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  • Nursing Home Study Finds Only Resident Decolonization Reduced Drug-Resistant Bacteria on Skin

    Nursing Home Study Finds Only Resident Decolonization Reduced Drug-Resistant Bacteria on Skin

    Only decolonizing residents reduced the drug-resistant bacteria they carried on their skin, and adding daily enhanced cleaning produced no measurable additional benefit, according to a study of two Southern California nursing homes published August 5 in JAMA Network Open.

    The comparison matters because infection control budgets in long-term care are finite. Facilities are frequently asked to do both, and this study suggests that when only one is affordable, the choice is not a coin flip.

    For families with a relative in a nursing home, the finding translates into a question worth asking at the next care conference. Multidrug-resistant organisms are endemic in these settings, with studies showing more than half of residents carry them on their skin, and carriage precedes infection. What a facility does about that is a legitimate thing for a family to inquire about.

    The Four-Phase Design and the Main Findings

    Researchers at the University of California Irvine School of Medicine ran a four-phase quality-improvement study at two nursing homes, using data collected between March 2019 and April 2021. The phases were implemented in sequence: universal decolonization alone, routine care as the control, once-daily enhanced cleaning alone, and decolonization combined with enhanced cleaning.

    The measured outcomes were carriage of multidrug-resistant organisms on resident skin and in nostrils, and contamination of high-touch objects in bedrooms and common areas.

    In adjusted models, decolonization alone was associated with a 59 percent reduction in carriage compared with the control phase and a 64 percent reduction compared with enhanced cleaning, CIDRAP reported in its summary of the findings. Enhanced cleaning alone did not reduce carriage, and it added no benefit when combined with decolonization.

    Decolonization in practice meant chlorhexidine used for routine bathing and showering, paired with a nasal iodophor such as povidone-iodine on a defined schedule. It is a resident-level intervention rather than an environmental one, which is precisely why the result is informative.

    Shared Spaces Told a Different Story

    Bedroom contamination followed the same pattern as skin carriage. Decolonization alone reduced it by 84 percent compared with control and by 74 percent compared with enhanced cleaning, while enhanced cleaning alone produced no reduction and added nothing to decolonization.

    Common areas broke the pattern. There, the combined intervention reduced contamination better than either approach alone.

    The logic is intuitive once stated. If bacteria on surfaces originate primarily from the people who touch them, reducing what residents carry reduces what ends up on the bed rail. Common areas gather traffic from many residents and staff over a day, and surface disinfection reaches contamination that resident-level treatment cannot.

    The authors framed the practical implication in resource terms. Writing in JAMA Network Open, they noted that implementing multiple strategies is expensive and resource intensive, and that “it is necessary to prioritize the most effective strategies.” Their conclusion was that resource-constrained settings should prioritize decolonization alongside targeted disinfection in shared spaces after activities.

    Families Choosing or Monitoring a Facility

    Nothing here is a diagnosis or a treatment instruction, and no family should attempt decolonization on their own. Chlorhexidine and nasal antiseptics used in these protocols are administered under a facility program with clinical oversight, and improvising carries risks including skin reactions and allergic responses.

    What a family can do is ask. Reasonable questions at a care conference include whether the facility uses chlorhexidine bathing, whether it has a nasal decolonization protocol, how it handles residents returning from hospital stays, and how it monitors infection rates. Facilities with active programs generally answer readily.

    The stakes are concrete for people with the highest exposure to health care. Residents who move between hospital and nursing home, those with indwelling devices such as urinary catheters or feeding tubes, people with open wounds or pressure injuries, and those who have received multiple courses of antibiotics carry the greatest risk of both colonization and subsequent infection.

    Older adults bear a disproportionate share of the burden from resistant infections generally. When a resistant organism causes an infection, treatment options narrow, hospital stays lengthen, and outcomes worsen. Prevention at the carriage stage is the intervention that happens before any of that.

    There is a household dimension as well. Residents who return home for weekends or who are discharged to family care can carry these organisms with them, and the standard advice for relatives is unglamorous but effective: hand hygiene before and after contact, careful wound care under a clinician’s direction, and telling any new provider about a known colonization history so treatment decisions account for it.

    Limits of a Two-Facility Study

    The design constraints deserve to be stated clearly rather than buried. This was a quality-improvement study at two facilities, not a randomized controlled trial across many sites, as McKnight’s Long-Term Care News noted in its account of the design.

    Phases were implemented sequentially over roughly two years, which means anything else that changed over that period, including staffing, resident turnover, seasonal factors, and pandemic-era infection control practices, could contribute to the differences observed. Two Southern California nursing homes may not represent facilities elsewhere with different staffing ratios, resident populations, or baseline practices.

    The study also measured carriage and contamination rather than infections, hospitalizations, or deaths. Those are reasonable surrogate outcomes because carriage precedes infection, but they are not the same thing.

    Importantly, this work builds on a stronger evidence base rather than standing alone. A large cluster-randomized trial in nursing homes previously found that universal decolonization reduced infection-related hospital transfers, with MDRO carriage prevalence falling from about 49 percent to 32 percent in the decolonization group while remaining near 47 percent under routine care. The new study addresses a narrower question about how decolonization compares with enhanced cleaning when resources force a choice.

    An accompanying JAMA Network Open commentary framed the work as an argument for hypothesis-driven research in nursing home infection prevention rather than as settled guidance. Current infection control guidance has not changed on the basis of this study, and larger multi-site work would be needed to establish how broadly the comparison holds. For facility administrators weighing where to spend a limited infection prevention budget, the finding offers a data point that was previously missing.

    Key Questions Answered

    What did the study find? Universal decolonization of residents was associated with a 59 percent reduction in multidrug-resistant organism carriage compared with routine care. Enhanced daily cleaning alone reduced nothing and added no benefit when combined with decolonization.

    What is decolonization? Chlorhexidine used for routine bathing and showering, paired with a nasal iodophor such as povidone-iodine on a set schedule, applied to all residents rather than only those known to be colonized.

    Did cleaning help at all? In common areas, combining cleaning with decolonization reduced contamination better than either approach alone. For resident skin and bedrooms, cleaning added nothing.

    How strong is the evidence? This was a four-phase quality-improvement study at two facilities, not a randomized trial. It measured carriage and surface contamination rather than infections or deaths.

    Should families try this at home? No. These are facility-level protocols with clinical oversight. Do not attempt decolonization independently.

    What can a family actually do? Ask whether the facility uses chlorhexidine bathing, whether it has a nasal decolonization protocol, how it handles residents returning from hospitals, and how it tracks infection rates.

    Which residents face the highest risk? Those moving between hospital and nursing home, people with catheters or feeding tubes, residents with wounds or pressure injuries, and those who have had multiple antibiotic courses.

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  • Liquid medication administration: MedlinePlus Medical Encyclopedia

    Liquid medication administration: MedlinePlus Medical Encyclopedia

    URL of this page: //medlineplus.gov/ency/article/002209.htm

    If the medicine comes in suspension form, shake well before using.

    Do not use flatware spoons used for eating for giving medicine. They are not all the same size. For example, a flatware teaspoon could be as small as one half teaspoon (2.5 milliliters [mL]) or as large as 2 teaspoons (10 mL).

    Measuring spoons used for cooking are accurate, but they spill easily.

    Oral syringes have some advantages for giving liquid medicines.

    • They are accurate.
    • They are easy to use.
    • You can take a capped syringe containing a dose of medicine to your child’s daycare or school.

    There can be problems with oral syringes, however. The FDA has had reports of young children choking on syringe caps. To be safe, remove the cap before you use an oral syringe. Throw it away if you do not need it for future use. If you need it, keep it out of reach of infants and small children.

    Dosing cups are also a handy way to give liquid medicines. However, dosing errors have occurred with them. Always check to make sure the units such as teaspoon, tablespoon, mL, or cubic centimeters (cc) on the cup or syringe match the units of the dose you want to give.

    Liquid medicines often do not taste good, but many flavors are now available and can be added to any liquid medicine. Ask your pharmacist.

    Unit conversions

    • 1 mL = 1 cc
    • 2.5 mL = 1/2 teaspoon
    • 5 mL = 1 teaspoon
    • 15 mL = 1 tablespoon
    • 3 teaspoons = 1 tablespoon

    Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Regional Medical Director of Penn Medicine Primary and Specialty Care, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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  • Congressional Panel Says the United States Is Losing Its Lead on Rare Disease Cures

    Congressional Panel Says the United States Is Losing Its Lead on Rare Disease Cures

    A congressional advisory commission has concluded that promising rare disease therapies are failing to reach American patients because of gaps in funding, data, regulation and manufacturing, and that the country’s long-held lead in the field is eroding.

    The National Security Commission on Emerging Biotechnology, a bipartisan legislative advisory body chaired by Sen. Todd Young of Indiana, released a white paper identifying four main hurdles and recommending an all-of-government approach to rare disease. Vice Chair Michelle Rozo said in a statement that emerging biotechnology now makes it possible to cure rare diseases rather than manage symptoms for life, and that what the country lacks is a national strategy to channel that innovation.

    These are recommendations to Congress. They are not law, not federal policy, and not binding on any agency, which matters for how families should read the coverage.

    Four Barriers the Commission Identified

    The commission’s framing is that the science increasingly works while the surrounding system does not.

    Research investment is the first barrier. Funding for rare disease work is limited relative to the number of conditions, and the large majority of rare diseases still have no FDA-approved treatment more than four decades after the Orphan Drug Act was enacted in 1983.

    Data and trial design form the second. Rare disease information sits in scattered registries, individual academic centers and disconnected health systems. The commission’s rare disease white paper argues that new statistical models better suited to small populations are needed, that the FDA should standardize how it handles variability in data from small groups, and that limited patient numbers may require new trial designs and individualized standards.

    Regulatory capacity is the third. The commission flagged persistent staffing shortages and knowledge gaps at the FDA that leave the agency less able to assess new technologies, noting that review teams often lack expertise in rare diseases, cell and gene therapy and data science, and that high turnover drains institutional knowledge. Thousands of FDA employees departed or were laid off over the past year, and the agency has since said it is looking to hire roughly 2,200 people.

    Manufacturing constraints are the fourth. Producing a therapy for a very small patient population is a different engineering problem from mass production, and capacity for it is limited.

    Two Offices It Wants Congress to Create

    The commission’s central structural recommendation is not new, which is part of its argument.

    It points back to two proposals from its April 2025 final report: a National Biotechnology Coordination Office to align work across federal agencies and streamline regulatory structures, and a biopharmaceutical manufacturing center of excellence to improve the reliability and efficiency of production methods while engaging regulators early. Both have already been introduced as legislation, including the National Biotechnology Initiative Act of 2025, and neither has been enacted.

    It also recommends that Congress urge the FDA to finalize its platform technology designation program, which allows validated data from one product to carry over to others built on the same platform. That program launched in 2024 and has had a complicated early record.

    The commission situates all of this as a national security question, arguing that developers are increasingly taking work to countries including China and Australia. China’s share of the drug pipeline rose sharply over the past decade, reaching 30 percent of the global drug development pipeline from about 6 percent ten years earlier.

    That framing is a choice. Readers can find the identified barriers real while recognizing that the national security packaging reflects the commission’s mandate.

    Recommendations Are Not Law

    This limitation belongs stated plainly rather than at the end.

    An advisory commission produces analysis and recommendations. Congress may act on them, may act on some of them in modified form, or may do nothing. The two offices it recommends have been sitting in introduced legislation without passage, which is a useful indicator of how long this can take.

    The report also does not evaluate whether any specific therapy works or should be approved. It is about the system that produces therapies, not about clinical evidence for particular products.

    Some federal activity is already moving in adjacent directions. The FDA announced a framework earlier this year aimed at accelerating development of individualized therapies for ultra-rare diseases, inspired in part by the case of an infant treated with a personalized gene-editing therapy, and the commission welcomed FDA’s proposed trial reforms for modernizing clinical trials and prioritizing supply chain security.

    Meaning for Families Living with Rare Disease

    Nothing in this report changes any patient’s care, and no therapy becomes available because of it.

    What families can act on is the part of the problem the report identifies as fragmented data. Enrolling in a disease-specific patient registry is free, takes little time, and is how researchers identify candidates when a trial does open. Many rare disease patient organizations maintain them, and a treating specialist can usually point to the right one.

    Genetic diagnosis is the prerequisite for nearly everything else. Patients commonly report years between symptom onset and a confirmed diagnosis, and a therapy cannot be designed or matched without knowing the specific variant. Anyone with an undiagnosed condition suspected to be genetic can ask a clinician about referral to a clinical geneticist or to an undiagnosed diseases program.

    ClinicalTrials.gov lists trials by condition and can be checked periodically, since rare disease trials open and close with little publicity. A specialist can assess whether any are appropriate.

    Families should be cautious about clinics offering gene therapy or experimental treatments outside registered clinical trials, which operate without the safety oversight legitimate programs require. Cost and coverage questions for approved orphan drugs are worth raising early with a specialty pharmacy, since manufacturer assistance programs and foundation grants exist for many of them.

    The bottom line: a bipartisan congressional advisory commission identified limited research funding, fragmented data and trial design problems, regulatory capacity gaps at the FDA, and manufacturing constraints as barriers keeping rare disease therapies from patients; its recommendations are proposals to Congress that have already been introduced without passing, and the most useful step families can take now is genetic diagnosis and registry enrollment.

    Key Questions Answered

    Who produced the report? The National Security Commission on Emerging Biotechnology, a bipartisan advisory body to Congress chaired by Sen. Todd Young with Michelle Rozo as vice chair. It released a white paper on rare disease therapy development.

    What barriers did it identify? Limited research investment, fragmented data and trial design challenges in small populations, regulatory capacity gaps at the FDA including staffing shortages and missing expertise, and manufacturing constraints.

    What did it recommend? An all-of-government approach, including a National Biotechnology Coordination Office and a biopharmaceutical manufacturing center of excellence, and urging the FDA to finalize its platform technology designation program.

    Are those recommendations new? No. Both offices were proposed in the commission’s April 2025 final report and have been introduced as legislation, including the National Biotechnology Initiative Act of 2025, but have not been enacted.

    Does the report change federal policy? No. It contains recommendations to Congress. Establishing new offices would require legislation and appropriations.

    Why frame this as national security? The commission’s mandate is to assess biotechnology’s national security implications. It argues developers are shifting work abroad, noting China’s share of the global drug pipeline reached about 30 percent from roughly 6 percent a decade earlier.

    What can families do now? Pursue genetic diagnosis through a clinical geneticist, enroll in disease-specific patient registries, and check ClinicalTrials.gov periodically with a specialist’s guidance.

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  • Befriend Vulnerability With A 12-Minute Meditation

    Befriend Vulnerability With A 12-Minute Meditation

    Learning to tune in to our own vulnerability is an act of courage that allows us to form deeper, more genuine relationships.

    If you’re someone who grew up being told that tears are a sign of weakness, or that you should never show fear lest you be exploited, you understand how very difficult it is to communicate complex emotions like jealousy, resentment, or sorrow. You protect these experiences, holding them close to your chest like a dislocated arm in a sling. Just as extending the injured arm would create a risk of further injury, keeping parts of yourself out of intimate relationships prevents emotional hurt and exploitation.

    You know how this looks for you.

    Maybe you become stoic and isolate yourself. Perhaps you bury yourself in work or your hobbies. If you’re in a fragile state, you might displace your anger and rage against someone innocent, or who’s an easy target. None of these things feel good, and it’s easy to feel ashamed if your actions have pushed people away.

    This limiting mindset doesn’t have to be a defining feature, however. Vulnerability can be learned. In fact, anyone can learn how to be vulnerable with themselves.

    A Practice to Begin Healing

    1. To begin, find a quiet place to reflect on these questions in silence. If you prefer, there’s also the option to write down your answers.
    2. What has been your relationship with vulnerability?
    3. Reflect on a time that turned out favorably when you made a decision to be vulnerable with someone you trust. It can be anything, even something small. Reflecting on that now, how did it feel to allow this person to witness you in your need? What did it perhaps do for your relationship?
    4. Keeping that positive experience of vulnerability in mind, is there a part of you that’s been hidden, and that you’re now needing to acknowledge? Consider a difficult emotion, like loneliness, that’s been hard to name, and the impact of just letting it be present without registering it.
    5. What would it be like to bring your experience to someone you trust? Consider the positive outcome you had in step three, in which you overcame your reluctance around vulnerability and brought your issue forward. If this were once again possible, is there something you would now need to address with someone trustworthy?
    6. Finally, reflect on what might be gained from this exercise in vulnerability: the ability to let someone else recognize and possibly help you carry a struggle, the opportunity to strengthen the bond of your relationship, the deepening of trust in addressing other vulnerable parts of your life that may show up in the future.

    A Guided Meditation to Befriend Vulnerability

    1. To begin, find a comfortable place in your home where you can sit or lie down and just listen to this meditation free of distractions, where you can just be for a few moments. Positioning yourself comfortably, allow yourself to take an in-breath through the nose. Exhaling through the mouth. Another breath in through the nose, and out through the mouth. Just continuing to breathe in this manner.
    2. In your mind’s eye, allow yourself to really observe that part of you that yearns to be seen, yearns to be noticed, that yearns to be forgiven, that yearns to be loved. And as you encounter this part of you, allow it to really be enhanced. Really notice the qualities of what it would mean to be seen, to be loved, to be healed.
    3. This is your gift. A gift to give to someone you trust. Reflecting now on this gift: Who in your life deserves to see, to know, to forgive, to love this part of you? Bring their face into your mind’s eye. Noticing the qualities that tell you this person is trustworthy, is deserving of your vulnerability.
    4. Allow yourself to see, as well, the potential for your own life and sharing this gift with this person. What would it mean to you to bring this part of you into this relationship now? Really notice them loving you. Forgiving you, healing you by witnessing you and your vulnerability.
    5. As you do so, make a commitment to yourself of what it is that needs to be said and shared with this person who has shown you that they are trustworthy.
    A 12-Minute Meditation to Cultivate an Open Heart 

    During times of crisis and uncertainty, touching into your groundedness while remaining open can help you find calm—and inspire others to do the same. Meena Srinivasan offers a guided practice for staying both rooted and open. Read More 

    • Meena Srinivasan
    • July 19, 2022



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  • Cyclosporiasis

    Cyclosporiasis

    Source: Medical Encyclopedia
    Related MedlinePlus Pages: Parasitic Diseases

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  • The Benefits and Risks of Hair Loss Drugs

    The Benefits and Risks of Hair Loss Drugs

    What are the pros and cons of Propecia and Rogaine for hair loss?

    “Any consumer looking on the Internet for a treatment for hair loss is exposed to a multitude of remedies.” However, we only have good evidence for efficacy for drugs approved by the U.S. Food and Drug Administration: finasteride (sold as Propecia) and minoxidil (sold as Rogaine). It’s considered a myth that all the patented hair-loss supplements on the market will increase hair growth. And they may actually be more expensive, with over-the-counter supplement regimens costing up to more than $1,000 a year, whereas the drugs may cost between $100 and $300 annually. The drugs can help but can cause side effects. Propecia can diminish libido and cause sexual dysfunction, while the topical minoxidil can cause itching.

    Below and at 1:12 in my video Pills for Hair Growth, you can see a list of some of the more common side effects of these FDA-approved drugs.

    To understand why there are so many hormonal side effects for Propecia, like impotence, testicular pain, and breast enlargement, it’s important to understand how the drug works.

    Androgens, male hormones like testosterone, are the principal drivers of hair growth in both men and women. We know this from studies half a century ago that show that castration of men stopped their hair loss. Why exactly were they being castrated? It was due to eugenics laws in the United States, when “mentally handicapped people” were castrated or forced to undergo tubal ligations against their will “to prohibit contribution to the genepool.” So-called “retarded persons were routinely sterilized without their consent or knowledge,” and the United States was the first country to introduce eugenic laws, which were later upheld by the U.S. Supreme Court. In the 1930s, a vocal proponent complained: “The Germans are beating us at our own game.”

    Back to hair loss. Testosterone is the primary androgen circulating in the blood and can be converted to dihydrotestosterone, which is even more powerful, by an enzyme called 5-alpha reductase, shown below and at 2:28 in my video.

    That’s the enzyme that is blocked by Propecia, so it inhibits the souping up of testosterone. That’s why women are not supposed to take it since it could feminize male fetuses; whereas for men, it has sexual side effects like erectile dysfunction, which can affect them for years. It’s something the drug companies had to disclose for the last decade: a “difficulty in achieving an erection that continues after stopping the medication,” a side effect that may even be permanent. Up to 20% of study participants reported “persistent sexual dysfunction” for six or more years after stopping the drug, suggesting the possibility that it may be permanent.

    It’s possible that the drug may structurally change the part of your brain responsible for sexual function. Indeed, though blood levels of hormones in users with persistent effects appear normal, analysis of the cerebrospinal fluid surrounding the brain, obtained via spinal tap, shows that neurosteroid levels do appear to end up being altered. So, “it is recommended that prescribers of finasteride, as well as potential users, be aware of the potential serious long-term risks of a medication used for a cosmetic purpose.”

    To date, no new interventions are used routinely in treating male or female pattern baldness. Given the side effects of the current drug options, “there is a need for alternative treatments.” So, what about food? Could what we eat help combat hair loss? That’s exactly what we’re going to explore next.

    Doctor’s Note

    This is the second in a three-part series on hair loss and growth. Do Hair Growth Supplements Work? is the first video, in case you missed it.

    Antidepressants like Prozac can also cause sexual dysfunction, but there is something that may help. See Best Food for Antidepressant-Induced Sexual Dysfunction.



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  • UCLA Wins .9 Million to Test Drugs That Might Make Melanoma Immunotherapy Work for More Patients

    UCLA Wins $3.9 Million to Test Drugs That Might Make Melanoma Immunotherapy Work for More Patients

    Immune checkpoint inhibitors transformed melanoma treatment. They also leave a large share of patients behind, and figuring out what to do for those patients is the central unsolved problem in the field.

    UCLA researchers have received a five-year, $3.9 million grant from the National Cancer Institute to work on it. The award goes to Cristina Puig-Saus, an associate professor of microbiology, immunology and molecular genetics and surgical oncology at the David Geffen School of Medicine and an investigator at the UCLA Health Jonsson Comprehensive Cancer Center, according to UCLA Health. She is also a member of the UCLA Broad Stem Cell Research Center and the UCLA Parker Institute for Cancer Immunotherapy.

    This is funding for research, not a result. Nothing has been shown to help any patient, and the work described is preclinical.

    The Grant Is About Fixing Non-Response, Not Explaining It

    A distinction worth drawing precisely, because it changes what to expect from this work.

    The project is not primarily a study of why some patients respond, and others do not. It is drug development aimed at overcoming barriers already identified. Using a drug screening platform developed in the Puig-Saus laboratory to test thousands of compounds, the team identified two candidates, and the two work by different routes.

    One appears to strengthen the interaction between T cells and cancer cells, helping the immune system mount a more effective attack. The other makes tumor cells more susceptible to destruction by T cells without directly altering the immune cells themselves. That second approach is notable because it sidesteps the problem of a patient’s T cells being exhausted or scarce.

    The funding will support testing whether those compounds boost the effectiveness of existing immunotherapies in preclinical melanoma models, investigating how the drugs work, and evaluating their potential to be used safely. Puig-Saus has said that because the compounds are designed to work alongside existing immunotherapies, the approach could potentially apply across many cancer types.

    Why So Many Patients Do Not Respond

    The underlying problem is worth explaining, because it is what any approach has to solve.

    Checkpoint inhibitors work by releasing the brakes on T cells so they can attack tumors. That only helps if T cells can find the tumor in the first place. Two failure modes dominate.

    The first is recognition. T cells often struggle to identify cancer cells, particularly when tumors reduce the display of the surface molecules that mark a cell as abnormal. A tumor the immune system cannot see is not helped by removing a brake.

    The second is evasion. Tumors evolve under immune pressure. They can lose the specific proteins T cells were targeting, recruit suppressive cells, or create a local environment that exhausts T cells. Tumors described as cold have few infiltrating T cells to begin with.

    The scale of the gap is substantial. UCLA has previously reported that 40 percent of patients with melanoma do not respond to checkpoint blockade, with response especially poor in rarer forms including acral melanoma on the palms and soles, uveal melanoma in the eye, and mucosal melanoma.

    The Screening Platform Is the Method Worth Noting

    How the two candidate compounds were found says something about where cancer drug discovery has moved.

    Rather than starting from a hypothesis about a single molecule, the laboratory built a screening platform capable of testing thousands of compounds for effects on the interaction between T cells and cancer cells. That approach asks which compounds change the behavior of the system, then works backward to understand why.

    The advantage is that it can surface candidates nobody would have predicted from existing biology. The trade-off is that a compound identified this way arrives without a fully worked-out mechanism, which is precisely why part of the grant is devoted to investigating how the drugs work rather than only whether they work.

    That mechanistic question is not academic. Understanding how a compound acts is what allows researchers to predict side effects, identify which patients might benefit, and design sensible combinations with existing immunotherapies.

    The Timeline for Anything Reaching Patients

    Preclinical grants are frequently reported in ways that imply proximity to treatment, and the arithmetic does not support that.

    Five years of preclinical work would be followed, if results justify it, by formal toxicology studies, manufacturing under regulated conditions, and an investigational new drug application before a first human trial. That first trial would test safety and dosing rather than benefit. Efficacy testing would follow.

    Most compounds entering this pipeline do not reach patients. That is not pessimism about this particular project; it is the base rate, and it is why the honest framing is that federal funding has been committed to a promising question.

    What patients with melanoma can act on is different. Checkpoint inhibitors, targeted therapies for BRAF-mutant disease, and tumor-infiltrating lymphocyte therapy are all available now depending on tumor characteristics and prior treatment. Molecular testing of the tumor determines which apply.

    For patients whose disease has progressed on checkpoint inhibitors, clinical trials are frequently the most substantive option, and enrollment is concentrated at academic and NCI-designated cancer centers. The same laboratory is separately advancing an experimental CAR T cell therapy for melanoma toward a trial, which is the kind of option worth asking an oncologist about directly.

    Melanoma prevention and early detection remain the most effective interventions available. Anyone noticing a mole that changes in size, shape, or color, has an irregular border or uneven color, or looks different from other moles should have it examined. Early-stage melanoma is frequently curable with surgery alone.

    This article is general information and is not medical advice.

    Frequently Asked Questions

    What was funded? A five-year, $3.9 million National Cancer Institute grant to Cristina Puig-Saus at UCLA.

    What will the money support? Preclinical testing of two compounds identified through a drug screening platform, aimed at boosting existing immunotherapies in melanoma models.

    How do the two compounds differ? One strengthens the interaction between T cells and cancer cells. The other makes tumor cells more vulnerable to T cells without altering the immune cells.

    Why do checkpoint inhibitors fail in some patients? T cells often cannot recognize cancer cells, and tumors evolve to evade immune attack. UCLA has reported that 40 percent of melanoma patients do not respond.

    Has anything been shown to work? No. This is funding for research. No patient benefit has been demonstrated.

    When could this reach patients? Not for many years, if at all. Preclinical work precedes toxicology, manufacturing, and first-in-human safety trials.

    What can melanoma patients do now? Ask about molecular testing, currently approved options, and open clinical trials, particularly at NCI-designated centers.

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  • A Smuggling Prosecution Over Inactivated Mpox Samples Has Scientists Warning About Outbreak Preparedness

    A Smuggling Prosecution Over Inactivated Mpox Samples Has Scientists Warning About Outbreak Preparedness

    Two National Institutes of Health virologists have pleaded not guilty to charges of conspiring to smuggle mpox samples into the United States, in a case that a dozen scientists interviewed by KFF Health News say has less to do with public danger than with the paperwork that governs how American laboratories study overseas outbreaks.

    The samples were inactivated. The FBI’s own testing confirmed it, and one of the charged researchers helped develop the inactivation technique. That detail sits at the center of why the prosecution has unsettled the infectious disease research community.

    The practical stakes for households are indirect but real. The pipeline that produces diagnostic tests for emerging viruses runs through exactly this kind of specimen transfer, and researchers say the case is already changing how willing they are to participate.

    The Case as Charged

    Vincent Munster, chief of the virus ecology section at NIH’s Rocky Mountain Laboratories in Hamilton, Montana, and Claude Kwe, a research fellow working under him, were stopped at Detroit Metropolitan Airport on January 25, arriving on a flight from Paris after nine days in the Republic of the Congo.

    They were arrested on June 2, when a criminal complaint was unsealed in federal court in Detroit charging conspiracy to smuggle mpox into the United States and lying to border agents. According to the complaint, the two told customs officials that the tubes in their luggage held diagnostic reagents. Each faces a maximum of five years.

    The Justice Department’s announcement said FBI testing had confirmed the viruses were inactivated but that the scientists jeopardized Americans’ safety. Jerome Gorgon, U.S. attorney for the Eastern District of Michigan, said the researchers had smuggled viral pathogens on a packed commercial airplane from an outbreak.

    Federal code requires researchers to register and certify inactivated viruses. The complaint states the pair lacked appropriate documents. Both scientists have been suspended and barred from the laboratory campus during an internal investigation, as MedicalDaily reported. Kwe’s federal community defender has said only that his client is presumed innocent and that comment should await further proceedings.

    The Reason Laboratories Bring Samples Home

    Studying an outbreak from a distance has limits. Developing a diagnostic test that reliably detects a circulating strain requires working with material from that strain, and validating a laboratory method requires the same.

    Several scientists told KFF Health News that the specimens Munster and Kwe carried were most likely intended for exactly the diagnostic development purpose stated to customs officers. Tracking viral evolution, evaluating whether existing tests still detect new variants, and assessing whether vaccines and treatments remain effective all depend on access to current specimens from where transmission is occurring.

    This work is regulated rather than freewheeling. Import permits, select agent rules, inactivation certification, institutional biosafety review and hazardous materials shipping requirements all apply, and researchers typically coordinate them weeks in advance with an institution’s biosafety office. The allegation here is a failure to satisfy those requirements, not an allegation that the material itself was dangerous.

    A Pattern Researchers Say They Recognize

    The case follows a series of prosecutions involving biological material carried or shipped by scientists, several brought by the same US attorney’s office in the Eastern District of Michigan. Earlier cases involved Chinese nationals at a University of Michigan laboratory and a Russian-born Harvard researcher stopped with frog embryos.

    Reporting by KFF Health News, published through CNN, found that a dozen scientists interviewed characterized the arrests as part of a broader campaign, arguing that any errors involved were procedural and posed no threat to the public.

    The reaction inside the field is about credibility as much as law. Kim Hasenkrug, an NIH scientist emeritus who worked at Rocky Mountain Laboratories for 31 years, said the episode gives ammunition to people trying to stop this valuable research and sows distrust even among people who had trusted the laboratory in the past.

    NIH has said it activated established notification procedures and is cooperating with law enforcement, while declining further comment.

    The Downstream Effect on Detection Speed

    The concern researchers raise is not about this case’s outcome. It is about what other scientists conclude from watching it.

    If participating in an international outbreak response carries perceived legal exposure, fewer researchers volunteer, fewer specimens move, and the interval between a new pathogen appearing somewhere and a validated test existing everywhere gets longer. That interval is what determines how early an outbreak is caught in a US emergency department.

    Funding is compounding the problem. Scientists told KFF Health News that cuts to US foreign aid and research funding have left tens of millions of dollars in gaps in the response to spreading Ebola and mpox outbreaks.

    None of this is measurable yet, and it would be overstating the evidence to claim detection has already slowed. What can be said is that the researchers doing this work say the deterrent is real, and that no formal change to import rules or NIH collaboration policy has been announced.

    For readers, mpox risk in the United States remains concentrated in specific exposure contexts rather than general community spread, and CDC guidance on vaccination for people at higher risk has not changed as a result of this case. The next developments to watch are further court proceedings, reported from Detroit, and any policy guidance from NIH or HHS on international specimen transport.

    Frequently Asked Questions

    Were the samples dangerous? FBI testing confirmed the mpox virus in the vials was inactivated. One of the charged researchers helped develop the inactivation method.

    What are the charges? Conspiracy to smuggle and lying to federal agents. Each carries a maximum of five years. Both defendants pleaded not guilty.

    Why do researchers import virus samples? To develop and validate diagnostic tests, track viral evolution and assess whether existing vaccines and treatments remain effective against circulating strains.

    Is that legal? Yes, with permits, inactivation certification, and proper declaration. The allegation is that those requirements were not met.

    Does this affect my mpox risk? No. The case does not change transmission risk or CDC vaccination guidance for people at higher exposure risk.

    Has anything about research rules changed? No formal change to import requirements or NIH collaboration policy has been announced. Both scientists are suspended pending an internal investigation.

    What happens next? The case proceeds through federal court in the Eastern District of Michigan.

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  • Histoplasmosis and Work | Histoplasmosis

    Histoplasmosis and Work | Histoplasmosis

    Overview

    Histoplasmosis is an infection caused by a fungus called Histoplasma. Anyone who works with or near material contaminated with Histoplasma can develop histoplasmosis.

    The fungus lives in the environment, particularly in soil that contains large amounts of bird or bat droppings. People can get histoplasmosis after breathing in the microscopic fungal spores (also known as conidia) from the air.

    Most people exposed to Histoplasma never have symptoms. For people who do get sick, the severity of histoplasmosis varies widely. The severity depends on:

    • The amount and length of the exposure.
    • If the person is at higher risk for developing the severe forms.

    Symptoms of histoplasmosis usually appear between 3 and 17 days after a person breathes in the fungal spores. Common symptoms include fever, cough, and fatigue.

    What to do

    What to do if you are exposed at your workplace

    If you think you’ve been exposed to Histoplasma at work, you should contact:

    • Your crew leader or supervisor.
    • Your occupational health or risk management department.

    If your workplace does not have these services, you should contact your local city, county, or state health department. We do not know if antifungal medication (prophylaxis) can prevent histoplasmosis after a workplace exposure. However, it can be considered for high-risk exposures.

    For more information about laboratory exposures to Histoplasma, please see Safety guidelines for laboratory workers who handle Histoplasma.

    What to do if you are sick

    If you think you have histoplasmosis after working in an area where Histoplasma is common:

    • Report your symptoms to your crew leader or supervisor.
    • Visit a healthcare provider, if needed.
    • Tell them you work in an area where Histoplasma is common.
    • Ask to be tested for histoplasmosis.

    People at increased risk

    Activities associated with histoplasmosis

    Environmental disruption of Histoplasma habitats is often a key factor associated with histoplasmosis outbreaks.1 It is also associated with isolated cases,2 although to a lesser extent. These activities include:

    • Disturbance of large accumulations of bird or bat droppings.
    • Soil disruption (digging or excavation).
    • Plant matter disruption (handling trees or landscaping).
    • Demolition, construction, or renovation.
    • Working in caves.

    Jobs associated with histoplasmosis

    In areas where Histoplasma is common, workers in some industries may be at higher risk for histoplasmosis:

    • Construction, demolition, and extraction occupations.
    • Agriculture and forestry industries.

    People who are also at risk include:

    • Workers in occupations or industries exposed to bird or bat droppings.
    • Those involved with activities that disrupt the environment.

    Most of what we know about jobs that may be related to a higher chance of getting sick comes from outbreak investigations. Approximately one-third of histoplasmosis outbreaks in the United States are work-related.1 However, outbreak-related histoplasmosis cases represent only a small fraction of overall known cases (about 5%).2 Examples of people affected by work-related histoplasmosis outbreaks include:1

    • Bridge workers.
    • Construction or demolition workers.
    • Farmers.
    • Landscapers or tree removal workers.
    • Microbiology laboratory workers.

    Histoplasmosis outbreaks have also affected people who were exposed in the workplace but not directly involved in activities that initiated the outbreak. For example, outbreaks affecting office building workers after construction or renovation.1

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  • The Zōē Method — Personalized Coaching Built for a Woman’s Body

    The Zōē Method — Personalized Coaching Built for a Woman’s Body

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