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Editorial, Opinion Piece Discuss Issues Related To Routine HIV Testing
A recent directive to streamline the HIV testing consent process in Massachusetts as well as consent forms "no longer hav[ing] to accompany test specimens to the lab," are bringing "the state closer to a CDC recommendation that clinicians provide HIV screening on an opt-out basis," according to a Boston Globe editorial. "The opt-out provision is at the heart" of legislation sponsored by state Sen. Patricia Jehlen (D) that would end the state"s requirement of written consent for HIV testing "and instead have healthcare providers inform patients verbally that the test is planned but that they can decline it," the editorial states, adding, "The Jehlen bill would help destigmatize HIV testing itself" (7/6).
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ACOG Issues New Guidelines On Fetal Monitoring To Resolve Inconsistencies In Interpretation
The American College of Obstetrics and Gynecology recently published new guidelines on electronic fetal monitoring in an attempt to increase consistency in the way physicians interpret and act on the results, the New York Times reports. Electronic fetal monitoring, which was introduced in the 1970s, is used during labor for more than 85% of the four million infants born alive in the U.S. annually, the Times reports. According to the Times, use of fetal monitors became standard obstetrical practice before it was known if the benefits outweighed the risks. The new guidelines refine the meaning of various readings from fetal monitors and could help doctors make better decisions about whether to intervene during labor.According to experts, the widespread adoption of fetal monitoring has produced both negative and positive consequences, including significant increases in caesarean deliveries and the use of forceps during vaginal deliveries. Monitoring has not been found to reduce the risk of either cerebral palsy or fetal death resulting from inadequate oxygen to the fetal brain, as it was intended to do. Furthermore, lawyers commonly use monitoring results to support malpractice cases that might have little merit, which in turn has driven rising malpractice insurance costs and prompted some obstetricians to stop delivering infants.The new guidelines divide monitor readings into three categories to help doctors interpret readings more consistently. The old guidelines had two categories -- reassuring and non-reassuring -- and it was up to the obstetrician to determine whether a non-reassuring reading required intervention. Under the new guidelines, the first category applies when tracings of the fetal heart rate are normal and no specific action is required. The second category is for indeterminate tracings that require evaluation, continuous surveillance and re-evaluation. Obstetricians treating patients in this category should consider other clinical factors that could affect the fetus and whether the patient could be safely moved to category one, according to Catherine Spong of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which produced recommendations on which the guidelines are based. The final category is for abnormal tracings that require immediate evaluation and efforts to reverse the abnormal heart rate. The Times reports that more refinements to the guidelines are expected to be released in 2010 (Brody, New York Times, 7/7).
News of the day
RCN Statement On Lord Ara Darzi
Commenting on news that Lord Ara Darzi will stand down as a government minister, Dr Peter Carter, Chief Executive of the Royal College of Nursing (RCN), paid tribute to his contribution to the health service. He said:
Mental Health

Addex Partner Starts First-Ever Clinical Trial Of An MGluR Positive Allosteric Modulator

Allosteric modulation company Addex Pharmaceuticals (SWISS: ADXN) announced today that its partner Ortho-McNeil- Janssen Pharmaceuticals Inc. (OMP) has started Phase I testing of ADX71149, a metabotropic glutamate receptor 2 (mGluR2) positive allosteric modulator (PAM). This product, which has potential to treat schizophrenia, anxiety, depression and other CNS disorders, is the first PAM of any mGluR subtype to enter clinical trials. Targeting mGluR2 with a PAM is a novel approach that may offer advantages over classical drug approaches. In reaching this milestone, Addex received a EUR 1 million payment from OMP and remains eligible for additional development milestones and royalties. Allosteric modulators are a novel class drugs that exert their effects on a specific receptor by interacting with a different site than the traditional binding site used by traditional "orthosteric" drugs and the body"s natural activators (i.e. endogenous ligands), glutamate in this case. Allosteric molecules afford modulation of receptors that is different than orthosteric drugs. Furthermore, Addex believes it can find specific drug-like allosteric modulators with more success than others have had with orthosteric drug discovery. "We are proud to have been able, together with our partner, to discover and develop the first mGluR2 PAM to reach human beings," said Vincent Mutel, CEO of Addex. "Because activating mGluR2 has been recognized as one of the most promising strategies for treating anxiety and more recently, schizophrenia, developing an allosteric modulator, like ADX71149, specifically targeting this brain receptor has been an exciting scientific endeavor and we are looking forward to seeing how differentiated this modulatory approach will be in humans." Note for editors: An orthosteric agonist binds at the same site on a receptor as the endogenous ligand, in this case, glutamate. Much like flipping a light switch on, endogenous ligands or orthosteric agonists, effectively turn receptors on, sending a message to the cell to perform a specific function. By contrast, an allosteric modulator binds at a different site on the receptor than the endogenous ligand. As a result, an allosteric modulator does not turn on/off a receptor but rather exerts its influence only when the endogenous ligand also is binding (i.e. the switch is turned on). Thus, allosteric modulators act much more like a dimmer than an on/off switch. Positive allosteric modulators increase the signal sent into the cell by the receptor, while a negative allosteric modulators (NAM) reduce it. This approach may prove advantageous because it allows the body to maintain control over the physiological on/off rhythm - something that no orthosteric drug has been able to emulate - while affording a new kind of therapeutic influence at disease mediating receptors. Although no drug specifically targeting mGluR2 is marketed, a Phase II clinical study published in Nature Medicine in 2007 showed that an orthosteric mGluR2/3 agonist improved symptoms of schizophrenia with efficacy similar to a leading marketed drug for schizophrenia. Separately, a related orthosteric mGluR2/3 agonist has been shown to have efficacy in Phase II trials in patients with generalized anxiety disorder. Activation of mGluR2 also has been shown to be efficacious in multiple preclinical models of anxiety. Addex Pharmaceuticals


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