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CDC Again Stresses Urgent Need to Adjust Practices or Pay a Steep Price

Posted on March 8, 2013  Comments (3)

Untreatable and hard-to-treat infections from Carbapenem-resistant Enterobacteriaceae (CRE) germs are on the rise among patients in medical facilities. CRE germs have become resistant to all or nearly all the antibiotics we have today. Types of CRE include Klebsiella pneumoniae Carbapenemase (KPC) and New Delhi metallo-beta-lactamase (NDM). By following the United States Center for Disease Control (CDC) guidelines, we can slow the penetration of CRE infections in hospitals and other medical facilities and potentially spread to otherwise healthy people outside of medical facilities.

The CDC has worked with hospitals to successfully apply these measures. The CDC worked with Florida to stop a year-long CRE outbreak in a long-term acute care hospital. With the improved use of CDC recommendations (such as educating staff; dedicating staff, rooms, and equipment to patients with CRE; and improving use of gloves and gowns) the percentage of patients who got CRE at the facility dropped from 44% to 0.

One travesty has been how poorly health care professionals have been about prescribe antibiotics wisely We need to improve and follow CDC antibiotics guidelines (stop the overuse of antibiotics) and use culture results (for patients undergoing treatment) to modify prescriptions, if needed. Antibiotic overuse contributes to the growing problems of Clostridium difficile (c-diff) infection and antibiotic resistance in healthcare facilities. Studies indicate that nearly 50% of antimicrobial use in hospitals is unnecessary or inappropriate (per CDC web site).

Israel decreased CRE infection rates in all 27 of its hospitals by more than 70% in one year with a coordinated prevention program. The USA is at a critical time in which CRE infections could be controlled if addressed in a rapid, coordinated, and consistent effort by doctors, nurses, lab staff, medical facility leadership, health departments/states, policy makers, and the federal government.

As I have been saying for years the damage we are creating due to our actions around the use and abuse of antibiotics is likely to kill tens of thousands, or more people. Because the deaths are delayed and often not dramatic we have continued dangerous practices for years when we know better. It is a shame we are condemning so many to increased risks. The CDC, and others, are doing good work, unfortunately too much bad work is continuing in the face of evidence of how dangerous that is.

Related: CDC Urges Increased Effort to Reduce Drug-Resistant Infections (2006) – Key scientific articles on Healthcare Associated Infections via CDC – Our Dangerous Antibiotic Practices Carry Great Risks – Dangerous Drug-Resistant Strains of TB are a Growing Threat

System for Approving New Medical Options Needs Improvement

Posted on December 31, 2012  Comments (0)

Something Doesn’t Add Up

Not only did the team find that evidence for Infuse’s benefits over existing alternatives for most patients was questionable; they also discovered in a broad array of published research that risks of complications (including cancer, male sterility and other serious side effects) appeared to be 10 to 50 times higher than 13 industry-sponsored studies had shown. And they learned that authors of the early studies that found no complications had been paid between $1 million and $23 million annually by the company for consulting, royalties and other compensation. Carragee, MD ’82, estimates Medtronic has sold several billion dollars’ worth of Infuse for uses both approved and “off label.”
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Without a rigorous, data-driven context, medicine’s expensive traditions and hunch-based treatments threaten to bankrupt us. “People say that we shouldn’t delay science; people are dying; we should get new treatments out there. I do not feel the pressure to do that until we have solid evidence,” Ioannidis asserts. “The resources many procedures draw are enormous.” And that leaves insufficient funds for the prevention plans and treatments we know actually work.

I have written about the problems with our health care research system several times. The existing system is in need of improvement and is made much worse by the general state of the broken health care system in the USA. Dr. John P.A. Ioannidis, the focus of the article, is doing fantastic work in this area.

Related: Majority of Clinical Trials Don’t Provide Meaningful Evidence – Statistical Errors in Medical Studies – USA Spends $7,960 Compared to Around $3,800 for Other Rich Countries on Health Care with No Better Health Results – Drug Company Funding Taints Published Medical Research – Mistakes in Experimental Design and Interpretation – Understanding Data

Toyota Human Support Robot

Posted on September 25, 2012  Comments (12)

Toyota continues to develop their partner robot initiative. Demographics in Japan make a compelling case for the need to provide solutions to those who need assistance to support independent living.

The aim is to contribute to the maintenance and improvement of quality of life.

In cooperation of the Yokohama Rehabilitation Center, Toyota conducted experiments for disabled people, using HSR in their homes, in 2011. Toyota has been integrating the feedback to the design, based on actual user experience.

The Human Support Robot (HSR) can pick up something on and bring it to the person. Also it can do small tasks such as opening the curtains.

Controlling the robot can be done easily, by using the voice recognition function or using a tablet control. In addition, Toyota is designing it to directly assist the person, helping them get into and out of a bathtub, for example.

They are also developing new features for remote viewing and remote operation (to provide off site help to make the robot more useful). They are working with health care professionals, including nurses, and research institutions aimed at practical use for such a robot.

Toyota, along with several other Japanese companies, continue to invest a great deal to create personal care robots.

Related: Toyota Partner Robots – Toyota Develops Thought-controlled Wheelchair – Honda’s Robolegs Help People Walk – Toyota Winglet, Personal Transportation

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Man in Coma for 7 Years was Given a Sleeping Pill and Woke Up

Posted on September 9, 2012  Comments (3)

Lazarus pill miracle for E Cape man, 9 September 2012

After reading a report in City Press last month, his wife, Nomfundo, insisted that he be given a prescription for the sleeping pill Stilnox, which has the opposite effect on those with brain injuries.

It worked – and brought him out of a seven-year coma.
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But on August 12, family friend Nceba Mokoena came across an article in City Press about a miracle recovery made by another car crash victim, hundreds of kilometres away in Gauteng.

Louis Viljoen was given the sleeping pill by chance by his mother, Sienie.

She had noticed he wasn’t sleeping peacefully and asked her doctor if she could give him half a sleeping tablet. After she did, Louis opened his eyes and said “Hello Mamma”, his first words in five years.

Very cool anecdote and example that modern medicine has many miraculous cures but the medical system can’t always use them as well as we would hope. Even with all the knowledge we have today just getting that information into the right doctor’s minds is very hard. And the complexity of diagnoses and interactions makes medical care still an art as well as a science.

So is this just some freak accident. Partially, in the mother giving her son a sleeping pill to reduce his seeming restlessness in the coma. But the effect of Stilnox in bringing coma victims out of a coma has been documented previously.

Reborn from persistent vegetative state, 12 September 2006

Four three years, Riaan Bolton has lain motionless, his eyes open but unseeing. After a devastating car crash doctors said he would never again see or speak or hear. Now his mother, Johanna, dissolves a pill in a little water on a teaspoon and forces it gently into his mouth. Within half an hour, as if a switch has been flicked in his brain, Riaan looks around his home in the South African town of Kimberley and says, “Hello.” Shortly after his accident, Johanna had turned down the option of letting him die.

Three hundred miles away, Louis Viljoen, a young man who had once been cruelly described by a doctor as “a cabbage”, greets me with a mischievous smile and a streetwise four-move handshake. Until he took the pill, he too was supposed to be in what doctors call a persistent vegetative state.

Across the Atlantic in the United States, George Melendez, who is also brain-damaged, has lain twitching and moaning as if in agony for years, causing his parents unbearable grief. He, too, is given this little tablet and again, it’s as if a light comes on. His father asks him if he is, indeed, in pain. “No,” George smiles, and his family burst into tears.

It all sounds miraculous, you might think. And in a way, it is. But this is not a miracle medication, the result of groundbreaking neurological research. Instead, these awakenings have come as the result of an accidental discovery by a dedicated – and bewildered – GP. They have all woken up, paradoxically, after being given a commonly used sleeping pill.

Medical care is still today an extremely difficult area where highly trained and continuously learning doctors still have a great deal of trouble keeping up with the latest medical knowledge.

Related: Hospital Reform, IHI’s efforts to get good practices adopted – Norway Reduces Infections by Reducing Antibiotic Use – Majority of Clinical Trials Don’t Provide Meaningful Evidence – Continual Learning – Physical Activity for Adults: Inactivity Leads to 5.3 Million Early Deaths a Year

Today, Most Deaths Caused by Lifetime of Action or Inaction

Posted on June 24, 2012  Comments (2)

Chart of the Leading Causes of Death in 1900 and 2010

Our instincts lead us to fear the unknown and immediate threats (probably so we can be ready to run – or maybe fight). But today the biggest risks to an untimely dealt are not lions, other people out to get us, or even just random infection. We have to adapt to the new risks by taking action to eat healthfully and exercise, in the same way we we have evolved to avoid becoming a meal for a hungry beast.

Today the largest causes of death are heart disease and cancer (which account for more than 60% of the deaths causes by the top 10 leading causes of death). The next leading causes are non-infectious airways diseases, cerebrovascular diseases and accidents. Alzheimer’s, diabetes, nephropathies, pneumonia or influenza and suicide make of the rest of the top 10 leading causes.

In 1900 Pneumonia or influenza and tuberculosis took as many lives (per 100,000 people) and cancer and heart disease take today. We have done well decreasing the incidents of death (fewer deaths per 100,000) by greatly reducing and nearly eliminating some causes of death (the 2 leading causes from 1900 are good examples).

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One Scientists 20 Year Effort to Defeat Dengue Fever

Posted on June 12, 2012  Comments (2)

As I have said many times scientific breakthroughs often follow many years of effort. Here is a great example of a scientist putting in great work for years and it looks like it is about to payoff for hundreds of millions of people.

A Scientist’s 20-Year Quest To Defeat Dengue Fever

Now as I said, Scott’s been pushing this idea of using Wolbachia to control dengue for decades, for a most of that time without any success. I asked Scott what it takes to stick with something for that long.

“I think being obsessive,” he replied. “Being maybe a little ill in that regard. And it’s just that I seem to have focused my obsession onto Wolbachia instead of on to postage stamps or model trains.”

And even though his obsession has brought him to the point where he’s shown he can get his Wolbachia-infected mosquitoes to spread in the wild, that’s not the success he’s ultimately after. “Success for me is having a significant impact on dengue disease in communities,” he says.

To do that, he’ll have to release his mosquitoes in a place where there’s a lot of dengue, and then see if that brings down the number of cases of the disease in humans. Those studies are being planned now.

The stakes are high. By some estimates, more than a billion people around the world are at risk for getting dengue. Even if it doesn’t kill you, I’m told a case of dengue can make you feel so bad, wish you were dead.
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But Scott says it’s not yet time to celebrate.

“We’ve got some good preliminary data, and we’re on the path. And it’s looking good. But you know I am a realist. It could fall over at any day,” says Scott.

Related: Engineering Mosquitoes to be Flying Vaccinators – Scientists Building a Safer Mosquito (2006) – Video showing malaria breaking into cell – Treated Mosquito Nets Prevent Malaria

Prostate Cancer Drug so Effective Trial Stopped to Give Drug to All Participants

Posted on June 4, 2012  Comments (0)

Prostate cancer drug so effective trial stopped by Victoria Colliver

The hormone treatment, Johnson & Johnson’s Zytiga, when added to a standard steroid therapy doubled the time it takes for the disease to progress in patients treated with the standard therapy alone, said the lead researcher, Dr. Charles Ryan, associate professor of clinical medicine at the UCSF Helen Diller Family Comprehensive Cancer Center.

The U.S. Food and Drug Administration last year approved Zytiga, also known as abiraterone, for use in men whose prostate cancer had spread to other parts of their body and had already been treated with chemotherapy.
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This trial focused on patients whose cancer had metastasized, may have been treated with other hormone therapies but had not yet gone through chemotherapy.
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Prostate cancer, the second most common form of cancer in males after only lung cancer, is diagnosed in about 200,000 men in the United States each year. And while it is generally treatable, the disease kills nearly 30,000 men a year.

Because their disease is often slow-growing, about a third of patients diagnosed with prostate cancer won’t be treated. Another third will undergo successful treatment, which could include surgery, various hormone therapies or chemotherapy.

Still, a third of patients will have recurrent or aggressive disease that may have been caught too late. Ryan said men tend to die when the cancer spreads outside the prostate, mostly to bone, and the patient becomes resistant to hormonal therapy. The cancer cells rely on testosterone to exist, so typically doctors treat patients with testosterone-blocking hormone therapy.

But patients become resistant when the cancer cells develop the ability to make their own hormone and learn to survive even in the face of the testosterone-blocking drugs, giving the disease the ability to progress, Ryan said.

Zytiga is the first FDA-approved drug that can go inside the cancer cell and block it from making its own testosterone.

The trial involved 1,088 men who were being treated by 151 cancer centers in 12 countries. Each was given a low dose of the steroid prednisone, which works to combat the cancer

This is very good news. There is lots of positive news over the years. Often it seems to come to nothing years later. Promising drugs in the lab turn out to be far less promising in clinical trail. But very successful clinical trials are very good news. Even this kind of news though really should be confirmed by larger scale success, but this is a very good start.

Related: Global Cancer Deaths to Double by 2030 – Nanoparticles With Scorpion Venom Slow Cancer Spread – The Only Known Animal That Doesn’t Get Cancer – UCSF Prostate Cancer Center

Majority of Clinical Trials Don’t Provide Meaningful Evidence

Posted on May 3, 2012  Comments (2)

The largest comprehensive analysis of ClinicalTrials.gov finds that clinical trials are falling short of producing high-quality evidence needed to guide medical decision-making.

The analysis, published today in the Journal of the American Medical Association, found the majority of clinical trials is small, and there are significant differences among methodical approaches, including randomizing, blinding and the use of data monitoring committees.

This is a critical issue as medical studies continue to leave quite a bit to be desired. Even more importantly the failure to systemically study and share evidence of effectiveness once treatments are authorized leaves a great deal to be desired. On top of leaving quite a bit to be desired, the consequences are serious. If we make mistakes for example in how we date fossils it matters but it is unlikely to cause people their lives or health. Failure to adequately manage and analyze health care experiments may very well cost people their health or lives.

“Our analysis raises questions about the best methods for generating evidence, as well as the capacity of the clinical trials enterprise to supply sufficient amounts of high quality evidence to ensure confidence in guideline recommendations,” said Robert Califf, MD, first author of the paper, vice chancellor for clinical research at Duke University Medical Center, and director of the Duke Translational Medicine Institute.

The analysis was conducted by the Clinical Trials Transformation Initiative (CTTI), a public-private partnership founded by the Food and Drug Administration (FDA) and Duke. It extends the usability of the data in ClinicalTrials.gov for research by placing the data through September 27, 2010 into a database structured to facilitate aggregate analysis.

Related: Statistical Errors in Medical Studies – How to Deal with False Research Findings – Medical Study Integrity (or Lack Thereof)

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Dangerous Drug-Resistant Strains of TB are a Growing Threat

Posted on March 28, 2012  Comments (1)

Drug-resistant strains of TB are out of control

The fight against new, antibiotic-resistant strains of tuberculosis has already been lost in some parts of the world, according to a senior World Health Organisation expert.
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Dr Paul Nunn, head of the WHO’s global TB response team, is leading the efforts against multi-drug resistant TB (MDR-TB). Nunn said that, while TB is preventable and curable, a combination of bad management and misdiagnosis was leaving pharmaceutical companies struggling to keep up. Meanwhile, the disease kills millions every year.

“It occurs basically when the health system screws up,” said Nunn. “Treating TB requires a carefully followed regime of medication over six months. In places where health services are fragmented or underfunded, or patients poor and health professionals ill-trained, that treatment can fall short, which can in turn lead to patients developing drug-resistant strains. It’s been estimated that an undiagnosed TB-infected person can infect 10 others a year.

We tend to do a poor job of dealing with systemic effects of poorly functioning systems. Direct present threats get out attention. And we are decent at directing brain power and resources to find solutions. We are not very good at dealing with failures that put us in much worse shape in the long term. For small threats we can wait until it becomes a present threat and then deal with it. There are costs to doing this (economic and personal) but it can be done.

Some problems though become enormously complicated to deal with once they become obvious. Global climate change, for example. And often, even once they are obvious, we won’t act until the costs (economic and in human lives) are very large. It is possible that once we decide to get serious about dealing with some of these issues that the costs (economic and in human lives) will be catastrophic.

The failure to use anti-biotics medicine properly is a very serious threat to become one of these catastrophic societal failures. While tuberculosis failures may be larger in poorer countries, rich countries are failing probably much more critically in the misuse of anti-biotics (I would guess, without having much evidence at my fingertips to back up my opinion. I believe the evidence exists I am just not an expert). These failures have huge costs for all of humanity but we are risking many premature deaths because we systemically fail to deal with issues until the consequences are immediate.

Related: Extensively Drug-resistant Tuberculosis (XDR TB) (2007) – What Happens If the Overuse of Antibiotics Leads to Them No Longer Working? – Antibiotics Too Often Prescribed for Sinus Woes – Overuse of Antibiotics (post from 2005) – CDC Urges Increased Effort to Reduce Drug-Resistant Infections (2006)

Potential Antibiotic Alternative to Treat Infection Without Resistance

Posted on February 23, 2012  Comments (1)

Researchers at the University of Michigan have found a potential alternative to conventional antibiotics that could fight infection with a reduced risk of antibiotic resistance. Sadly Michigan is another school that is allowing work of those paid for by the citizens of Michigan to be lock away, only due to the wishes of an outdated journal business model instead of supporting open science. The Big Ten seems much more interested in athletic riches than in promoting science. The Big Ten should be ashamed of such anti knowledge behavior and require open science for their schools if they indeed value knowledge.

By using high-throughput screening of a library of small molecules, the team identified a class of compounds that significantly reduced the spread and severity of group A Streptococcus (GAS) bacteria in mice. Their work suggests that the compounds might have therapeutic value in the treatment of strep and similar infections in humans.

“The widespread occurrence of antibiotic resistance among human pathogens is a major public health problem,” said David Ginsburg, a faculty member at LSI, a professor of internal medicine, human genetics, and pediatrics at the U-M Medical School and a Howard Hughes Medical Institute investigator.

Ginsburg led a team that included Scott Larsen, research professor of medicinal chemistry and co-director of the Vahlteich Medicinal Chemistry Core at U-M’s College of Pharmacy, and Hongmin Sun, assistant professor of medicine at the University of Missouri School of Medicine.

Work on this project is continuing at U-M and the University of Missouri, including the preparation of new compounds with improved potency and the filing of patents, Larsen said. Large research schools are also very interested in patents. That is ok, though seems to cloud the pursuit of knowledge too often when too large a focus is on dollars at many schools. But, it seems to put the schools primary focus on dollars; education seems to start to be a minor activity at some of these large schools.

Current antibiotics interfere with critical biological processes in the pathogen to kill it or stop its growth. But at the same time, stronger strains of the harmful bacteria can sometimes resist the treatment and flourish.

An alternate approach is to suppress the virulence of the infection but still allow the bacteria to grow, which means there is no strong selection for strains that are resistant to antibiotics. In a similar experiment at Harvard University, an anti-virulence strategy was successful in protecting mice from cholera.

About 700 million people have symptomatic group A Streptococcus infections around the world each year, and the infection can be fatal. Most doctors prescribe penicillin. The newly identified compounds could work with conventional antibiotics and result in more effective treatment.

Related: full press release – What Happens If the Overuse of Antibiotics Leads to Them No Longer Working? – Norway Reduces Infections by Reducing Antibiotic Use – New Family of Antibacterial Agents Discovered – Many Antibacterial Products May Do More Harm Than Good – Anti-microbial Paint

NASA Biocapsules Deliver Medical Interventions Based Upon What They Detect in the Body

Posted on February 10, 2012  Comments (1)

Very cool innovation from NASA. The biocapsule monitors the environment (the body it is in) and responds with medical help. Basically it is acting very much like your body, which does exactly that: monitors and then responds based on what is found.

The Miraculous NASA Breakthrough That Could Save Millions of Lives

The Biocapsules aren’t one-shot deals. Each capsule could be capable of delivering many metred doses over a period of years. There is no “shelf-life” to the Biocapsules. They are extremely resilient, and there is currently no known enzyme that can break down their nanostructures. And because the nanostructures are inert, they are extremely well-tolerated by the body. The capsules’ porous natures allow medication to pass through their walls, but the nanostructures are strong enough to keep the cells in one place. Once all of the cells are expended, the Biocapsule stays in the body, stable and unnoticed, until it is eventually removed by a doctor back on Earth.
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Dr. Loftus [NASA] thinks we could realistically see wildspread usage on Earth within 10 to 15 years.
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The cells don’t get released from the capsule. The cells inside the capsule secrete therapeutic molecules (proteins, peptides), and these agents exit the capsule by diffusion across the capsule wall.

NASA plans to use the biocapsules in space, but they also have very promising uses on earth. They can monitor a diabetes patient and if insulin is needed, deliver it. No need for the person to remember, or give themselves a shot of insulin. The biocapsule act just like out bodies do, responding to needs without us consciously having to think about it. They can also be used to provide high dose chemotherapy directly to the tumor site (thus decreasing the side effects and increasing the dosage delivered to the target location. Biocapsules could also respond to severe allergic reaction and deliver epinephrine (which many people know have to carry with them to try and survive an attack).

It would be great if this were to have widespread use 15 years from now. Sadly, these innovations tend to take far longer to get into productive use than we would hope. But not always, so here is hoping this innovation from NASA gets into ourselves soon.

Related: Using Bacteria to Carry Nanoparticles Into Cells – Nanoparticles With Scorpion Venom Slow Cancer Spread – Self-Assembling Cubes Could Deliver Medicine – Nanoengineers Use Tiny Diamonds for Drug Delivery