Posts about Health Care

Alzheimer’s and the Complex Scientific Inquiry Process

This webcast provides an interesting look at the complex scientific inquiry process: An Alzheimer’s Drug That Doesn’t Treat Alzheimer’s?

Medical research is complex. Once we figure out what is most critical and discover effective treatments often the explanations can then make it seem fairly simple. But that process is often decades of efforts that include years of frustration and confusion.

For long term medical impacts we often need to guess at important biomarker indications that may be closely related to health outcomes. But that process often isn’t as easy as it sounds.

Much Alzheimer’s research for the last few decades has focused on amyloid plaque reduction.

A new Alzheimer’s drug has been approved. But should you take it?

Aducanumab (brand name Aduhelm) is a monoclonal antibody engineered in a laboratory to stick to the amyloid molecule that forms plaques in the brains of people with Alzheimer’s. Most researchers believe that the plaques form first and damage brain cells, causing tau tangles to form inside them, killing the cells. Once aducanumab has stuck to the plaque, your body’s immune system will come in and remove the plaque, thinking it’s a foreign invader. The hope and expectation are that, once the plaques are removed, the brain cells will stop dying, and thinking, memory, function, and behavior will stop deteriorating.

I personally do not think the drug should have been approved. Continued research would be fine, but approving an extraordinarily expensive drug without strong evidence of significant positive health outcomes is very poor public policy.

Related: The Amazing Reality of Genes and The History of Scientific InquiryScientific Inquiry Leads to Using Fluoride for Healthy TeethIntroduction to Fractional Factorial Designed ExperimentsBenefits of a Mediterranean Diet May Include Reduced Risk of Cognitive Impairment As We Age

Widespread Misuse by Those Who Use Antibiotics Infrequently Leads to Resistance

Widespread, occasional use of antibiotics in USA linked with resistance

The increasing prevalence of antibiotic resistance in the U.S. appears more closely linked with their occasional use by many people than by their repeated use among smaller numbers of people, according to a large new study from Harvard T.H. Chan School of Public Health.

The study also found that antibiotic use varies across the nation, and that in areas where particular antibiotics are used more frequently, resistance to those antibiotics is higher.

“We know that efforts to reduce inappropriate use of antibiotics are critical to addressing the problem of antibiotic resistance.

“Our results show that most antibiotic use is occasional—by people taking just one antibiotic course in a year—and that this occasional use is more closely linked with antibiotic resistance than intense, repeated use.”

The problems created by misuse of antibiotics are significant and continuing. The consequences are long term and diffuse. The lack of immediate and damaging impacts makes the continued misuse seem to have little consequence. However, the consequences are dire but not immediate.

In this way it is similar to the problems caused by pumping huge amounts of green house gases into the atmosphere and causing massive climate changes (though delayed by several decades). As a society we really have to get better at changing our behavior when the long term consequences are dire and clear.

It is good to learn from these efforts to understand the most significant aspects of our continued misuse of antibiotics in order to prioritize where we focus our improvement efforts.

Related: What Happens If the Overuse of Antibiotics Leads to Them No Longer Working? (2011)Our Dangerous Antibiotic Practices Carry Great Risks (2012)80% of the Antibiotics in the USA are Used in Agriculture and AquacultureCDC Urges Increased Effort to Reduce Drug-Resistant Infections (2006)Antibiotics Breed Superbugs Faster Than Expected (2010)

Saving Lives with Appropriate Technology Health Care Solutions: Treating Infant Pneumonia

How a shampoo bottle is saving young lives, a doctor in Bangladesh has found a simple way to treat infant pneumonia

Last year 920,000 children under the age of five died of pneumonia, making it the leading killer of people in that age group. This figure is falling (in 2011 it was 1.2m), but it still represents 16% of all infant deaths. Such deaths are not, however, evenly distributed. In Bangladesh pneumonia causes 28% of infant mortality.

Dr Chisti says that, as well as saving lives, his device has cut the hospital’s spending on pneumonia treatment by nearly 90%. The materials needed to make his version of a bubble-CPAP ventilator cost a mere $1.25. The device also consumes much less oxygen than a conventional ventilator. In 2013 the hospital spent $30,000 on supplies of the gas. In 2017 it spent $6,000.

Efforts are underway to test this innovation and spread the adoption of this appropriate technology solution to other poor countries. It is wonderful to see engineering innovation making such important improvements in health care around the world.

Related: Appropriate Technology Health Care Solution Could Save 72,000 Lives a Year (low-tech visual exam cut the cervical cancer death rate)Drone Deliveries to Hospitals in Rwanda$1 Device To Give Throat Cancer Patients Their Voice AgainWristband Thermometer Can Save Many Babies’ Lives

Drone Deliveries to Hospitals in Rwanda

Partnering with the Government of Rwanda, Zipline serves 21 hospitals nation-wide. They provide instant deliveries of lifesaving blood products for 8 million Rwandans.

Their drones are tiny airplanes (instead of the more common tiny helicopter model). Supplies are delivered using parachute drops from the drone. Landings are similar to landings on aircraft carriers (they grab a line to help slow down the drone) and, in a difference from aircraft carrier landings, the drone line drops them onto a large air cushion.

Zipline Muhanga Distribution Center launched in October 2016 making Rwanda the first country to integrate drones into their airspace and to begin daily operations of autonomous delivery.

As of May 2017, Zipline had completed over 350 delivery flights to real hospitals and their pace is accelerating. Zipline can cut delivery time from 4 hours to 15 minutes (which is extremely important in time critical health care emergencies).

I wrote in 2014 about the huge potential for drone delivery of medical supplies. It is wonderful to see Zipline improving people’s lives with their effort.

Related: Inspirational Engineer, William Kamkwamba from Malawi (2008)Using Rats to Sniff Out TBUS Fish and Wildlife Service Plans to Use Drones to Drop Vaccine Treats to Save FerretsWater Wheel

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USA Health Care Crisis: Opioid Abuse

Video embedding has been broken, so embedded video was removed.

In 2014 about 34,000 deaths in the USA died in car crashes and about the same number of deaths resulted from gun violence, but more than 47,000 people died from drug overdoses.

Opioid abuse has greatly increased these deaths in the last decade. Chronic pain is a real problem we need to manage. But the current practices are leading to troubling results as are our methods for dealing with drug abuse (including illegal drugs such as heroin). Abusing prescription drugs such as addictive opioids and illegal drugs such as heroin are both leading to an increasing number of deaths in the last decade.

Worldwide somewhere between 26 and 34 million people are abusing opioids. More than 2 million of them are Americans abusing prescription opioids.

Heroin is an example of a non-prescription opioid.

Admissions for the treatment of abuses of prescription opioids constituted about 1% of [USA emergency room] admissions in 1997, and they made up 5% of admissions a decade later.

Related: President Obama Proposes $1.1 Billion in New Funding to Address the Prescription Opioid Abuse and Heroin Use Epidemic200,000 People Die Every Year in Europe from Adverse Drug Effects – How Can We Improve?The War on Drugs has been a Huge Failure with Massive Unintended Consequences (we need to use health care strategies to manage the problem not war strategies)Over-reliance on Prescription Drugs to Aid Children’s Sleep? (2007)

Manufacture Biological Sensors Using Silk and Looms

The fabric chip platform from Achira Labs in India uses looms to manufacture biological sensors.

Image of process for creating silk test strips

image by Achira Labs

Yarn coated with appropriate biological reagents like antibodies or enzymes is woven into a piece of fabric at the desired location. Strips of fabric are then cut out, packaged and can form the substrate for di erent biological assays. Even a simple handloom could produce thousands of these sensors at very low cost.

The resulting fabrics can be used to test for pregnancy, diabetes, chronic diseases, etc.. Achira Labs, an Indian start-up, received $100,000 in Canadian funding in 2013 to develop a silk strip that can diagnose rotavirus, a common cause of diarrhea and can be used in diapers.

The company is planing to start selling silk diabetes test strips using there process this year and expects costs to be about 1/3 of the existing test strips using conventional manufacturing processes.

Related: Appropriate Technology Health Care Solution Could Save 72,000 Lives a YearWater WheelUsing Drones to Deliver Medical Supplies in Roadless AreasAppropriate Technology: Self Adjusting Glasses

A Healthy Lifestyle is More About Health Care than the Sickness Management That We Call Health Care Is

American Heart Association Recommendations for Physical Activity in Adults

Being physically active is important to prevent heart disease and stroke, the nation’s No. 1 and No. 4 killers. To improve overall cardiovascular health, we suggest at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). Thirty minutes a day, five times a week is an easy goal to remember. You will also experience benefits even if you divide your time into two or three segments of 10 to 15 minutes per day.

For people who would benefit from lowering their blood pressure or cholesterol, we recommend 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week to lower the risk for heart attack and stroke.

The simplest, positive change you can make to effectively improve your heart health is to start walking. It’s enjoyable, free, easy, social and great exercise. A walking program is flexible and boasts high success rates because people can stick with it.

It really is important for giving yourself the best chance for health by taking sensible steps to exercise based on your own situation (obviously some health conditions may limit your ability to exercise safely, which is something each person has to judge and see a doctor about if necessary).

Doing small things like using a treadmill while you watch TV or taking the stairs instead of the elevator for short trips can help. Another option is to walk instead of driving your car, or if you drive parking a few blocks away (or at the far side of the parking lot) walking, or if you are running several errands walk between those that you can even if you are using your car. Biking to work is another healthy lifestyle choice (if you city has made this safe – too often they fail to do sensible things).

photo of a forest

Forest hike on Hole in the Wall trail, Olympic National Park, Oregon, USA by John Hunter

Swimming is good exercise and something I took up several years ago (I was super lame at first but within a month or two it was better. I love hiking through national parks. A standing desk (or treadmill desk) is another option to reduce the damage of our sedentary lives.

Another thing to remember is losing weight is hard. It is better to avoid gaining too much weight in the first place. Avoiding the weight gain may also be a challenge but it is better than the alternative.

Too often we treat “health care” as sickness management. Doing things like creating a healthy lifestyle are are health care. Taking pills and antibiotics is mainly about sickness management.

Related: Better Health Through Exercise, Not Smoking, Low Weight, Healthy Diet and Low Alcohol IntakePhysical Activity for Adults: Inactivity Leads to 5.3 Million Early Deaths a YearHealthy Diet, Healthy Living, Healthy WeightStudy Finds Obesity as Teen as Deadly as Smoking

Using Drones to Deliver Medical Supplies in Roadless Areas

This is an awesome use of technology to tackle important problems. Engineers are great.

Humanitarian drones to deliver medical supplies to roadless areas

That idea soon became a start-up called Matternet – a network for transporting matter – which aims to help the one billion people who do not have year-round access to roads.

[Andreas] Raptopoulos said the new system would be used to leapfrog the building of infrastructure, in the same way mobile networks have overtaken fixed lines in poorly connected countries.

In sub-Saharan Africa, 85% of roads are inaccessible during the wet season, cutting off huge swaths of the population and hindering the transport of medical supplies, he said.

There are three parts to the system delivering medical goods: the UAVs themselves, landing stations where packages can be dropped off and transferred, and the software that ensures vehicles get securely from point to point. Because of their short battery life, networks of drones are needed to work together, shuttling between ground stations

Approximate costings from Matternet put the price of unmanned aerial vehicles at £6,000 each and ground stations at £3,000 each. A network of five ground stations and 10 UAVs, as well as setup and training, would cost a charity in the region of £90,000, according to Raptopoulos. An eight-propeller drone can carry 2kg and travel 10km in good weather. Batteries need to be replaced every 600 cycles.

They are hiring: software engineer and avionic engineering [the broken link has been removed] right now. They are Palo Alto, California.

Related: Appropriate Technology Health Care Solution Could Save 72,000 Lives a YearCellphone MicroscopePay as You Go Solar in IndiaWater and Electricity for All

Drugmakers Are Desperate to Know Why Placebos Are Getting More Effective

Fascinating article from Wired: Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.

The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today’s economy, the fate of a long-established company can hang on the outcome of a handful of tests.

Potter discovered, however, that geographic location alone could determine whether a drug bested placebo or crossed the futility boundary. By the late ’90s, for example, the classic antianxiety drug diazepam (also known as Valium) was still beating placebo in France and Belgium. But when the drug was tested in the US, it was likely to fail. Conversely, Prozac performed better in America than it did in western Europe and South Africa. It was an unsettling prospect: FDA approval could hinge on where the company chose to conduct a trial.

In one study, Benedetti found that Alzheimer’s patients with impaired cognitive function get less pain relief from analgesic drugs than normal volunteers do. Using advanced methods of EEG analysis, he discovered that the connections between the patients’ prefrontal lobes and their opioid systems had been damaged. Healthy volunteers feel the benefit of medication plus a placebo boost. Patients who are unable to formulate ideas about the future because of cortical deficits, however, feel only the effect of the drug itself. The experiment suggests that because Alzheimer’s patients don’t get the benefits of anticipating the treatment, they require higher doses of painkillers to experience normal levels of relief.

Benedetti often uses the phrase “placebo response” instead of placebo effect. By definition, inert pills have no effect, but under the right conditions they can act as a catalyst for what he calls the body’s “endogenous health care system.” Like any other internal network, the placebo response has limits. It can ease the discomfort of chemotherapy, but it won’t stop the growth of tumors. It also works in reverse to produce the placebo’s evil twin, the nocebo effect. For example, men taking a commonly prescribed prostate drug who were informed that the medication may cause sexual dysfunction were twice as likely to become impotent.

Moreover, a pill’s shape, size, branding, and price all influence its effects on the body. Soothing blue capsules make more effective tranquilizers than angry red ones, except among Italian men, for whom the color blue is associated with their national soccer team—Forza Azzurri!

Medical research presents significant difficulties. The funding of the health care system also distorts behavior and pushes companies to focus on being able to justify selling drugs instead of focusing on finding effective solutions. Even without incentives distorting behavior, the challenges are difficult enough. Adding the distortions just makes it worse.

It is wonderful we have so many scientists accepting these challenges and spending their careers fighting the odds to help find us wonderful health breakthroughs.

Related: The Majority of Clinical Trials Don’t Provide Meaningful EvidenceSystem for Approving New Medical Options Needs ImprovementMedical Study Integrity (or Lack Thereof)Discussing Medical Study Results

Appropriate Technology Health Care Solution Could Save 72,000 Lives a Year

We need more medical solutions that serve the majority of humanity instead of just the rich. Some medical research is innately costly and therefore require large costs to pay back the investment. But too little concern is shown for solutions that help people (with so much focus only on solutions that will make organizations rich).

Cheap vinegar test cut cervical cancer deaths in India; could help many poor countries

This low-tech visual exam cut the cervical cancer death rate by 31 percent, the study found. It could prevent 22,000 deaths in India and 72,600 worldwide each year, researchers estimate.

More progress against cervical cancer may come from last month’s announcement that two companies will drastically lower prices on HPV vaccines for poor countries. Pilot projects will begin in Asia and Africa; the campaign aims to vaccinate more than 30 million girls in more than 40 countries by 2020.

India continues to invest in medical research for solutions that are affordable to a majority of the world. The rich health care companies largely neglect the majority to focus on the most wealthy.

Related: Using Available Technology (Cellphone) as a MicroscopeDangerous Drug-Resistant Strains of TB are a Growing Threat‘Refrigerator’ Without Electricity

Engineers Save a Life

photo of car resting in river

This photo was taken by the driver’s parents when they arrived. It doesn’t show much of what it went through to get there, but it gets most of the point across. The picture was taken 200 feet away and looking down from the road.

I got into a major accident today that I was able to somehow walk away from. I lost control of my car and went off of a cliff into boulders, and after flipping a few times, settled in the river. I walked away with cuts on my hands from the broken glass and a bruise that runs from my chest over my left shoulder where my seat belt held me in place.

I shouldn’t be alive discussion on Reddit.

swapsrox: Time to send a letter to the manufacturer thanking them for their safety design! I guarantee your letter will be put on an engineer’s wall, and they’ll know there is a reason they go to work every day.

cmdshftn: Great engineering saved your life. The vehicle’s safety systems from the seatbelt to the crumple zones to the design of the seat kept you safe and alive despite all hell going on around you. Please write a letter to the manufacturer thanking their design team, but above all, follow up with whoever you need to in that jurisdiction to find out why there isn’t a guard rail on that road! Vehicle safety helps, but great road design to prevent an accident like yours helps more!

Related: Electronic Stability Control Could Prevent 33% of Crash DeathsDriver Thanks Engineer Who Hit Him on PurposeSmokeless Stove Saves LivesToyota Scion iQ: 37 MPGEngineer Tried to Save His Sister and Invented a Breakthrough Medical Device

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