Year in and year out, it seems as though we’re greeted with the same news from health organizations: that the worldwide data on HIV/AIDS infection rates and treatments could not be more disparate. We keep hearing about the fact that, although awareness is at an all-time high, outreach to the world’s most affected populations continues to struggle. Two thousand nine/2010 are no different. This year, only a third of treatable persons worldwide are actually being treated.[1] That’s in spite of the fact that world leaders have pledged no narrow that gap, time and time again.
What about on these shores? Two days ago, the U.S. recognized National Gay Men’s Awareness Day. There is no doubt that a major increase in awareness in this country since the late 1980s has brought forth some of the world’s greatest pharmacological achievements in the fight against this dreaded infection. But, there is no escaping the fact that the celebration of 9/27 itself because of these achievements — was eclipsed by one startling statistic: that nearly half of all gay men do not know that they are infected with HIV. The nature of the infection, although constantly changing and being researched, is clearly well known. Perhaps education — or lack of it — about HIV as a sexually transmitted infection needs a re-examination itself. Perhaps, there is still a stigma attached to the relay of that information to the most appropriate points of contact: from the provider to the patient. Or, maybe, its the overconcern of the lifetime cost of care for someone infected with HIV.
All of these reasons (and probably many more too numerous to mention) are valid ones to consider as we pass yet another milestone in the history of HIV/AIDS, and the strategy to make this infection entirely preventable becomes more important than ever. | LINK
It can identify tuberculosis in 2 hours. That’s a far cry from a current modality which takes at least 2 days to even screen for. The latest advance in the war against TB — thought to have been largely won in the latter quarter of the 20th century — can now be characterized by a rapid assay said to be more than 97 percent accurate and is even able to diagnose drug-resistant TB. Current testing involves the use of a microscope and is prone to investigator error and poorly obtained samples — something that can result in a missed diagnosis at alarmingly high rates. In endemic areas of the globe, that inconsistency is, of course, problematic.
As a result, TB is able to be identified in one single office visit. TB is a chronic bacterial infection spread through the air and usually infects the lungs, although other organs of the body can be involved. Most people who are infected with tuberculosis bacterium (Mycobacterium tuberculosis) don’t have symptoms, but some will develop the disease. Around 2 billion people — one-third of the world’s population — are thought to be infected with M. tb. The World Health Organization estimates that 8 million people develop active TB each year and nearly 2 million die. The test will be up for FDA approval and is already available in Europe. | LINK
Lately, Doctor Pundit has been reporting some tidbits from the arena of medical research. Here are a few more to make the wires for 9/1.
The huge drive to immunize the masses against threat of H1N1 in the 2009/10 influenza season (which the WHO has officially declared concluded) has created more than a watershed moment in 21st century public health response to a potential biological catastrophe, it has also touched off a political debate that’s just getting started. And it all has to do with authoritarian mandate of the vaccine for healthcare workers.
Contrary to popular thought, many healthcare workers do not receive the vaccine; in fact, approximately 40 percent of said workers actively refused [PDF link] the vaccine last year — during infection’s peak. This notion does not sit well with a couple of policy organizations — one academic and one medical. Both groups say mandatory influenza vaccine should be a condition of employment. The groups stress increased availability of the vaccine, a steadier supply of healthy workers to administer care in times of a crisis, and an overall decrease in the incidence of influenza-related deaths in already compromised inpatients with other medical problems.
Already, the state of New York is hard at work in developing regulatory actions for its public healthcare workers. | LINK
Just how effective are vaccines at keeping mass pandemics of infectious disease abated? Well, it may not be so easy to estimate.
[T]he number of annual flu-related deaths in the United States has ranged from a low of about 3,300 to a high of about 49,000. This is a revision of the static estimate of 36,000 annual deaths that has been reported consistently for years by the U.S. Centers for Disease Control and Prevention.
The CDC has revised its projections on the preventive care of the seasonal influenza vaccine, moving from statistical dead targets to ranges of mortality among influenza outbreak figures. Its projections cover most of the past 30 years (up to 2007, and not inclusive of last year’s H1N1 pandemic). | PDF LINK to latest issue of CDC’s Morbidity & Mortality Weekly
Pharma company Eli Lilly recently scrapped further development of an anti-Alzheimer drug designed to fight the disease from the plaque mechanism; its compound would inhibit the enzyme responsible for catalyzing the process in forming the amyloid plaques pathognomonic for the disorder.
Their reasoning? That the enzyme also works on the formation of other proteins in the brain that have no consequence in the natural histopathological history of the disease. Scientists working on the R&D for this drug have also gone as far as to question this hypothesis as a valid point of research into anti-Alzheimer development. The implications of these second thoughts have yet to be fully realized, but there could be an immediate effect on other Pharma companies researching similar treatments for degenerative dementia should they decide to follow like concerns. | LINK
The research into HIV and AIDS vaccinations may be getting a literal shot in the arm, as new mechanisms involving autoimmunity could hold the answers to neutralization of the infection at a greater rate than studied in previous eras. The ability for some with the disease to mount a hightened autoimmune response to the viral burden is the focus of scientists wishing to develop vaccines that fight the gamut of the infection’s trajectory — not just in specific, static phases of disease.
Of course, the ability of HIV to mutate at a rapid clip does pose challenges. (In one trial, scientists have noted a camouflage-type of mechanism the HIV virus is able to utilize with an enveloping sugar molecule to avoid detection.) At any rate, the boldness and bullish nature of the scientific community at this point in HIV/AIDS research is refreshing and exciting. There’s also always the hope that this specialized research into a disease-free organism will naturally occur as a result. | LINK
Although the results of a study from the Annals of Internal Medicine are out today noting an increase in the rate of sexually transmitted infections (STIs) among those taking drugs for erectile dysfunction, this item “hot off the wires” practically invites the media to take a stance assuming direct causation.
Jokes aside — and you can assume that lead-ins are probably replete with them — the compelling numbers[1] suggest a greater problem afoot: the overall numbers of sexually active men over 55 years of age is increasing. Re-evaluating incidence and prevalence rates to include this ever-burgeoning population will only become more commonplace in medical education as this retrospective study underscores one major point: the necessity of other types of trials studying the effects of preventive practices toward STIs in those much younger and applying them to this patient population. | LINK
Some headlines prior to the Independence Day holiday. Normal posting resumes here at Doctor Pundit on July 6. Have a happy and safe holiday weekend!
The medical-loss ratio measures how much of premiums insurers pay out for medical care versus administrative costs. The new law requires that insurers use at least 80% of the premiums from individuals and small businesses to pay for medical care and profit-taking, and 85% of premiums from larger employers. Health insurers are waiting for regulators to clarify how companies must account for the numbers—whether they can average the MLRs of their subsidiaries, for instance.
[LINK]
The battlelines are drawn in the latest medicolegal war which tests how far patient activism can go when the patient asks for, rather demands, a particular treatment regimen unproven in the pantheon of well-studied and documented clinical medicine. The treatment of Lyme disease, an infectious disorder in which the deer tick (found in abundance here in Minnesota) acts as a vector of transmission, is under fire from patient activist groups who say that they aren’t being treated effectively for the disorder’s possible long-term effects, which can be disabling.
Pity the role of infectious disease experts who are often called upon to consult and produce national guidelines based upon sound medical and clinical research. These intrepid physicians now have to navigate and overcome the legislative process which appears to be siding with patients who feel as though they are being maltreated. In Minnesota, the state medical board (which regulates, disciplines, and licenses physicians) has had to initiate a moratorium against actions that may arise out of patient complaints with respect to the treatment of Lyme disease. Elsewhere, activist groups are gaining steam and appear to be influencing its evaluation, classification, and treatment[1] without the involvement of physician specialists and experts…and with the support of lawmakers. | LINK
Diabetes mellitus, type 2 is an epidemic problem in the United States, with at least 21M people diagnosed, a problem made more complex with very disappointing new trial data.Two new reports from the ACCORD trial released yesterday show that lowering either blood pressure or cholesterol below current guidelines does not provide additional benefit and, in fact, increases the risk of side effects. A third arm of the study, known from two years ago, shows that excessively lowering blood sugar levels actually increases the risk of heart disease.
This is very frustrating news, given that the pipeline for novel therapies is not advancing at a rate congruent enough with the increasing incidence since the start of this century. Is aggressive management of other risk factors of cardiac disease and strokes actually harmful to these patients? While these developments throw into question far-reaching guidelines on the issue, some physicians in response are taking results of these negative studies (here and here) [PDF] and applying them on a case-by-case basis. | LINK
It’s one thing for medical researchers to suspect an answer they set out to prove is within the scope of the methods by which they conduct the study. It’s quite another when the results of said study give a totally unexpected conclusion. This is perfectly illustrated in this week’s NEJM, in which investigators show that cardiologists are essentially inappropriately heading right for the high-cost (and apparently low-value) procedure known as the angiogram in attempting to diagnose coronary disease.
Out of almost 400 000 patients studied, investigators found that 4 out of every 10 patients who underwent this procedure (which involves invasive catheterization) had absolutely no findings of disease (blockages). Not exactly half, but you get the idea. Although it’s clear that these subspecialists must do a better job in stratifying the most appropriate patients for this procedure, what’s even more salient is the fact that coronary angiograms — being an invasive procedure — are not without risk. Their implementation carries an approximate risk of 1% of an acute coronary event (ie., heart attack), not to mention the amount of radiation exposure involved. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
RT @markraganceo: 14 ways social media may change doctors' visits http://t.co/CXpyRFRV #hcsm #physicians
FCC proposes allocation of spectrum for Medical Body Area Networks (for vote on 5/24) http://t.co/bAiyRaRk #mHealth
#eHealth News: These Stocks Will Thrive, Obamacare or Not http://t.co/6uXhFARZ http://t.co/b7p882rP
#pharma news: Playoff Trifecta Means Windfall Curbed by L.A. Traffic http://t.co/voOlghpt
RT @Ziggy_Daddy: Hunger Growing Problem Among Seniors | Crooks & Liars http://t.co/FRRGv4d4 But hey #GOP, let's turn #Medicare into a voucher system, right?
DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
