDS advocacy group in India to help find partners for HIV-positive men and women who often are shunned by their families and communities. Thirty men and women living with the virus on Sunday in Surat, India, met at a session called “HIV+ Find a Life Partner,” which was hosted by the local HIV/AIDS advocacy group Network of Surat People Living with HIV+, Reuters UK reports. During the two-hour “matchmaking” event, the men and women “shared their experiences, discussed their families, medical histories and professions, with some even introducing their prospective partners to accompanying relatives, before agreeing [to] marry,” according to Reuters UK. Daksha Patel, an event organizer, said the goal was to help as many HIV-positive people as possible find compatible partners. “Let them find, choose and decide on a partner. It will add a new spark to the lonely lives and give them a new zest to start all over again,” Patel said. Patel, who also is HIV-positive, said many of the women who participated in Sunday’s event were widows or divorcees who contracted HIV from their husbands and were disowned by their relatives. According to Reuters UK, many HIV-positive people “face acute stigma” because of misconceptions and lack of education about the disease. HIV-positive people and HIV/AIDS advocates have been pushing for a law to prevent discrimination against people living with the virus but have said the Indian government is intentionally delaying action on the legislation (Jain Nair, Reuters UK, 10/2).

Health care spending on U.S. residents with private health insurance increased by 7.4% in 2005, in part because of increased spending on hospital and physician services, according to a study conducted by the Center for Studying Health System Change, the AP/Philadelphia Inquirer reports. In addition, the study finds that health care spending increased by 7.7% in the first quarter of 2006. The study also finds:

* Total spending on hospital services increased by 9% in 2005, compared with 8.5% in 2004;

* Spending on inpatient hospital services increased by 7.1% in 2005, compared with 5.3% in 2004, and spending on outpatient services by increased 10.4% in 2005, compared with 11.2% in 2005;

* Use of inpatient and outpatient hospital services increased by 4.5% in 2005, compared with 1.3% in 2004;

* Spending on physician services increased by 7.1% in 2005, compared with 6% in 2004, an indication of increased use of such services;

* Spending on home health care and ambulance services increased by 12% in 2005, compared with 6.3% in 2004; and

* Spending on prescription drugs increased by 4.9% in 2005, compared with 8.3% in 2004 and 18.4% in 1999.

According to HSC President Paul Ginsburg, the 7.4% rise in health care spending in 2005 marked the third consecutive year of increases of between 7% and 8%, a trend that could lead to larger increases in health insurance premium rates in the future (Agovino, AP/Philadelphia Inquirer, 10/3). Ginsburg said, “Health insurance will be less affordable to more and more people, especially low-to-moderate wage workers and their employers” in the event that the trend continues (Lopes, Washington Times, 10/3).

A chemically altered form of vitamin E mixed into mouse chow dramatically reduced spread of aggressive mammary cancer in mice, suggesting that the compound in pill form could be used to treat human metastatic cancer, according to a report in the October 1 issue of the journal Cancer Research.

The study, by investigators at the University of Arizona, is the first to show that the synthetic compound has potent anti-cancer properties when given in the simplest way possible - as a dietary supplement.

“We tried other ways of delivering different forms of the synthetic vitamin, such as by force feeding and injections, but found that one form, a-TEA, was more effective when incorporated into food, and that makes it much more clinically useful,” said the study’s lead investigator, Emmanuel T. Akporiaye, Ph.D., professor in the Department of Immunobiology at the University of Arizona.

Mice eating the super chow had a 4.8-fold reduction in the number of tumors that spread to the lungs, compared to control mice, Akporiaye said. An even greater effect was seen when the animals began eating a-TEA-laced food as a cancer preventive, he said.

“These preliminary studies are very promising, and it could be that combining this synthetic vitamin E derivative with other anti-cancer treatments may offer the potential of both treating and preventing human breast cancer,” Akporiaye said.

Although vitamin E (alpha tocopherol) is an anti-oxidant, it cannot destroy tumor cells by itself, he said. To improve the vitamin, derivatives have been created by swapping a hydroxyl chemical group with an acid. One is alpha-tocopheryl succinate (a-TOS), which used a succinic acid residue, and another is alpha-tocopheryloxyacetic acid (a-TEA), which used acetic acid.

Replacing the hydroxyl group in vitamin E helps force cancer cells to self destruct, Akporiaye said, because the compounds work to free up pro-apoptotic proteins that are normally held in check within cells. “Cell survival is maintained when pro-apoptotic proteins are confined, and these synthetic forms of vitamin E release them, pushing the cell into committing suicide,” he said.

“Only a little part of vitamin E is changed in these synthetic derivatives, but they show amazing anticancer properties, and they selectively target tumor cells,” Akporiaye said.

To make the synthetic vitamins water soluble (not fat soluble like natural vitamin E), researchers have added sodium hydroxide. In this way, these vesiculated forms, called Va-TOS and Va-TEA, can be delivered clinically through injection or oral gavage (feeding through a tube), and experiments have shown they can treat melanoma, lung and breast cancer in rodent models.

In this study, the Arizona researchers evaluated the anti-tumor effect of Va-TOS and Va-TEA on mice with an aggressive form of mammary cancer that is similar to human breast cancer that readily metastasizes. They also looked at how well a-TEA would affect tumor growth if incorporated into the food (”chow”) that the mice ate.

They found that injecting Va-TOS or Va-TEA into the peritoneal cavity of the mice reduced the average volumof tumors by two fold, compared to control mice that did not receive the injections. Administering Va-TOS daily through a feeding tube had the same effect on tumor size, but Va-TOS was ineffective when delivered in this way, Akporiaye said. “We found that Va-TOS wasn’t stable, and returned to its natural vitamin E state,” he said.

To gauge the effectiveness of a dietary treatment, the researchers had special rat chow manufactured that incorporated a fairly large quantity of a-TEA into the food. They then tested the chow as a cancer preventive and as a cancer treatment.

For the prevention study, the mice ate a-TEA chow starting on the same day that they were injected with rodent mammary tumor cells known to spread quickly to the lungs and bones. The mice were allowed to eat as much food as they wanted, and at the end of 29 days, the average tumor volume was reduced by 6.7-fold, compared to control mice who had not been fed a-TEA.

In the therapy experiment, mice started eating a-TEA chow 11 days after tumors were implanted, and in the experimental group, there was a 3.6-fold reduction in average tumor volume compared to control mice, Akporiaye said.

In both preventive and therapeutic studies, mice fed a-TEA chow had a 4.8-fold reduction in the number of tumors that had spread to the lungs, compared to control mice. “The results were very impressive,” he said. “The chow was very effective in slowing down the growth rate of the tumor and significantly reducing metastases.”

The a-TEA diet produced no visible adverse side effects, not even weight loss, Akporiaye said.

“The combined characteristics of ease of delivery, relevance of route of delivery and selectivity for killing tumor cells suggest that dietary a-TEA may be useful for treating metastatic breast cancer,” he said.

The researchers are now testing the effect of reduced doses of a-TEA in the chow and plan to test the synthetic vitamin in combination with dendritic cell immunotherapy. “When you kill tumor cells, they release antigens that can be picked up by specialized cells that stimulate the immune system,, and this two-step process could provide a longer lasting outcome,” Akporiaye said.

States are making steady progress in adopting effective policies that help people with pain to alleviate their suffering, according to a newly released national report card. However, there are still states with policies that prevent healthcare professionals from effectively alleviating the suffering of their patients.

The report, Achieving Balance in State Pain Policy: A Progress Report Card (Second Edition), was prepared by the University of Wisconsin Pain & Policy Studies Group (PPSG) and jointly funded by the nation’s leading information and advocacy groups for people with cancer: the American Cancer Society, the Lance Armstrong Foundation (LAF) and the Susan G. Komen Breast Cancer Foundation.

PPSG researchers evaluated whether state pain policies and regulations enhance or impede pain management. In the report, each state is assigned a grade from ‘A’ to ‘F’ that reflects the effectiveness of its pain policy. PPSG also evaluated policies in place in 2000 and 2003 to determine what changes have been made over time. Results show continued momentum for positive policy change over the six-year evaluation period:

– Two states (Michigan and Virginia) received an ‘A’ grade, which no state received in 2003.

– 82 percent of states have a grade above ‘C,’ up from 49 percent that received a ‘C’ in 2000 and 67 percent in 2003.

– No state’s grade decreased between 2000 and 2006.

– 19 states saw their grades improve from 2003.

“We’re seeing positive results because healthcare regulators have adopted policies encouraging pain management, palliative care, and end-of-life care,” said Aaron Gilson, Ph.D., associate director of US policy research of the PPSG. “Additionally, many state legislatures have repealed restrictive or ambiguous policy language that has prevented healthcare professionals from aggressively treating pain.”

“Despite this progress, most states still face the challenge of removing their remaining policy barriers, communicating the new or revised policies to healthcare practitioners and ensuring that the spirit of these policies are put into practice.”

“The results of PPSG’s research show a very encouraging improvement in state pain policies, but more needs to be done to effectively address the national health crisis of undertreated pain,” said John R. Seffrin, Ph.D., CEO of the American Cancer Society. “States must effectively inform the medical community about improved pain policies so people with pain can benefit from them. Patients, health organizations, healthcare professionals, regulatory officials, licensing boards, and policymakers all have a role to play to promote a balanced approach to pain control policy and practice.”

“Cancer survivors deserve to have their pain managed effectively so that they can focus on living life on their own terms,” said Mitch Stoller, president and chief executive officer of the LAF. “We must ensure that policies are in place to help people obtain medical care to promote the highest quality of life possible. We know that many states still have work to do to remove barriers to effective pain management, and we are proud to join in that critical work.”

“Effective treatment of pain is a key element in ensuring a good quality of life for cancer patients and other people faced with life-threatening illness. We are committed to making sure remaining barriers to effective pain management are removed and that health care workers are adequately informed of recent policy changes that can positively impact the lives of their patients,” said Hala Moddelmog, president and CEO of the Susan G. Komen Breast Cancer Foundation.

Balanced Policies Necessary

For years, many states have had restrictive or ambiguous policies that could create barriers to the effective treatment of pain. An estimated 100 million Americans who are affected by chronic diseases and conditions suffer from pain. Untreated pain can devastate a person’s quality of life, affecting all aspects of daily functioning, including sleep, work, and relationships.

While there are several effective medications and non-drug therapies available for pain treatment, opioid pain medications are often the best treatment for managing serious, persistent pain. But health professionals can be reluctant to prescribe such medications because of the risk of violating laws aimed at preventing trafficking and abuse of controlled substances.

“Because state and federal policies can either enhance or interfere with pain management, it is important that such policies are balanced to ensure that prescription pain medications are available to patients who need them while at the same time preventing illegal trafficking and non-medical use of opioids,” Dr. Gilson said.

Additional details about the report findings and pain as a public health problem are attached. This project was made possible through joint funding provided by the American Cancer Society, the Lance Armstrong Foundation and the Susan G. Komen Breast Cancer Foundation.

Slipped disc is a common ailment that causes a great deal of back pain and nerve pain in the bone­-sciatica­-that leads to many sick days home from work. Sometimes the disorder rectifies itself, but sometimes a rather complicated operation is needed. But now it seems that a gentler alternative, ultrasound, is on its way. The new method has been developed at Lund University and the University Hospital at Lund in Sweden. The technique is described in a dissertation by the physicist Johan Persson.

The principle is to direct focused ultrasound directly at the disc that has started to bulge outward and press against the nerves. When the disc cartilage warms up, its collagen fibers shrink, so the cartilage no longer bulges so much. This means that it no longer presses against the nerves that cause the pain.

Johan Persson’s dissertation work involves the design of an ultrasound transmitter, temperature measurements in the laboratory, and simulation of the temperature distribution in the disc during ultrasound treatment­-some of the key steps in the development of this new technique. In traditional slipped disc operations, the damaged disc is opened up. The operation requires hospital care and a long period of sick leave, and it also involves a risk of complications. Ultrasound treatment, on the other hand, is done with a local anesthetic, takes only six minutes, and requires no hospital stay. If the method lives up to its promise, it will therefore be both more attractive to patients and cheaper for health care.

According to Björn Strömqvist, professor of orthopedics, the ultrasound method is intended for slipped discs that are not too large (so-called covered, non-perforated hernias). It is being tested now in a so-called multi-center study in Sweden, Germany, South Korea, Italy, and Turkey. The study is still in a very early phase, but preliminarily it seems that two thirds of the slipped disc patients treated have been helped by ultrasound.

Under the direction of Björn Strömqvist, the Section for Orthopedics at Lund will also study whether the method can be used for so-called disc degeneration. This is an age-related change in the cartilage discs of the vertebrae that is even more common than slipped discs.

nuLase announces an amazing new alternative to costly surgery, chemical peels and collagen injections; the first ever laser enhanced skin care treatment for use in the home. The nuLase Soft Touch Laser is part of a skin care system that works in tandem with our scientifically formulated moisturizer to penetrate the epidermis and stimulate production of cellular energy (ATP) within the skin cell. ATP (adenosine triphosphate) is the fuel our skin cells use for repair and rejuvenation. Unlike the typical ointments and creams that line the shelves of local pharmacies, this patent-pending laser technology gently stimulates the skin repair process from within the skin cell rather than from the surface of the skin.

The complete nuLase system is a daily three-step process that includes a foaming cleanser, microderm exfoliator, and a regenerating moisturizer. These exclusive formulations are augmented by the soft touch laser to deliver restorative nutrients deep within the skin’s cellular level for a clearer, more youthful looking complexion.

The Soft Touch Laser by nuLase works by emitting a safe and gentle laser light that oscillates in a uniform parallel wavelength targeting your skin cells. It helps clear up acne, reduce wrinkles, fade age marks, and diminish stretch marks.

Smoking might increase the risk of contracting HIV, according to a study published in the Aug. 21 online edition of the journal Sexually Transmitted Infections, the New York Times reports (Nagourney, New York Times, 9/26). Andrew Furber, a public health consultant at the South East Sheffield Primary Care Trust in the United Kingdom, and colleagues conducted a systematic review of studies examining tobacco smoking as a risk factor for either HIV infection or progression of the virus to AIDS. Of the six studies the researchers examined, five suggest that smoking tobacco is an independent risk factor for HIV seroconversion after adjusting for confounding factors (Furber et al., Sexually Transmitted Infections, 8/21). According to the study, smokers are between 60% and 300% more likely to contract HIV than nonsmokers (BBC News, 9/23). The researchers said they are not sure why the link exists, but they note the increasing evidence that smoking raises the risk of contracting all types of infections, possibly because it might alter the structure of the lungs or weaken the immune system. According to the researchers, tobacco use is often higher among groups at higher risk for HIV transmission, including commercial sex workers (New York Times, 9/26). Nine of 10 other studies the researchers looked at showed no evidence that tobacco smoking increased the progression of HIV to AIDS, according to the researchers (Reuters, 9/20).

Conclusions, Reaction
The researchers concluded that smoking tobacco might be an “independent risk factor for HIV infection although residual confounding is another possible explanation.” They also write that smoking does not “appear to be related to progression to AIDS, although this finding may not be true in developing countries or with the longer life expectancies seen with highly active antiretroviral therapy” (Sexually Transmitted Infections, 8/21). “More research clearly needs to be done in this area,” Furber said. He added, “As the tobacco market is squeezed in the developed world, the tobacco industry increasingly looks to Asia, Eastern Europe and Africa.” Keith Alcorn, a senior editor at National AIDS Map, said, “The weakness of this analysis, as the authors themselves acknowledge, is that most of the studies reviewed were carried out before the widespread use of antiretroviral therapy in developed countries.” According to Alcorn, a large study in 2006 of HIV-positive women in the U.S. receiving antiretroviral therapy finds that smokers had a 36% greater risk of developing an AIDS-related illness over five years of follow-up care. “Anyone living with HIV would be strongly advised by their doctor to stop smoking because of the increased risk of cardiovascular disease and the much greater risk of various smoking-related cancers for HIV-positive people, whether on treatment or not,” Alcorn said (BBC News, 9/23).

After years of research, scientists at The University of Texas M. D. Anderson Cancer Center are now able to explain, in exquisite molecular detail, how the estrogen hormone can help keep breast cancer cells alive.

In the Sept. 24 issue of the journal, Nature Cell Biology, they assign roles to a number of genes and proteins thought to play a part in breast cancer cell survival, and in the process, have identified potential molecular drug targets.

“It’s a very complex story, but we have been able to bring together a number of basic discoveries from different fields of research to work out the basic mechanism by which estrogen can exert a pro-life effect on cancer cells,” said the study’s lead author, Edward T. H. Yeh, M.D., professor and chair of The University of Texas M. D. Anderson’s Department of Cardiology.

Along the way, the researchers have provided some novel insights. One is that they have provided a role for breast cancer-associated protein 3 (BCA3), which had been recently found to be over-expressed in both breast and prostate cancers. Yeh and his team show that this protein, by itself, doesn’t have any relationship to the cancer, but when modified by the protein NEDD8, can act like a tumor suppressor.

The researchers also found that SIRT1, a key protein involved in this molecular pathway, is a member of a family of proteins responsible for prolonging life span in both yeast and worms. “The fact that these molecules, which maintain life span in other species, has been found to be involved in suppressing cancer development seems important to us,” Yeh said. “The reason people live longer is that they don’t develop cancer as readily.”

Players in this newly defined pathway are:

* BCA3, which had no known function.

* NEDD8, a protein that can bind to other proteins and alter their function.

* SENP8, a protease (enzyme) that can break bonds between other molecules.

* SIRT1

* NFkB (Nuclear Factor kappa B), a family of proteins that turn on genes involved in cell death (apoptosis) and cell proliferation. When over-expressed, NFkB can protect cells from undergoing apoptosis, and in general, the more NFkB is expressed, the more resistant the cell is to apoptosis.

* Estrogen, a hormone that acts as growth fuel for about 70 percent of breast cancers.

Researchers are interested in ways that cells can efficiently turn genes on or off, and one of the newest mechanisms is dubbed “NEDDylation,” which Yeh helped to find 10 years ago. This process requires multiple enzymes to attach NEDD8 to other proteins.

To find proteins that can be altered by NEDD8, the four-member research team used yeast as their experimental platform, and SENP8 as a tool. This enzyme is known to be able to separate NEDD8 from the proteins it binds to. In this way, they could use SNEP8 “as bait” to fish for protein complexes held together by NEDD8.

They first found that BCA3 binds to SENP8 and was modified byNEDD8, and then discovered that this complex affects NFkB signaling. It does this by binding on to p65, one of the two proteins that make up NFkB proteins, the researchers say. “NEDD8 modified BCA3 regulates the activity of NFkB, but BCA3 alone does not have any impact on NFkB,” says Yeh.

Then they looked at how this NEDDylation further works to suppress the ability of NFkB to transcribe (activate) other genes. Here the investigators found SITR1, the molecule known to prolong life span in several other species. SITR1 is a histone deacetylase, a protein that blocks transcription factors from regulating genes. “When NEDD8 modified BCA3, it binds to p65 and recruits SITR1 to suppress NFkB-mediated transcription,” Yeh said.

Finally, the researchers discovered that estrogen blocks NEDD8 from modifying BCA3, a finding which goes some way to “explaining estrogen’s pro-life effect in breast cancer cells,” Yeh says. “Estrogen could enhance the survival of breast cancer cells by silencing BCA3, through eliminating its hold on NFkB transcription.”

Now that this cancer-promoting molecular pathway has been described, Yeh says it might be possible to interfere with a number of the players to inhibit cancer growth. “NEDD8 is key,” he said. “It may be possible to design drugs that block the removal of NEDD8 from BCA3.” By increasing the amount of NEDD8-modified BCA3, there will be a corresponding decrease in the level of NFkB and the cancer cells will be more sensitive to chemotherapy, Yeh says.

“There is a lot we need to sort out, of course, but this is a model of how estrogen may function to promote growth in breast cancer that we can all now work from,” Yeh says.

CDC’s revised recommendations on HIV testing in the U.S. — that say HIV tests should become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling should be dropped — could harm the health and civil rights of people who receive the tests, the American Civil Liberties Union said in a release on Thursday, CQ HealthBeat reports (Reichard, CQ HealthBeat, 9/22). The recommendations, published in the Sept. 22 edition of CDC’s Morbidity and Mortality Weekly Report, say health care providers should continue routine HIV testing unless they establish that less than one of every 1,000 patients tested is HIV-positive, “at which point such screening is no longer warranted.” Providers do not have to require patients to sign written consent forms or undergo counseling before receiving an HIV test, but physicians must allow patients to opt out of the test, according to the guidelines. The recommendations — which states can choose to adopt and modify — also say that all pregnant women should be tested for the virus unless they opt out and that women who inject illicit drugs, are commercial sex workers or who live in a higher prevalence region should be tested again in the third trimester of pregnancy (Kaiser Daily HIV/AIDS Report, 9/22). “CDC should be commended for trying to increase the number of people tested for HIV, but eliminating the only safeguards that guarantee that testing is voluntary and informed does little to ensure that people will receive the care they need,” Rose Saxe, a staff attorney with the ACLU AIDS Project, said, adding, “Without pre- and post-test counseling requirements, we risk losing a critical opportunity to educate people about HIV and how to prevent the spread of it” (ACLU release, 9/21). Saxe said privacy could be compromised under the guidelines because most states collect the names of HIV-positive people and “[m]any states also require doctors to report private information, such as drug use and sexual history about those who test positive.” Kevin Fenton, director of CDC’s National Center for HIV, STD and TB Prevention, said the recommendations will make “routine HIV screening feasible in busy medical settings where it previously was impractical,” adding, “Making the HIV test a normal part of care for all Americans is also an important step toward removing the stigma still associated with testing” (CQ HealthBeat, 9/22).

Related Editorial
CDC “took the right step” in revising its HIV testing guidelines to recommend routine testing, which offers “the best hope to reduce the stubborn persistence of HIV infections in the American population,” a New York Times editorial says. “[T]imes have changed” since the “early days of the AIDS epidemic,” the editorial says, adding that new treatments have made early HIV diagnoses more “valuable,” that the stigma surrounding the disease seems to have lessened and that health officials have proven they can keep test results private. In addition, written consent requirements “for HIV testing beyond the general consent forms signed by patients all too often scares patients away from a test that would help them,” the editorial says. Analogous policies to CDC’s revised recommendations for routinely testing pregnant women for HIV have “greatly reduced” HIV prevalence among infants, the editorial says, adding, “Surely it would be better for every [HIV-positive] individual to learn of his status as early as possible … [a]nd surely it would be better for community health if hidden chains of transmission could be detected and interrupted to slow the spread of infection” (New York Times, 9/25).