Protection Without a Vaccine

Last month, a team of scientists announced what could prove to be an enormous step forward in the fight against H.I.V.

Scientists at Scripps Research Institute said they had developed an artificial antibody that, once in the blood, grabbed hold of the virus and inactivated it. The molecule can eliminate H.I.V. from infected monkeys and protect them from future infections.

But this treatment is not a vaccine, not in any ordinary sense. By delivering synthetic genes into the muscles of the monkeys, the scientists are essentially re-engineering the animals to resist disease. Researchers are testing this novel approach not just against H.I.V., but also Ebola, malaria, influenza and hepatitis.

“The sky’s the limit,” said Michael Farzan, an immunologist at Scripps and lead author of the new study.

Dr. Farzan and other scientists are increasingly hopeful that this technique may be able to provide long-term protection against diseases for which vaccines have failed. The first human trial based on this strategy — called immunoprophylaxis by gene transfer, or I.G.T. — is underway, and several new ones are planned.

“It could revolutionize the way we immunize against public health threats in the future,” said Dr. Gary J. Nabel, the chief scientific officer of Sanofi, a pharmaceutical company that produces a wide range of vaccines.

Whether I.G.T. will succeed is still an open question. Researchers still need to gauge its safety and effectiveness in humans. And the prospect of genetically engineering people to resist infectious diseases may raise concerns among patients.

“The reality is we are touching third rails, and so it’s going to take some explanation,” said Dr. David Baltimore, a Nobel Prize recipient and virologist at Caltech who is testing I.G.T. against a number of diseases.

Conventional vaccines prompt the immune system to learn how to make antibodies by introducing it to weakened or dead pathogens, or even just their molecular fragments. Our immune cells produce a range of antibodies, some of which can fight these infections.

In some cases, these antibodies provide strong defenses. Vaccinations against diseases such as smallpox and measles can lead to almost complete protection.

But against other diseases, conventional vaccines often fail to produce effective antibodies. H.I.V., for example, comes in so many different strains that a vaccine that can protect against one will not work against others.

I.G.T. is altogether different from traditional vaccination. It is instead a form of gene therapy. Scientists isolate the genes that produce powerful antibodies against certain diseases and then synthesize artificial versions. The genes are placed into viruses and injected into human tissue, usually muscle.

Photo Dr. Michael Farzan, an immunologist at Scripps Research Institute, helped develop an artificial antibody that inactivated H.I.V. in monkeys. Credit Benjamin Rusnak for The New York Times

The viruses invade human cells with their DNA payloads, and the synthetic gene is incorporated into the recipient’s own DNA. If all goes well, the new genes instruct the cells to begin manufacturing powerful antibodies.

The idea for I.G.T. emerged during the fight against H.I.V. In a few people, it turned out, some antibodies against H.I.V. turn out to be extremely potent. So-called broadly neutralizing antibodies can latch onto many different strains of the virus and keep them from infecting new cells.

Dr. Philip R. Johnson, a virologist at the University of Pennsylvania, had an idea: Why not try to give broadly neutralizing antibodies to everybody?

At the time, Dr. Johnson and other researchers were experimenting with gene therapy for disorders like hemophilia. Researchers had figured out how to load genes into viruses and persuade them to invade cells, and it occurred to Dr. Johnson that he might be able to use this strategy to introduce the gene for a powerful antibody into a patient’s cells.

After the cells began producing antibodies, the patient in effect would be “vaccinated” against a disease.

The idea represented a radical new direction for gene therapy. Until then, researchers had focused on curing genetic disorders by providing working versions of defective genes. I.G.T., on the other hand, would protect healthy people from infectious diseases.

And there was no guarantee that it would succeed. For one thing, the best virus Dr. Johnson had for delivering genes worked only to invade muscle cells — which normally would never make antibodies.

In 2009, Dr. Johnson and his colleagues announced that the approach worked after all. In their experiment, they sought to protect monkeys from S.I.V., a primate version of H.I.V. To do so, they used viruses to deliver powerful genes to the monkeys’ muscles.

The muscle cells produced S.I.V. antibodies, as Dr. Johnson and his colleagues had hoped. Then they infected the monkeys with S.I.V. The monkeys produced enough antibodies in their muscles to protect them from S.I.V. infections, the scientists found. Without the I.G.T. procedure, monkeys dosed with the virus died.

Dr. Johnson’s study persuaded Dr. Farzan that I.G.T. has great promise. “I started drinking the Kool-Aid,” he said. Dr. Farzan and his colleagues have been modifying H.I.V. antibodies to develop more potent defenses against the virus.

Meanwhile, in 2011, Dr. Baltimore and his colleagues showed that antibodies delivered into cells with viruses could protect mice against injections of H.I.V., suggesting that I.G.T. could protect people against H.I.V. in contaminated needles.

But most H.I.V. infections occur through sex. So Dr. Baltimore and his colleagues also infected female mice with H.I.V. through their vaginal membranes. Last year, they reported that the technique also protected mice from infection in this way.

“We’re going around the immune system, rather than trying to stimulate the immune system,” Dr. Baltimore said. “So what we’re doing is pretty fundamentally different from vaccination, although the end result is pretty similar.”

Gary W. Ketner, a microbiologist at the Johns Hopkins Bloomberg School of Public Health, was intrigued by Dr. Baltimore’s results and wondered if I.G.T. could be marshaled against another major disease that has eluded vaccines: malaria.

Photo Dr. Philip R. Johnson, a virologist at the University of Pennsylvania, developed an approach of giving neutralizing antibodies to healthy people. Credit Jessica Kourkounis for The New York Times

Dr. Ketner, Dr. Baltimore and their colleagues found a potent antibody against malaria and used a virus to deliver the gene for making it into mice. Last August, they reported that when malaria-laden mosquitoes bit the mice, up to 80 percent of the treated animals were protected.

“It is encouraging,” Dr. Ketner said. “It’s good for a first shot of an unproven method, but it should be better.” Now Dr. Ketner is searching for better antibodies that provide more protection in a smaller dose.

These experiments suggest that antibodies created by I.G.T. could help against diseases that have resisted vaccines for decades. Other studies suggest that I.G.T. might also help against sudden outbreaks in the future.

Dr. James M. Wilson, a pathologist at the University of Pennsylvania, and his colleagues have investigated using gene therapy to treat cystic fibrosis by delivering genes into the cells lining patients’ airways. It occurred to him that many fast-spreading viruses, such as influenza and SARS, also attack the same cells.

In 2013, Dr. Wilson and his colleagues reported that viruses carrying antibody genes into airway cells can enable mice and ferrets to fight off a wide range of flu strains. Since then, he and his colleagues have tested I.G.T. against other viruses causing deadly outbreaks — including Ebola.

Dr. Wilson and his colleagues teamed with Mapp Biopharmaceutical, a company that has developed an antibody against Ebola called ZMapp. The scientists have synthesized a gene for the ZMapp antibody and have delivered the gene into mouse muscles. The experiments are only in their early stages, but “we have encouraging data,” Dr. Wilson said.

For Dr. Johnson, the growing interesting in I.G.T. is gratifying. “It’s catching on, but it’s certainly not mainstream,” he said. That seems likely to change, and soon.

Last February, Dr. Johnson began the first clinical trial of I.G.T. in humans. His team has placed H.I.V. antibody genes into the muscles of volunteers to see if the treatment is safe. The researchers expect to finish gathering the results this spring. “We’re optimistic. We’re hopeful,” Dr. Johnson said.

Dr. Baltimore is collaborating with the National Institutes of Health to start a similar trial of an I.G.T.-engineered virus against H.I.V. Dr. Wilson is preparing to test I.G.T. against the flu later this year.

There is no guarantee that the successes in the animal trials can be replicated in humans. “Humans are not just big mice,” said Dr. Ronald G. Crystal, chairman of genetic medicine at Weill Cornell Medical College.

Human immune systems may attack the artificial antibodies or the viruses delivering them, destroying their protection. Or muscle cells might make too many antibodies, because they do not have the built-in regulation that immune cells do.

Dr. Farzan and other researchers are investigating molecular switches that can turn off the production of antibodies, or just adjust their dose. “If we really want to see this blossom, we need regulatory ‘off’ switches,” he said.

Despite the lingering concerns about I.G.T., Dr. Nabel says he remains optimistic. “There are safety concerns that have to be addressed, but there are logical ways to approach them,” he said.

Bioethicists do not foresee major ethical hurdles to I.G.T., because it is based on gene therapy, which has been developed for more than 30 years. “It doesn’t strike me as a radical departure,” said Jonathan Kimmelman, an associate professor at McGill University.

Still, Dr. Baltimore says that he envisions that some people might be leery of a vaccination strategy that means altering their own DNA, even if it prevents a potentially fatal disease.

“But my feeling, as a basic scientist, is that it’s our responsibility to take things into the clinic that we feel will make a difference,” he said.

Prostate, breast cancer share genetic link

A family history of prostate cancer may be tied to a woman's risk of breast cancer, a new study suggests.

Women whose father, brother or son have had prostate cancer may have a 14 percent higher risk of developing breast cancer, said Jennifer Beebe-Dimmer, a researcher at the Barbara Ann Karmanos Cancer Institute at Wayne State University in Detroit.

Those women with a family history of both prostate and breast cancer were at a 78 percent greater risk of developing breast cancer, the researchers found. And the risk was greater for black women than whites.

The researchers found a link, not a direct cause-and-effect relationship, between family history of prostate cancer and women's breast cancer risk. However, this is "one of the largest studies, if not the largest study, to examine the association," Beebe-Dimmer said.

The 14 percent increase "is a modest increase in risk," she said. Of the two, "breast cancer family history is likely still more important in terms of risk assessment," she added.

10 Photos

Prostate Cancer Self-Defense: Nine Deadly Myths

Frequent Sex Blocks Prostate Cancer? That's Just One of Many Myths about the Disease

The findings underscore the need for women to know their complete family medical history, "particularly cancer diagnosed among first-degree relatives," including fathers, brothers and sons, Beebe-Dimmer said.

Doctors should ask about all cancers in the family, even in members of the opposite sex, she suggested.

"Communication of this information to the physician is important in assessing future risk of breast cancer and may impact screening recommendations," Beebe-Dimmer said.

For the study, published online March 9 in the journal Cancer, Beebe-Dimmer's team evaluated more than 78,000 women enrolled in the Women's Health Initiative Observational Study between 1993 and 1998. At the study start, all were free of breast cancer. When follow-up ended in 2009, more than 3,500 breast cancer cases had been diagnosed. The researchers looked to see which patients' family members had either breast or prostate cancer.

Cancers of the breast and prostate are among the most common invasive cancers found in the United States, Beebe-Dimmer said. In 2014, an estimated 233,000 new breast cancer cases and 233,000 new prostate cancer cases were diagnosed in the United States, according to background information in the study.

Beebe-Dimmer can't say for sure what may be driving the potential link between prostate and breast cancers. "It may be genetic, it may be shared environment," she said. The two cancers have similar causes in that both are driven by exposure to the sex steroid hormones estrogen and testosterone, she explained.

Dr. Courtney Vito, assistant professor of surgical oncology at City of Hope Cancer Center in Duarte, Calif., was not involved with the study. She said the "article raises an interesting point."

26 Photos

Breast cancer awareness: 25 myths busted

How much do you really know about breast cancer? Less than you might think

Some of the possible increased risk, Vito said, may be due to the presence of the BRCA1 and BRCA2 gene mutations. However, that information was not available to the researchers. Men with BRCA1 and 2 mutations have a higher risk of prostate cancer, and women with the mutations have higher risks of breast and ovarian cancer, researchers have found.

These mutations "may explain some of this relationship but not all," Vito said.

Discoveries about new genes that may function in concert with the BRCA genetic mutations might shed more light on the possible link, she said.

Vito and Beebe-Dimmer agreed that more study is needed to figure out to what extent genes and shared environment contribute to risk for both breast and prostate cancer.

FDA Approves United States' First 'Biosimilar 'Drug, Zarxio

The U.S. Food and Drug Administration (FDA) has approved the first biosimilar product in the U.S.

By Rebekah Marcarelli r.marcarelli@hngn.com | Mar 08, 2015 05:38 PM EDT

The FDA approved the country's first biologically similar product. (Photo : Wikimedia )

The U.S. Food and Drug Administration (FDA) has approved the first biosimilar product in the U.S.

The drug, dubbed Zarxio (filgrastim-sndz), is biosimilar ("highly similar to an already-approved biological product") to Amgen Inc.'s Neupogen, the FDA reported. Biological products are those derived from living organisms such as yeasts or even humans and animals.

Zarxio is approved for the same applications as Neupogen, which includes prescriptions for: "patients with cancer receiving myelosuppressive chemotherapy; patients with acute myeloid leukemia receiving induction or consolidation chemotherapy; patients with cancer undergoing bone marrow transplantation; patients undergoing autologous peripheral blood progenitor cell collection and therapy; and patients with severe chronic neutropenia."

"Biosimilars will provide access to important therapies for patients who need them," said FDA Commissioner Margaret A. Hamburg. "Patients and the health care community can be confident that biosimilar products approved by the FDA meet the agency's rigorous safety, efficacy and quality standards."

The approval of this new biosimilar drug was based on "structural and functional characterization, animal study data, human pharmacokinetic and pharmacodynamics data, clinical immunogenicity data and other clinical safety and effectiveness data." The most common side effects seen with the newly-approved drug include aching in the bones and muscles as well as irritation at the injection site. Serious side effects can occur such as spleen rupture, serious allergic reaction, and acute respiratory distress syndrome.

The Biologics Price Competition and Innovation Act of 2009 (BPCI Act) was passed as part of the Affordable Care Act and creates an abbreviated licensure pathway for biological products that can be proven to be biologically similar to those that have already been FDA approved. It allows biosimilar biological product to be licensed based on "less than a full complement of product-specific preclinical and clinical data," the FDA stated. 

A drink a day may not be good for everyone

Based on a new analysis, the health benefits of having a drink a day may be exaggerated, UK researchers say.

Only women over age 65, if anyone, might get a protective effect from light drinking, compared to people who never drank, the study found.

Much past research has shown that people who drink a low to moderate amount of alcohol – about one drink per day – fare better than both heavy drinkers and those who abstain completely.

But that non-drinker comparison group may be skewing the results, according the new study’s lead author Craig S. Knott of the department of Epidemiology and Public Health at University College London.

People who used to drink but don’t anymore, for whatever reason, tend to be less healthy and more likely to die than others, he told Reuters Health by email.

“With existing research having largely grouped former and never drinkers together, there was the possibility that reductions in risk among lighter drinkers may be partly due to their comparison against people who are simply less healthy,” he said.

And people who have never had alcohol may have other health conditions that make drinking unsafe and make them less healthy than others, he noted.

When he and his coauthors left out former drinkers and compared light, moderate and heavy drinkers to those who only occasionally drank, the apparent benefits of drinking disappeared almost entirely.

They used annual, nationally-representative surveys of English adults age 50 or older collected from 1994 to 2008 and including a total of more than 45,000 people. At each survey, the participants reported how often they consumed alcohol during an average week and how much they drank on the heaviest drinking day of a typical week.

As other studies have found, currently drinking alcohol was associated with a lower risk of death in almost all age groups and levels of drinking compared to people who were not current drinkers, based on a linked database of deaths in England.

But when the researchers excluded those who used to indulge but had given it up, the apparent protective effect remained only for men between ages 50 and 65 and women over age 65. Protection was minimal for the men and only applied to those who drank at least seven pints of beer in an average week. It was broader, but still low, for the women, the authors write in BMJ.

Some other studies have in fact found the opposite, that alcohol in moderation is more effective for men than women, according to Dr. Giovanni de Gaetano of the University of Milan in Italy, who was not involved in the new study.

“Relative to occasional drinkers, there was little to no indication that regular light consumption may actually be of benefit in any age-sex group, at least in terms of mortality risk,” Knott said.

Any reductions in risk that remained after the study team adjusted for personal, socioeconomic and lifestyle factors, and left out the former drinkers, could still be the result of other biases in group selection, inaccurate alcohol reporting or residual factors that haven’t been accounted for, Knott said.

“On this basis, it seems sensible for current drinkers to consider moderating the amount of alcohol they consume, and for non-drinkers to remain abstinent,” he said.

Assigning a group to drink alcohol and another to abstain for a study would be unethical, so researchers have to try more sophisticated ways of comparing people in the real world and trying to account for other differences between them, he noted.

There is no good biological explanation for why light drinking might benefit older women, according to Jürgen Rehm, director of the Social and Epidemiological Research (SER) Department of the Center for Addiction and Mental Health in Toronto, Canada.

“Let us face it: alcohol is not consumed for health reasons,” Rehm told Reuters Health by email. “To avoid too much risk, people should drink lightly, best one drink at most per day. Most European drinkers exceed this limit and put themselves into risk.”

As age increases, it gets harder and takes longer for the body to eliminate ethanol from the blood, the authors note. Alcohol-related hospitalizations and deaths are most common for older age groups, they write.

“Nobody should drink alcohol for health reasons,” Rehm said.

Children’s Lung Health Improves as Air Pollution Is Reduced, Study Says

Pollution hangs over Los Angeles in the early 1990s. A new study shows that reducing air pollution leads to improved lung function in children.Credit Steve Starr/Corbis

For the first time, researchers have shown that reducing air pollution leads to improved respiratory function in children ages 11 to 15, a critical period of lung development.

Scientists have long known that air pollution is linked to smaller lung capacity and compromised breathing in children. But it had not been clear whether, and to what extent, a reduction in air pollution over the years might prevent these problems.

Environmentalists have maintained that federal emission standards are not stringent enough to safeguard health, while some conservatives criticize the regulations as overly restrictive and expensive. The new study, conducted in Southern California and published on Wednesday in The New England Journal of Medicine, provides evidence that better air quality, a result of stricter regulation, improved health among children, experts said.

Morton Lippmann, a professor of environmental medicine at New York University School of Medicine, said the research would be influential and predicted that within the next few years, when federal emission standards are due for review, “this kind of information will play a major role.”

“It provides confirmation that the work we’ve done to improve air pollution has made a difference in kids’ health,” said Dr. Joel Kaufman, a physician and epidemiologist at the University of Washington, who was not involved in the research. “There are more kids comfortable running around.”

Over 17 years, researchers at the University of Southern California studied air pollution levels as they declined in five regional communities. The scientists also measured breathing capacity in 2,120 schoolchildren from the communities during three periods: 1994-1998, 1997-2001 and 2007-2011.

The communities included the port city of Long Beach, Calif., as well as the inland city of Mira Loma, Calif., where mountains trap pollution blown eastward from the coast and downwind from agricultural production.

During those years, federal and state emission standards lowered the billowing output of California’s automobiles, diesel trucks, refineries, ships and trains. By the study’s conclusion in 2011, fine particulates had fallen by 50 percent and nitrogen dioxide levels by 35 percent in the communities, changes that were representative of declining pollution across the Los Angeles basin.

The children studied were in a period of pubertal growth during which lungs almost finish developing. Using a device called a spirometer, the children exhaled into a tube that measured both how much air they could breathe out in one second and how much air they could blow out completely.

The second measure, capacity, is often used as a surrogate to describe the size of the lungs themselves.

As emission standards tightened and the air became cleaner, the scientists found that lung development in children born in later years was more robust than in those born earlier. Moreover, the percentage of children with significantly impaired lung function declined during the study period, from 8 percent to 3.5 percent.

In 2011, the third wave of 15-year-olds was assessed. Over the four years the children were tested, the growth in their lung capacity had been about 10 percent greater than that of the 15-year-olds measured in 1998. The positive effects were observed in boys and girls, and regardless of race and ethnicity.

The average teenager running around a soccer field might not notice an appreciable difference, said W. James Gauderman, a professor of preventive medicine at the University of Southern California and the lead author of the Children’s Health Study, from which the data was drawn.

The larger implication, he said, was that the latest group of children may have a jump-start on longevity compared with children who grew up breathing more polluted air. Absent factors such as smoking or asthma, normal lung function slowly begins to decrease in early adulthood.

“When they’re done with the teenage years, they’re stuck with the lungs they have for the rest of their lives,” Dr. Gauderman said.

Studies have shown that adults exposed to high levels of air pollution are more susceptible to premature death from pulmonary and cardiovascular disease.

Dr. Kaufman speculated that a 10 percent improvement in lung function might translate into a five- or six-year delay in the onset of clinical lung disease, although such results could only be determined years from now.

During the years of the study, ozone levels declined only modestly. Although ozone has been associated with acute health problems, such as asthma attacks, Dr. Gauderman and his colleagues concluded that its reduction does not have the long-term effects on overall lung function that fine particulates and nitrogen dioxide do.

This study adds to a growing body of research that addresses not only the deleterious effects of air pollution on health, but restorative possibilities when pollution is reduced, including lowered mortality risk of lung cancer and cardiovascular disease.

“Some have argued that the substantial improvements in air quality over the past 40 years are sufficient to protect public health and that there is little evidence to support more stringent standards,” noted Douglas W. Dockery, a professor of environmental epidemiology at the Harvard T.H. Chan School of Public Health, in an editorial accompanying the new study. “However, the current report and other studies suggest that further improvement in air quality may have beneficial public health effects.”

Diane Katz, a research fellow in regulatory policy at the Heritage Foundation, a conservative policy organization, said it was good news that air pollution was reduced and children’s lung function had improved. But, she added, “The study doesn’t say anything about regulation. We don’t know what would have happened if we had had less burdensome regulation,” or whether automobile technology or other sources of emission controls alone “would have been just as effective.”

In an interview, Dr. Dockery said, “Ultimately, it’s a political decision about where we set the standards. There are trade-offs in restrictions in reducing automobile emissions and other industry curbs.”

“But if there is the opportunity to improve air quality,” he said, “we should think about those types of improvements to benefit our kids.”

For more fitness, food and wellness news, “like” our Facebook page.

A version of this article appears in print on 03/05/2015, on page A17 of the NewYork edition with the headline: Better Air Is Found to Improve Young Lungs.

The Infuriating Way Social-Media Companies Deal With Sex - Refinery29

This country has a sexual-health crisis on its hands, and our favorite websites aren't helping. In fact, social-media companies — including tech giants Facebook, Twitter, and YouTube — are compounding the U.S.'s dangerous lack of sexual-health information by refusing to allow sex educators to share their messages on healthy sex. And, sex therapist Amber Madison has had enough. "In the fall, I was at a conference with a bunch of different sex educators, and they were all talking about it," Madison told R29. "Of these major organizations, almost every single one had a story about Twitter, Facebook, YouTube — any social-media giant that you could think of — censoring their content, and usually stuff that was pretty mundane."

The problem: 89% of teens count the Internet as their primary sex-ed source, and it's failing them. In her story in The Atlantic, "When Social-Media Companies Censor Sex Education," out today, Madison details example after example of social-media platforms denying organizations the right to promote safe sex. Twitter, for example, claims it permits the promotion of tweets about "safer sex education, HIV/STD awareness campaigns, and non-prescription contraceptives," with the caveat that these tweets cannot "contain sexual content and do not link to sexual content." This means that a tweet such as "A condom can actually fit over your entire head!" is A-OK, while a tweet linking to a website that discusses both condoms and sexual pleasure can get an organization in trouble. The website of sex-education organization Bedsider, for example, addresses how to have both safe and pleasurable sex — which is why Twitter informed Bedsider that it would not allow promotion of Bedsider's tweets, because Bedsider was "painting sex in a recreational/positive light versus being neutral and dry" (Twitter's words). If we don't want our sex to be "dry" or "neutral," why should our sex education be? 

Similar policies — vague, ambiguous, inconsistently enforced — exist across social platforms. "While Kim Kardashian’s bare butt is 'breaking the Internet' with click-throughs," Madison observes in The Atlantic, "sexual-health organizations must compete for attention with slogans fit for high-school health books." It's clearly not a fair fight. Sex doesn't exist in a vacuum, nor should sex education be sanitized and disconnected from the lives of those it targets. Yet, social-media policy continues to insist this be the case.

It's why Madison chose to cover the issue, and start a petition at change.org requesting that social-media companies stop censoring sexual-health information. "I get that you don’t want to fill your platform with porn — though the irony is that some [social-media companies] are — but, you have to be a responsible citizen," Madison told us. "While it may not be easy to figure out a policy that allows sex educators to share their content while blocking content that is gratuitously sexual, it’s better than what they're doing now."

New Healthcare Insurance Scheme Strengthens Demand for Low-Cost Medicines in Indonesia, Finds Frost & Sullivan

JAKARTA, Indonesia, Mar 03, 2015 (PR Newswire Europe via COMTEX) -- -- Healthcare market in the country offers significant revenue opportunities for multinational drug makers

JAKARTA, Indonesia, March 3, 2015 /PRNewswire/ -- Indonesia is rapidly evolving into one of the most attractive healthcare markets for investors. In spite of the initial regulatory hurdles in setting up manufacturing units in Indonesia, companies from every healthcare sector, including hospitals, medical devices, pharmaceuticals and diagnostics, continue to look at the country as a major investment destination.

New analysis from Frost & Sullivan, Indonesia Healthcare Outlook (https://www.frost.com/p80f [https), finds that Greater Jakarta remains the most promising market due to strong infrastructure support, accessibility, and the presence of major hospitals. Kalimantan and Papua (outer Jakarta) too offer attractive potential. The manufacturing hub, currently in Bandung and Surabaya, is likely to move to newer areas such as Sei Mangke in North Sumatra and Tanjung Lesung in Banten as well as to the existing free-trade zone in the Riau Islands of Batam, Bintan and Karimun.

For complimentary access to more information on this research, please visit: http://corpcom.frost.com/forms/APAC_PR_DJeremiah_P80F-52_30Jan15 [http://corpcom.frost.com/forms/APAC_PR_DJeremiah_P80F-52_30Jan15].

The implementation of the Jaminan Kesehatan Nasional (JKN) insurance scheme has spiked patient volumes significantly, heightening the demand for hospital beds, medical devices, affordable medicines and diagnostic services. A few clinics in Bandung reported up to a 200 percent rise in patient volumes in the first 2 months after the scheme's implementation.

"Through JKN, government-run hospitals are looking to improve access to and affordability of healthcare in rural areas, thus spurring the demand for drugs," said Frost & Sullivan Healthcare Industry Manager Siddharth Dutta. "JKN is likely to fuel the need for drugs in the lower end of the market rather than the large-scale substitution of premium products."

However, domestic companies, especially in the pharmaceutical sector, still have a long way to go in terms of quality, efficiency and innovation. Further, Indonesia's physical infrastructure is considered sub-standard, as the archipelagic nature of the country makes it difficult to keep the national healthcare infrastructure together. Hospitals are unevenly distributed with maximum concentration of the Java and Sumatera islands.

Private healthcare services are addressing this gap in healthcare. It is helping meet the needs of the rapidly growing patient pool, which is also looking for quality care. Private healthcare is also opening up revenue streams for foreign and non-traditional healthcare companies. For instance, the in-vitro diagnostics (IVD) sector has more foreign companies than domestic, with approximately 80 percent of the market held by multinationals such as Roche (www.roche.com [http://www.roche.com/]), Abbott (www.abbott.com [http://www.abbott.com/]), BioMeriux (www.biomerieux.com [http://www.biomerieux.com/]) and Sysmex (www.sysmex.com [http://www.sysmex.com/]).

"The healthcare segment will remain a focal point for investors as streamlined processes like the implementation of e-catalogs or online pricing systems by the Indonesian government facilitate market entry," remarked Dutta. "The system will help control medical device prices and create healthy competition among foreign and domestic suppliers in the country."

For now, establishing partnerships with or acquiring local drug makers and distributors will provide quick access to the thriving Indonesian healthcare space. Considering that the Indonesian government prefers goods with local content - to stimulate domestic sourcing while procuring -foreign participants must leverage their strong finances and branding by having local partners to manage the business.

Indonesia Healthcare Outlook is part of the Life Sciences (http://www.lifesciences.frost.com [http://www.frost.com/prod/servlet/svcg.pag/HCLS]) Growth Partnership Service program. Frost & Sullivan's related studies include: End-User and Regional Perspectives on the China Healthcare IT Market, Multi-parameter Patient Monitoring Market in Asia-Pacific, Global Orthopedic Implant Market, and Global Wound Care Market Outlook. All studies included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.

About Frost & Sullivan

Frost & Sullivan, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today's market participants.

Our "Growth Partnership" supports clients by addressing these opportunities and incorporating two key elements driving visionary innovation: The Integrated Value Proposition and The Partnership Infrastructure.

For more than 50 years, we have been developing growth strategies for the global 1000, emerging businesses, the public sector and the investment community. Is your organization prepared for the next profound wave of industry convergence, disruptive technologies, increasing competitive intensity, Mega Trends, breakthrough best practices, changing customer dynamics and emerging economies?

Contact Us: Start the discussion [http://www.frost.com/prod/servlet/register-form.pag?refpage=http://www.frost.com/prod/servlet/frost-home.pag&SRC=Contact]

Join Us: Join our community [http://www.frost.com/prod/servlet/register-form.pag?refpage=http://www.frost.com/prod/servlet/frost-home.pag&SRC=Join]

Subscribe: Newsletter on "the next big thing" [http://www.frost.com/prod/servlet/register-form.pag?refpage=http://www.frost.com/prod/servlet/frost-home.pag&SRC=PRFooter]

Register: Gain access to visionary innovation [http://www.frost.com/prod/servlet/register-form.pag?refpage=http://www.frost.com/prod/servlet/frost-home.pag&SRC=Register]

Indonesia Healthcare Outlook P80F-52

Contact: Donna Jeremiah Corporate Communications - Asia Pacific P: +61 (02) 8247 8927 F: +61 (02) 9252 8066 E: djeremiah@frost.com [mailto:djeremiah@frost.com]

Carrie Low Corporate Communications - Asia Pacific P: +603 6204 5910 F: +603 6201 7402 E: carrie.low@frost.com [mailto:carrie.low@frost.com]

Melissa Tan Corporate Communications - Asia Pacific P: +65 6890 0926 F: +65 6890 0999 E: melissa.tan@frost.com [mailto:melissa.tan@frost.com]

Shena Agusta Corporate Communications - Indonesia P: +6221 571 0838 M: +62 856 887 0992 E: shena.agusta@frost.com [mailto:shena.agusta@frost.com] http://www.frost.com [http://www.frost.com/]

Web site: http://www.frost.com/

Copyright (C) 2015 PR Newswire Europe

Research and Markets Offers Report: Market Attractiveness and Future Prospects of the Indonesian Takaful Insurance Industry

Research and Markets has announced the addition of the "Market Attractiveness and Future Prospects of the Indonesian Takaful Insurance Industry" report to its offerings.

In a release, Research and Markets noted that report highlights include:

The industry recovered from 2012 and gross written premium registered significant growth during 2012-2014. The industry's written premium value has almost tripled in 2013, as compared to the written premiums in 2009; at a review-period (2009-2013) compound annual growth rate (CAGR) of 43.7 percent. The emerging middle class, improvements in the life segment's performance, an increase in interest from international investors, rising domestic consumption, product innovation and the adoption of alternative distribution channels supported the growth of the Indonesian takaful industry during the review period. Merger and acquisition (M&A) activity is expected to rise over the forecast period (2013-2018), as most existing insurers are unable to meet the minimum capital requirement set by the insurance regulator, Otoritas Jasa Keuangan (OJK).

Key Highlights

-The industry's written premium value has almost tripled in 2013, as compared to the written premiums in 2009 at a review-period (2009- 2013) compound annual growth rate (CAGR) of 43.7 percent

-The Indonesian life insurance segment emerged as one of the fastest growing in the Southeast Asia region. According to the statistics released by the Indonesia Life Insurance Association (AAJI), the takaful life segment grew at a CAGR of 53.5 percent during the review period

-Indonesia is one of the fastest-growing internet markets in Southeast Asia. According to the World Bank, internet penetration in Indonesia reached 28.8 percent of the total population in 2013

-The government of Indonesia introduced a compulsory health insurance scheme, BPJS Kesehatan in 2013, aiming to cover all Indonesians by 2019

-The Insurance Regulatory Authority (IRA) is responsible for the regulation of the Indonesian takaful insurance industry

Companies Mentioned

-Prudential

-Allianz

-Manulife

-AXA

-PT Asuransi Takaful Keluarga

Report information:

http://www.researchandmarkets.com/research/bgm67s/market

Widening superbug outbreak raises questions for FDA, manufacturers

By the time 18-year-old Aaron Young wound up at Ronald Reagan UCLA Medical Center in Los Angeles last October, he’d been wrestling for months with excruciating stomach pain and vomiting that repeatedly sent him to the emergency room.

Diagnosed with acute pancreatitis, he underwent what is typically a low-risk procedure in which doctors inserted a special device down his throat to treat his digestive system.

But instead of recovering, Young developed a raging bacterial infection and a relentless 104- degree fever. He recovered after nearly three months in the hospital but had to return for another procedure in late January. The infection flared anew, and he is now likely to be in the hospital for at least another month, his family says.

Young is among seven patients at UCLA who were infected with a hard-to-treat “superbug” that hospital officials traced to two specialized scopes that they said were contaminated despite being thoroughly cleaned. Two of the patients later died, and scores more were potentially exposed.

After the incident became public, the Food and Drug Administration warned that the devices, called duodenoscopes, can be difficult to sanitize and “may facilitate the spread of deadly bacteria.”

The dirt on duodenoscopes

Now medical experts and lawmakers want to know why the FDA and the manufacturers of the devices — all of which have been aware of the potential problem for years — didn’t move more quickly and aggressively to ensure patient safety.

The urgency around the issue intensified Wednesday after ­Cedars-Sinai Medical Center in Los Angeles disclosed that four patients who underwent endoscopic procedures had been infected by the same germ as at UCLA: a drug- resistant form of carbapenem- resistant Enterobacteriaceae, or CRE.

[FDA warns about medical scopes after ‘superbug’ hits California hospital]

Hartford Hospital in Connecticut said Wednesday that 281 patients were possibly exposed during the same type of procedure to a strain of E. coli.

Young’s family, meanwhile, has sued Olympus Corp., the manufacturer of the device involved in the UCLA case, on his behalf, alleging fraud and negligence. The suit claims the company didn’t provide updated cleaning protocols to hospitals when it ­introduced a newer version of the device in 2010.

“The lawsuit is almost beside the point,” said Lori Smith, Aaron’s adoptive mother and herself a registered nurse, in her first interview on the matter. “We’d just like them to do something so that people are better informed. Nobody said Aaron could get something from these scopes that could kill him. . . . We just had no idea.”

The family of Antonia Torres Cerda, a 48-year-old woman who died in November after apparently being exposed to a contaminated duodenoscope at the hospital, has sued the company for wrongful death. Cerda underwent the endoscopy procedure before receiving a liver transplant.

An Olympus spokesman said the company “does not comment on active legal matters or speculation” but added that it “continuously strives to improve our products for safe and effective use.”

‘Why did it take so long?’

For years, the FDA has received warnings — from hospitals, from clinicians, and from the Centers for Disease Control and Prevention — about possible links between the duodenoscopes and the spread of deadly infections. The devices are used in a procedure known as ERCP, or endoscopic retrograde cholangiopancreatography, on roughly 500,000 patients annually in the United States. They are considered a critical tool in diagnosing and treating cancers, gallstones and other ailments of the digestive system in a minimally invasive way.

[California public health officials are tracking down 179 patients after superbug deaths]

The general public may not have known about the small but serious risks associated with bacteria harbored in duodenoscopes, but some medical experts have been flagging the problem for decades.

“We have known about this even as early as 1983 or 1984,” said John Allen, a professor at the Yale School of Medicine who is president of the American Gastroenterological Association. In 1987, Allen wrote in an academic journal about 10 of his patients in Minnesota mysteriously becoming infected with a bacteria known as Pseudomonas. He and his colleagues traced the infections to a single duodenoscope, whose small crevices harbored bacteria despite repeated cleanings.

Officials at Ronald Reagan UCLA Medical Center in Los Angeles say as many as 179 patients were possibly exposed to a drug-resistant “superbug” through special scopes used for procedures. (AP)

In 2009, after a dozen patients in France were infected with drug- resistant bacteria linked to a contaminated duodenoscope, the FDA, the CDC and the Department of Veterans Affairs warned hospitals and other medical facilities about the risk of cross-contamination if scopes weren’t properly cleaned and sterilized. That warning applied to all medical scopes, not just duodenoscopes.

But since 2012, infections linked to duodenoscopes have occurred at Advocate Lutheran General Hospital near Chicago, where 44 people were infected, and at the Virginia Mason Medical Center in Seattle, where at least 32 patients became ill and 11 died. It’s unclear how significant a role the CRE bacteria played in those deaths.

Over the years, Allen said, experts responded to outbreaks by adding another cleaning step, such as flushing the devices with alcohol. The latest outbreak “reemphasizes the fact that we haven’t solved the fundamental problem,” which he said ultimately could boil down to a design flaw.

During the past two years, the FDA has received at least 75 reports about the devices, involving at least 135 patients, and those numbers may be low given that many such events don’t get reported. In 2013, the agency said, it received notice from the CDC about a possible association between the complex devices and multi-drug-resistant bacteria. Sen. Patty Murray (D-Wash.) last month wrote to FDA Commissioner Margaret Hamburg, urging the agency to publicly address the issue.

“The big question is, why did it take so long?” said John Greene, an infectious-disease doctor at Moffitt Cancer Center in Florida, who in 2013 co-authored an article about an outbreak involving duodenoscopes in Tampa. “It’s a very fair question. . . . Unfortunately, things don’t happen until bad outcomes occur.”

Ten House members are asking similar questions. In a letter Wednesday to the FDA, they wrote, “The alarming spread of superbug outbreaks across the country demands a forceful, substantive response from the federal government.” One of the letter’s authors, Rep. Ted Lieu (D-Calif.), represents the district where Ronald Reagan Medical Center is located and has called for a congressional hearing.

Seven people were infected, including two who later died, by a drug-resistant “superbug” at Ronald Reagan UCLA Medical Center in Los Angeles. Scores of other patients were potentially exposed, hospital officials said. (Reuters)

Stephen Ostroff, the FDA’s chief scientist and soon to be its acting commissioner, said in an interview that the agency had indeed been closely studying the problem before the most recent outbreak. He said agency officials had become especially concerned about the 2013 Illinois infections because there were no obvious sterilization lapses and because the devastating CRE bacteria was becoming more common across the country.

The agency redoubled its efforts, scouring medical research and adverse events reports to try to answer several critical questions: Are existing disinfection procedures sufficient? If not, what are the alternatives? Is the problem unique to one model or manufacturer? Does the intricate design of duodenoscopes make them especially hard to sterilize?

Last year, Ostroff said, the FDA requested more data from the three manufacturers marketing duodenoscopes in the United States — Fujifilm, Pentax and Olympus — to prove that their cleaning instructions actually work. It asked for more data after deciding the first batch was insufficient and began conducting its own tests to see if specific features make the devices hard to sanitize.

“These are not things you do overnight,” Ostroff said.

Olympus began selling its TJF-Q180V duodenoscope in 2010. The company had altered its previous design, sealing up a part of the scope known as the “elevator” mechanism in an effort to help prevent infections. But the company never notified regulators, despite rules that require FDA clearance if changes can “significantly” affect a device’s safety or effectiveness.

Olympus said in a statement that it had determined the changes were minor enough not to warrant a new application. The FDA disagreed. After it learned of the changes, the agency last year asked the company to apply for approval of its updated duodenoscope.That application is pending. But the FDA has continued to allow Olympus to sell the device, in part, it said this week, because removing it from the market could lead to a harmful shortage of duodenoscopes in the United States.

“They are absolutely essential devices,” Ostroff said. “We know that there’s approximately half a million of these procedures that are done every year, and the overwhelming majority of them are done safely and without complications. That needs to be kept in mind. Our job is to see what we can do to make this procedure even safer than it currently is.”

That effort is well underway. Bret Petersen, a Mayo Clinic doctor who serves on the board of the American Society for Gastrointestinal Endoscopy, said the group will meet on the issue this month with federal officials, hospital officials and device makers. Allen, the American Gastroenterological Association president, said his group will focus on the issue at a conference in San Francisco. He said federal officials and device makers, as well as venture capitalists, are planning to attend.

“We’re putting them all in a closed room,” he said, “and saying, ‘What do we have to do to innovate our way out of this and drive the infection rate to zero?’ ”

‘It’s just complete fear’

Lori Smith and her husband, Glenn, don’t blame Ronald Reagan Medical Center for the hellish months their son has endured since becoming infected last fall. The hospital has said it closely followed national guidelines and instructions from Olympus in sterilizing its scopes, and now is using even stricter protocols.

“We don’t believe UCLA did anything wrong,” Glenn Smith said. “Aaron is alive today because of UCLA.”

Their anger is aimed at the FDA and the manufacturer, which they say should have done more to ensure the device’s safety.

But on many days, their anger is trumped by sadness and worry.

Young, who also suffers from sickle cell disease, had the first endoscopic procedure last fall to check for gallstones and to place a stent in his bile duct. The second procedure was to remove the stent. Separately, he also had his gallbladder removed. What followed should have been a relatively quick and smooth recovery, but has been neither. At times, he has been on six different antibiotics.

Lori and Glenn, who spent months at his bedside, take turns visiting each day but have jobs they can’t afford to quit. Young’s siblings come by as often as they can. But he spends a lot of lonely hours in his third-floor room, sleeping and texting on his iPhone, his TV almost always muted but tuned to Nickelodeon.

Even when Young does return home, he won’t be in the clear. The CRE bacteria is no longer infecting his bloodstream, but doctors have said that the bug remains colonized in his body, meaning he faces an elevated risk of another infection.

“Is the next time it flares up the time the antibiotic won’t work? Or the time he’ll be so sick he won’t come out of it? It’s just complete fear for his future, and it takes a toll on his whole family,” his mother said. “It’s just something that’s going to be there for the rest of his life.”

When Social-Media Companies Censor Sex Education

Health organizations can find themselves held back by the policies of sites like Facebook and Twitter, which often classify their messages of safe sex as inappropriate content.

PeJo/Shutterstock/The Atlantic

When The National Campaign to Prevent Teen and Unplanned Pregnancy launched Bedsider three years ago, it wanted to create the “cool kid” of sexual health and contraceptive information. Bedsider live-tweets the Golden Globes, has a Frisky Friday newsletter full of sex tips, and tweets things like: “98 percent of women have used birth control. Not one of them? Maybe it’s time to upgrade your sex life.” While this irreverent and quirky take on sexual health has gotten Bedsider more than 50,000 Twitter followers, it’s also gotten the program blocked from promoting its tweets, because Bedsider’s account has violated Twitter’s ad policy.

As one might expect, Twitter prohibits the promotion of adult or sexual products or services. “Safer sex education, HIV/STD awareness campaigns, and non-prescription contraceptives” can be promoted, but only with the provision they “do not contain sexual content and do not link to sexual content.” For example, an approved condom tweet might read: “A condom can actually fit over your entire head! #Themoreyouknow,” whereas an offending tweet would be “If you think condoms aren’t for you, you just haven’t found the right one yet. See how good safer sex can feel.”

In fact, it is exactly those words that sounded the alarms last spring, when a sponsored tweet linked back to the Bedsider homepage, where the article about loving condoms (with the above tagline) was featured. It wasn’t the words of the promoted tweet itself that were an issue, it was the fact that that tweet linked back to a website with “sexual content.” A Twitter account strategist alerted Bedsider’s director, Lawrence Swiader, there would be an issue promoting any tweets while the condom love article was featured on Bedsider’s homepage. Even though the article was about safer sex, said the rep, “It still paints sex in a recreational/positive light versus being neutral and dry.”

 The elements of a changing world, from technology and business to politics and culture.Read More

Under Twitter’s ad policy, it’s okay to have messages about safer sex, they just can’t be sexual. So if an organization wants to encourage safer sex, they are limited to headlines like, “Use Condoms.” This is a problem for Bedsider, the entire existence of which is based on the premise that safer sex is better sex. “We need to be able to talk about sex in a real way: that it’s fun, funny, sexy, awkward … all the things that the entertainment industry gets so well,” Swiader says. “How can we possibly compete with all of the not-so-healthy messages about sex if we have to speak like doctors and show stale pictures of people who look like they’re shopping for car insurance?” While Kim Kardashian’s bare butt is “breaking the Internet” with click-throughs, sexual-health organizations must compete for attention with slogans fit for high-school health books.

Sexual health is something that has to be sold, like anything else. “We have to make healthy behaviors desirable by using creative, humorous, and positive appeals. We don't use negative, fear-based messaging to promote products, and we can't use it to promote behaviors,” says Susan Gilbert, co-director of The National Coalition for Sexual Health. “If we really want to improve sexual health in this country, we must give Americans access to accurate and engaging information that can help them protect their bodies, build good relationships, and access key health services."

Twitter’s non-sexy sex policy is one of many that have made online ventures difficult for the sexual-health community. A Facebook ad for a Bedsider article titled “Six Things You Should Know About Your Well-Woman visit” with the tagline “You’re so sexy when you’re well” was recently rejected because it violated “Facebook's advertising guidelines for language that is profane, vulgar, threatening or generates high negative feedback.” So said the email Facebook sent to Bedsider disapproving the ad. This policy, like many others, is so vaguely written that it’s difficult for organizations to abide by it. Was it the word sexy that was “profane?” Or is the idea of a well-woman visit threatening? (Fair enough, speculums can be intimidating.)

Even policies that are ostensibly black and white can have room for interpretation. One sexual-health organization ran into this problem while selling contraceptive education kits online using Google Checkout. They were told they were no longer able to sell the kit because “Google didn’t allow the sale of sex toys.” Confused, the organization asked what in the kit was considered a sex toy, and discovered the Google representative was referring to the wooden penis demonstration model used for showing how to put on a condom. The organization debated extensively with many different representatives—each time having to explain that wood would be uncomfortable to insert into a vagina, and that the user would risk splinters if the model were actually used as a sex toy. But the representatives stood by their interpretations, and the kits were removed from Google Checkout.

Sexual health is something that has to be sold, like anything else.

According to Deb Levine, many policies are enforced with overly strict interpretations, or are so broad that they’re enforced completely inconsistently. Levine has worked in the sexual-health and tech field since 1993, and is the founder of YTH (Youth+Tech+Health) an organization that focuses on promoting young people’s reproductive health using technology. “Ambiguous terms of service are left completely up for interpretation by individual customer-service reps,” she says.

Inconsistency persists across the board when it comes to sex and social media. While Bedsider cannot have its tweets link back to its website if the homepage features any content deemed too sexual, Playboy has been able to promote its Twitter account even though its feed has shown bare breasts and highly suggestive text that is decidedly not health-oriented. Many non-branded Twitter feeds are highly sexual, too—belfies (sexual selfies showing bare butt), for example, are a thing. “Twitter, Facebook … all of these platforms with such strict policies … it’s like they don’t know their sites are absolutely flooded with sexual content,” Levine says. “We just want to get in there and offer some healthy sexual messages alongside everything else people are inundated with on a daily basis.”

This double standard is simply a microcosm for how sex and sexuality are dealt with in our larger culture, according to Gilbert. “We live in a hypersexual world.” she says. “Sexual images and content are literally everywhere, from suggestive advertisements and erotic romance novels to provocative TV series to sex-tip columns in magazines and on the Internet. Yet we have limited access to positive, credible sexual-health information and open dialogue that can help keep us healthy.”

Social media’s strict policies wouldn’t be such an issue if teens (and adults) didn’t use technology as one of their primary sources of sexual-health information. But in fact, 89 percent of teens say they learn about a variety of sexual-health issues online. There is no other source—not doctors, friends, school, parents, TV, magazines, anything—where teens are more likely to get their information.

"It’s like Twitter and Facebook don’t know their sites are absolutely flooded with sexual content."

And so even the Centers for Disease Control and Prevention have turned to social-media vehicles to help raise awareness about sexually transmitted diseases. “It is important for us to continue harnessing the power of digital technology to engage with populations that are especially vulnerable to sexual risk,” says Rachel Kachur, a health-communications specialist in the CDC’s Division of STD Prevention. “Whether it is the Internet, mobile phones, or gaming, technology is increasingly influencing the lives of youth and has changed the way they interact and access information.”

Access to approachable and scientifically accurate information about sexual health is especially important in light of the statistics. While teen births have decreased by half since the 1990s, the U.S. still has one and a half times the teen birth rate of the U.K. (which has the highest birth rate in Europe) and nearly 10 times the teen birth rate of Switzerland (which has the lowest). When an American teen gives birth, she’s significantly less likely to graduate from high school or attend college, and significantly more likely to end up in poverty.

Chlamydia rates in the U.S. are more than three times that of Europe, gonorrhea rates are more eight times that of the Europe, and prevalence of HIV/AIDS is three times higher than Europe’s. The U.S. spends $16 billion a year in healthcare costs related to STDs, and $12 billion in costs related to teen pregnancy—combined, that’s double the direct healthcare costs of child obesity. So it’s unfortunate that many positive messages about sexual health are prohibited by these social media policies.

It’s fair to say that over the past few years many sexual-health organizations have reached out—mostly unsuccessfully—to a number of tech platforms about their overly strict policies. A year and a half ago YouTube took down four educational videos about women and girls’ health produced by Spark and YTH. The organizations made numerous attempts to contact YouTube to rectify the error, including filing two appeals through an online process. When they were unsuccessful, they contacted a lawyer, and even then, were only able to get their videos restored because their lawyer happened to go to law school with someone high up in YouTube’s policy department, according to Levine."While some organizations have had success getting content through after initial rejection, the process of winning that minor victory is tireless,” Swiader says. “Many smaller organizations just don't have the bandwidth to fight for each individual piece of content."

"Many smaller organizations just don't have the bandwidth to fight for each individual piece of content."

Even people who have made more visible protests have been ignored. This past summer, Twitter banned ads by Lucky Bloke, a condom retailer with a mission to educate people about how proper condom fit leads to greater pleasure and more consistent use. Melissa White, the CEO, started a petition and a #Tweet4Condoms campaign in response to the ban that was supported by thousands of individuals and organizations, according to White’s publicist. And yet she says Twitter only responded to her once, and that was to refer her back to their policy. “It was very clear they were just waiting for it to blow over and for us to go away,” she says.

One might wonder how it is that the technology field—otherwise associated with innovation and forward progress—could have such conservative policies towards sexual health. But on the other hand, it’s easy to see why a tech platform wouldn’t want to risk looser policies that might offend some of its users and affect its bottom line.

“Our ask,” Levine says, “is to get some of the higher-ups at Twitter, Facebook, YouTube, Pinterest, Yahoo, and all the other platforms we use, to sit down with some people in the sexual-health field, and we can work to amend these policies.” YTH is holding its annual conference in San Francisco at the end of April. Levine says they would be delighted to feature a conversation between tech giants and sexual health educators about potential policy revisions. If that doesn’t work, “We’ll come to you,” Swiader says. “We’re happy to bring some sexual health experts to Silicon Valley and hash this out together. We provide content your users want and need to be informed and healthy—and it’s bad business, and poor citizenship, to restrict them from it."