“Anti-Vaxxers” as they are commonly called, have been increasingly in the news over the past few years, even garnering support from high-profile celebrity figures that are distrustful of the science behind vaccines. Their chief complaints seem to stem from not fully understanding or appreciating various studies and papers released by agencies such as the CDC. Sometimes, flights of fancy take over, and these reports are “imaginatively augmented,” such that the information that winds up circulating widely on the internet bears little relation to the reports that were initially released.

 

 

There have been a number of politicians and activist groups who have had conversations about what could potentially be done to rein in the misinformation and get people to more readily embrace vaccinations, but none of those conversations have borne much fruit as yet. Recently, however, there have been a few new ideas floating around the internet that just might help turn the tide. Of these, the most compelling is also one of the simplest.

It was an idea that was once proposed for cigarettes.
 
Put graphic images of the human lung on each and every pack. The smokers would have little choice but to confront exactly what they were doing to their bodies. The same thinking could be applied to any number of diseases. If we pull no punches and graphically demonstrate what the worst of these diseases actually do to a human body, odds are excellent that more people would give up their reservations about vaccinations in general. It’s hard to argue against such an approach on grounds of its potential effectiveness, but there are some who would say that it goes too far, because of course, some of the diseases we vaccinate against are truly awful when they run their course. The fear here is that the images we would be displaying would be “too graphic” for the general viewing public.

The question though, really comes down to which is worse? Is it worse to have the tender sensibilities of a few disrupted by such images, or to suffer an outbreak of a truly awful disease? There aren’t many ways to make the case that the former is worse than the latter.

If that approach is deemed impractical, however, verbal descriptions could be used in the place of images, although these would lack the visceral impact of photos. Last year, in the United States, we saw the highest number of cases of measles since the disease was declared eliminated in this country by the CDC in the year 2000. According to CDC statistics, fully 79% of the cases last year occurred among the population of individuals who choose not to receive the MMR vaccine, driven by personal beliefs and concerned about their safety.

Many medical professionals feel that a less confrontational approach would be to simply describe the impacts of the disease, and there may be something to do that. Professor Keith Holyoak, at the University of California (Los Angeles) conducted a detailed study that seemed to bear this out. The results demonstrated that this approach was not perfect, but it did change more than 30% of people’s minds, and every little improvement helps!

Biotech is one of the fastest growing industries in the world right now, and probably will be for the foreseeable future.  It’s the fusion of IT and medicine, and is currently poised to usher in a whole raft of new advances that will change the face of medicine.

 

One of the biggest recent developments in the IT universe has been the development of the “Internet of Objects,” also called the “Internet of Everything.”  This has been made possible by new devices from CISCO that enables almost any object to become ‘net connected and feed data to cloud-based databases.  Predictably, one of the results of this technology is that businesses in every area of the economy are now swimming in oceans of data they’ve never had access to before.  That includes, of course, the medical profession.  New devices are beginning to proliferate that are putting more data than ever before into the hands of doctors and other health care providers.

 

The data sets are so big, in fact that an entire new set of tools had to be designed just to handle the inflow.  Those new tools are in place now, and health care professionals and others are beginning to reap the benefits.

 

Recently, researchers at Johns Hopkins University have been making strides to help reduce the number of deaths, nationwide, from Sepsis.  It’s a creeping killer that doesn’t get a lot of headlines, but the reality is that every year, more people die from Sepsis than die from AIDS, breast cancer, and prostate cancer combined.  Early detection is the key, and as the people at Johns Hopkins are now demonstrating, Big Data has an important role to play in early detection.

 

By compiling a massive database and constructing an algorithm that is currently undergoing refinement testing, the new model they’re building can correctly predict septic shock 85% of the time, via commonly used screening methods.  That number is expected to see further increases as the model continues to develop.

 

This is a huge win for the medical community, because especially in the case of Sepsis, time is critical, and hours matter.  The earlier it can be detected or predicted, the more likely it is that health care professionals can save a life.

 

You can expect to see a great many other practical uses for the oceans of data we are now able to collect on patients.  In every case, the broad, overarching theme will be the same.  Earlier detection of health care issues so that doctors can fix problems while they’re still small, or preferably pre-emptively, before they’re actually even problems at all.

 

So far, we’ve seen several innovations in the health care field that promise to greatly expand this kind of predictive capability.  From apps installed on handheld devices, to flexible circuitry that can be worn for days at a time (and is even shower-resistant), to 3d-printed veins and organs which could even be installed with sensors to detect potential failures well in advance, the shape of medicine is changing.  It’s a very exciting time to be in the profession.

Statistics indicate that Fibromyalgia afflicts about one in seventy Americans; however, the condition can be notoriously difficult to diagnose, so that number may be off. It is a chronic pain syndrome that strikes selectively. Most of the sufferers are women.

 

 

The condition is often triggered by head trauma, although severe emotional stress or certain neurological infections can also cause it. Symptomatically, you’ll see patients present with chronic fatigue and a variety of musculoskeletal pains. Mood swings and memory loss are also common symptoms.

 

Because it is so difficult to diagnose, patients who suffer from it often suffer for months or years as various treatment approaches are experimented with. Fortunately, once it is diagnosed, a new treatment option developed by a group operating out of Tel Aviv University, may offer some much needed relief.

 

Their approach is innovative, and uses pain medications combined with hyperbaric oxygen treatment. The group, led by the late Professor Eshel Ben-Jacob, believes they have also identified the root cause of the condition. If true, then their research will lead to new and even better treatment options in the future.

 

Hyperbaric oxygen chambers are used to expose patients to pure oxygen at high atmospheric pressures. Typically, this type of treatment is common when treating patients with carbon monoxide poisoning, embolisms, decompression illness, and burns. This is the first time it has ever been tried on patients suffering from Fibromyalgia.

 

The trial involved a test group of sixty women who had been diagnosed with the condition at least two years prior. Half of the patients received forty 90-minute hyperbaric oxygen treatments which exposed them to pure oxygen at 2x atmospheric pressure. The treatments were given five days a week for a period of two months. The results were impressive indeed, with more than 70 percent of the women in the hyperbaric oxygen group reporting a drastic reduction, and in some cases, an outright elimination of the pain caused by their condition. Pain that traditional drug therapies masked, but did nothing to prevent.

 

The researchers did discover some discrepancies in the data that bear mentioning. Depending on the triggering mechanism for the condition, the treatment was less effective, so the catalyst matters. Patients who saw the onset of their Fibromyalgia due to a traumatic brain injury saw a complete elimination of symptoms, while patients who got the condition via other means saw somewhat less in the way of overall improvement. Contrary to being a strike against the treatment option, or an indication that there was some flaw in the research or methodology, this result makes sense, given what we know of hyperbaric treatments and their effectiveness on patients with embolisms.

 

Although Professor Ben-Jacob passed away before the study concluded, the rest of the team has already indicated that they will continue the research. Based on the early results, it is likely that their efforts could result in an innovative, highly effective form of treatment for a tricky, difficult to diagnose condition, and finally bring much needed relief to millions of Fibromyalgia sufferers.

Nanospheres exist at the very bleeding edge of scientific research.  They are the latest creation of the nascent biotech industry that is only just now beginning to find its footing.  If you haven’t heard of them yet, you’re not alone, but you’ll be hearing a lot more about them, and a host of other new inventions from the biotech industry in the months ahead.

 

 

 

In brief, nanospheres are “smart” nanoparticles.  They’re designed and programmed to recognize proteins.  In the presence of the “right” protein, the particle’s code is executed, and the drugs contained within the particle are released.  Put enough of these particles in a patient’s body, and they’ll be able to release any dose of any drug that is required, under the particular circumstances of the patient.

 

 

The problem with drugs and drug delivery is that getting the dosage right can be a tricky proposition.  In your own practice, how many times have you prescribed medication to a patient with the proviso that “we’ll see how you do, and in a couple months, we’ll adjust the dose if we need to.”

 

 

Probably more than once.  It’s a fairly common practice.  With nanospheres, there’s no need to guess.  Simply inject the particles into a patient.  The particles contain the needed drug, and will only release it if the conditions of its programming are met.  Thus, the patient only gets the drug if and when he needs it, and only in the amount necessary to satisfy the parameters of the program that drives them.

 

This is potentially exciting news, but the development is not without its skeptics.  Critics say (and rightly so) that it all comes down to the quality of the programming that drives the nanoparticles.  If the programming is wrong, then the patient could wind up either getting not nearly enough of a dose of the drug in question to make a difference, or a massive, and potentially fatal dose.

 

 

Admittedly, the biotech industry is still in its infancy, and we’re only just now beginning to see a raft of new inventions and devices that seem poised to change the face of medicine forever.  It’s very exciting, and it’s all too easy to get caught up in that excitement.  The critics are right, however, to advocate for a cautious, measured approach when it comes to practical application.  After all, when you make an estimate on the correct dose of a given drug to prescribe, you always play it safe, relying on years of hands-on experience to guide you.  Where these nanoparticles are concerned, one misplaced comma somewhere in a line of code could literally mean the difference between life and death for a patient.

 

 

All that to say, yes.  Nanospheres are a fantastic invention with an enormous amount of potential, developed by the most dynamic sector of the healthcare industry.  It’s very exciting, but like any new invention, deserves to be greeted with a healthy dose of skepticism until it can be proven as safe and effective as it promises to be.

Researchers at Johns Hopkins University have delved into new territory to uncover the causal linkages between breast cancer survival and weight gain.  The linkage between the two is fairly well known to those in the medical community, and of course, to the survivors themselves, but the reason for the eight year research project was the simple lack of data on the topic.

 

 

 

The Johns Hopkins group assembled 303 breast cancer survivors and 307 cancer-free women for the study.  One of the questions they sought to answer was “does chemotherapy contributes to weight gain?”  Certainly on the surface of it, this seems to be the case, but again, prior to this study, there was a conspicuous absence of hard data to base any firm conclusion around.

 

Basic Findings

 

First and foremost, the study confirmed what many in the medical community have long understood.  Breast cancer survivors are approximately twice as likely to suffer weight gain after their course of treatment.  For the purposes of this study, the Johns Hopkins team used an at least eleven pound weight gain as their definition of “significant.”

 

These findings were consistent across the entire population of breast cancer survivors, cutting across age, menopausal status, and other factors, so clearly, there’s something going on here.  Some connection between either breast cancer itself, or the treatments used, and later weight gain.

 

 

To help get to the bottom of that, the team next began investigating the types of cancer treatments each woman had, in order to identify a pattern.  Sure enough, one emerged.  Women who were treated with cholesterol-blocking drugs after receiving chemotherapy treatments tended to have a higher chance of weight gain, and when they gained weight, tended to gain more of it.

 

It should also come as no surprise, but the data also confirmed that women who had a family history of obesity were more likely to see weight gain regardless, which is one of the limitations of the current study.  The researchers at Johns Hopkins recognize this, and already have a plan to continue following all of the women in the study group to continue tracking their weight history over time.

 

While most of the report contained no surprises, the possible linkage between cholesterol-blocking drugs and weight gain might raise a few eyebrows.  It’s important to remember that this is a single study, with follow ups planned, so while the early conclusions are interesting, they are by no means definitive.  Clearly, more study is needed, but this has proved to be an interesting first look into an area where there has been little work done to date.  In your practice, if you treat women who are breast cancer survivors, this study does not, sadly, provide all the answers, but it is a tantalizing first look, with the promise of more to come.  By itself, it’s certainly not enough to influence treatment decisions, but it is compelling enough to at least bring it to the attention of your patients, so they are aware.

AIDS has proved to be a cunning, efficient killer, and we have been living under its shadow for decades now.  In the year 2000, a UN committee introduced eight MDG’s (Millennium Development Goals) which provided a broad outline of the most pressing problems facing the world, and detailed plans for addressing them.

 

One of the eight goals on the list was to stem the tide of new AIDS infections.

 

 

You hear a lot about the UN in the news, and much of what you hear isn’t all that praiseworthy.  It’s an organization that always seems to mean well, but historically, tends to underwhelm and under-deliver.  This was one of those rare, shining moments when things were different.

 

It’s been fifteen years since the MDG’s were introduced, and the world responded to this one in particular, with relish.  Billions of dollars of funding poured in to spur AIDS research.  According to the most recent report, every dollar of funding provided is generating $17 in returns.

There are 83 countries responsible for 83% of AIDS cases worldwide.  Today, most of these (developing and third world) nations have halted the spread of the disease.  The numbers are staggering.  In the year 2000, there were 3.1 million new HIV infections.  In 2014, the number had dropped some 35% to just 2 million.  Yes, two million is still a huge number, but the magnitude of the drop has been nothing short of breathtaking.

 

In addition to this, however, fully fifteen million more people have access to antiretroviral therapy, and among the infected population, deaths from tuberculosis fell by a third.  Perhaps the most exciting statistic from the UN report, however, is the fact that fully 73% of pregnant women living with HIV now have access to antiretroviral therapy, and new HIV infections in children have dropped by more than half (down fully 58% since 2000).

 

As good as all of this news is, the UN urges everyone to maintain focus and keep the pressure on.  AIDS is on the retreat, but it’s not yet beaten, although Michel Sidibe, the Executive Director of UNAIDS, which produced the report was pleased to announce that if things continue on their current trajectory, we stand to have AIDS utterly eradicated by as early as 2030.  That’s news good enough to make everyone in the health care industry cheer.

 

Some Dark Spots in the Data

 

Despite all the good news, there were also some troubling trends revealed in the data.  For instance, despite massive progress in the developing world, HIV infection rates, especially among gay men, are on the rise again in Europe and North America.  The report also puts a fairly specific price tag on meeting its target.  By Sidibe’s estimates, an additional #31.9 Billion dollar investment is needed to fully fund AIDS Response in 2020 and another $29.3 billion in 2030 in order to see the disease fully eradicated.

 

Even with the glowing report on their progress, it remains to be seen whether a sufficient amount of global support remains to put that kind of funding together, and if not, then Sidibe’s entire timetable could be in jeopardy.

Addiction can be a difficult subject to broach with your patients.  Both in and out of the medical community, there’s a raging debate.  Is it a disease, or simply a bad habit gone wrong?  A compelling case can be made for both, and patients tend to get defensive when the topic of a potential addiction comes up.

 

There is heartening news, however, in the form of a study conducted by UC Berkekey.  As with most studies of this type, for a variety of legal reasons, this study was conducted on mice.  Nonetheless, it offers some intriguing insights into addiction, and how it might be combated.

 

 

The structure of the study was fairly simple, but remarkable illuminating.  Two groups of mice, seventy in all.   One was offered cocaine, and nothing else.  Nothing in the way of mental stimulation or challenges.  The other group was also offered cocaine, but in addition to that, given the opportunity to run mazes in exchange for rewards.

 

Interestingly, the mice offered the stimulation were far less likely than their counterparts in the other group to actually take it.  This then, the deprivation of intellectual challenges, is shown to directly impact the level of drug-seeking behavior in the test subjects.

 

Could it be that simple?  Could providing an environment filled with intellectual stimulation help protect against the urge to take drugs?  If the mice are any indication, the answer to that question is a resounding yes!

 

This study, while preliminary, appears promising indeed.  Clearly more work is needed, and it would be nice if some group could find a population of admitted drug users and test the theory on human brains, but it surely stands to reason that if a drug-dependent individual is placed in a rich, stimulating environment, the urge to turn inward, and more specifically, to turn back to drugs as a form of release or escape would be lessened.

 

This in turn, could open the door to a host of promising new addiction treatment options.  Again, it’s too early to say with certainty, on the basis of this single study, but the results show great promise.  These may be the first tentative steps toward finally being in a position to craft a comprehensive, viable drug treatment program that gets to the heart of the matter:  The individual’s craving for, and desire to use.

 

If that craving could be cleverly redirected, the patient would, over time, find himself simply less and less in need of the chemical stimulation provided by his or her drug of choice.  Instead, it would be replaced by healthier options.

 

If you have patients who struggle with addiction, or know anyone personally who faces those kinds of challenges, this study should give you hope.  It’s a first step, true, but an important and exciting one, and the UC Berkeley group has already announced a continuation and expansion of their investigations, so there will be more coming from this group, and related studies as they are developed.

 

Addiction is a cruel mistress, and very hard to treat.  This study holds out the hope, at least, that things might be changing.

Times have changed. In the fifties and sixties, a new, non-smoking recruit to the US Army would be converted to a smoker before the end of his first day in Boot Camp. Why? Because everybody else smoked, and because smokers got more breaks. It was a virtually fool-proof system that created a generation of smokers.

 

Then science happened, and as it did, the world got the creeping realization that the scientists in the employ of the tobacco industry might have an agenda behind their reports, which categorically stated that there was no health risks associated with smoking.

 

These days, the landscape could not be more different. In fact, May 31st was World “No-Tobacco Day.” The reason for the creation of the annual No-Tobacco day is both simple and compelling. There are more than six million smoking related deaths, each year.

 

Fortunately, along with the changing views on tobacco, a staggering array of forces is now arrayed against tobacco. In the US, cigarette sales have been in decline for years. For a time, the difference could be made up in other parts of the world, but these days, the industry is struggling. Then again, it’s somewhat hard to find a good sales pitch for a habit that ultimately kills your customers.

 

It all seems to be ending though. Granted, cigarette manufacturers are in no danger of going extinct any time soon, but there is now an increasingly coordinated global effort to continue hammering away at smoking’s numerous downsides, and they’re having a notable effect.

 

We’re not talking about a single group, but rather, a series of independent or semi-independent initiatives that are breathtakingly cross-discipline. These initiatives are run by political scientists, health care researchers, environmentalists, legal experts, government officials, and more.

 

Together, these groups are pioneering new and innovative approaches in tobacco control. The aim here is not to outlaw cigarettes. That is seen as a non-starter, and would only serve to drive smoking underground. That would turn the fight into a prohibition-style battle, and we’ve learned better than to attempt such a heavy handed approach.

 

Make no mistake. Tobacco, and the illnesses that arise from its use, represents an epidemic in every sense of the word. This cross-disciplinary, globe-spanning approach is absolutely essential. It’s the only way to meet the still entrenched tobacco interests and continue to make headway. Only by keeping the pressure up on a multitude of fronts, can we finally get a handle on, and ultimately begin reducing the number of deaths we see each year.

 

The UN has even taken the step of developing the FTTC (Framework Convention on Tobacco Control). What’s missing, at least so far, is the integration of this framework into the larger architecture of the UN’s Sustainable Development Goals. It’s just a matter of time before such an integration occurs, however, and when it does, we can expect to see further, and more rapid progress toward the goal of finally bringing an end to the decades’ old tobacco epidemic.

Right now, in the United States, there are approximately 124,000 patients on waiting lists for various organs for transplantation surgery. Each year, more than ten thousand patients die while waiting for a call that will never come. They die each year waiting for organs that simply aren’t available.

 

 

It’s a grisly topic, but one that bears a closer look: Where, exactly, do organs for organ donation come from?

 

In the United States, organs are harvested for transplantation via three primary channels. First, neurologic deaths. Second, controlled circulatory deaths, and finally, live donors for partial liver and kidney transplants.

 

Unfortunately, the number of organs available from these three sources is completely inadequate to the task at hand, and any expectation that a sufficient number of organs can magically be made available by way of simple volunteerism is pure fantasy. What then, can be done? Or, can anything be done at all?

 

There has been some talk of “growing” a variety of organs, or even “printing” them via 3d printing technology, but from a practical perspective, those technologies are still decades away from being able to meet even a fraction of the total annual organ demand.

One possible solution then is offered by a European model. It bears a closer look, because it would potentially make scores of thousands of organs available, and do much to solve for the organ shortage.

 

So what’s Different?
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The key phrase is “Uncontrolled donation after circulatory determination of death” (UDCDD). The central idea here is that upon a person’s death, whether in or out of the hospital, the deceased family is asked if they have an interest in preserving the organs for possible later donation.

 

Note the separation here. This idea respects the family’s pain and relative lack of an ability to make decisions of that magnitude immediately following the death of a loved one. By merely making the decision to PRESERVE organs for possible donation later, rather than having to make the decision to donate immediately, the family is given space and time to grieve. In allowing for that, the decision to donate organs later, once those first awful few days are behind the family, is much more likely.

 

In practice, where this approach is currently being used in Europe, it has led to an enormous increase in organ availability. While it may not completely close the gap between supply and demand here in the United States, it would singlehandedly cover much of the shortfall. Not only would this mean thousands of lives saved each year, but it would also do much to curtail the illegal organ trade, worldwide.

 

Uncontrolled donation after circulatory determination of death isn’t a perfect solution. It isn’t a panacea, but it is an ethical solution to a problem that impacts more than a hundred thousand people in this country alone. Finding a viable solution to the problem of our nation’s organ shortage would represent a huge improvement in the overall quality of care in this country.

No matter what your feelings are about the ACA, one of the things it has done is the fact that it has made a tremendous amount of data available that we’ve never had access to before.  The last time we got a view into national statistics like this was the 1960’s, when programmatic expansions led to millions of new enrollees.

 

 ACA enrollment data has given us some interesting insights and observations.  For example, those who enrolled early on in the process tended to be older.  The average age of enrollees has been dropping since the doors first opened.  This stands to reason.  A high percentage of the nation’s poor are older Americans who have had enormous difficulty getting back into the workforce after the Great Recession ended.  They’re too old to be good candidates for employers looking for young and hungry workers, and they’re too young for Medicare, so it should come as no surprise that this group would have been among the first to join the ACA’s enrollment roster.

 

Another interesting fact about the early enrollees is that they filled twice as many prescriptions as those who enrolled later on.  Again, this is revealing and highly suggestive.  It points to the fact that one of the biggest hardships faced by this group has been the cost of prescriptions.  Based on that, it also hints at better healthcare outcomes in future months.  One of two things must be truth here.  Either the early enrollees were getting their medication through other channels, and took the opportunity cost for doing so by not eating as well or making other budgetary cuts to compensate or they weren’t taking their medications at all.  In either case, healthcare outcomes should be better for this group.

 

In yet another subset of the data, this one comparing prescription medication from people who got their insurance coverage from the Marketplaces versus people that got their coverage via employer-based plans.  Those in the first group, who enrolled via the Marketplace, were significantly more likely to fill prescriptions for Hepatitis C medications and HIV medications.

 

At first blush, this might seem curious, but a deeper look takes much of the mystery out of the equation.  Insurance companies in the pre-ACA landscape had rescission policies that made it quite easy for them to drop or deny coverage for certain classes of people.  In a cruel twist of fate, members of the most vulnerable populations are (or were, until the new law forbade it) among the first to see their coverage dropped.

 

The big reveal in these statistics then, is the fact that the ACA seems to be accomplishing its two primary goals.  The total number of uninsured Americans is dropping, and members of vulnerable populations are increasingly gaining access to prescription medications they had previously been denied.  Granted, there is considerable overlap between the two groups mentioned above, but in both cases, it points to a probable long term improvement in health care outcomes in the United States.  That’s a very good thing.