TIME medicine

First Successful Penis Transplant ‘Massive Breakthrough’, Doctors Say

The operation took 9 hours to perform

A 21-year-old man has received the world’s first successful penile transplant, surgeons say.

The man, whose name was not revealed for privacy reasons, had his organ amputated three years ago after a circumcision went wrong. Doctors at Stellenbosch University and Tygerberg Hospital in South Africa operated for nine hours in December, and just a few months later they say he’s already regained full function in the transplanted organ —a much faster recovery than they had hoped for.

“It’s a massive breakthrough. We’ve proved that it can be done – we can give someone an organ that is just as good as the one that he had,” Prof Frank Graewe, head of the Division of Plastic Reconstructive Surgery at Stellenbosch University, said. “It was a privilege to be part of this first successful penis transplant in the world.”

While at least one other attempt has been made at penile transplant, the surgeons say this is the first such operation to succeed.

In their announcement, the doctors emphasized the psychological trauma of penile amputation, a problem they say is particularly acute in South Africa.

TIME ebola

Why West Africa Might Soon Have 100,000 More Measles Cases

Now more than ever: Measles vaccinations have dramatically cut disease rates in Africa
Spencer Platt; Getty Images Now more than ever: Measles vaccinations have dramatically cut disease rates in Africa

One lethal epidemic could give rise to another

Correction appended, March 12

There’s not a war college in the world that couldn’t learn a thing or two from the way viruses operate. They’re stealthy, they’re territorial, they seek and destroy and know just where to hit. And, just when you think you’ve got them beat, they forge an alliance with another of your enemies. That, according to a new paper published Thursday in Science, is what’s poised to happen with Ebola and measles—and it’s the babies and children of Africa who will overwhelmingly pay the price.

The Ebola epidemic is by no means over, but it is being contained and controlled. With nearly 24,000 cases and more than 9,800 fatalities so far—mostly in Guinea, Sierra Leone and Liberia—the epidemic is still claiming new victims, though more slowly. The crisis, however, has disrupted health-care delivery across the entire affected region, preventing children from receiving badly needed measles vaccines. That, the new study reports, could result in an additional 100,000 measles cases over the next 18 months, leading to an additional 2,000 to 16,000 deaths. Rates of vaccination against other diseases—particularly polio and tuberculosis—have fallen too. But measles’ ease of transmission makes it especially worrisome.

“When there’s a disruption of medical services, measles is always one of the first ones in the door,” says Justin Lessler, of the Johns Hopkins Bloomberg School of Public Health, a co-author of the paper. “The Ebola epidemic significantly increases the likelihood of a major measles outbreak occurring.”

Lessler and his co-authors arrived at their numbers painstakingly. First, they used health data to map and estimate the share of vaccinated and unvaccinated children in 5 km by 5 km (3.1 mi. by 3.1 mi.) squares across the three affected countries. They then estimated a 75% reduction in vaccination rates during the epidemic and projected forward by 6, 12 and 18 months. They factored in the transmissability of the virus within each region and estimated the likely number of deaths using what’s known as a Case Fatality Ratio—a mathematical tool that, as its name suggests, estimates lethality for any particular disease under any particular set of circumstances.

The final numbers—especially the potential 16,000 deaths—rightly alarmed the researchers, though lessler does admit that they are by no means a certainty. “The 75% decrease in vaccinations is a little too pessimistic,” he concedes. But the critical word in that admission is “little,” and the investigators did consider 25%, 50% and 100% rates too, before settling on 75% as at least the most plausible. No matter what, the odds are still high of a five figure death rate and a five to six figure additional case rate—and the Ebola epidemic, which led to the problem in the first place, has not even fully abated.

Lessler and his colleagues are not waiting until it does to sound the alarm, urging global health groups to mobilize a vaccination campaign now so it can be ready to launch in the affected areas the moment the Ebola all-clear sounds. The new push would first target children who were born during the Ebola epidemic since they would have likely received almost no medical attention at all up until that point, and then expand to all children in the most measles-susceptible age group—about 6 months to 5 years.

“The best time to start the campaign would be as soon as it’s logistically feasible,” says Lessler. “For every month no campaign begins, the risk of an outbreak occurring and the impact of such an outbreak worsens.”

The happy news, Lessler believes, is that done right, the campaign could not only prevent the measles epidemic from beginning, but could actually put West Africa in a better position than it was before Ebola, with vaccine coverage for measles and other diseases exceeding the pre-outbreak rates. “Previous campaigns have reached coverage in excess of 90%,” he says.

Victory in the battle against Ebola—to say nothing of the battle against measles—is by no means yet assured. But, again as the war colleges would teach, with the right cooperation and the right deployment, the good guys can win.

Correction: An earlier version of this story misidentified an assistant professor at the Johns Hopkins Bloomberg School of Public Health. He is Justin Lessler.

TIME health

What Made the Spanish Flu so Deadly?

Red Cross 1918
APIC / Getty Images Red Cross volunteers fighting against the spanish flu epidemic in United States in 1918

Mar. 11, 1918: A soldier in Fort Riley, Kans., reports to the infirmary with what will become known as Spanish flu

Nearly a century after it made its grisly debut, the mysteries surrounding Spanish flu continue to plague epidemiologists. In 2005, as Slate has reported, scientists succeeded in sequencing the virus’ RNA — eight years after exhuming a flu victim’s frozen corpse from an Alaskan grave to obtain a sample. But they still don’t know exactly where the virus came from or how it achieved such staggering lethality, killing more than half a million Americans and an estimated 50 million people worldwide in a single year.

Some researchers believe the story began on the morning of this day, Mar. 11, 1918, when a soldier in Fort Riley, Kans., went to the camp infirmary with a fever. According to the PBS documentary Influenza 1918, more than 100 soldiers had reported to the infirmary by noon. Within a week, that number had quintupled. Several dozen soldiers died there that spring, before the contagion seemed the ebb; the official cause was pneumonia.

As soldiers fanned out to fight World War I, however, the virus made its way around the globe, from European battlefields to remote areas of Russia and Greenland, spawning two more pandemic waves that were even deadlier than the first. (It became known as Spanish flu only because the Spanish news media was the first to widely report the epidemic, which had been hushed by wartime censors elsewhere in Europe.)

What made this flu different from all other flus was a dramatically higher fatality rate, plus the fact that while ordinary flus claimed casualties among the very young and the very old, this virus was especially deadly to young adults between the ages of 20 and 40. And their deaths weren’t pretty. As Slate tells it, “Many sufferers came down with severe nosebleeds — some spewed blood out of their nostrils with such force that nurses had to duck to avoid the flow. Those unable to recover eventually drowned in their own bodily fluids.”

Why Spanish flu was so fatal, especially to people in the prime of their lives, is what scientists are striving to understand, as TIME reported in the wake of Hong Kong’s 1997 avian flu outbreak. It was during that outbreak that a pathologist named Johan Hultin collected an intact, long-frozen sample of the Spanish flu virus from a mass grave in a tiny Alaska town called Brevig Mission, where 85 percent of the population had been felled by the flu in a single week. Research on that sample has shown that one way Spanish flu worked was by overstimulating the immune system and turning it against its owner — so having a strong immune system to begin with may have been a disadvantage.

But there is more to it than that, other scientists say. And understanding the full story of Spanish flu could help develop vaccines to protect us from the next flu epidemic — an epidemic that is inevitable, as Hultin told TIME in 1998. In the meantime, there’s only one surefire method of surviving pandemic flu, according to Hultin: Isolate yourself in a mountain hideaway until the outbreak subsides. TIME explains: “It was a tactic… successfully used in 1918 by a village just 30 miles from Brevig. Its elders, after learning of the advancing plague, stationed armed guards at the village perimeter with orders to shoot anyone who tried to enter. The village survived unscathed.”

Read original coverage of the Hong Kong outbreak, here in the TIME archives: The Flu Hunters

Read next: Why the Government Has Legal Authority to Quarantine

Listen to the most important stories of the day.

TIME Innovation

Five Best Ideas of the Day: March 6

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. India has banned a documentary on the 2012 gang rape that rocked the country. That was a huge mistake.

By Shashi Tharoor at NDTV

2. Berkeley decided to give campus departments a real incentive to cut power consumption by charging them directly — and energy use went down.

By Meredith Fowlie in The Berkeley Blog

3. Pakistan is helping Afghanistan’s president make peace with the Taliban. Other powers should back him.

By the Economist

4. Ukraine’s military will never be strong enough to beat Russia outright. But it doesn’t have to be.

By Alexander J. Motyl in Foreign Policy

5. Micro-bubbles — guided with magnets, deployed with sound waves — could revolutionize the delivery of medicine and even chemotherapy.

By Charvy Narain at the Oxford Science Blog

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME medicine

One Hour of Sleep Makes a Difference In What You’ll Eat

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Lynn Koenig—Getty Images/Flickr RF

When it comes to teens and sleep, it’s not how much sleep, but how consistently they sleep the same amount that’s important for their health

Plenty of studies have documented that teens don’t get enough sleep. They’re supposed to be in bed for eight to nine hours a night, but most get seven or less. Now the latest sleep research, presented at the American Heart Association EPI/Lifestyle 2015 meeting, shows when it comes to weight gain—which has been tied to sleep deprivation and disturbances—it’s not necessarily the amount of sleep that tips the scales but rather the consistency of that nightly rest.

Fan He, an epidemiologist at Penn State University College of Medicine, and his colleagues found a strong correlation between the variation in sleep patterns among a group of teens and the amount of calories they consumed. And for every hour difference in sleep on a night-to-night basis over a week, for example, they ate 210 more calories—most of it in fat and carbohydrates. Those with uneven sleep patterns were also more likely to snack.

Previous studies have linked poor or disrupted sleep to obesity; people not getting enough shut-eye, for example, may experience changes in the hormones that regulate appetite and how well they break down glucose in their diet. Levels of the hormone leptin, for instance, drop in those who are sleep deprived, and less leptin prompts the body to feel hungry.

MORE: The Power of Sleep

In the current study, however, all the teens got an average of seven hours a night, so it wasn’t as if some of the teens were sleeping for extremely long or short periods of time. Any metabolic changes they would have experienced due to their sleeping less than the recommended eight to nine hours would have been similar among the consistent and inconsistent sleepers.

Dr. Nathaniel Watson, president-elect of the American Academy of Sleep Medicine and co-director of the University of Washington Medicine Sleep Center, stresses that good quality sleep involves three things — getting enough sleep, making sure the timing of the sleep if appropriate, and avoiding sleep disorders. While the amount of sleep has gotten the lion’s share of attention in recent years, a new phenomenon called social jet lag, which the current study investigates, may deserve equal consideration. “We live in a society of yo-yo sleep in which people sleep less because of social or work demands, then try to catch up,” says Watson. “There haven’t been a lot of studies that looked at what kind of impact this has on our health, but teenagers may be particularly susceptible to social jet lag than older adults, and this study assessed that.”

MORE: This Is What’s Keeping Teens From Getting Enough Sleep

These results show that it was the variability in their sleep that was most strongly linked to their eating habits.

Why? The researchers guess that teens who aren’t sleeping consistently are more likely to get too little sleep on one night, for example, and therefore be more tired or sedentary the following day, which leads them to sit around and eat more. It may also be possible that teens with irregular sleep habits are more likely to stay up later on weekends; He found that these adolescents had a 100% higher chance of snacking on weekends compared to those who slept more regularly.

MORE: School Should Start Later So Teens Can Sleep, Urge Doctors

That suggests that health experts should focus not just on the amount of sleep teens are getting, but on their sleep patterns. “Instead of focusing on how much we sleep, we also need to pay attention to maintaining a regular sleep pattern,” says He. Such consistency, however, may not be so easy for teens to master.

 

TIME medicine

4 Things to Know About Zinc And Your Cold

woman-using-tissue
Getty Images

Zinc can help treating a cold, but it doesn't prevent

Zinc is often touted as a way to fight the common cold. But while research suggests it does work, there are some caveats. Tod Cooperman, MD, president of the independent testing group ConsumerLab.com, provides the scoop:

Zinc helps treat—not prevent—a cold

Popping zinc within 24 hours of the start of symptoms helps shorten your sniffle, according to a 2013 Cochrane review. The authors say significant effects were seen at doses of at least 75 mg (the equivalent of three or four lozenges) per day, taken as long as your cold lasts. How does it work? The theory, according to the Mayo Clinic, is that zinc may keep cold viruses from multiplying and taking up residence in your nose and throat. But don’t bother taking it just to take it; there’s no evidence it’ll actually prevent a cold.

Read more: Best and Worst Foods to Eat When You’re Sick

Pick a lozenge, not a spray

Back in 2009, the U.S. Food & Drug Administration warned against using zinc gel sprays and nasal swabs after receiving more than 130 reports of people losing their sense of smell after using these products. (The manufacturer pulled the products from store shelves, though they claim no link has been established.)

Though you can no longer buy zinc nasal spray, it’s still available as a throat spray, which might be problematic, according to Dr. Cooperman. “If you spray it into your throat it can still go up your nose,” Dr. Cooperman says.

The best way to go is still the good old lozenge. Just make sure you suck—not crunch—it: “It needs to dissolve slowly to be effective so it can coat your throat,” explains Dr. Cooperman.

Read more: Best and Worst Exercises to Do When You Have a Cold

Not all lozenges are created equal

In order for a lozenge to provide enough zinc to be effective, it needs to contain between 13 and 23 milligrams, Dr. Cooperman says. Yet only two of the four lozenges Consumer Lab tested—Cold-Eeze Homeopathic Cold Remedy and Nature’s Way Zinc—provided enough. (There are other brands of zinc they didn’t test.)

Read more: 14 Reasons You’re Always Tired

You can’t pop ’em like candy

The safe upper limit for zinc in adults is 40 milligrams per day, as determined by the Institute of Medicine. While it’s okay to exceed that 40mg limit for three to five days (or roughly the length of a cold), you still don’t want to down the lozenges like crazy. At most, only take one every three hours if you’re sick, and limit yourself to one a day if you’re healthy: “Too much zinc can actually depress your immune system,” explains Dr. Cooperman.

Read more: How to Stop a Cold In Its Tracks

This article originally appeared on Health.com.

TIME medicine

Antipsychotics Frequently Prescribed to Adults with Dementia Despite Risks

TIME.com stock photos Health Prescription Pills
Elizabeth Renstrom for TIME

The drugs can increase the risk of death for certain people with dementia

Antipsychotic drugs are being over-prescribed to men and women with dementia, according to a new report from the federal government.

The report published on Monday shows that around one third of older adults with dementia living in nursing homes had been prescribed an antipsychotic in 2012, as well as 14% of older adults with dementia who lived outside a nursing home. The U.S. Government Accountability Office (GAO) discovered the numbers when reviewing Medicare’s prescription drug program.

The high number of prescriptions is a concern since the U.S. Food and Drug Administration (FDA) has warned that antipsychotic drugs can increase the risk of death for certain people with dementia. The officials note that while the Department of Health and Human Services (HHS) has taken steps to address the use of antipsychotic drugs in nursing homes, it still has more outreach to do to educate people about the hazards of prescribing the drugs.

The report shows that patients with dementia are often given the drugs at a hospital, possibly to treat the irritation and mood swings caused by the disorder, and then the drugs continue to be used when the patients enter a nursing home. The drugs are most often prescribed when facilities have low staff numbers.

“Educational efforts similar to those provided for nursing homes should be extended to other settings,” the GAO study’s authors write. The agency recommends more education be provided for caregivers working with patients living at home or in assisted facilities.

TIME vaccines

Many Doctors Give In When Parents Want to Space Out Vaccines

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JGI/Jamie Grill—Getty Images/Blend Images

The vast majority of doctors don’t believe that spacing out childhood immunizations is a good idea, but they’re doing it anyway. Here’s why

It’s an eye-opening survey, to say the least, and its findings are clear: Nearly all — 93% — primary care doctors and pediatricians surveyed say that in a typical month, parents ask them to deviate from the recommended childhood immunization schedule and instead give the shots over a longer period of time, according to a report published Monday in the journal Pediatrics. And while nearly 90% thought that such spacing out of the immunizations would put the children, and the community at risk of spreading infectious diseases like measles, 37% said they agreed to do so often or always. That was a 131% increase since the last survey, conducted in 2009, when only 16% said they agreed to changing the recommended vaccine schedule.

“Doctors are feeling really conflicted because they overwhelmingly think this is the wrong thing to do, and is putting children at risk, but at the same time, they want to build trust with their patients and meet people halfway,” says Dr. Allison Kempe, professor of pediatrics at University of Colorado and Children’s Hospital Colorado, who is the lead author of the study.

MORE How Safe Are Vaccines?

Even more concerning, she says, is the fact that 40% of the physicians said that the vaccine issue was the source of their job dissatisfaction. The survey also asked them about different strategies the doctors employed with parents to discuss the importance of following the existing vaccination schedule, but the doctors revealed very little confidence in those methods. In fact, the strategy they believed worked most often only garnered a 20% effectiveness rating, and that was telling parents that the doctors immunized their own children according to the recommended schedule.

“It’s a terrible conflict when I have to make a decision when I’m doing my vaccine orders for a particular child and decide if it’s going to be the pertussis vaccine for that infant or the Hib or the pneumococcal,” says Dr. Julie Boom, director of the immunization project at Texas Children’s Hospital and associate professor of pediatrics at Baylor College of Medicine, of the decision she has to make when parents insist on giving their babies only one immunization during a visit. While Boom makes every effort to discuss with parents the importance of sticking with the recommended immunization schedule, she says “I will offer the vaccine at that visit and explain the risks and benefits of the decision that parent is making and try to get them to come back as quickly as possible to take the next vaccine so the baby will be fully vaccinated as on time as possible.”

MORE Childhood Vaccines Are Safe, Says Pediatrics Group

But she does that knowing that the baby leaves her office at higher risk of potentially getting sick since he is not fully immunized. “The baby leaving my office is at risk of getting the illnesses for which he’s not vaccinated,” she says. “To know I’m going to pick one [vaccine] and leave the other behind, despite all the time I spend explaining the risks and benefits to the parents—it’s very difficult for me.”

And it’s increasingly a problem for her colleagues as well. While parents who refused to vaccinate their children gained the most media attention in recent years and likely contributed to pertussis and measles outbreaks, even more parents – about 13% — used an alternative vaccine schedule that included delaying some of the shots. These parents often express concern about “overloading” their babies’ immune systems with too many shots in one visit (the most that infants generally get are five, at the year-old visit). In the survey, 35% of doctors said they realized that allowing parents to delay shots sent mixed messages; parents could interpret the action as proof that the existing schedule wasn’t so important after all if doctors ended up changing it.

Part of the conflict may come from the advice from organizations to which these physicians turn for help. As some frustrated doctors began to “fire” their patients and refuse to see them if they declined to vaccinate their children or asked for alternative immunization schedules, in 2005, the American Academy of Pediatrics advised its members to not dismiss those parents and urged them to discuss and educate them instead about the importance of vaccinations and of getting them on time. That may explain why 82% of doctors in the current survey said they felt agreeing to delaying some vaccines would build trust with their patients; 80% said that if they refused to accommodate the parents wishes, these parents would leave to find some doctors who would.

MORE Nearly One in Ten Americans Think Vaccines Are Unsafe

“Nobody is in favor of dismissing patients, but I think we need to get a little bit straighter about communicating to these parents about how strongly we feel about vaccinations, and how detrimental spacing them out is for their child,” says Kempe.

Among the most commonly used strategies to convince parents, doctors cited their comfort with vaccinating their own children according to the schedule, stressing that spacing out vaccines puts their children at risk of getting sick, reminding them of recent outbreaks of vaccine-preventable diseases, and explaining that alternative schedule haven’t been studied for their safety. Doctors have even informed parents that bringing their child back for multiple visits to get jabbed with a shot can be more painful for the baby. None were rated by the physicians as being more than 20% effective, leaving doctors at a loss.

MORE Dr. Tom Frieden: Vaccines Can Prevent Measles From Being a Disease of the Future

That’s why professional organizations should take a stronger role in providing doctors with more guidance about what may work and what doesn’t. Conducting more studies on different methods of educating and addressing parents concerns could arm doctors with more data and scientific evidence to back up their belief in the established immunization schedule, for example. Kempe also notes that starting to educate parents earlier, such as during pregnancy, may help to reinforce their comfort with vaccines and what they can do to protect their baby once he is born. And reaching parents and parents-to-be on a more consistent basis may also be key to alleviating their concerns about vaccines. “We as doctors have not exploited mass media or the kinds of media that the anti-vaccine movement has,” says Kempe. “We are not doing a great job of countering the misinformation out there, and also not doing a good job of enlisting parents who are pro-vaccine in a proactive way to establish a social norm.”

Part of that has to do with the fact that the time that doctors typically have with parents during well-baby visits is short. Most doctors reported having to spend at least 10 minutes with parents to address their vaccine concerns; that’s about half of the time of an average visit, which also has to cover other important wellness issues such as nutrition, car safety, and more. So Kempe says other strategies, such as group visits or sessions to address vaccine questions specifically, or designated staff at family practices or pediatricians’ offices who are assigned the task of answering questions about vaccines and vaccine safety might be more effective. In Boom’s practice, she often schedules a separate visit for parents to discuss just their vaccine questions, so she doesn’t feel rushed to come to a decision about whether to help the parents space out vaccines or not.

For Boom, the key is understanding where the parents’ concerns come from. “For one parent it may be about long term effects of vaccinations, and for another it may be something else,” she says. “You have to understand where the misinformation is coming from, and then very specifically address each parent’s questions. It does take time.”

Using this strategy, Boom feels she is relatively successful in educating parents about the need to follow the recommended vaccination schedule. But she admits that working in an academic institution, she has the luxury or more time with her patients.

For those that don’t, it’s clear that frustration is reaching a boiling point in doctors’ offices. “I hope this study is a wake-up call, and I hope it’s time to say ‘okay, what we are doing isn’t working,’ and start asking ‘what should we be doing?’” says Kempe.

Read next: I Was on the Front Line of L.A.’s Last Measles Outbreak

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TIME medicine

First Human Head Transplant Could Happen Within Two Years

Sergio Canavero, a doctor in Italy, has drawn up the plans for a human head transplant

A surgeon says the first human head transplant could take place within the next two years.

Sergio Canavero, a doctor in Turin, Italy, has drawn up the plans for the radical surgery and hopes to begin assembling a team this June, the Guardian reports.

“If society doesn’t want it, I won’t do it. But if people don’t want it, in the U.S. or Europe, that doesn’t mean it won’t be done somewhere else,” he said. “I’m trying to go about this the right way, but before going to the moon, you want to make sure people will follow you.”

Although Canavero says the technology isn’t far off from making this surgery possible, he could confront a range of ethical issues. “The real stumbling block is the ethics,” Canavero told New Scientist magazine. “Should this surgery be done at all? There are obviously going to be many people who disagree with it.”

The first successful head transplant was completed in 1970 on a monkey. The monkey couldn’t move its body and died after nine days.

Read next: Scientists Find a Black Hole 12 Billion Times More Massive Than the Sun

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TIME medicine

7 Dizzying GIFs of Spinning Cannabis Strains

This new approach to cannabis photography was created by the San Diego based company Nugshots. Applying traditional still-life photography techniques, the company began by photographing buds of marijuana for local dispensaries. The images are created using a computer-controlled motor, rotating the marijuana buds only a few degrees at a time. The resulting 50 photographs were then color-corrected and uploaded onto a custom-built player that allows the viewer to rotate the images by dragging their cursor.

Each crop of plants produces unique buds, which requires the dispensaries to commission new photography for each shipment that comes in.

Nugshots has turned its attention toward more stable forms of marijuana-related income. They recently released T-shirts with their macro images printed on them. Soon they will be releasing a book of marijuana photography entitled Green: A Field Guide to Marijuana, featuring hi-resolution macro photography of over 170 different strains.

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