Inflammation and stories on medicine

Palliative CareAccording to the Quality of Death Index, developing countries are typically “unable to provide basic pain management due to limitations in staff and basic infrastructure.”

However, Mongolia recently exceeded expectations, ranking 28 out of 80 countries in the 2015 Index. The country’s success is largely due to its National Palliative Care Program which was spearheaded by Dr. Odontuya Davaasuren.

Palliative care is defined as a multidisciplinary approach to medical care for people with serious illnesses.

According to the World Health Organization (WHO), 40 million people require palliative care each year especially in countries with aging populations and where the incidence of noncommunicable diseases is high.

In Mongolia specifically, 79 percent of deaths are the result of noncommunicable diseases such as cancer and cardiovascular disease.

Dr. Davaasuren was first inspired to create the program after participating in the 2000 Palliative Care Conference in Stockholm. In a letter to the International Palliative Care Resource Center (IPCRC), Dr. Davaasuren said she was amazed that such a program did not exist in her country.

However, turning a dream into a reality was no easy feat for the Mongolian doctor. Many of Dr. Davaasuren’s assertions were initially met with criticism during the program’s introduction.

For example, the use of opioids as a form of treatment was traditionally frowned up because health care providers feared that patients would become dependent on the drugs.

Per her IPCRC letter, the doctor held steadfast to her belief that “It is a human right to receive palliative treatment, even when the disease is not curable” and continued to work on introducing the program.

The National Palliative Care Program was created based on four foundational measures: public health policy changes, the indispensability of available drugs for palliative care, the education of health care professionals in palliative care, as well as the actual integration into the overall national health care system.

Notably, since 2005, all medical schools in Mongolia integrated palliative care into their education programs.

At the 67th World Health Assembly in January 2014, the World Health Executive Board called on health systems worldwide to improve upon their palliative care systems. According to the WHO, doing so is “fundamental to improving the quality of life, well-being, comfort and human dignity for individuals.”

Jocelyn Lim

Sources: IPCRC, Odontuya Davaasuren et al., Quality of Death Index, 2015, United Nations, World Health Organization
Photo: Google Images  

MedicSMS
A diagnosis could be as quick as a text message away through the program MedicSMS.

MedicSMS is a new way for doctors to give diagnoses to patients in developing countries. The service is provided by means of Artificial Intelligence (AI), an upcoming technology that is gaining credibility and popularity.

Many people in developing countries have access to basic mobile phones. According to the 2015 Ericsson Mobility Report there are 2.6 billion smartphone subscriptions that exist globally. By the year 2020, Ericsson predicts that number will jump to 3.5 billion.

MedicSMS capitalized on growing mobile connections, creating a new way for patients and their doctors to interact when “in-person” is not an option. The program works collaboratively with IBM Watson, a “supercomputer platform” that can “analyze health data” and Twilio, the SMS service used. The machine, using basic question and answer sets, will “reveal insights from large amounts of unstructured data,” according to IBM.

After the data is received from the patient, Watson goes to work. The AI interface translates the SMS into a “likely diagnosis,” according to MedicSMS. The patient is then delivered a set of steps to follow for their newly diagnosed condition.

After a diagnosis is made, patients can start a treatment regimen immediately.

A service similar to MedicSMS, called FrontlineSMS, is seeing success from its pilot project in Malawi, which is the world’s poorest country, according to data from the World Bank.

According to the FrontlineSMS website, the service saved hospital staff an estimated “1,200 hours of follow-up time and $3,000 in motorbike fuel.” The time saved by Frontline SMS could be allocated to other patients in need of “in-person” aid, while the financial resources could be stretched further to assist other people in need.

The MedicSMS AI interface also asks for a location from the patient. That information is logged and transported to local health authorities that can administer extra aid if needed, as well as medication that the patient requires.

The GPS location also allows health authorities to pinpoint where illnesses and diseases are taking place, helping them to be better prepared for future outbreaks of certain diseases.

Harley Katz, one of the Ph.D. members of the MedicSMS team, hopes that soon, health organizations can better understand where the epicenter for diseases and outbreaks are taking place.

“Eventually, we’re hoping to track much more, including where similar symptoms are popping up on the map,” he said.

Alyson Atondo

Sources: World Bank, Ericsson, IBM, Frontline SMS, Techcrunch, Devpost
Photo: Google Images

Health_World_Photo_

Health care is considered by many to be a fundamental right. However, there are so many people in the world that do not have access to the care and services they need, creating a global health crisis.

A project called Waiting for Health brings awareness to this problem through a photo series that chronicles the stories of those waiting for health care. The photos are taken by 12 photographers and focus on 12 different countries.

The Waiting for Health project was created by the Global Coalition for Universal Health Coverage. It also had support from the Rockefeller Foundation.

Ultimately, the project hopes to spark a conversation about the disparity that exists in health care around the world.

According to the World Health Organization (WHO), approximately one billion people in developing countries do not have the access to health care that they need due to a number of factors such as high costs, poor quality facilities as well as a shortage of health care workers.

A 2014 WHO World Health Statistic revealed that in the African Region there were approximately 2.6 physicians per 10,000 patients. The density of the remaining health workforce to the population is also concerning: nursing and midwife personnel (12), dentistry personnel (0.5) and pharmaceutical personnel (0.9).

Due to the lack of financial resources, many people living in extreme poverty often have to choose between getting the medical attention that they need or buying food for survival.

Waiting for Health hopes to rejuvenate the conversation surrounding health care. Photographer Aurelie Marrier d’Unienville says that the photos will give people a different perspective on health care in developing countries. The photos will add a touch of “humanity” giving viewers a better visual understanding of what is occurring around them.

“Statistics and surveys present us with inanimate and abstract figures of which we can’t relate,” she said. “These photos present a compelling and visual story, which can evoke a sense of real understand and empathy.”

Her photos focused on the health care crisis in Guinea, but the series documents many other global experiences. Another example focuses on Libyan refugees in Norway waiting for mental health care.

According to the Waiting for Health website, “We hope these photographs inspire all of us to slow down and think more deeply about what really needs to change and make universal health care coverage a reality,”

Alyson Atondo

Sources: European Parliamentary Research Service, World Bank, Waiting for Health, Mashable
Photo: Flickr

nobel_prize_in_medicineFor the past 43 years, a lifesaving treatment for malaria, perfected by pharmacologist Tu YouYou, has received little recognition until winning the Nobel Prize in Physiology or Medicine on Monday, Oct. 5. This long-known remedy has already demonstrated its efficacy through its use in southern Asia; however, the issue still remains as a staggering 90 percent of deaths caused by malaria occur in sub-Saharan Africa.

In 1967, Mao Zedong established a secret project dubbed “Project 523” in order to develop a cure for the widespread disease that disabled thousands of soldiers and civilians. Tu Youyou was selected to work on the cure after the group failed to create a synthetic medicine that proved effective.

Tu Youyou, then a student at the China Academy of Chinese Medical Sciences, began her search in 1969 for any herbal cure to the issue. She collected 2,000 possible remedies before cutting her list to 380 and testing her compounds on mice.

It wasn’t until 1972 that Tu Youyou successfully produced chemically pure artemisinin, which was then assessed by a group of scientists; despite their efforts, the artemisinin weakened as the chemists’ trials continued. After discovering a method in “Emergency Prescriptions to Keep Up One’s Sleeve,” an ancient text on Chinese medicine, Tu Youyou procured another solution that worked 100 percent of the time on primates and rodents.

Tu Youyou tested the medicine herself and human trials began; artemisinin treatments became the fastest-acting antimalarial medicine. Despite this, it wasn’t until 2011 that Tu Youyou’s discovery earned a Lasker prize as its first award.

Tu Youyou’s find has held promise for the eradication of malaria since its discovery, being rewarded with a Nobel Prize in Medicine on Oct. 5, 2015. New drug-resisting malaria vectors, however, have drastically altered the reception of antimalarial therapy across the world. A prominent example is that of sub-Saharan Africa.

The most recent number calculated by the WHO records that in 2013 there were an estimated 198 million cases of malaria worldwide. Malaria is the cause of about 450,000 deaths per year and 90 percent of these occur in sub-Saharan Africa, with 77 percent being children at the age of 5 and younger.

Despite the drug-resisting vectors, mortality rates have fallen 47 percent globally since 2000, with a drop of 54 percent in the WHO’s African region. The WHO also suggests halting production and marketing of artemisinin-based monotherapies until variations of the treatment are developed.

Although no specificity is provided on when other alternatives will be available, the WHO launched an emergency response in April 2013 with the hopes of containing and managing any known outbreaks, continuing today as the WHO emphasizes that “urgent actions now will deliver significant savings in the long run.” It has since received aid from the leaders of the East Asia Summit and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

For now, we must enjoy “[the] gift for the world’s people from traditional Chinese medicine,” Youyou said after winning the Lasker prize in 2011.

Emilio Rivera

Sources: CNN, Columbia, Vox, WHO                                                                                                                                                                                                                                   
Photo: Flickr

doctor_patient_sad_comforting_The American Academy of Family Physicians (AAFP) recently released a report that touted understanding and compassionate family medicine as one way to help ease the burden of poverty.

The paper released by the AAFP suggested that family physicians can help mitigate the health effects of living in poverty by being more understanding of patients’ individual coping strategies and needs, as well as making them aware of the community resources at their disposal.

Paper author Patricia Czapp, M.D., explained that while being poor does not doom those individuals to negative health effects, it does place them at a far greater risk of encountering adverse environmental factors.

These negative factors can include lack of neighborhood safety, limited education opportunities, limited access to medical services and more.

“These factors all stack up. You can see why the average life expectancy is so much shorter in lower-income neighborhoods and why poverty is a generational problem, a cycle from which it is difficult for the individual to break free,” said Czapp.

According to the most recent census data collected by the U.S. Census Bureau, 9.1 million families, comprised of roughly 14 million children under 18, are living in poverty.

The census further found that nearly 10 percent of children from impoverished households weren’t covered by any type of health insurance, compared to 7 percent of children from non-impoverished families.

In the paper, Czapp says it’s important for family physicians to understand where their patients are coming from. One example she used is that of a patient who isn’t taking his insulin as prescribed in order to make each prescription last as long as possible.

“Don’t lecture to him about using his insulin appropriately until you’ve helped him get the electricity turned back on in his dwelling,” said Czapp. Her vision for healthcare is all about understanding patient priorities and not making them feel disrespected by questioning their choices.

Even with the Affordable Care Act expanding medical coverage to millions of previously uninsured Americans, Czapp says that navigating the waters of medical insurance and claims can be extremely intimidating for some. The Census Bureau estimates there are still 41 million U.S. citizens without health insurance today.

“For the novice, this can be a humiliating and bewildering process to navigate, and it is so important that we and our staff react with compassion and understanding to help the newly insured learn what it means to be a patient within a medical home,” said Czapp.

Good health is crucial to being able to lead a happy and productive life, but when individuals and families don’t have access to even routine health care, their livelihoods suffer.

Acknowledging the myriad of challenges faced by those struggling to overcome poverty and taking measures to help keep them healthy during that struggle are important steps toward breaking the cycle of poverty once and for all.

Gina Lehner

Sources: AAFP, United States Census Bureau
Photo: Medscape

Medical_Tourism_in_Dubai
In front of representatives and officials from more than 80 countries, Dubai was presented with the award for “Destination of the Year” at the 10th World Health Tourism Congress.

Those in attendance at the reception, which took place in Dubai Healthcare City at the Mohammed Bin Rashid Academic Medical Center, included senior government officials, ministers, and health and medical experts, as well as tourism industry stakeholders.  

According to Dr. Ahmed Bin Kalban, the CEO of the Hospital Services Sector at Dubai Health Authority (DHA), the city is known for its high-quality medical care and attractiveness as a destination. Both factors are key drivers for medical tourism in Dubai, a concept in which people travel to another country to receive medical care.

The top services offered in the medical tourism field in Dubai include orthopedics, aesthetics, dental care, fertility tests, and preventive health and wellness. In the first half of this year, 260,000 medical tourists visited Dubai, generating revenues of over one billion dirhams, equivalent to more than $272 million.

His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE, Ruler of Dubai, created DHA in June 2007 via Law 13 to serve as the strategic health authority for the nation. It works to set policies and strategies for health and make sure both are implemented.

DHA’s aim is to deliver an efficient, accessible and unified healthcare system, improve the quality of life, and protect public health. The mission of the body is to guarantee access to health services, improve the status of health for nationals, residents and visitors, and supervise an effective and modern health sector.

Prior to the creation of DHA, the authority for the delivery of health services in the UAE was the Department of Health and Medical Services (DOHMS), which was established in 1973.

Matt Wotus

Sources: CDC, Prometric, Zawya,
Photo: Pixabay

pills
After months of negotiation, the public has spoken. Public health outcry surrounding the Trans-Pacific Partnership (TPP) resounds online, in print and on television.

“We have raised our voice as loudly as we can,” said Manica Balasegaram, executive director of Doctors Without Borders’ (DWB) access campaign. “This is a terrible deal for access to affordable medicines.”

The idea behind campaigns like the one headed by DWB is to remove the intellectual property laws (many pertaining to pharmaceuticals that treat life-threatening conditions) from the Trans-Pacific Trade Partnership (TPP).

As it stands, according to a November 13 Wikileak, the TPP would seek to extend the patent on brand-name pharmaceuticals an additional five years (delaying the onset of cheaper generic drugs that compete with brand-names), as well as 12 years of “data exclusivity” for biologic drugs, of which include many cancer and multiple sclerosis therapies.

While these intellectual property rights are sure-fire ways to keep pharmaceutical prices high—even unreachable for many in developing countries—defenders of the TPP laud them as ways to improve health, not hamper it.

The first line of the secret TPP document that was leaked by Julian Assange in 2013 decries that the thought process behind these intellectual property laws is to “enhance the role of intellectual property in promoting economic and social development in relation to the new digital economy, technological innovation, and transfer the dissemination of technology and trade.”

As increases in antibiotic resistance demands more innovation in pharmaceuticals, they remove incentives for Big Pharma to pursue antibiotic options (data shows that the more times you use these antibiotics, the less effective they are, so profits are capped).

Beneath this intellectual property clause that is a roadblock to doctors and patients everywhere, lies a real problem–how can we incentivize further development of life-saving antibiotic therapies?

The best way our society knows how to incentivize something is to monetize it. The idea of writing hours of code at a computer was abhorrent, for many, until Bill Gates and Steve Jobs turned personal computers into million-dollar industries.

The intellectual property laws surrounding pharmaceuticals (especially, antibiotics) exist to serve this purpose—to create an industry that is robust, profitable and differentiated.

It is even present in the existing TRIPS free trade agreement which guarantees some intellectual property laws in free trade agreements, even providing special waivers to certain developing countries that exempt them having to abide by pharmaceutical patents until at least January 2016.

“The LDC waivers [exemption from TRIPS-sponsored patent law for drugs] are among the important flexibilities available in the TRIPs agreement,” wrote a UNAID 2012 report.

“Retaining the flexibility to adapt intellectual property law and policy to meet national development objected has facilitated the development of robust generic industries such as India and Brazil. Generic competition, primarily from Indian pharmaceutical manufacturers, has been one of the key factors in the dramatic decrease in prices of…medicines for HIV treatment.”

If the TPP must go through, which according to some reports will happen before the dawn of the 2016 election year, the TRIP waiver program has already given us the skeleton of a tool to combat it.

If intellectual property rights for biologic therapies and drugs in the US are to be tightened, the extension of the waivers for generic development elsewhere may be necessary.

Diversify the market–let the developing nations step in with their own budding pharmaceutical industries and mollify the situation that the TPP has the power to create.

Emma Betuel

Sources: UNITAID, UNAIDS, About News, Doctors Without Borders (MSF), WikiLeaks, Health Affairs, Center for American Progress
Photo: Pixabay

Rabies outbreaks in poor rural areas
Rabies occurs in more than 150 countries in the world. The disease is present on all continents with the exception of Antarctica. Each year, tens of thousands of people die from the infection it causes.

Most of the areas that are affected are in Asia and Africa and account for over 95% of human rabies deaths. The disease occurs mainly in remote rural communities. Rabies outbreaks are rampant among impoverished and vulnerable populations.

Rabies is a zoonotic disease. It is caused by a virus that allows the disease to be transmitted to humans from animals. The disease may affect domestic and wild animals, known carriers include foxes, raccoons, skunks, jackals, mongooses and other wild carnivore host species. However, dogs are the primary sources of human rabies deaths. Rabies is spread to people through close contact with an infectious substance such as bites, saliva or scratches. Most people usually become infected after a deep bite or scratch by an infected animal. Upon the onset of the disease developing, the disease is nearly always fatal.

Prevalence in rural areas is due to the lack of vaccinations. There is low vaccination coverage of dogs, and an inability to finance the costs of vaccination for humans. Other factors include poor management of dogs, and in particular the free movement of dogs, which increases their risk of contracting rabies from wildlife.

In terms of policy, rabies is lacking policy formulations to combat rabies throughout developing countries. As a result of the poor level of political commitment and effort to control rabies, there is a lack of understanding of how rabies impacts public health and socioeconomic affairs.

Rabies is a vaccine-preventable viral disease. Each year over 14 million people receive a post-exposure vaccination to prevent the disease. This vaccination prevents hundreds of thousands of rabies deaths. Other strategies to control the disease consist of controlling the dog population, vaccinating domesticated animals and education about prevention to reduce the number of animal bites. After a bite, immediately cleaning the wound, and immunization within a few hours after contact with the animal can prevent the onset of rabies.

The World Health Organization promotes human rabies prevention through the elimination of rabies in dogs. Their target is for the elimination of human and dog rabies in all Latin American countries by 2015, and South-East Asia by 2020.

Erika Wright

Sources: Iowa State University, International Journal of Infectious Diseases, NIH, WHO
Photo: CNN

UNAIDS Wants Trade Agreements to Uphold Commitments to Public HealthWith the celebration of reaching 15 million people with HIV treatments and committing to end the AIDS epidemic, UNAIDS reminds countries that new trade agreements should not limit access to medicine.

At the 2011 Political Declaration on HIV/AIDS, governments reconfirmed their commitment to the use of existing flexibilities under the Trade-Related Aspects of Intellectual Property Rights (TRIPS). Specifically, governments reiterated their commitment to promoting access and trade of medicines and to ensure that intellectual property rights provisions in trade agreements do not undermine existing flexibilities.

TRIPS had to be reestablished with governments because as explained by UNAIDS Executive Director, Michel Sidibé, “We are entering a crucial phase of the AIDS response which will decide whether we end the epidemic as a public health threat by 2030. Anything that undermines that response must be avoided.”

Trade negotiators from 12 countries are working to conclude the Trans-Pacific Partnership Agreement (TPP). Under this text, there are reportedly provisions that go beyond what is required under the TRIPS Agreement.

With these “TRIPS-plus” provisions, generic competition could become more difficult. This would lead to higher drug prices. “Generic competition in the pharmaceutical industry, as well as the use of intellectual property flexibilities, have helped make prices for life-saving drugs much more affordable and enabled the unprecedented scale up of HIV treatment programmes.”

To achieve the elimination of AIDS by 2030, treatment drugs should not become more expensive. Instead, testing and medications should become more abundant and affordable to individuals.

The Fast Track Initiative not only wants to treat individuals who are infected with the virus but prevent the further spread of infection. With the combination of treatment and spreading awareness, this is how AIDS will be eliminated.

With this initiative, 28 million HIV infections will be avoided between 2015 and 2030. Twenty-one million AIDS-related deaths with be avoided during that same time period. A main point in this initiative is that the billions of dollars spent on HIV treatment will be made available to be spent on other areas of health care.

Early testing and treatment of HIV will save a generation that may not even be aware that they are infected. With many African countries being plagued by the spread of HIV, informing people about treatment and options is one of the best ways to end AIDS.

If the global Aids response is to attain the 90-90-90 treatment target by 2020 — 90 percent of people living with HIV knowing their status, 90 percent of people who know their status on treatment, and 90 percent attaining viral suppression — HIV treatment must be accessible and scale up must be financially sustainable.

Kerri Szulak

Sources: UNAIDS 1, UNAIDS 2
Photo: Flickr

Vaccinating the MassesFlu shots are synonymous with cold and wintry conditions. Lines stretching hundreds of feet from the doors of CVS and middle schools become commonplace during the first months of a new year.

Every year, children squirm awaiting the dreaded shot, vaccinating them from the clutches of the dreaded flu. We’ve become accustomed to this process over the years, but the reality is that this tedious cycle may be coming to an end with new medical advancements on the horizon.

The world’s first universal vaccine may be right around the corner. Researchers at Rockefeller University are working to develop a new type of vaccine that, according to the Times of India will, “harness a previously unknown mechanism within the immune system to create more effective and efficient vaccines against this virus which may ultimately result in a vaccine that provides life-long immunity against flu infections.”

The vaccine operates by targeting all varieties of flu strains and utilizes modified antibodies.

These new antibodies are being formulated to target flu strains that often are not treated by standard vaccines. An article in EurekAlert examined the science behind this bold undertaking by scientists.

“Work in the Ravetch lab suggests a new alternative: chemical modifications to the Fc region of antibodies. These regions go on to form complexes with vaccine antigens, which then modulate the evolving vaccine response,” reads an excerpt from EurekaAlert.

Essentially, once the new vaccine is administered to the patient, it continually evolves to combat any future flu strains that may arise in the patient.

The possibility of a universal flu vaccine being only years away would revolutionize world health. By only needing to be administered once, the vaccine could be distributed all over the world.

This would allow for those in poverty to receive vaccination and have life-long immunity. Mortality rates all over the world would decrease incrementally with life-long vaccination a reality.

– Diego Catala

Sources: Eurekalert, Times of India
Photo: Google Images