Are we misleading women with Breast self-examination?

The latest data seems to suggest so. A new Cochrane review has found the practice doesn’t reduce cancer deaths.

What’s more, it may cause harm as women doing the self exams had twice as many biopsies for lesions that were ultimately benign.

The latest conclusion supports the 2003 review that came to a similar conclusion. This new study includes results from almost 390,000 women in Russia and China that compared a cohort of women who examined their breasts regularly with a group that didn’t.

If you are a disciple of Cochrane you will buy it whole sale – but I’m still not sure what to think. I’ll wait to hear from the breast specialists – or read it myself if time permits. But there are cultural differences and a range of other confounders I’m interested to hear about. What’s more, they don’t seem to take into account the educational or awareness value breast self-examination has created.

A Lesson in Business Strategy

Information technology is perhaps the only industry that is as big and complex as healthcare. It remains difficult to predict, has several major players as well as numerous other big ones and is rapidly changing with technology. It is also hampered by certain ways of thinking and old business models.

So any great changes and successes in the IT field always catch my eye as potential signs of where healthcare business might be going.

While until a few months ago Google’s stranglehold on the IT world was supposedly tight. Now the iPhone is seen as evidence that Apple has yet again turned the IT world upon it’s head and hold the locus of control for years to come. How did they do it?

In this article, you can read the history of 3G phone development and Apple’s, or Steve Jobs’ early vision of where mobile computing and the internet were heading.

Likewise in Big Pharma, I believe that technology will dictate the future in unexpected ways – hence my personal interest in the mixture between traditional pharma ways and newer biotech, IT and machines.

In IT, for example, we are moving more towards a socially networked and customer friendly healthcare system. Big Pharma has been slow in my opinion to capitalise on this. While you hear many examples of pharma acquiring smaller and more innovative biotechs, we don’t hear about them acquiring less related entities.

Certainly the traditional business mantra that one should focus on one’s area of expertise is understandable, but it is precisely the failure to recognise that pharmaceuticals are no longer just pharmacology and clinical trials but must sync with a number of other requirements and market pressures – the power of the better informed consumer being just one.

In my vision of the future I hypothetically ask, where is the iPhone equivalent in healthcare? Mac’s growing market share is primarily due to it’s seamless integration: and the iPhone connects to everything and has all the popular features the young and hip require. Look across to healthcare, and we live in a splintered world of information silo’s, professional boundaries decided by ancient guilds, technologies from a vast array of companies that are not remotely compatible. It has taken us years to agree on a basic coding system for health IT.

Certainly healthcare is slow to evolve – but this could change if we are forward thinking and comprehensive enough to develop and plan that incorporates the changing needs, new technology and likely barriers to good health in the future, worldwide. And I believe information technology will form the backbone of any blueprint.

Sequence your entire DNA in 15 minutes!

Today I took an arterial blood sample from a patient. As soon as I had it in a bag on ice it was sent up a transfer chute to a lab. The blood gas analysis was back in 15 minutes.

That’s not bad when you have a patient hyperventilating and his desperate wife asking you to do something. Yet within a few years I will be able, in the same 15 minutes, to gather 9 billion base pairs of information from any patient’s DNA. Using this DNA sequence I might predict a range of health concerns, both present and future, as well as tailor medications specifically for that patient. This kind of information is the dream goal of personalized medicine.

This dream is being made possible with the SMRTTM technology developed by Pacific Biosciences. For anyone that has spent hours, or even years, slaving away at DNA sequncing machine- this will blow your mind. It is also a useful comparison to remember that it took 13 years to first sequence the human genome.

I believe this to be a humbling moment for humanity. It is even more humbling for me as some 8 years ago I made a bet with a classmate that the human genome would never be sequenced this rapidly. He replied, “didn’t people once say that man would never walk on the moon?”

Pets the new Market for Pharma

It’s been a while since my last post. So what better to begin with than a heart warming story about pharma companies repackaging their psychtropic meds for good old Fido.

To quote Fiercepharma, “Lilly’s Prozac has become chewable and beef-flavored and dubbed Reconcile, for dogs with separation anxiety. Pfizer’s Anipril treats cognitive dysfunction so elderly dogs–who get absent-minded just like their human masters do–remember how to find their food bowls. And Anafranil, the tricyclic antidepressant made by Novartis, now comes in a dog-emblazoned box and is called Clomicalm; it’s used not only for its FDA-approved indication, separation anxiety, but also off-label for compulsive disorder. The New York Times describes a dog who can’t stop chasing his tail until Clomicalm enters the picture, hidden inside a wad of turkey“.

Why bother some might ask? I suspect it’s the same reason they develop drugs for humans: money! For example, Pfizer alone collected some $1 billion in sales off its companion-animal products last year.

From Reuters: The American Pet Products Manufacturers Association released figures on Tuesday showing pet owners spent an estimated $41 billion on their animal friends last year which was almost double the $21 billion spent in 1996.

But the non-profit industry group projected this would rise by nearly six percent to $43.4 billion in 2008 as pet owners treated their animals to spas, designer clothing, and other high-end goods (such as pet health insurance!) as well as gourmet foods.

While I find my parents dog Chica cute, I don’t know if I’d be putting her on meds I find quite expensive. While understandable, it does seem like these companies are gaining from human excess.

But what good would $41 billion do to the $2.1 trillion American ‘human’ health system anyway??? But then it is twice the amount spent on foreign aid by the American government in 2008 according to the people at Washington.

New Pharma Business Models II

What do you do when your major client threatens not to buy your (potentially) most profitable product?

At least that was the question JnJ might have been asking themselves when the NHS threatened not to pay for Velcade without a money-back guarantee. Not that Velcade is JnJ’s only highly profitable product – but it could be soon.

This is another sign that the tides are turning for all pharma and new models are needed. Other pharma companies are looking to get governments involved early on in drug development in order to better accommodate their needs.

In general, the shift is moving from selling pure products to selling ‘health outcomes’.

My prediction is that this will benefit companies that have the capacity in other areas such as diagnostics and devices that can be linked into their product package to solve a problem – not just help out a little with a few pills. In other words, drug companies will move from being pure vendors to being more like service providers.

There is also space in emerging markets in developing countries, particularly the individual buyers market in these countries where healthcare is generally at a lower level.

Whatever happens, there are a few painful years ahead for pharma and for the first time we may see some major losers.

Medical Tourism: is everybody doing it?

Have you ever met anyone that left Australia for medical treatment? Until I met a girl that went to China for a cheap plastic surgery procedure, I hadn’t either.

The only other reason an Australian would leave our shores for treatment is to seek some cutting edge or highly dubious treatment not available here – such is the quality of our public health system.

This is not the case in most countries however. Healthcare staff here will be familiar with dual citizens that fly to Australia to avoid hospitals at their other home. I know wealthy Vietnamese that fly to Korea for anything remotely serious.

But now, topping these all, Americans are flying to New Zealand for cheaper treatment sponsored by their insurance companies.

If there was any proof that things are a little out of hand in the USA – this is it!
The purpose is purely economic. Procedures costing up to $100 000 in the USA can be done in NZ for about $40 000. Quality is assured – if you believe the NZ company that arranges it all.

A credible study into medical tourism suggested that less than 100,000 people internationally seek treatment in an overseas hospital. About 40% of “medical travelers” identified in the report are patients, largely in developing countries, seeking top-notch medical care, primarily in the U.S. Another 32% sought better care than was available at home. About 15% sought to circumvent waiting times at home, particularly in Canada and the United Kingdom (no surprises there).

The study ignores people such as my friend who had her procedure done incognito by an army surgeon. It also all those illegal transplant operations, and many others that go for dental or less invasive treatment that may not require formal hospital admission. It is for this reason that some studies suggest as many as a million people engage in medical tourism each year.

Whatever the case, I hope it never becomes a common place practice in Australia. I believe you should be able to access the best care as close to your home as possible – and we certainly shouldn’t have to go to NZ for help!*

* Disclaimer – I am actually half-Kiwi, from my beautiful mothers side. All comments made against NZ are in pure jest.

Big Pharma not as Evil as many think

It’s the prevalent view amongst medical students in Australia: pharmaceutical companies are mostly evil – or at least bad news for the consumer and developing countries.

This view is usually uninformed. I can say this having sat on many student committees, both at the local and international medical student level. This does not mean however that I am fully informed, nor that I believe the pharma business model could be improved.

I was surprised, however, to read about Prescription Assistance Programs in the USA.

Under this scheme pharmaceutical companies offer medication to the uninsured – no strings attached. Even companies like Pfizer, who is not doing so well financially, give away amounts to the tune of hundreds of millions in drugs every year.

Cynics suggest it is just a PR exercise. Yet the programs are so little known that even free health clinics in the USA are only now becoming aware of them.

Simple Solutions are the Best

After spending a summer in a Filipino village surrounded by TB patients that had stopped taking their medicine, I wondered what the WHO was coming to.

To add to my intrigue was the fact that the villagers lived in grass shacks but many owned satellite dishes and a TV – and virtually all had mobile phones. Yet often basic healthcare, and the TB DOTS program, were nowhere to be seen.

So I was happy to read that text messaging and free minutes on mobile phones has been successfully trialled as a way to increase medication adherence.

Now you might ask yourself – who would pay any attention to an annoying text that tell you to take tablets? Well you are right. But in a smart psychological move, the patient is rewarded with free call time on their phone if their urine test on a home based chip system comes up positive for their meds (it gives a unique code).

Amazing but simple – piggybacking on the largest roll out of technology worldwide to treat one of our biggest health scourges!

The Origin of the great Scientist Species

Where do great scientists come from?

Over the centuries we have witnessed some people that have changed science in a remarkable. the Millenium Technology prize is given to one such person every two years and the recipient this year is Robert Langer.

Dr. Langer has been cited as “one of history’s most prolific inventors in medicine”. He has over 600 issued and pending patents, has published approximately 1000 articles and 13 books, and is known as the father of controlled drug delivery and tissue engineering. His patents have been licensed or sublicensed to over 200 pharmaceutical, chemical, biotechnology and medical device companies. He was also named by CNN and Time magazine in 2001 as one of the 100 most important people in the United States.

There are three things I find remarkable about Langers story – facts that I believe should be noted by those wishing to foster great scientific talent.
First: his interest in science started with his parents giving him science kits at a young age. Second: he pursued academia rather than the money of the then booming oil industry on graduating.
Third: he was mentored by Judith Folkman, whose nanotechnology efforts were recently mentioned in my blog on the amazing anti-cancer drug TNP-470. Like the lab of Watson and Crick, her lab is evidence of just how powerful great leadership can be on the world.

E-health Records take a Major Step

Privacy is the major concern in E-health worldwide. Now two recent announcements are blazing a trail towards a solid E-health foundation.

NEHTA, the Australian E-health transition authority, has come up with a privacy blueprint, and on the global scale, a large proportion of America’s key players and global IT firms have also reached a consensus on a privacy framework.

The NEHTA Privacy Blueprint is designed to elicit feedback on the business case that is being presented to the Council of Australian Governments (COAG) later this year.

In related news, Australia, Canada, the United Kingdom and the United States have formed a Tri-Continental Foundation of Experts called Open Health Tools to collaborate on global health IT solutions.

The quote from Skip McGaughey, executive director of OHT, summed up the whole shebang quite well: “Advancements in medical procedures and patient care have changed the way the world views health and wellness. However, modern healthcare information technology has not kept pace with the complexity of today’s healthcare systems. There is a critical need for interoperability between healthcare systems and the consistent and seamless exchange of accurate data.”

Research points to a potential annual savings of $77.8 billion in the United States alone from the introduction of healthcare information exchange and interoperability. Wow!