A Sickly System: The Ethics of Modern Medicine Distribution

Medicine is a resource, and, like many resources, its fair distribution according to need has not quite been figured out by our ostensibly sophisticated society. Systems of supply and demand send goods around the world from their sources to wherever they can earn the most profit—medicine is no different. The result of this arrangement is that those with the least purchasing power are left out of access to resources. When the resource in question is medicine, and the outcome of its uneven distribution is widespread death and suffering caused by curable diseases, the ethics of our current system are called into serious doubt.
The World Health Organization (WHO) publishes a list of the bare necessities of a health care system, the WHO Model List of Essential Medicines. According to the WHO, “essential medicines are medicines that satisfy the priority health care needs of a population. They are selected with regard to disease prevalence, safety, efficacy, and comparative cost-effectiveness.” According to the WHO, the last time this survey was conducted in 1997, over two billion people lacked access to essential medicines. Sufferers of diseases known to be treatable, such as malaria, sleeping sickness, and HIV, are denied the drugs that would vastly improve their quality of life. Meanwhile, cosmetic procedures like breast augmentation and liposuction are widespread in the affluent world; even the emotional ups and downs of peaceful and prosperous life are the target of substantial medical spending.
The reasons for the current situation are purely economical—pharmaceutical companies do not profit from catering to the poorest people and they do not recoup their investment in R&D for medicines that would benefit the poorest; doctors generally treat those who can reward them monetarily for it. Worldwide health care is implicitly run by economics and selfishness.
Take, for example, opiate painkillers. Morphine, the active chemical in opium, and its derivatives are the most effective painkillers known to medicine. Morphine and Codeine are on the WHO’s Essential Medicines list. The world is currently in the midst of a massive opiate shortage, estimated by the International Council on Security and Development to be equivalent to 10,000 tons of opium per year. 10,000 tons is 20,000,000 lbs, or 9,100,000,000 grams of raw opium, or 1,200,000,000 grams of morphine (typical morphine content is 10-16%). A typical dose is 15 milligrams. The world is short about 80 billion dosage units of morphine in a typical year.
Meanwhile, in the United States, the most widely prescribed drug is Vicodin, an opiate painkiller prescribed 128.2 million times in 2009, according to Forbes. Why does the U.S. have such wide access to this drug? Do Americans suffer more pain than people in other countries? I doubt it—we live comfortable and painless lives compared to the vast majority of the world’s people. In fact, Americans seem to be using a great deal of their opiate painkillers recreationally—an estimated 20% of us have used prescription drugs for nonmedical reasons, according to the National Institutes of Health. It is unconscionable both that we have this preferred status in regard to medicine access and that we add insult to injury by using such necessary medicines to obtain a cheap high. Health care is broken—not only in this country, but worldwide.
However, this is not to say that the outlook is entirely bleak. There is reason to believe that the situation is improving and no reasons but cynical generalizations about human nature that we will not eventually figure out a fair and ethical worldwide health care system. The 20th century was a time of great triumphs in medicine. Diseases like smallpox and polio were beaten back, and advances in sanitation have led to reduced rates of infectious disease and mortality. The infant mortality rate declined from 152 to 47 per 1,000 births from 1950 to 2008, according to a UN report. The percentage of people with access to essential medicines increased from 50% to 65% over the 20 years from 1977 to 1997. These are promising statistics, and the work done by organizations like the WHO and Doctors Without Borders continues to improve the state of global medicine. I have a lot of hope for the future, but I also know that we have a very long way to go.

By Devin van Dyke
Source:The Bi-CollegeNews

AMAI assails Kerala govt over gross neglect of Ayurveda in state budget 2012-13

The Ayurveda Medical Association of India (AMAI) has assailed the Kerala government over its gross neglect of Ayurveda in the state budget 2012 – 13, presented by the state finance minister in the assembly recently.
In a representation submitted to the finance minister K M Mani, Dr Rejith Anand, the secretary of AMAI said the minister has not provided any worthwhile schemes or reforms in the budget with a view to enhance the areas of health, diseases and treatment. Criticizing the budget, the association secretary said the state finance minister has thwarted the over all development of the country’s traditional system with his budget.
He said that certain schemes are there for infrastructure development in view of global marketing, which will help only for commercial transactions. As far as the poor people are concerned, who are the beneficiaries of the system, the budget gives only disappointment, Dr Rejith complained.
Castigating the government for not putting up special schemes for launching more number of Ayurveda dispensaries, AMAI has requested the government to review their demands in order to boost the Ayurveda system of Kerala. The traditional physicians reminded the minister that in Kerala 211 village punchayaths have no Ayurveda dispensaries. Despite a host of memorandums to the government, no fruitful step was taken by the former or the present government.
However, the Association has hailed the government’s decision regarding allocation of Rs.5 crore for setting up a Global Ayurveda Village in Thiruvananthapuram. It welcomed the decision to sanction Rs.1 crore for the establishment of an Ayurveda University in the state. It had earlier put up a demand to the government to create a separate department for Ayush in the state, but it was also rejected by the government, the association said.
In the budget the finance minister has reduced the tax rate of certain ayurvedic products by including them into the category of cosmetics and included a scheme to grow herbal plants on the river sides, those reforms were welcomed by the Ayurveda medical association.
Source:Pharmabiz

DBT, ICMR to carve a roadmap for stem cell research soon

The Department of Biotechnology (DBT) and the Indian Council of Medical Research (ICMR) would soon come out with a roadmap for stem cell research and therapy, revealed Dr A P J Abdul Kalam, former president of India during the inauguration of an international conference on stem cell and regenerative medicine at Indian School of Business here in Hyderabad.
Dr Kalam said the DBT and ICMR had been working together in promoting stem cell research in the country. “A roadmap is being evolved for stem cell research through three areas namely adult stem cells, umbilical cord stem cells and embryonic stem cells,” he said.
With the growing burden of incurable diseases increasing every passing day, the need for stem cell research has gained significance in the recent days. Though there has been intense research going on in this area a concrete roadmap has not been developed so far.
Expressing his happiness over the development of stem cell research roadmap, Dr Kalam said, “The experts group involved in the project promised me that they will submit the roadmap in a month’s time for development, production and clinical application of stem cells.”
Advocating a mission mode operation on stem cell research the former president said one should not make many small sub-critical efforts, but aim at a few focused diseases with full investment of financial and human resources.
Research and Development (R&D) in human stem cells are expected to revolutionize present day medical treatment options for hard-to-treat diseases such as type-I diabetes and Parkinson’s disease.
Professor Stephen Minger, global head (R&D), GE Healthcare, UK, was honoured with the Federation of Asian Biotech Association award for his contribution to stem cell research.
Senior scientist Dr Seyed E Hasnain, Prof Ajit Rangnekar, dean of ISB, major industries minister Dr J Geeta Reddy and others spoke on the occasion.
Source:Pharmabiz

Smokers could be more prone to schizophrenia

Schizophrenia has long been known to be hereditary. However, as a melting pot of disorders with different genetic causes is concealed behind manifestations of schizophrenia, research has still not been able to identify the main gene responsible to this day.
In order to study the genetic background of schizophrenia, the frequency of particular risk genes between healthy and ill people has mostly been compared until now. Pharmacopyschologist Professor Boris Quednow from University Hospital of Psychiatry, Zurich, and Professor Georg Winterer's workgroup at the University of Cologne have now adopted a novel approach. Using electroencephalography (EEG), the scientists studied the processing of simple acoustic stimuli (a sequence of similar clicks). When processing a particular stimulus, healthy people suppress the processing of other stimuli that are irrelevant to the task at hand. Patients with schizophrenia exhibit deficits in this kind of stimulus filtering and thus their brains are probably inundated with too much information. As psychiatrically healthy people also filter stimuli with varying degrees of efficiency, individual stimulus processing can be associated with particular genes.
Smokers process stimuli less effectively
In a large-scale study involving over 1,800 healthy participants from the general population, Boris Quednow and Georg Winterer examined how far acoustic stimulus filtering is connected with a known risk gene for schizophrenia: the so-called "transcription factor 4" gene (TCF4). TCF4 is a protein that plays a key role in early brain development. As patients with schizophrenia often smoke, the scientists also studied the smoking habits of the test subjects.
The data collected shows that psychiatrically healthy carriers of the TCF4 gene also filter stimuli less effectively – like people who suffer from schizophrenia. It turned out that primarily smokers who carry the risk gene display a less effective filtering of acoustic impressions. This effect was all the more pronounced the more the people smoked. Non-smoking carriers of the risk gene, however, did not process stimuli much worse. "Smoking alters the impact of the TCF4 gene on acoustic stimulus filtering," says Boris Quednow, explaining this kind of gene-environment interaction. "Therefore, smoking might also increase the impact of particular genes on the risk of schizophrenia." The results could also be significant for predicting schizophrenic disorders and for new treatment approaches, says Quednow and concludes: "Smoking should also be considered as an important cofactor for the risk of schizophrenia in future studies." A combination of genetic (e.g. TCF4), electrophysiological (stimulus filtering) and demographic (smoking) factors could help diagnose the disorder more rapidly or also define new, genetically more uniform patient subgroups.
Source:Eurekalert

Study suggests new way to treat chronic pain

Gene that encodes crucial pain receptor may be key to individualizing therapy for major health problem
Nearly one in five people suffers from the insidious and often devastating problem of chronic pain.
That the problem persists, and is growing, is striking given the many breakthroughs in understanding the basic biology of pain over the past two decades. A major challenge for treating chronic pain is to understand why certain people develop pain while others, with apparently similar disorders or injuries, do not. An equally important challenge is to develop individualized therapies that will be effective in specific patient populations.
Research published online in Nature Medicine points to solutions to both challenges. A research team led by Prof. Jeffrey Mogil of McGill University in Montreal and Prof. Michael Salter of The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, has identified a major gene affecting chronic pain sensitivity. The findings also suggest a new approach to individualizing treatment of chronic pain.
The gene that the researchers identified encodes the pain receptor known as P2X7. Specifically, the scientists discovered that a single amino-acid change in P2X7 controls sensitivity to the two main causes of chronic pain: inflammation and nerve damage.
The amino-acid change is known to affect only one function of P2X7 receptors – the forming of pores that permit large molecules to pass through – while leaving intact the other function, of allowing much tinier ions to flow through. Using a peptide that targets pore formation only, the researchers found that pain behaviours were dramatically reduced.
The scientists then examined genetic differences among human patients suffering from two distinct types of persistent pain: chronic post-mastectomy pain and osteoarthritis. In both cases, they found that individuals with genetically inherited low pore formation in P2X7 receptors experienced lower pain levels.
"Our findings indicate that it may be possible to develop drugs that block pores in this crucial receptor, while leaving its other function intact – thereby killing pain while minimizing side effects," said Prof. Mogil, E.P. Taylor Professor of Pain Research in McGill's Department of Psychology.
Prof. Salter, Anne and Max Tanenbaum Chair in Molecular Medicine at SickKids, said these discoveries "point toward a new strategy for individualizing the treatment of chronic pain." Scientists from the U.S. and Israel also contributed to the study.
Source:Eurekalert

Foods to Beat High Blood Pressure

Raisins and soy help prevent high blood pressure, show studies.
Munching on a handful of raisins three times a day helped people with slightly elevated blood pressure lower their numbers after several weeks, said one of the studies presented at the American College of Cardiology conference.
The randomized clinical trial -- believed to be the first formal measurement of raisins' benefits on blood pressure -- involved 46 people with a condition known as pre-hypertension.
That means their blood pressure ranged from 120 over 80 millimeters of mercury (mm Hg) to 139 millimeters of mercury over 89 mm Hg, or just higher than normal.
Compared to people who snacked on cookies or crackers, the raisin-eating group saw significant drops in blood pressure, in some cases lowering the top number, or systolic pressure, by 10.2, or seven percent over the 12-week study.
Researchers are not sure exactly why the raisins work so well, but they think it may have to do with the high level of potassium in the shriveled, dried grapes.
"Raisins are packed with potassium, which is known to lower blood pressure," said lead investigator Harold Bays, medical director of Louisville Metabolic and Atherosclerosis Research Center.
"They are also a good source of antioxidant dietary fiber that may favorably alter the biochemistry of blood vessels, causing them to be less stiff, which in turn, may reduce blood pressure."
A handful of about 60 raisins contains a gram of fiber and 212 milligrams of potassium. Raisins are often recommended as part of a high-fiber, low-fat diet to reduce blood pressure.
A second study on soy showed that daily intake of foods like tofu, peanuts and green tea helped lower blood pressure in more than 5,100 white and African American people aged 18-30.
The study began in 1985 and was based on self-reported data about the food the participants ate.
Those who consumed about 2.5 or more milligrams of isoflavones, a key component in soy, per day had significantly lower systolic blood pressure -- an average of 5.5 mmHg lower -- than those who ate less than 0.33 mg per day.
That daily level should not be hard for most people to reach -- a glass of soy milk contains about 22 mg of isoflavones, or nearly 10 times the amount needed to see an effect, according to the research.
"Our results strongly suggest a blood pressure benefit for moderate amounts of dietary isoflavone intake in young black and white adults," said Safiya Richardson, a graduating medical student at Columbia University's College of Physicians and Surgeons and the study's lead investigator.
"Our study is the first to show a benefit in African Americans, who have a higher incidence of high blood pressure, with an earlier onset and more severe end-organ damage."
Eating soy could be a way for people with slightly elevated blood pressure to avoid progressing to high blood pressure, and potentially ward off the need to take medications, she added.
"Any dietary or lifestyle modification people can easily make that doesn't require a daily medication is exciting, especially considering recent figures estimating that only about one third of American hypertensives have their blood pressure under control."
Soy and the isoflavones it contains work by boosting enzymes that create nitric oxide, which in turns helps to widen blood vessels and reduce blood pressure.
"Based on our results and those of previous studies, we would encourage the average adult to consider including moderate amounts of soy products in a healthy, well-balanced diet to reduce the chances of developing high blood pressure," Richardson said.
Source-AFP

Antibiotic Resistance Could Bring ‘End of Modern Medicine’

As bacteria evolve to evade antibiotics, common infections could become deadly, according to Dr. Margaret Chan, director general of the World Health Organization.
Speaking at a conference in Copenhagen, Chan said antibiotic resistance could bring about “the end of modern medicine as we know it.”
“We are losing our first-line antimicrobials,” she said Wednesday in her keynote address at the conference on combating antimicrobial resistance. “Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units.”
Chan said hospitals have become “hotbeds for highly-resistant pathogens” like methicillin-resistant Staphylococcus aureus, “increasing the risk that hospitalization kills instead of cures.”
Indeed, diseases that were once curable, such as tuberculosis, are becoming harder and more expensive to treat.
Chan said treatment of multidrug resistant tuberculosis was “extremely complicated, typically requiring two years of medication with toxic and expensive medicines, some of which are in constant short supply. Even with the best of care, only slightly more than 50 percent of these patients will be cured.”
Antibiotic-resistant strains of salmonella, E. coli, and gonorrhea have also been discovered.
“Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry,” said Chan. “A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”
The dearth of effective antibiotics could also make surgical procedures and certain cancer treatments risky or even impossible, Chan said.
“Some sophisticated interventions, like hip replacements, organ transplants, cancer chemotherapy and care of preterm infants, would become far more difficult or even too dangerous to undertake,” she said.
The development of new antibiotics now could help stave off catastrophe later. But few drug makers are willing to invest in drugs designed for short term use.
“It’s simply not profitable for them,” said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University Medical Center in Nashville. “If you create a new drug to reduce cholesterol, people will be taking that drug every day for the rest of their lives. But you only take antibiotics for a week or maybe 10 days.”
Schaffner likened the dilemma to Ford releasing a car that could only be driven if every other vehicle wasn’t working.
“While we try to encourage the pharmaceutical industry to create new antibiotics, we have to be very prudent in their use,” he said.
But there are ways to limit the potential for bacteria to develop antibiotic resistance: Use antibiotics appropriately and only when needed; follow treatment correctly; and restrict the use of antibiotics in food production to therapeutic purposes.
“At a time of multiple calamities in the world, we cannot allow the loss of essential antimicrobials, essential cures for many millions of people, to become the next global crisis,” said Chan.
Source:abc news