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Clinical Issues

Malaria Control: A 21st Century Public Health Success Story

According to a report in the journal Nature, 663 million cases of malaria have been prevented in the past 15 years; that’s a drop of 60% over pre-2000 levels.

Since the year 2000, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa.The bulk of malaria cases, 80%, occur in Africa, where even with this major progress, a child still dies from malaria once every minute.

About 2/3 of the reduction in cases is being attributed to the distribution of a billion insecticide-treated bed nets. The drug Artemisinin and the spraying of insecticides in homes account for the rest of the decline. Interestingly, the leaves of the tree Artemisia annua, from which Artemisinin is derived, have been used for treating malaria for over two thousand years.  The combination of methods in combating malaria is a vital part of the continued fight against the disease, given serious concerns on the development of drug-resistant parasites as expressed by the World Health Organization (WHO).

The executive director of UNICEF, Anthony Lake, noted: “We know how to prevent and treat malaria. Since we can do it, we must.”

 

The Cost of Medicine

by Jen Jenkins, Market Analyst

In most lines of business, the cost of goods and services is known down to the penny. Typically this information is essential in order to set prices and ensure the business is operating efficiently. In the world of medicine though, a field where everything else is succinctly measured, this is not the case.

A recent New York Times article delves into this topic using a question posed by Dr. Vivian Lee, Chief Executive of the University of Utah Health Care. Several years ago, Dr. Lee simply asked her team what the goods and services provided by the hospital system cost; no one had the answers. Due to this revelation, she initiated a project in order to get such answers, which presently are not only saving money but are also improving care.

The key element in this project at the University of Utah Health Care has been a fascinating computer program, which is continuously being developed. The program has 200 million rows of costs for nearly anything that can be thought of in the medical field as well as a way to track hospital stays and re-admissions, among other things.

The progress made here as far as determining costs of care was labeled by a Harvard economist as “epic.” In comparison, there are hardly any other medical institutions that have even a remote idea what their costs are. Fortunately as this is issue is glaringly brought to attention, more and more establishments in the medical field are following the lead of Dr. Lee and the University of Utah Health Care since there is now a tried and true way to solve what was previously labeled a serious problem.

Hospitals Are Getting Bigger (And Not Just In Texas)

by Jen Jenkins, Market Analyst

Parkland Hospital in Dallas, Texas is gaining exposure, and it isn’t due to its plush newness, updated equipment, sophisticated technology, or a tragic event of 1963 (for readers who are familiar with the name “Parkland Memorial.”). Instead, Parkland is getting attention because each room in the hospital has been specifically designed to more effectively treat overweight patients, or more accurately, “the bariatric population.” This population is made up of patients who typically have a body mass index of 40 or higher and as the need to accommodate these patients has grown, so has the trend to redesign hospital rooms across the country.

According to Nancy Connolly, a senior executive at a hospital consulting group, “Most hospitals we are building are providing an increasingly larger percentage of rooms that can accommodate the larger person.” These changes are necessary due to the unique challenges obese patients tend to face: beds, wheelchairs, and other equipment need to be larger and sturdier which also means that door frames and the rooms themselves need to designed differently. This is now routinely kept in mind as old hospitals are updated and new hospitals are built.

Regardless of what this new trend may indicate, the overall idea moving forward is for hospitals to be designed with the “universal patient” in mind so that every single person may feel comfortable and accounted for. Many arguments can and are being made about what this means about our society, food consumption, economic issues, etc. However, in this scenario hospitals are simply doing what is necessary to be in a better position to care for patients in every way possible – which is undoubtedly their most pertinent responsibility.  According to an article featured in The New York Times, although this trend is being seen across the country, Parkland has done an especially remarkable job in its new design, which will likely be replicated here on out.

 

The Great Sugar Anomaly

by Jen Jenkins, Market Analyst

Sugar is a familiar substance to all of us, but the history of its unnatural counterpart may be less so. The first artificial sweetener, saccharin, was discovered by accident in 1879; due to sugar rationing during WWI and WWII the artificial sweetener found fame. It wasn’t until 1965 that Aspartame, the second major artificial sweetener, was developed.

Controversy began when Canada banned saccharin in 1977 because of studies indicating it caused cancer in rats. The FDA considered banning the sweetener as well but due to large demand a moratorium was placed on the ban and then extended seven different times. In 1991 Congress withdrew the ban completely. The bottom line in that decision: numerous studies have been done on these artificial sweeteners since questions were first raised in 1977 and none have been able to prove a correlation between human consumption and cancer. Thus, artificial sweeteners remain prevalent in the diet of many Americans today.

For a long time, since sugar was deemed “bad,” diet enthusiasts touted artificial sweeteners to be the holy grail of dieting without giving up a sweet tooth. However, as is the tendency with many fads, the tables turned and a new battle has been waged. Which is worse: Sugar or its artificial equivalent? Opinions are vast and varied. This article by a professor of pediatrics at Indiana University School of Medicine argues that despite having been attacked for decades as “harmful chemicals” there is no scientific link showing humans are harmed by consuming artificial sweeteners, whereas there has been significant scientific evidence that sugar is harmful to humans and their health.

No matter where you stand in the debate it is interesting to scroll through the comments section of these articles to view the different stances people are taking (many of them volatile). Due to an overwhelming response to the article mentioned above, the author responded to some questions here. Whether you are team sugar or team artificial sweetener the key word seems to be moderation, or not at all, so what’s with all the hostility?

The Physician Who Saved Countless Babies from Birth Defects

Dr. Frances Oldham Kelsey, who died last week at the age of 101, became a 20th-century North American heroine for her role in the thalidomide case, celebrated not only for her vigilance, which spared the United States  from widespread birth deformities, but also for giving rise to modern laws regulating pharmaceuticals.

In 1960, Kelsey was hired by the FDA in Washington, D.C. At that time, she was one of only seven full-time and four young part-time physicians reviewing drugs for the FDA. One of her first assignments there was to review an application for the drug thalidomide as a tranquilizer and painkiller for pregnant women for morning sickness. Even though it had already been approved in Canada and more than 20 European and African countries, she withheld approval for the drug and requested further studies. Despite pressure from thalidomide’s manufacturer, Kelsey persisted in requesting additional information to explain an English study that documented a nervous system side effect.

After  the story received press coverage in July 1962, there was a substantial public outcry. The Kefauver Harris Amendment was passed unanimously by Congress in October 1962 to strengthen drug regulation. Companies were required to demonstrate the efficacy of new drugs, report adverse reactions to the FDA, and request consent from patients participating in clinical studies. Read more about Dr. Kelsey…

Hyperbaric Chambers and Helmet Sensors: Effective Concussion Treatments?

Start-ups and doctors are in zealous pursuit of new and sometimes controversial ways to prevent, detect and treat concussions, as noted in this article.

A growing industry has developed around concussions, with entrepreneurs, academic institutions and doctors scrambling to find ways to detect, prevent and treat head injuries. An estimated 1.7 million Americans are treated every year after suffering concussions from falls, car accidents, sports injuries and other causes.

While the vast majority quickly recover with rest, a small percentage of patients experience lingering effects a year or longer afterward. Along with memory issues, symptoms can include headaches, dizziness and vision and balance problems.

Since 2007 research spending has increased dramatically. At that time Congress, facing criticism that the military had ignored the psychological and physical toll on soldiers of serving in the Afghanistan and Iraq conflicts, allocated $600 million for research and treatment on traumatic brain injury and post-traumatic stress disorder (PTSD), two major conditions faced by many returning soldiers. In turn much of the traumatic brain injury research has included a look at treating concussions. Many highly publicized cases in the NFL of concussed football players have added to the call for more research and treatment options.

The search for ways to treat and prevent concussions has spawned screening tools, helmet sensors, electronic mouthpieces, diagnostic blood tests and brain imaging devices. Start-ups are marketing their products to the military, schools, hospitals, sports teams and parents, and controversial therapies like hyperbaric oxygen are being promoted to patients. But as the industry booms, medical experts are raising concerns that it is a business where much of the science is sketchy, belief frequently outruns fact, and claims of technological breakthroughs evaporate soon after they are made. Read more…

What Are Nanoparticles – and Why Should You Care?

Per this article in Fortune, Nanoparticles “touch nearly every Fortune 500 company and aspect of our lives”; the Project on Emerging Nanotechnologies estimates that it’s $20 billion industry.

Nanoparticle are between 1 and 100 nanometers in size (a billionth of a meter). They’re not particularly well understood but they’re present all around us in the environment – and in many of the products we buy and ingest. The interesting and sometimes unexpected properties of nanoparticles stem from the large surface area of the material relative to their overall size.

They’re not a new discovery – nanoparticles were used by artisans as far back as the ninth century in Mesopotamia for generating a glittering effect on the surface of pots. In 1857 Michael Faraday provided the first description, in scientific terms, of the optical properties of nanometer-scale metals. But their applications have changed considerably in the past few years.

Arturo Keller of the University of California, Santa Barbara has been studying nanoparticles, in particular titanium dioxide, in common products such as cosmetics, sunscreens, and lotions. It’s important to note that titanium dioxide is chemically inert and has been around humans for decades, and its practical applications includes use in joint replacements.

But at the nanosize, per Dr. Keller’s research the particles “can also cross the blood-brain barrier or enter cells and destroy genetic material,” leading to increased rates of cancer, heart disease, and neurological disorders.  The Environmental Working Group, a research organization based in Washington, D.C., estimates that nano titanium dioxide is in about 10,000 over-the-counter products, including food, a trend which started over a decade ago.

As research such as Keller’s is completed, many companies and the US government are paying close attention to their use and safety and the FDA is discussing regulations. Their small size allows for many positive uses such as highly targeted drug delivery at the molecular level, and a more targeted delivery of pesticides to crops. As Fortune notes, “perhaps the most concerning and harmful aspect of heightened fears about nanoparticles is the potential for a broad, ill-informed backlash.” Read more…

Celebrating 60 Years of Polio Vaccinations!

Sunday April 12th marks 60 years since the polio vaccine, developed by Dr. Jonas Salk, was declared “safe, effective, and potent.” April 12th also marks 70th years since of the death of President Franklin D. Roosevelt, whose paralysis was generally believed to be caused by polio.

Prior to 1955 the dreaded disease afflicted 600,000 people around the world each year, including about 50,000 children in the U.S. There is still no known cure for the disease which could cause various degrees of paralysis and is sometimes fatal. The testing of the vaccine, known as the Francis Field Trial, was the largest medical experiment in history up at that point, involving more than 1.8 million children from Maine to California.

Polio was officially eradicated in the United States in 1979. However, worldwide there still remain occasional outbreaks. In fact, in 2014 the World Health Organization declared polio’s renewed spread a “world health emergency” and the civil in Syria has led to more than 90 cases reported in that country. There have also been at least 20 cases reported in Pakistan in 2015.

Given recent measles outbreaks in the U.S. — another preventable disease with an effective vaccination — a 2010 documentary on the polio vaccination is receiving extra attention these days. Carl Kurlander, CEO of the company which produced the film A Shot Felt ‘Round the World reports increased interest in the film from groups interested in promoting the importance of vaccination. The World Health Organization hopes to eradicate polio worldwide by 2018.

“There’s no technical reason why there should be cases anywhere in the world by the end of this year,” said Oliver Rosenbauer, communications officer for the World Health Organization’s Global Polio Eradication Initiative. “It’s a question of political will and societal will.”

A Disease of Time

Post Traumatic Stress Disorder is a psychiatric disorder, the fourth-most-common one in America.  Over a decade into the global war on terror, PTSD purportedly afflicts as many as 30 percent of the conflict’s veterans. And the disorder’s reach extends far beyond the armed forces.

David J. Morris, who served in Iraq from 2004 to 2007, provides us with a new understanding in his recently released The Evil Hours: A Biography of Post-Traumatic Stress Disorder. PTSD, he notes, is “in a manner of speaking, a way of institutionalizing moral outrage.”

From Morris’s website is a brief summary of The Evil Hours: Drawing on his own battles with post-traumatic stress, David J. Morris — a war correspondent and former Marine — has written a humane, unforgettable book…Through interviews with people living with PTSD; forays into the rich scientific, literary, and cultural history of the condition; and memoir, Morris crafts a moving work that will speak not only to those with PTSD and their loved ones, but to all of us struggling to make sense of an anxious and uncertain time.

David Morris notes:

I first got interested in PTSD when I read a newspaper article about how some Iraq veterans felt “poisoned” by the war, as if it had fundamentally altered their existential position in the world. I am fascinated by this moral component of survivorship—how events in life can freeze us in time, seeming to render us unfit for the everyday world. This is essentially the same question confronted by Ishmael at the end of Moby Dick, as he looks out on the vast sea from Queequeg’s coffin: How does one live in the aftermath of the impossible?

The Evil Hours has been widely and quite favorably reviewed, from “an eye-opening investigation of war’s casualties” (Kirkus Reviews)  to “Well-integrated autobiographical elements make this remarkable work highly instructive and readable. (Publishers Weekly) Read more…

Transforming Medicine into an Information Science

Responding to data trends is not a new to the practice of medicine. A quick Google search reminds us that the scientific method itself is defined as “principles and procedures for the systematic pursuit of knowledge involving the recognition and formulation of a problem, the collection of data through observation and experiment, and the formulation and testing of hypotheses.”

But the Icahn School of Medicine at Mount Sinai, New York — along with several other major medical schools — is pushing the concept further. They’re turning directly to data science as a big part of the future of medicine and health care.

Mt. Sinai has recently added Jeffrey Hammbacher to their faculty. Hammerbacher is a number cruncher — a Harvard math major who went from a job as a Wall Street quant to a key role at Facebook to a founder of a successful data start-up. He was recruited by Eric Schadt, a computational biologist at Mt. Sinai who had concluded that medicine was ripe for a data-driven revolution.

Hammbacher leads a team whose objective is to alter how doctors treat patients someday. For example, Mount Sinai medical researchers have done promising work on personalized cancer treatments. It involves the genetic sequencing of a patient’s healthy cells and cancer tumor. Once the misbehaving gene cluster is identified and analyzed, it is targeted with tailored therapies, drugs or vaccines that stimulate the body’s defenses.

Mr. Hammerbacher’s team does not do the basic science. Other researchers do that. His group works on the “computational pipeline,” he said, with the goal of making personalized cancer treatments more automated and thus more affordable and practical. “It’s ultimately what cancer cures are going to look like,” he said. Read more…