“Thousands of patients with advanced Alzheimer’s disease could benefit from drugs,” according to BBC News. The broadcaster said the results of a new medical trial suggest that the drug Aricept reduces the rate at which memory declines during advanced Alzheimer’s disease.
Aricept, also known as donepezil, is already used to help manage earlier stages of Alzheimer’s disease. But new research has looked at the effect of continuing the drug during moderate and severe stages of the disease. In this research, 295 Alzheimer’s patients in England and Scotland were randomly assigned to either continue or stop using the drug for a period of 12 months.
The study found that over 12 months, patients who stayed on donepezil had a slower decline in their mental ability than those who stopped using the drug, as assessed in certain tests. However, improvements in mental ability and the ability to manage daily activities associated with donepezil were small compared with the overall decline that all participants experienced.
The benefits of this modest improvement need to be considered from the patients’ perspective, and this study is likely to ignite debate about whether donepezil should continue to be prescribed to people with dementia once they progress past moderate symptoms. Another factor that contributes to the debate is that much cheaper versions of the drug have reportedly become available recently.
Where did the story come from?
The study was carried out by researchers from England and Scotland and was funded by the UK Medical Research Council and the Alzheimer’s Society. Many of the researchers declared having a conflict of interest, as they received payments (such as grants, lecture fees, consultation fees and expenses from commercial drug companies. These included Eisai and Pfizer, which developed and marketed the drug donepezil under the trade name Aricept.
The study was published in the peer-reviewed New England Journal of Medicine.
This study received wide media coverage, with many sources fielding debate on whether Alzheimer’s patients should continue using donepezil once they progress past moderate symptoms. The reporting of the study in these articles was generally balanced.
What kind of research was this?
This double-blind, placebo-controlled randomised controlled trial looked at continuing Alzheimer’s medication in patients who had previously received donepezil (Aricept and who had moderate or severe Alzheimer’s disease. It also looked at using the drug alongside another medicine called memantine, which is used to treat Alzheimer’s disease and other forms of dementia.
Dementia is a long-term progressive mental disorder that adversely affects memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. The National Institute for Health and Clinical Excellence (NICE reports that Alzheimer’s is the most common form of dementia and estimates that around 50-64% of people with the condition have mild to moderately severe disease. Approximately 50% of people with Alzheimer’s are estimated to have moderate to severe disease.
The study authors reported that clinical trials have shown the benefits of drug treatments for mild to moderate Alzheimer’s disease. However, it is not known whether treatment benefits continue after it has progressed to moderate to severe disease.
The researchers say that very limited evidence is available to guide the difficult decision of whether to stop or continue Alzheimer’s drug treatments when the disease progresses. However, continued treatment is known to be associated with an increase in adverse outcomes, such as loss of consciousness, the need for pacemakers and hip fractures.
What did the research involve?
The researchers recruited 295 Alzheimer’s patients in England and Scotland who had been taking donepezil (Aricept for at least three months and who had moderate or severe Alzheimer’s. Patients were recruited during the period from February 2008 to March 2010. All patients were “community living”, in other words were not in hospital or nursing homes, but had carers who lived with them or visited regularly. The researchers wanted to see if continuing using the Alzheimer’s drug donepezil would benefit these patients and whether starting a second drug, called memantine, could also be beneficial.
A moderate to severe diagnosis of Alzheimer’s disease was defined as a score of 5 to 13 on a recognised cognitive examination called the Standardized Mini-Mental State Examination (SMMSE . Scores range from 0 to 30, with higher scores indicating better mental function.
Once recruited, patients were randomised into four groups to receive different combinations of active drugs and inactive placebos. They were not told which combination they would take. The groups received the following treatment plans for 52 weeks:
- continue on donepezil alongside a memantine placebo
- discontinue donepezil, begin taking donepezil placebo alongside a memantine placebo
- discontinue donepezil and start memantine alongside a donepezil placebo
- continue on donepezil and start memantine
Patients, caregivers, clinicians, researchers and statisticians were unaware of the treatments that were assigned. This is a standard procedure used during trials, known as blinding. It is designed to help prevent the study’s results being distorted by people’s knowledge of what drug they are taking.
The researchers looked for changes in patients’ mental ability using SMMSE scores taken before, during and after they received the study treatment. The researchers also assessed patients’ functional ability to manage daily activities. They used a test designed specifically for use in patients with dementia, called the caregiver-rated Bristol Activities of Daily Living Scale (BADLS , which assesses 20 daily living abilities. The researchers reported that the minimum clinically important difference in scores would be a 1.4 point difference on the SMMSE and a 3.5 point difference on the BADLS.
Patients were excluded from the study if they had severe or unstable medical conditions, were receiving memantine before the study or were considered unlikely to adhere to the study regimens.
The statistical analysis of the study’s results was appropriate and on an “intention to treat” basis. This type of analysis looks at the outcomes of all participants originally entered into the study, and not just those who completed the study. It gives a more realistic picture of the effect of the drugs in real world situations, as it includes people who stop taking the drug during the study for various reasons. These reasons could include unpleasant side effects or worsening of the patients' condition, although often participants simply drop out of the trial and the reasons for leaving cannot be recorded.
What were the basic results?
Many comparisons were reported in the study. The key results are highlighted below:
- In all groups, mental ability declined as assessed by the SMMSE, on average from a score of approximately 9 at the start of the study to a score of 3–6 after 52 weeks. Scores on the BADLS test of daily living increased from around 26–29 at the start of the study to 34–42 after 52 weeks. These results indicate an overall decline in mental ability and function over the 12-month study period.
- Patients who continued donepezil scored on average 1.9 points higher (95% confidence interval [CI] 1.3 to 2.5 on the SMMSE compared with those who discontinued donepezil. This suggests continuing the drug was beneficial.
- Patients who continued donepezil scored on average 3.0 points lower (95% CI 1.8 to 4.3 on the BADLS compared with those who discontinued donepezil. This indicated less impairment when continuing the drug treatment.
- The severity of dementia at enrolment significantly influenced the effect donepezil had on SMMSE scores. Larger benefits were observed in patients with moderate disease compared with those who had severe disease.
- Patients assigned to receive memantine alongside donepezil placebo had an SMMSE score on average 1.2 points higher (95% CI 0.6 to 1.8 and a BADLS score that was 1.5 points lower (95% CI 0.3 to 2.8 compared with those assigned memantine placebo alongside donepezil placebo.
- The effectiveness of donepezil and memantine did not differ significantly in the presence or absence of each other.
- There were no significant benefits of the combination of donepezil and memantine over donepezil alone.
- There was no evidence that serious adverse events or death differed according to the treatment groups assigned.
How did the researchers interpret the results?
The authors concluded that, in patients with moderate or severe Alzheimer’s disease, continued treatment with donepezil was associated with cognitive benefits, which exceeded the minimum clinically important differences they had set out before the trial. They said that donepezil led to significant functional benefits over the course of 12 months.
Conclusion
The drug donepezil is already clinically used to treat earlier stages of Alzheimer’s disease, but this new research examined the value of using it as Alzheimer’s disease progresses. To examine the issue, researchers used a robust study design, called a double-blind, placebo-controlled trial. They enrolled community-living patients with moderate or severe Alzheimer’s disease who were already receiving treatment with donepezil. Overall, its results showed that there were modest cognitive and functional benefits of continuing donepezil over the course of 12 months.
The study provides important new information on the use of medicines to manage Alzheimer’s symptoms, but the following limitations should be considered when interpreting the results:
- The improvements in cognition (SMMSE score and function (BADLS associated with donepezil and memantine were small compared with the size of the decline overall in cognitive and functional ability experienced by all patients. A “clinically important difference” was defined before the study started, and only the difference in SMMSE score reached this threshold. The impact that this small slowing of decline could have for patients should be given due consideration when debating whether this is an effective treatment.
- The study excluded patients who “were considered to be unlikely to adhere to the study regimens”. This would have the effect of biasing the study, to make it more likely that a beneficial effect was found by giving the drugs. Outside a clinical study, people who are unlikely to adhere to drug treatment may still be given the drug, and the beneficial effect in these patients is likely to be lower than that described in the study.
- All patients were “community living”, in other words not in hospitals or nursing homes. As a large number of people with moderate to severe Alzheimer’s are likely to live in these settings, it will be important to demonstrate a beneficial effect in this setting too.
This study is likely to re-ignite debate about whether donepezil (Aricept should continue to be prescribed to people with dementia once they progress past moderate symptoms. An additional factor sparking renewed interest in the debate is that much cheaper versions of the drug have reportedly become available recently.
Analysis by Bazian
Links To The Headlines
Thousands more should be on dementia drug: researchers. The Daily Telegraph, March 8 2012
Alzheimer's treatment in late stages of disease does slow progression. The Independent, March 8 2012
Hundreds of thousands of dementia patients could be helped by drug breakthrough. Daily Mail, March 8 2012
Alzheimer's patients 'should stay on drugs for longer'. BBC News, March 8 2012
Alzheimer's drugs also work for those in later stages of illness, study finds. The Guardian, March 8 2012
Links To Science
Howard R, McShane R, Lindesay J et al. Donepezil and Memantine for Moderate-to-Severe Alzheimer's Disease. New England Journal of Medicine 2012; 366:893-903
NPR. "We're not talking about abandoning standards for safety and efficacy, we're talking about leveraging opportunities in science so we can do a more effective job as regulators and also improve the drug development process." The agency said eliminating or reducing the number of routine visits to the doctor could free up prescribers "to spend time with more seriously ill patients, reduce the burdens on the already over burned health care system and reduce health care costs." Drugmakers would have to request a switch for each drug individually, and the FDA would judge the safety of each proposal on a case-by-case basis. "We're not talking about very specific drugs right now, we're talking about the concept," Dr. Janet Woodcock, director of FDA's drug center, told NPR. --- On the Net:
The Guardian. Bakewell received her new kidney but her two own damaged kidneys were left in place. “I feel fantastic now and my kidney function is just amazing. It’s probably quite a lot better than a lot of people my age with two kidneys. When I was on dialysis it was for nine hours a night, seven nights a week. Now I have my freedom. We have booked our first holiday in years for June, to Majorca,” an excited Bakewell said. “The preliminary results from this ongoing study are exciting and may have a major impact on organ transplantation in the future,” said Joseph Leventhal, associate professor of surgery at Northwestern University Feinberg School of Medicine. He added that this technique may also improve the lives of people who receive other transplants. While stem cells from organ donors have been used before, this is the first time it has been used for “mismatched” transplants, in which donors and recipients do not have to be related and immunologically similar. If normothermic perfusion proves successful in a larger group of people, future transplant recipients may need to take anti-rejection drugs only briefly, and some who rely on them now could discontinue them safely. The technique could also offer hope for patients receiving bone marrow transplants to treat blood cancers, speeding the process of finding a donor by allowing physicians to use stem cells that would normally be rejected as incompatible. “Few transplant developments in the past half century have been more enticing,” transplant surgeons James F. Markmann and Tatsuo Kawai of Massachusetts General Hospital wrote in a commentary accompanying the study. These findings “may potentially have an enormous, paradigm-shifting impact on solid-organ transplantation.” Markmann told
BBC News that the greatest benefit of techniques described in the research would be to greatly improve the lives of transplant patients by freeing them of a lifetime of anti-rejection drug use. But it might also ease the shortage of transplantable organs somewhat by reducing the number lost to rejection, he said. The National Kidney Foundation states 4,573 US patients died in 2008 awaiting a kidney transplant because of a donor shortage. Markmann said the study offers a “huge potential” for donors who could donate stem cell transplants to patients fighting blood cancers. Currently, many of the 6,000 patients yearly who have a stem cell transplant “have to look far and wide for a perfect match.” In a controversial move to protect the commercial interest in the new technique, the authors of the study declined to detail what stem cells were used and how they are identified and treated. But they reported that earlier studies in mice revealed that these facilitating cells “potently prevent graft-versus-host disease.” Transplant patients were sent home with strict instructions to avoid exposure to sick people and germs and to wash their hands carefully for several days until their immune system stirred to life. At one month after the transplants, three of the eight patients failed to achieve the state that would allow ongoing acceptance of the mismatched kidney. One eventually rejected the kidney and got another; the other two have staved off rejection with continued use of anti-rejection drugs. The remaining five were able to stop all drug use after a year without incident. “We’re really excited about it,” Dr. Suzanne T. Ildstad, director of the Institute for Cellular Therapeutics at the University of Louisville in Kentucky, and lead researcher of the study, told The
Los Angeles Times. She said she hoped next to use the new techniques to explore the transplantation of livers and pancreatic islet cells between mismatched donors and recipients. The success of the new research’s five transplant patients has implications beyond the 93,000 Americans currently awaiting a kidney transplant. For some of the 12,000 patients awaiting hearts, lungs and other organs, the regimen could point the way to improving success rates and reducing reliance on anti-rejection drugs for them as well, said Ildstad. The authors believe their research could also allow for the retroactive treatment of transplant patients who are living with imperfectly matched organs if those donors are still alive and willing to donate stem cells. --- On the Net:
Telegraph. The supervisors of one trial noted, “It was rather common for patients to claim significant insights into their problems, to feel that they had been given a new lease on life, and to make a strong resolution to discontinue their drinking.” In the 70s, governments began crackdowns on any aspect of LSD being clinically studied and research was left incomplete and shelved. None of the experiments that were begun featured enough patients to draw any firm conclusions, however a reanalysis of all the data taken together suggests the compound could have potential after all. A study, presented in the Journal of Psychopharmacology, looked at data from six trials with 536 patients and it said there was a “significant beneficial effect” on alcohol abuse, which lasted several months after as little as one dose was taken. LSD is one of the most powerful hallucinogens ever identified. It appears to work by blocking serotonin in the brain, which controls functions including perception, behavior, hunger and mood, reports
BBC News. For the group of patients taking LSD, 59 percent showed reduced levels of alcohol misuse compared with 38 percent in the other group. This effect was maintained for up to six months after taking the hallucinogen, but it disappeared after a year. The report’s authors, Teri Krebs and Pal-Orjan Johansen, told BBC News: “A single dose of LSD has a significant beneficial effect on alcohol misuse,” and suggested that more regular doses might lead to a sustained benefit. Norwegian researcher and fellow of Harvard Medical School, who led the research, Pal-Orjan Johansen said in a recent press statement: “Given the evidence for a beneficial effect of LSD on alcoholism, it is puzzling why this treatment approach has been largely overlooked.” Dr. David Nutt, former advisor on drugs to the government, told The Telegraph: “I think this study is very interesting and it is a shame the last of these studies were done in the 1960s.” “I think these drugs might help people switch out of a mindset which is locked into addiction or depression and be a way of helping the brain switch back to where it should be, in a similar way that Alcoholics Anonymous programs do.” For the moment, studying human behavioral responses rather than brain chemistry may be more helpful in understanding how the drugs work, writes Arran Frood for
Nature. Robin Carhart-Harris, a psychopharmacologist at Imperial College London who has researched how psilocybin could treat depression, told Frood that psychedelics must work at both biological and psychological levels. “Psychedelics probably work in addiction by making the brain function more chaotically for a period — a bit like shaking up a snow globe — weakening reinforced brain connections and dynamics,” he said. --- On the Net:
reported earlier this week that it found the unsafe levels of the chemical 4-methylimidazole (4-MI -- used to make caramel color -- in cans of Coke, Pepsi, Dr. Pepper, and Whole Foods’ 365 Cola. Coca-Cola confirmed that changes were being made at its facilities to keep within the law but argued that the CSPI’s allegations on the dangers the ingredient posed on humans were false. “The company has made the decision to ask its caramel suppliers to make the necessary manufacturing process modification, to meet the specific Californian legislation,” A spokesperson for Coca-Cola told
Daily Mail Online. “Those modifications will not change our product.” California added 4-MI to its list of carcinogens, after studies showed high levels of the chemical led to tumors in lab animals. However, the studies were inconclusive on whether the chemical was dangerous to humans or not. “Caramel is a perfectly safe ingredient and this has been recognized by all European food safety authorities,” the spokesperson added. “The 4-MEI levels in our products pose no health or safety risks. Outside of California, no regulatory agency concerned with protecting the public’s health has stated that 4-MEI is a human carcinogen.” “The caramel color in all of our ingredients has been, is and always will be safe. That is a fact,” the spokesperson said. This had been the CSPI’s second go-around with the Food and Drug Administration (FDA over the dangers of 4-MI in soft drinks. It first petitioned the regulator last year, but the FDA has continually maintained that the claims were exaggerated. “It is important to understand that a consumer would have to consume well over a thousand cans of soda a day to reach the doses administered in the studies that have shown links to cancer in rodents,” said FDA spokesman, Doug Karas to the Daily Mail's Laura Pullman. CSPI maintains that the regulator is allowing soft drink companies to needlessly expose millions of Americans to a chemical that is known to cause cancer. “If companies can make brown food coloring that is carcinogen-free, the industry should use it,” CSPI’s executive director Michael Jacobson told
Reuters. The FDA said it will review the watchdog’s petition, but that the soft drinks in question were still safe. CSPI took cans from stores in the Washington DC area, where they found some had levels of 4-MI near 140 micrograms per 12-ounce can. California has a legal limit of 29 micrograms of 4-MI per 12 ounces, it noted. The FDA’s limit for 4-MI in caramel coloring is 250 parts per million (ppm . Once the caramel is mixed in with the soda it becomes diluted. According to calculations by Reuters, the highest levels of 4-MI found in the soft drinks were about 0.4 ppm, significantly within the safe zone. “This is nothing more than CSPI scare tactics,” the American Beverage Association (ABA told Reuters in a statement. “In fact, findings of regulatory agencies worldwide ... consider caramel coloring safe for use in foods and beverages.” ABA said its member companies will continue to caramel coloring in certain products but that adjustments were being made to meet California requirements. “Consumers will notice no difference in our products and have no reason at all for any health concerns,” the ABA said. Diana Garza-Ciarlante, a representative for Coca-Cola, said its suppliers would modify the manufacturing process used to reduce the levels of 4-MI, which is formed during the cooking process and as a result may be found in trace amounts in many foods. “While we believe that there is no public health risk that justifies any such change, we did ask our caramel suppliers to take this step so that our products would not be subject to the requirement of a scientifically unfounded warning,” she said in an email to
The Telegraph. --- On the Net:
Daniel Radcliffe, Emma Watson and Rupert Grint are rich enough to never work again – but who has the talent and ambition for adult success?
Three weeks after its release, The Woman in Black has claimed a remarkable achievement: it is by some distance the most successful homegrown horror film ever released in Britain.
Equally significantly, perhaps, it marks the transition of the Harry Potter star Daniel Radcliffe – playing the lead role of widowed solicitor Arthur Kipps – from one of the most successful, well paid child stars of all time to something approaching a grown-up acting career.
For all the fame and money the bespectacled Hogwarts schoolboy has brought Radcliffe over the eight-film franchise, he could provide a straitjacket for the 22-year-old actor. Radcliffe's Potter co-stars, Emma Watson, 21, and Rupert Grint, 23, face a near-identical dilemma. All three spent their teenage years in front of the cameras, becoming solidly identified with a single character. In short, do they have a future?
"It's a tough question," said Charles Gant, film editor of Heat magazine. "They've all got pluses and minuses. Radcliffe is good casting in The Woman in Black, even if he's arguably a little young to play a grieving father. But to be honest, it's a struggle to see him playing a lead role in a lot of popular genres, like, say, a contemporary romance. Or an action movie. He hasn't got a heavily masculine persona, and that's what you need to be a leading man in Hollywood."
Steven Gaydos, executive editor of Variety magazine, suggests Hollywood has its eye on him all the same. "Daniel has established himself as a first-rate actor," he said. "I'm sure he and his handlers are looking for that Bafta/Oscar role to further prove this."
Radcliffe's most obvious comparison is to another young English actor, 25-year-old Robert Pattinson, also a franchise veteran (of the Twilight films and who is also negotiating a similarly tricky transition. Pattinson has done period too – the forthcoming Bel Ami – but his status as a teen idol means that he can land sexier projects, such as David Cronenberg's adaptation of Don DeLillo's Cosmopolis.
According to Gant: "The real money in Hollywood is for guys who, as the cliche has it, men want to be, and women want to be with. I don't know if Radcliffe is quite in that bracket. But people have grown up with him and have a great deal of affection for him. A good chunk of Woman in Black's success was down to their desire to see him move on from Harry Potter."
Watson, on the other hand, is taking things more carefully. While Radcliffe demonstrated his acting ambition by taking theatre jobs and the like during breaks in the Potter schedule, Watson opted to take a degree course at university and sign up for modelling and design work. She had occasional acting roles – the most recent of which was the small part of a costume assistant in My Week with Marilyn.
Gaydos says she "is under the most pressure as lovely young actresses all face the most career pressure", while for Gant, she "looks like a movie star". "But in terms of her inheritance from the Potter franchise, she hasn't got the same level of fan love as the other two: maybe it's because Hermione just wasn't as endearing as Harry and Ron."
Glamour
Watson's route out of Potter would seem in keeping with her predilection for intellectualised glamour: she has just finished filming the US indie The Perks of Being a Wallflower, the adaptation of Stephen Chbosky's spiky novel about a high-school student discovering sex and drugs, and has signed up for Sofia Coppola's The Bling Ring, about teens who break into celebrities' houses in LA.
In neither film does she play a lead; that will only come with Your Voice in My Head, drawn from journalist Emma Forrest's account of her relationship with her psychiatrist.
"She hasn't tried to be the centre of anything yet," said Gant. "It's a smart move, but it means there's a massive question mark as to her USP. We're waiting for something that defines her. She needs a role where you get a strong flavour of who she is."
Watson's nearest contemporary is probably Carey Mulligan, whose career has been ballasted by her star-making lead role in An Education. Watson would probably be envious of Mulligan's ability to move between British psychodramas including Shame, Hollywood noirs such as Drive, and romantic epics such as the forthcoming Great Gatsby.
The third member of the Potter trio, Grint, is the one who looks like he'll be most up against it now that Potter has finished. During the series, his popularity among the franchise's fans meant he could take a string of roles, from Northern Irish indie Cherrybomb to the Viz-esque Thunderpants. Now, however, his Ringo Starr-ish position is perhaps becoming apparent, with no clear future as a solo performer mapped out.
"He's a conundrum," said Gant. "He was impressive in the first Potter films, with good comic timing, but as an actor he's grown the least. He's not natural casting for leading man roles, and could only have a career as a sidekick, really. He can be quite funny, but when you look at the wealth of comedic actors in the US – Jonah Hill, Michael Cera, Seth Rogen – they seem much bigger talents somehow. I'm not struck by his ambition, unlike the other two."
Ambition, indeed, is the issue – after the hefty pay deals offered to keep the Potter films motoring along, all three never need to work again. In the
2011 Sunday Times Rich List, Radcliffe's worth was estimated at ?48m, and Watson and Grint at ?24m apiece.
Gaydos points out that "successful young actors and successful young athletes have a lot in common", adding: "Huge salaries, great fame, great temptations, brief careers."
Time will tell if the Potter kids have whatever it is that drives on the likes of Leonardo DiCaprio and Ryan Giggs. It has to be more than simply money.
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Russia’s problems are many and varied – low life expectancy and falling population figures, soaring rates for crime, alcoholism and drug abuse, not to mention ubiquitous corruption. In a country rich in natural resources, half the population lives in poverty. Andrei Konchalovsky takes us through the horrifying facts and figures and argues that things can only change when Russians themselves learn to be horrified by them.
I chose my title for a reason. There’s a famous saying by Marx, that ‘to inspire courage in a nation, you have to make them horrified at themselves’.
For many years now I have been appealing to my fellow-Russians to be horrified by many facts and conditions of Russian life, in order to gain courage and the desire to desire. To desire to change oneself and the life around oneself.
I have long since been dismissed as a Russophobe who holds his people in contempt. That is nonsense – if it were the case then you could apply the name of Russophobe to Chekhov, Gorky, Herzen and Chaadayev – great Russians who wished to awake Russia from its sleep, and not just constantly find others to blame for its own woes.
The Russian people are not a corpse, to be spoken only good of. They are a living people, full of energy and talent, who have just not yet completed the historical journey that leads to wellbeing and success for each individual. So let’s look for a moment at what is horrific in Russian life today. And anyone who wants to hear good things about themselves can go and read President Medvedev’s speeches or Afanasyev’s folk tales.
Life expectancy and population loss
Today I would like to remind you of a few startling facts and figures showing that according to many social indicators Russia is on a par not with Europe and not even with Asia – in terms of levels of corruption, life expectancy, investment in science etc. we are comparable to Africa!
‘The figures for suicide, poisoning, murder and accidental deaths in Russia are comparable with death rates in Angola and Burundi.’
I will go further and say that it is not we that should feel insulted by such a comparison, but the Africans. They at least have an explanation for their lack of development: they had four centuries of exploitation and extermination by racists and colonisers, whereas over the last three centuries who colonised us Russians and treated us with contempt but ourselves?
We often ignore statistics, and it is true that it can be difficult to grasp the reality behind dry figures. But the scale of the tragedy being played out in our country is so great that I urge you to give it your full attention.
Museums of Russian vodka seen throughout Russia convey a simple message: drink and have fun. Yet alcoholism has remained one of Russia’s major social problems. With consumption of 15 litres of pure alcohol per head, millions of Russians ruin their health and die early (photo: flickr.com, jimjimovich's photostream .
Russia’s death rate: the last 20 years saw the deaths of more than seven million Russians. This converts to a death rate 50% higher than in Brazil and Turkey, and several times the rate for Europe.
In terms of population, Russia loses each year the equivalent of a district similar to Pskov, or a city the size of Krasnodar.
The figures for suicide, poisoning, murder and accidental deaths in Russia are comparable with death rates in Angola and Burundi.
Global tables of male life expectancy put Russia in about the 160th place, below Bangladesh.
Russia has the highest rate of absolute population loss in the world.
According to UN estimates, the population of Russia will fall from its present 140 million to 121-136 million by 2025.
The family in crisis
Other statistics reflect the crisis of the family in Russia. Eight out of ten elderly people in residential care have relatives who could support them. Nevertheless they are sent off to care homes.
Between two and five million kids live on our streets (after World War Two the figure was around 700,000 . In China, a country with a population of 1.4 billion, there are only 200, 000 homeless children – 100 times less. That’s how important children are to the Chinese! And surely the welfare of children and the elderly is the foundation of a healthy nation.
Eighty percent of children in care in Russia have living parents. But they are being looked after by the state!
We head the world for the number of children abandoned by their parents.
All these figures bear witness to the erosion of the family in this country.
Crime and corruption
Crimes against children: according to data published by the Russian Federation Investigative Commission, in 2010 there were 100,000 child victims of crime, of whom 1700 were raped and murdered (theses figures are higher even than those for South Africa .
'Four or five children are murdered in Russia every day'
This means that four or five children are murdered in Russia every day.
In 2010, 9500 sexual offences were committed against underage victims, including 2600 rapes and 3600 cases of non-violent sexual relations (the last eight years have seen a twentyfold rise in sexual crime . Only South Africa has a higher rate of such crimes.
Drug addiction and alcoholism. Thirty thousand Russians, equivalent to the population of a small town, die annually from drug overdoses.
Seventy thousand Russians drink themselves to death each year.
According to WHO statistics, Russia gets through the annual equivalent of 15 litres of pure alcohol per head of population. And bear in mind the fact that alcohol consumption of more than eight litres per annum per head of population constitutes a threat to a nation’s survival.
Corruption: the scale of bribery in Russia has increased tenfold, and the goings on in a London court battle between two oligarchs have made us the laughing stock of the global business world. The impunity of our judicial system is such that a criminal charge has been instigated against Sergey Magnitsky, a lawyer who died in prison in 2009. In Europe such a thing last happened in the 17th century!
Russia comes out as one of the world’s most corrupt places (154th out of 178 countries in Transparency International’s annual Corruption Index, where it is listed next to Guinea-Bissau and Kenya.
Looking at all these figures one can safely talk of a decline in national morality – and it is our rulers who are ultimately responsible for this state of affairs.
‘It is shameful that in a country with such rich natural and aquatic resources over 50% of the population should be classified as poor.’
And now, did you know that:
- in the last 10 years 11,000 villages and 290 towns have disappeared in Siberia;
- average population density in Siberia and the Russian Far East is two people per square kilometre;
- average population density in Russia’s central regions is 46 people per square kilometre;
- average population density in China is 140 people per square kilometre;
- average population density in Japan is 338 people per square kilometre?
It is shameful that in a country with such rich natural and aquatic resources over 50% of the population should be classified as poor.
All these figures send me into a state of shock. I am sure that all the facts are known to Putin. I wonder what effect they have on him.
And it will only get worse...
The tragedy is that I believe things will only get worse; we still haven’t touched bottom, and the Russian people has still not reached the stage where it can feel horrified at itself and finally gain the courage to ask ‘Where are we living?’. We no longer notice the stink in hallways and public toilets. We are used to people being murdered around us. We are accustomed to the fact that people all over Russia are literally fighting for their lives.
Journalist Anatoly Yermolin was born in Kushevskaya, a village in Southern Russia which was the scene of a mass murder in 2010. He wrote of this incident: ‘If twelve people hadn’t been murdered in one go, if there had been five incidents with two people killed in each, no one would have paid any attention to it, as is normally the case in our country’. But surely it is obvious that Kushevskaya doesn’t just belong to the Krasnodar region – it’s part of Russia as a whole! Local mafia boss (and district councillor Sergey Tsapok and his gangsters are the people you put into power by voting for them at local elections! Everybody everywhere knows who the local hard man is, who has connections with the police and the prosecutor’s office.
The Kremlin is only pretending to fight corruption when it sacks Interior Ministry generals and middle level bureaucrats by the dozen. In the old days they would have been shot – now they get to spend a ‘well-earned retirement’ in Dubai or the Cote d’Azur! Do our rulers really believe that is the way to end corruption? But then you all elect to your local council candidates with the words ‘I am a thief’ branded on their foreheads, and then wonder why corruption rules!
‘Russia today is facing a demographic and moral catastrophe, the like of which it has never seen before.’
I wonder: will it take the extinction of half the nation and the shrinkage of Russia to the Urals, for the people (that is, the mass of the population, not a tiny group of thinking people to wake up and demand of their rulers not pleasant, reassuring news stories and the usual promises, but the truth, and in the first place an admission of how bad things are.
That, as you may remember, was what Stalin was forced to do in the face of a German invasion in 1941.
It is also what Khrushchev was forced to do in 1956, when the Bolsheviks realised they might be called to account for decades of terror.
Russia today is facing a demographic and moral catastrophe, the like of which it has never seen before.
There are many reasons for this, the chief one being the irresponsible economic policies of the 1990s that overwhelmed people accustomed to feudal rule, without any experience of either private property or capitalism, and who in seventy years of Soviet rule had lost any potential entrepreneurial spirit.
So what is to be done?
As the writer and cultural commentator Mikhail Berg has written (I quote from memory : ‘We live in one country, but we are two nations. There is a tiny handful of thinking people who demand freedom and fair elections, and the enormous ‘slumbering’ mass of ‘ordinary’ Russians. And between them lies a huge gulf of fear, fear of the most acute and dangerous kind, and social distrust…We can fight the ‘party of swindlers and thieves’, we can blame the Russian bureaucratic mindset that has messed up the whole of Russian history, but we can’t escape the fact that a definite majority of the Russian population has not changed its basic mentality for centuries.’ And I would add to that - your oppressors come from your own ranks.
Homelessness and juvenile crime have remained serious problems in Russia. Pictured is a Russian youth detention center in a remote part of the Urals. The boys, many under 12, are doing time for crimes. Mostly they are there for thieving, but there are a fair number of murderers too (from ‘Alone in four walls’, a documentary film directed by German filmmaker Alexandra Westmeier .
So I don’t know what is to be done, apart from trying to shake people up and make them horrified at themselves. Yulia Latynina thinks me not only a pessimist, but a de-motivator. I think one can motivate someone who is conscious and wants to be saved. But what if he is unconscious or in a lethargic doze? Sometimes, to bring someone round, a doctor will slap their cheeks.
I know what you will say to that, but I know that if a third of the people who will read these words agree with me, Russia would be a different place.
‘I don’t know whether Vladimir Vladimirovich Putin has it in him to proclaim the equality of all before the law. If he does have it in him, he will win himself a prominent place in the Pantheon of Russian history. If not…’
I am convinced that Russia needs a leader with the daring of Peter the Great, who would tell people things they haven’t heard for a long time. The truth will be bitter, for it is difficult to accept that the reason why Russia cannot move forward is because it doesn’t want to admit to itself how far it lags behind Europe in terms of developed civilisation. Only a clear and inspiring message - let it be harsh, so long as it is invigorating and sincere - can provide an impetus for the nation to awake from its feudal torpor.
Only if that happens can one hope that the nation’s instinctive wisdom will prompt it to take the hard and possibly unforgiving road which is the only way to drag our country out of the pit in which it currently languishes. I don’t know whether Vladimir Vladimirovich Putin has it in him to take such a suicidal step, to take the bull by the horns and proclaim the equality of all before the law. If he does have it in him, he will win himself a prominent place in the Pantheon of Russian history. If not…
I am a Russian and I miss my country, because I don’t see it! I don’t see a country of which I want to be proud. I see a crowd of unhappy, frustrated faces and people alienated and afraid of one another. I want to be proud of my country, and instead I am ashamed of it. When did I last feel any pride in Russia? I don’t remember! But I know for a fact that if the truth, the truth about the situation our people find themselves in, were to be shouted loud and clear to the whole world, I would feel even more pride than if our hockey team were to win gold at the Olympics.
A recent study shows personalized medicine may be more complex than originally thought. But Y-ME peer counselor Jane Perlmutter, Ph.D, cautions current patients about altering their own treatment regimen. "Science is complicated, perhaps more so now than when the ideas of tumor sub-types and personalized medicine were first introduced. Still, the approach has had a very positive impact on many women diagnosed with breast cancer, especially those treated with endocrine therapy or Herceptin. Women undergoing treatment now should continue to take their medicine, but may want to discuss the article with their health care providers.”
The excerpt below, from The Wall Street Journal, sheds some light on the issue. For further commentary, see Y-ME's Expert Corner Blogs for insight from
Dr. Gordon B. Mills, MD Anderson Cancer Center.
A tumor's genetic makeup can vary significantly even within the same tumor sample, researchers said, a finding that poses new challenges to the personalized-medicine movement in cancer.
One big implication of the new research, being published Thursday in the New England Journal of Medicine, is that analyzing only a single sample of a patient's tumor—the current practice—may miss important genetic mutations that affect the course of the disease.
That, in turn, could hinder emerging efforts to match patients with drugs that target the mutations affecting their tumors, a basic strategy of personalized medicine.
The findings don't diminish enthusiasm for the idea that genetic knowledge about tumors can transform cancer care, the researchers said. But it could make personalized treatment more complex—and more costly.
"It's a sobering finding," said Andrew Futreal, a co-author of the study who until recently was director of cancer genetics and genomics at Wellcome Trust Sanger Institute in London.
In an editorial accompanying the study, Dan L. Longo, an editor at the journal, suggested the varied genetic makeup of tumors described in the study stands in contrast to "overoptimism" among proponents of personalized medicine. The report indicates that matching tumors and treatments based on genetic characteristics won't be as simple as some suggest, he wrote.
Excerpted from the "'Personalized Medicine' Hits a Bump," by Ron Winslow, Wall Street Journal Online, March 8, 2012.
Read full text of the article.
When Mal Brough announced the Northern Territory National Emergency Response into remote Aboriginal communities, I experienced an uncanny sliding doors moment.
I remembered working at a rural Victorian sexual assault service, and the claustrophobic sense of gated paedophilia I started to sense about that township. Perpetrators ranged from the ex-police chief to local bikies gang-raping two-year-olds.
Gathering dust in a back room were the victim files. That hideous archive of self-generating social dysfunction went from the floor to the roof and it was jammed with the lifelong suffering of mostly women and girls, but increasingly boys, inflicted by men - most of whom had histories of violent abuse themselves. The thing is they were close to all white offenders.
That room put a disproportionate part of the local community on skids. I rarely met survivors with life passions that informed their education or professions. Most of them were unemployed, lost and trying to manage a bunch of kids they'd had too young because they had no clue what else to do with their lives. These were brave, inspiring women. But so often they drank or got into drugs, they got into relationships with violent drongos, they struggled everyday with depression, anxiety, panic attacks, isolation, rage and despair.
To my mind that file room defined dystopia. Every day I worked at that juncture of disclosure, between victims wanting justice and support, and the men who actively set about destroying human potential. I wanted someone to send in the army. Not the nice army, with ukuleles and footballs and women soldiers that the community knew, as was said of NORFORCE, but battalions of scary SWAT teams who busted in on offenders in riot gear and carried them off to somewhere akin to Guantanamo Bay, leaving the rest of us, finally, in peace.
You simply could not get angrier than I was at men that bashed and raped women and children. I saw the devastation they wrought and I wanted them dead.
We've been hearing from shell-shocked health professionals working in remote Aboriginal communities, staring glassy-eyed into our living rooms, trying to convey to the rest of us what the inside of that file room looks like when it becomes the outer parameters of an entire community.
Eleven-year-old girls hanging themselves; mothers with head injuries; children needing genital surgery to remain continent. The extent of damage being perpetrated against Aboriginal women and children hasn't been known since the frontier.
Then as now, it beggars belief. Then as now, it's easier for non-Indigenous Australians to think of it, not as something we do, but as something particular to Aboriginal manhood. It's clear men's violence is worse in some remote communities; that is not that same as being exclusive to those communities.
Aboriginal women are wary of white feminists like me talking about Aboriginal men's violence. Some have pointed out white women were part of the cycle, enforcing patriarchal family structures as missionaries that undermined Aboriginal women's traditional autonomy and authority, or employing desperately lonely, vulnerable girls removed from their loving families as domestic indentures. In both scenarios white women were themselves violent to Aboriginal women and girls.
'Demonising' Aboriginal men as wholesale rapists and wife-bashers only alienates Aboriginal communities further. Louis Nowra and others have attempted to characterise Aboriginal men's violence as intrinsic to traditional warrior identity.
I have surveyed large swathes of the colonial archive and extracted over 50,000 words of settler imaginings of Aboriginal women's gender status. There is no question the frontier was one of the most dangerous places for women in the history of human conflict, but the tropes of bride capture, of eating tossed scraps, of routine camp violence, were confected by a handful of settlers and recirculated through the press as credible ethnological data. That's until Bronislaw Malinowski undertook a thorough survey of the available literature in 1913 and found them to be the repetitions of the erroneous views of early settlers.
I have traced the bride capture trope to David Collins (Judge Advocate and Secretary of the Colony , and later to John McClennan's 1865 Primitive Marriage, who sourced his rather florid account from an anonymous newspaper article in the popular London magazine Chambers's Journal of Popular Literature Science and the Arts
.
Why did settlers cling to these speculative tales? Because they wanted to believe that colonialism was an act of gallantry. In the process of disavowing their own violence against Aboriginal women, Aboriginal men's violence became a staple fetish.
Violence isn't a problem of Aboriginality, but of offender masculinity which some Aboriginal men became assimilated to over generations of impoverishment, structural disadvantage, alcohol and more recently violent porn.
With billions of dollars invested in services still missing from remote communities, non-Indigenous communities manage to contain the fallout of male violence, keep it under wraps, keep it nice. In remote communities it has climaxed to this level of cultural visibility because the services to contain the fall out aren't there. This isn't to deny the situation is in crisis in those communities. It is to say men's violence has created a salt and pepper crisis throughout the wider community and we should stop using violence by Aboriginal men as a distraction from the rest.
Offenders need to be singled out as in fact anomalous to the majority of men in their respective communities. They need to be held to account and removed from the families and communities they damage. Not left in their homes and communities reoffending while protracted legal cases telescope into plea bargaining and appeals. And not removed to prisons, but to something like rehabilitation/health /training and education centres. Every city and regional centre in this country needs an offender centre.
It is from here that men who have been charged need to pursue their legal defence, so their wives and children can stay in their homes and get on with their lives in safety. It is here that offending men need to undergo best practice psychiatric assessment, treatment and particularly rehabilitation from alcohol and other addictions. It is from here they need to heal from both the devastation they have wrought in their own lives and very likely their own histories of learnt abuse. It is from here offenders need to redefine their manhood with the best intervention programs into hyper-macho identity money can buy. It is from here they need to reconnect to their passions and talents and work out how to generate income from them. It is from here offenders need to learn how to consume, as do men who aren't self-destructive, food, grog and porn.
Where cultural factors inform their offending, like intergenerational unemployment and racism, they need to be sensitively addressed, such as by implementing every recommendation of the Aboriginal Deaths in Custody Report. It is critical that the most brilliant, dedicated and inspiring health professionals and educators in the country staff these offender ventures. I cannot think of more important work any of us could do.
And if it takes years, even the rest of their adult lives before they pose no risk to our communities so be it. Let's be clear. Offenders are our foe. For too long their legal rights have been prioritised over that of women and children's right to safety. What was needed from Mal Brough, what was always needed, then and now, right around the country, is a national emergency response into offender masculinity.
Liz Conor is an academic at the National Centre for Australian Studies. She will present this talk tonight on a panel for International Women's Day convened by Melbourne Free University. View her full profile
here.
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