With the help of data specialists and genomic specialists, one can assess large pools of information through the lens of the individual patient.By Taher Abbasi, CEO & Co-founder Cellworks

The phenomenon of personalization has permeated in all verticals of human life. The one-size-fits-all approach is no longer relevant for Retail, IT, Academia, Travel and Hospitality; it is also impacting Medicine paving the way for potentially remarkable changes that improve overall patient care.

This personalized era of precision medicine has dawned with customized medical therapies that are provided based on individuals own measurement reading of genes. This provides a roadmap for more clarity and informed decision vs. flying blind.This rapidly evolving field is getting mainstream with centre of excellence for precision medicine being established across institutions globally. The goals of precision medicine are simple: to offer individual patients the right medical care at the right time, by taking their genes and clinical information into account. And by understanding the patients tumor characteristics predict diet sources which support the treatment paradigm.However, to bring the promise of precision in health requires a fundamental change from population based solutions to sub-population based solutions with segmentation identified by genomic and clinical attributes.

Traditionally, medicine decision has been based on pre-defined one-size-fits-all treatment strategies. In the past few years, the amount of available patient data has exploded, to the point where it has become overwhelming. To take full advantage of these breakthroughs, doctors must add a working knowledge of data and molecular biology science to the clinical sciences that have traditionally been the focus of professional training. With the help of data specialists and genomic specialists, one can assess large pools of information through the lens of the individual patient.

Imprecision of modern medicine

Data reveal that drugs for diseases like cancer work in about 30% of patients, and also they are efficacious for a limited period of time. For cancer patients, treatment options are hit-or-miss. The oncologist can access large quantum of patient data but not the technology and tools to research the options, and then select one or more drugs that may impact the tumor. When one round of therapy does not work, another is tried, but there is no clear way to tell which treatment will work best for that patient, at that precise moment. Hence lack of precision is indeed a life-and-death situation for cancer patients. This hit-and-miss treatment strategy, coupled with the associate drug side effects to be managed by the physician, sky rocketing costs of treatments, further emphasis the implications of being imprecise.

Considering genetic variations of patients

The key characteristics of cancer is the variations in tumor abnormalities across patients. This heterogeneity is further complicated by the fact that the patient tumours are not static and change based on treatment pressures and other factors. While we now have technologies to measure patient specific tumor variations we are limited to looking at individual measurements or dots and do not have the means to connect all the dots. The treatment personalization using point information has improved treatment response rates but resistance to therapies are developed quickly. In this context being precise for treatments will imply patient specific measurements which holistically influence decision making for treatments. And also influence diet decisions namely precision diet.

In conclusion

The underlying intent of healthcare should be to diagnose a condition quickly and unambiguously, and then to match the diagnosis to a specific medicine or therapy, determined in part by the patients genotype or phenotype. Ineffective treatments, waste and late-stage pipeline attrition can be mitigated with precision medicine approaches. In cancer, for example, the one big variability is the cancer tumour across patients even within the same indication. And the technology to measure this variability exists now - making it possible to collect big data measurements per patient.

For the cancer patient on a wrong treatment path, can be life-and-death decision.Hence being precise benefits patients. The physicians benefit from not avoiding managing adverse effects of these treatments when not needed and rationale information for making treatment decisions. The pharma benefits for running smaller and very targeted clinical trials for getting drugs approved for marketing. Consequently, the time is now to make use of the genomics measurements and other clinical data to impact patient care and outcomes.

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Can we be imprecise in medicine? - ETHealthworld.com

Dr. John Short and Casey Johnson have returned to the Hancock County medical community with the opening of Hancock County Family Medicine.

The hospital and community hosted a ribbon cutting ceremony on July 11 and the practice has been open since June 26. Officials from the community and Wellmont Health Systems attended the ribbon cutting to welcome the two medical professionals.

The practice is located inside Wellmont Hospital, which has been a fixture in Hancock County for more than a decade. Hancock County Family Medicine will be a fixture of the hospital itself but will be managed by Wellmont Medical Associates.

Short has had a 21-year medical career, during which he served as the hospitals medical director and most recently practiced medicine at Lakeway Family Medicine in Morristown. He graduated from the University Of Tennessee College of Medicine in Memphis and completed his internship and residency in family medicine at the University of Tennessee in Knoxville.

Johnson was a paramedic at Hancock County Hospital and Hancock County Ambulance Service. He has also volunteered for Hancock County Rescue Squad. He has an associates degree in public safety as a paramedic from Walters State Community College, a bachelors degree in biology from Lincoln Memorial University and a masters degree from LMUs Debusk College of Medicine.

It is such an important day in the expansion of our continuum care and delivery of services provided by Hancock County Hospital, Rebecca Beck, president of Hancock County Hospital, said. Our hospital currently provides 24/7 emergency care, in-patient hospitalization, radiology, respiratory and cardiac services. The addition of primary care today now helps us to ensure the patients of our community receive care in the most appropriate of settings.

The patients of Hancock County Family Medicine will have access to tests and treatments typically found in a family medical setting, but they will also have the option of accessing outpatient services in the hospital. The patients will have the option to obtain X-rays and laboratory testing on site.

This is a great day for Hancock County and Hancock County Hospital. It is something that is an addition to what we already have, Ken Smith, chairman of the hospitals board of directors, said. Quality care has been a key component of this hospital since its beginnings. We have one of the best rural hospitals in the state of Tennessee and it is recognized nationally along with the state. You can have a beautiful facility, but without caring people, you do not have quality healthcare. We have that here.

In establishing this family practice, we are going to see a broad spectrum of patients from pediatrics to geriatrics, he continued. They dont have to go across the mountain and they dont have to go somewhere else to get their laboratory tests or X-rays. This is so important because all too often, we would hear of people having to go across the mountain to get tests or X-rays done. We love the convenience that this is going to give everyone.

Hancock County Hospital has been nationally recognized for its quality of rural care. In 2015, the National Rural Health Association selected the hospital as one of the 20 critical access hospitals in the country. Beckers Hospital Review, a national publication, has chosen the family for the past two years as one of the Critical Access Hospitals to Know. The hospital also scored 94 out of 100 points in the national Pediatric Readiness Assessment.

This community has been blessed to have access to such a wonderful facility, Mike Gibson, chairman of the Hancock County Chamber of Commerce, said. We all remember years ago when our hospital closed. Standing here today, this is such a contrast. We are certainly blessed.

Jim Wozniak, media relations director for Wellmont Health System, said when the hospital reopened, it was the result of a partnership within the community and county.

Thomas Harrison, Hancock County Mayor, recognized the value the hospital brings to the community, especially with the current call center building project, which will add 150 new jobs to Hancock County.

Hancock County Hospital has been a key player in our delivery of superior care with compassion in our rural communities, Eric Deaton, Wellmont Health Systems chief operating officer, said. The physicians and other medical professionals have repeatedly demonstrated to the community how patients can receive tremendous care for a broad range of medical conditions. Were now grateful for the opportunity to expand our scope with the addition of our family medicine practice.

The hospital is located at 1519 Main Street in Sneedville. For more information about Hancock County Family Medicine, visit http://www.welmontphysicians.org. Appointments are available by calling 423-733-5070.

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Hancock Family Medicine opens in Wellmont Hospital - Citizentribune

American Veterinary Medical Association

AVMA's champion for global veterinary medicine American Veterinary Medical Association For the past three years, Dr. Ren Carlson has been president of the World Veterinary Association, the internationally recognized voice of global veterinary medicine. A federation of roughly 90 veterinary organizations representing 500,000 ...

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To the Editor:

I have worked as an optometric physician in Oklahoma for 15 years and have seen more than 10,000 patients. In addition to fitting patients with contacts and prescription eye glasses, I diagnose and treat debilitating conditions like glaucoma, macular degeneration, and ocular surface disease; I perform both traditional and laser surgeries; and I advise patients whose eyes show signs that they are at risk of a stroke or a heart attack. I have diagnosed patients and saved lives with vision and life threatening conditions like brain tumors, brain aneurysms, and different types of cancers.

Today, my profession and most importantly, the health of my patients, is being directly attacked by Walmart.

Under the guise of market competition, Walmart wants to change Oklahomas constitution to eliminate the legal barriers between medicine and retail sales. In other words, they want optometric physicians like me to work in a Walmart store and practice medicine somewhere between the frozen food section and their auto-parts shop.

Our state Constitution currently prohibits such a set-up, a choice that Oklahoma lawmakers consciously and wisely made (and have since reaffirmed) to treat medical care as something other than a normal mass market retail product.

There are two important reasons for that degree of separation. The first is quality.

I work in a private practice and my only business is optometry. My clinic is a sterile environment. I have the tools and the equipment I need to provide my patients with the best service and care available; I am not assigned a budget by a Walmart manager or asked to cut corners. I know my patients by name, and I know their families. I have every incentive to offer the highest quality of care.

Walmart, I think it is fair to say, does not specialize in providing high quality goods and services. They are known for bulk sales and cheap products. That is fine if you are buying a garden hose; it is not fine if you are getting laser eye surgery.

Other than guaranteeing quality of care, another reason for separating medicine from big box store environments is trust.

If a doctor tells a patient they need a procedure or a new prescription, the patient needs to trust he or she is receiving advice based on sound medicine and nothing else. I took an oath when I graduated from optometry school to First, Do No Harm. In other words, the patient needs to know he or she is dealing with a doctor who is committed to taking care of them for life and not a salesperson looking to meet a quarterly quota.

Big box stores rely on bulk sales the fast and dirty work of selling as much stuff as possible to as many people as possible. In states where Walmart contractors can practice optometry that approach has trickled down to eye doctors: there are numerous examples of optometrists who are pressured to change how they practice medicine to increase sales. That may be good business for Walmart; it is most certainly bad medicine.

Quality care and trust are the bedrock principles that all doctors operate on and all patients demand. Sadly, both are being torn down and commoditized by Walmart and being replaced with just one: profit.

Dr. Selina McGee

Oklahoma City

Editors Note: Selina McGee is a doctor of optometry who lives and practices in Oklahoma. She is the vice president of the Oklahoma Association of Optometric Physicians, a fellow of the American Academy of Optometry and a Diplomate of the American Board of Optometry.

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LETTER: Walmart wants to remove barriers between medicine, retail sales - Edmond Sun

Hours of commuting may be mind-numbingly dull, but new research shows that it might also be having an adverse effect on both your health and performance at work. Longer commutes also appear to have a significant impact on mental wellbeing, with those commuting longer 33 per cent more likely to suffer from depression

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It is not possible to be overweight and healthy, a major new study has concluded. The study of 3.5 million Britons found that even metabolically healthy obese people are still at a higher risk of heart disease or a stroke than those with a normal weight range

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When you feel particularly exhausted, it can definitely feel like you are also lacking in brain capacity. Now, a new study has suggested this could be because chronic sleep deprivation can actually cause the brain to eat itself

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David Lloyd Gyms have launched a new health and fitness class which is essentially a bunch of people taking a nap for 45 minutes. The fitness group was spurred to launch the napercise class after research revealed 86 per cent of parents said they were fatigued. The class is therefore predominantly aimed at parents but you actually do not have to have children to take part

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Tobacco and alcohol companies could win more easily in court cases such as the recent battle over plain cigarette packaging if the EU Charter of Fundamental Rights is abandoned, a barrister and public health professor have said.

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A major new study into the side effects of the cholesterol-lowering medicine suggests common symptoms such as muscle pain and weakness are not caused by the drugs themselves

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New research has found that babies born to fathers under the age of 25 or over 51 are at higher risk of developing autism and other social disorders. The study, conducted by the Seaver Autism Center for Research and Treatment at Mount Sinai, found that these children are actually more advanced than their peers as infants, but then fall behind by the time they hit their teenage years.

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Commuters who swap their car or bus pass for a bike could cut their risk of developing heart disease and cancer by almost half, new research suggests but campaigners have warned there is still an urgent need to improve road conditions for cyclists. Cycling to work is linked to a lower risk of developing cancer by 45 per cent and cardiovascular disease by 46 per cent, according to a study of a quarter of a million people. Walking to work also brought health benefits, the University of Glasgow researchers found, but not to the same degree as cycling.

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Ketamine helps patients with severe depression when nothing else works doctors say

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Scientists conducted the research on 71 car crash victims as they were waiting for treatment at one hospitals accident and emergency department. They asked half of the patients to briefly recall the incident and then play the classic computer game, the others were given a written activity to complete. The researchers, from Karolinska Institute in Sweden and the University of Oxford, found that the patients who had played Tetris reported fewer intrusive memories, commonly known as flashbacks, in the week that followed

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Major measles outbreaks are spreading across Europe despite the availability of a safe, effective vaccine, the World Health Organisation has warned. Anti-vaccine movements are believed to have contributed to low rates of immunisation against the highly contagious disease in countries such as Italy and Romania, which have both seen a recent spike in infections. Zsuzsanna Jakab, the WHOs regional director for Europe, said it was of particular concern that measles cases are climbing in Europe when they had been dropping for years

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Vaping has been given an emphatic thumbs up by health experts after the first long-term study of its effects in ex-smokers. After six months, people who switched from real to e-cigarettes had far fewer toxins and cancer-causing substances in their bodies than continual smokers, scientists found

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Millions of people are putting themselves at risk by cooking their rice incorrectly, scientists have warned. Recent experiments show a common method of cooking rice simply boiling it in a pan until the water has steamed out can expose those who eat it to traces of the poison arsenic, which contaminates rice while it is growing as a result of industrial toxins and pesticides

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An injectable contraceptive gel that acts as a reversible vasectomy is a step closer to being offered to men following successful trials on monkeys. Vasalgel is injected into the vas deferens, the small duct between the testicles and the urethra. It has so far been found to prevent 100 per cent of conceptions

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Women who work at night or do irregular shifts may experience a decline in fertility, a new study has found. Shift and night workers had fewer eggs capable of developing into healthy embryos than those who work regular daytime hours, according to researchers at Harvard University

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A major pressure group has issued a fresh warning about perilously high amounts of sugar in breakfast cereals, specifically those designed for children, and has said that levels have barely been cut at all in the last two and a half decades

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Scientists have made a monumental leap forward in the treatment of pancreatic cancer after discovering using two drugs together dramatically improved patients chances of living more than five years after diagnosis.

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The Japanese government has announced measures to limit the amount of overtime employees can do in an attempt to stop people literally working themselves to death. A fifth of Japans workforce are at risk of death by overwork, known as karoshi, as they work more than 80 hours of overtime each month, according to a government survey.

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The Food Standards Agency (FSA) has issued a public warning over the risks of acrylamide - a chemical compound that forms in some foods when they are cooked at high temperatures (above 120C).

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Cervical screening tests are a vital method of preventing cancer through the detection and treatment of abnormalities in the cervix, but new research shows that the number of women using this service has dropped to a 19 year low.

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The ConversationIt is well known that high blood pressure is a risk factor for dementia, so the results of a new study from the University of California, Irvine, are quite surprising. The researchers found that people who developed high blood pressure between the ages of 80-89 are less likely to develop Alzheimers disease (the most common form of dementia) over the next three years than people of the same age with normal blood pressure.

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The majority of antidepressants are ineffective and may be unsafe, for children and teenager with major depression, experts have warned. In what is the most comprehensive comparison of 14 commonly prescribed antidepressant drugs to date, researchers found that only one brand was more effective at relieving symptoms of depression than a placebo. Another popular drug, venlafaxine, was shown increase the risk users engaging in suicidal thoughts and attempts at suicide

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Scientists have taken a very positive step towards creating a universal vaccine against cancer that makes the bodys immune system attack tumours as if they were a virus, experts have said. Writing in Nature, an international team of researchers described how they had taken pieces of cancers genetic RNA code, put them into tiny nanoparticles of fat and then injected the mixture into the bloodstreams of three patients in the advanced stages of the disease. The patients' immune systems responded by producing "killer" T-cells designed to attack cancer. The vaccine was also found to be effective in fighting aggressively growing tumours in mice, according to researchers, who were led by Professor Ugur Sahin from Johannes Gutenberg University in Germany

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A compound found in green tea could improve the cognitive abilities of those with Downs syndrome, a team of scientists has discovered. Researchers found epigallocatechin gallate which is especially present in green tea but can also be found in white and black teas combined with cognitive stimulation, improved visual memory and led to more adaptive behaviour. Dr Rafael de la Torre, who led the year-long clinical trial along with Dr Mara Dierrssen, said: The results suggest that individuals who received treatment with the green tea compound, together with the cognitive stimulation protocol, had better scores in their cognitive capacities

Taking antidepressants during pregnancy could almost double the risk of a child being diagnosed with autism in the first years of life, a major study of nearly 150,000 pregnancies has suggested. Researchers have found a link between women in the later stages of pregnancy who were prescribed one of the most common types of antidepressant drugs, and autism diagnosed in children under seven years of age

Parents have been warned that giving children paracetamol-based medicines such as Calpol and Disprol too often could lead to serious health issues later in life. Leading paediatrician and professor of general paediatrics at University College London, Alastair Sutcliffe, said parents were overusing paracetamol to treat mild fevers. As a result, the risk of developing asthma, as well as kidney, heart and liver damage is heightened

Scientists have pinpointed how connections in the brain are destroyed in the early stages of Alzheimers disease, in a study which it is hoped will help in the development of treatments for the debilitating condition. At the early stages of the development of Alzheimers disease the synapses which connect the neurons in the brain are destroyed, according to researchers at the University of New South Wales, Australia. The synapses are vital for brain function, particularly learning and forming memories

The technology lets paralysed people feel actual sensations when touching objects including light taps on the mechanical finger and could be a huge breakthrough for prosthetics, according to its makers. The tool was used to let a 28-year-old man who has been paralysed for more than a decade. While prosthetics have previously been able to be controlled directly from the brain, it is the first time that signals have been successfully sent the other way

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Drug industry to challenge health service decision over medicine price limits - The Independent

July 11, 2017

As West Africa declares war on the market for expired and counterfeit medicines, start-ups are putting quality control in the hands of patients to stop them risking their lives trying to get well.

Not only can such drugs fail to treat the diseases they are bought to combat, experts say, but they may encourage resistance to antibiotics and even cause death as diseases continue to course unchecked through the body.

At an April meeting in Liberia, the 15-member Economic Community of West African States (ECOWAS) announced a region-wide investigation into the trafficking of expired and counterfeit drugs, and a public awareness campaign.

Traffickers in bad medicine prey on some of the world's poorest and most in need, who also face high costs for health care and often lack insurance, said Adama Kane, who founded the health start-up JokkoSante in Senegal to tackle the problem.

Perversely, piles of perfectly good medication go unused in Senegal, Kane noteda problem that JokkoSante tackles by organising the collection of unused drugs from people who are awarded points in exchange to obtain other medicines later.

Handing in asthma medication at an exchange point in a health centre in Passy, central Senegal, JokkoSante user Marie Gueye is one of those to benefit.

"My family and I no longer have problems getting medication. All we have to do is come here and collect the points," she told AFP.

Rewards

For Senegal's rural households, up to 73 percent of health-related expenses go on medication, according to JokkoSante research. Half the overall population has no health insurance coverage.

"Our app is used by hospitals, pharmacies and health centres," Kane said, adding it was still at the pilot stage with 1,500 users so far. People create an account and operate the points system all via their mobile phone.

For those too poor to buy drugs at all, JokkoSante has teamed up with large company sponsors, including phone operator Sonatel, who cover the cost of providing patients with free medicine.

Again, the system operates through a mobile app.

At Diamniadio children's hospital, near Senegal's capital, Dakar, Yacina Ba described the fear of coming to the end of the 50,000 CFA Francs ($85, 75 euros) she scraped together to buy treatment and medication for her sick six-month-old baby, finally begging a doctor for help.

"She had rashes all over her arms," Ba told AFP, explaining how the free treatment sponsorship scheme made all the difference.

'Most vulnerable people'

A health worker at the hospital, who asked not to be identified, conceded that a lack of specialists meant medics often over-prescribe medication to those able to pay.

This can lead to stockpiles of unused, expired drugs which may then fall into the wrong hands.

"Fake drugs are usually bought by the most vulnerable sections of society," said JokkoSante's Kane, who now oversees a small network of pharmacies using his platform, while the government considers a nationwide rollout.

The American Society of Tropical Medicine and Hygiene estimated in 2015 that 122,000 children under five died due to taking poor-quality antimalarials in Sub-Saharan Africa, which, along with antibiotics as the two most in-demand, are the medicines most likely to be out-of-date or cheap copies.

China, India drive trafficking

Counterfeited drugs from China and India are awash in west African markets, according to the Paris-based International Institute of Research Against Counterfeit Medicines (IRACM).

And they are often indistinguishable from the genuine item, it warned.

A joint IRACM and World Customs Organization (WCO) seizure of medical supplies at 16 African ports late last year yielded no fewer than 113 million items of fake medication, 5,000 medical devices and even veterinary products.

Everything from fake cancer drugs to fake sutures for operations can be found in such hauls.

IRACM is working with MPs on drafting legislation to crack down on trafficking in west Africa, but two innovative companies have already taken the matter in hand.

Battling fakes

Sproxil, an anti-counterfeiting start-up established in 2009, works by attaching a scratch panel to drug packets.

Consumers can check their product is the real deal by sending an SMS verification code to the company, which confirms the authenticity.

In the last six years, the firm has had 50 million text messages from customers across Africa and India.

Ireti Oluwagbemi, its Nigeria-based spokeswoman, said fraudsters "target brands based on their market share", making household names the biggest targets.

There is plenty of money to be made. The global counterfeit drug market is currently worth around $85 billion, according to IRACM, and the proceeds drive organised crime.

Sproxil's clients include pharma giants such as GlaxoSmithKline and Novartis, firms which lose millions each year from pirated products carefully stamped with their branding.

"The consequences of ingesting these chemicals can range from discomfort to persistence of the disease it's supposed to be treating, to death," Oluwagbemi told AFP.

mPedigree, a Ghanaian start-up with a similar scratch card guarantee, has also been adopted as an industry-wide standard by the Pharmaceutical Society of Ghana, and records data on maps where fakes are appearing.

Explore further: Ivory Coast breaks up huge fake drugs market

2017 AFP

Ivory Coast authorities deployed dozens of police Wednesday to break up a fake drugs market in Abidjan estimated to supply nearly a third of all treatments sold in the country.

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West Africa's fight to keep bad medicine off shelves - Medical Xpress

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Treatment prevents virus from crossing placenta to infect fetus, mouse study shows

Human placental cells (blue) infected with Zika virus (green) responded to the malaria drug chloroquine (left). The drug prevented the virus from growing, unlike the drug rapamycin, which prompted the virus to grow rapidly (right). Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis found that Zika virus manipulates the bodys normal barrier to infection, and that hydroxychloroquine, a malaria drug related to chloroquine, interferes with this process, protecting the fetus from viral infection.

Devastating consequences of Zika virus infection are suffered in the womb, where the virus can cause brain damage and sometimes death.

Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis have learned that the Zika virus infects the fetus by manipulating the bodys normal barrier to infection. Moreover, they showed that a malaria drug that interferes with this process protects the fetus from viral infection. That drug already is approved for use in pregnant women for other medical purposes.

We found that the malaria drug hydroxychloroquine effectively blocks viral transmission to the fetus, said senior author Indira Mysorekar, PhD, an associate professor of obstetrics and gynecology, and of pathology and immunology. This drug already is used in pregnant women to treat malaria, and we suggest that it warrants evaluation in primates and women to diminish the risks of Zika infection and disease in developing fetuses.

The findings are published July 10 in The Journal of Experimental Medicine.

In late 2015, doctors in Brazil began to notice a surge in the number of babies born with microcephaly, or unusually small heads, an indicator of neurological damage. The epidemic soon was linked to the mosquito-borne Zika virus, which was spreading through the tropical parts of the Americas. Doctors advised pregnant women to avoid mosquito bites by wearing bug spray and long-sleeved clothing, but had little other advice to offer. There were, and still are, no drugs or vaccines approved for use in pregnant women to protect them or their fetuses from Zika infection.

The developing fetus is uniquely vulnerable to damage from infection, so the body mobilizes robust defenses to keep microbes from ever reaching the fetus in the first place. The placenta is the last line of defense. Mysorekar and others have shown that a process known as autophagy the cellular waste-disposal pathway by which cells grind up debris, unwanted organelles and invading microbes is an important part of the formidable placental barrier to infection. However, previous studies by Mysorekar and others have shown that Zika not only can invade the placenta, but multiply there.

To learn more about how Zika breaches the placenta, Mysorekar, postdoctoral fellow Bin Cao, PhD, and colleagues infected human placental cells with Zika virus. They found that exposure to the virus activated genes related to autophagy.

However, when the researchers treated the cells with drugs to ramp up the autophagy pathway, the number of cells infected with Zika virus increased. Drugs that suppressed autophagy resulted in fewer placental cells infected with Zika virus. In other words, the virus multiplied and spread more effectively when the researchers dialed up the barrier response, and performed more sluggishly when they dialed it down. The virus seemed to be doing a form of microbial martial arts, turning the bodys weapons to its own advantage.

Mysorekar and colleagues verified these findings using mice whose autophagy response was hobbled by low levels of a key autophagy protein. They infected two groups of pregnant mice with Zika: one in which the autophagy process was disrupted and the other in which it worked normally.

Five days after infection, the mothers with a weak autophagy response had about the same amount of virus in their bloodstreams as the mice with a normal response. However, in mice with a weak autophagy response, the researchers found 10 times fewer viruses in the placenta and the heads of the fetuses and less damage to the placentas.

It appears that Zika virus takes advantage of the autophagy process in the placenta to promote its survival and infection of placental cells, Cao said.

Since hydroxychloroquine suppresses the autophagy response, the researchers questioned whether it also could protect fetuses against Zika.

To find out, they repeated the mouse experiment using only mice with a normal autophagy response. Female mice at day nine of pregnancy were infected with Zika and then dosed with hydroxychloroquine or placebo every day for the next five days.

Following treatment, the researchers found significantly less virus in the fetuses and placentas from the mice that had received hydroxychloroquine. In addition, these placentas showed less damage and the fetuses regained normal growth. Both the untreated and the treated mothers had about the same amount of Zika virus in their bloodstreams, indicating that hydroxychloroquine was able to protect fetuses even when the virus was circulating through the mother.

Although hydroxychloroquine has been used safely in pregnant women for short periods of time, the researchers caution that further studies are needed before it can be used in pregnant women to fend off Zika. Pregnant women living in areas where Zika circulates may need to take the drug for the duration of their pregnancies, and the safety of hydroxychloroquine for long-term use is unknown.

We would urge caution but nevertheless feel our study provides new avenues for feasible therapeutic interventions, said Mysorekar, who is also co-director of the universitys Center for Reproductive Health Sciences. Our study suggests that an autophagy-based therapeutic intervention against Zika may be warranted in pregnant women infected with Zika virus.

Cao B, Parnell LA, Diamond MS, Mysorekar IU. Inhibition of autophagy limits vertical transmission of Zika virus in pregnant mice. The Journal of Experimental Medicine. July 10, 2017.

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH), grant number R01 HD091218; National Institute of Allergy and Infectious Diseases, grant numbers R01 AI073755 and R01 AI104972; the Burroughs Wellcome Fund through a Preventing Prematurity Initiative grant; and the March of Dimes, award number 21-FY13-28.

Washington University School of Medicines 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked seventh in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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Poor sleep leads to increase in Alzheimer's proteins associated with cognitive decline

Research from Washington University School of Medicine in St. Louis, Radboud University Medical Centre in the Netherlands, and Stanford University shows that disrupting just one night of sleep in healthy, middle-aged adults causes an increase in a brain protein associated with Alzheimers disease. Further, a week of poor sleep leads to an increase in another brain protein that has been linked to brain damage in Alzheimers and other neurological diseases.

A good nights sleep refreshes body and mind, but a poor nights sleep can do just the opposite. A study from Washington University School of Medicine in St. Louis, Radboud University Medical Centre in the Netherlands, and Stanford University has shown that disrupting just one night of sleep in healthy, middle-aged adults causes an increase in amyloid beta, a brain protein associated with Alzheimers disease. And a week of tossing and turning leads to an increase in another brain protein, tau, which has been linked to brain damage in Alzheimers and other neurological diseases.

We showed that poor sleep is associated with higher levels of two Alzheimers-associated proteins, said David M. Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor, head of the Department of Neurology and the studys senior author. We think that perhaps chronic poor sleep during middle age may increase the risk of Alzheimers later in life.

These findings, published July 10 in the journal Brain, may help explain why poor sleep has been associated with the development of dementias such as Alzheimers.

More than 5 million Americans are living with Alzheimers disease, which is characterized by gradual memory loss and cognitive decline. The brains of people with Alzheimers are dotted with plaques of amyloid beta protein and tangles of tau protein, which together cause brain tissue to atrophy and die. There are no therapies that have been proven to prevent, slow or reverse the course of the disease.

Previous studies by Holtzman, co-first author Yo-El Ju, MD, an assistant professor of neurology, and others have shown that poor sleep increases the risk of cognitive problems. People with sleep apnea, for example, a condition in which people repeatedly stop breathing at night, are at risk for developing mild cognitive impairment an average of 10 years earlier than people without the sleep disorder. Mild cognitive impairment is an early warning sign for Alzheimers disease.

But it wasnt clear how poor sleep damages the brain. To find out, the researchers Holtzman; Ju; co-first author and graduate student Sharon Ooms of Radboud; Jurgen Claassen, MD, PhD, of Radboud; Emmanuel Mignot, MD, PhD, of Stanford; and colleagues studied 17 healthy adults ages 35 to 65 with no sleep problems or cognitive impairments. Each participant wore an activity monitor on the wrist for up to two weeks that measured how much time they spent sleeping each night.

After five or more successive nights of wearing the monitor, each participant came to the School of Medicine to spend a night in a specially designed sleep room. The room is dark, soundproof, climate-controlled and just big enough for one; a perfect place for sleeping, even as the participants wore headphones over the ears and electrodes on the scalp to monitor brain waves.

Half the participants were randomly assigned to have their sleep disrupted during the night they spent in the sleep room. Every time their brain signals settled into the slow-wave pattern characteristic of deep, dreamless sleep, the researchers sent a series of beeps through the headphones, gradually getting louder, until the participants slow-wave patterns dissipated and they entered shallower sleep.

The next morning, the participants who had been beeped out of slow-wave sleep reported feeling tired and unrefreshed, even though they had slept just as long as usual and rarely recalled being awakened during the night. Each underwent a spinal tap so the researchers could measure the levels of amyloid beta and tau in the fluid surrounding the brain and spinal cord.

A month or more later, the process was repeated, except that those who had their sleep disrupted the first time were allowed to sleep through the night undisturbed, and those who had slept uninterrupted the first time were disturbed by beeps when they began to enter slow-wave sleep.

The researchers compared each participants amyloid beta and tau levels after the disrupted night to the levels after the uninterrupted night, and found a 10 percent increase in amyloid beta levels after a single night of interrupted sleep, but no corresponding increase in tau levels. However, participants whose activity monitors showed they had slept poorly at home for the week before the spinal tap showed a spike in levels of tau.

We were not surprised to find that tau levels didnt budge after just one night of disrupted sleep while amyloid levels did, because amyloid levels normally change more quickly than tau levels, Ju said. But we could see, when the participants had several bad nights in a row at home, that their tau levels had risen.

Slow-wave sleep is the deep sleep that people need to wake up feeling rested. Sleep apnea disrupts slow-wave sleep, so people with the disorder often wake up feeling unrefreshed, even after a full eight hours of shut-eye.

Slow-wave sleep is also the time when neurons rest and the brain clears away the molecular byproducts of mental activity that accumulate during the day, when the brain is busily thinking and working.

Ju thinks it is unlikely that a single night or even a week of poor sleep, miserable though it may be, has much effect on overall risk of developing Alzheimers disease. Amyloid beta and tau levels probably go back down the next time the person has a good nights sleep, she said.

The main concern is people who have chronic sleep problems, Ju said. I think that may lead to chronically elevated amyloid levels, which animal studies have shown lead to increased risk of amyloid plaques and Alzheimers.

Ju emphasized that her study was not designed to determine whether sleeping more or sleeping better reduce risk of Alzheimers but, she said, neither can hurt.

Many, many Americans are chronically sleep-deprived, and it negatively affects their health in many ways, Ju said. At this point, we cant say whether improving sleep will reduce your risk of developing Alzheimers. All we can really say is that bad sleep increases levels of some proteins that are associated with Alzheimers disease. But a good nights sleep is something you want to be striving for anyway.

Shown are brain waves during slow-wave sleep, measured as a study participant slept.

Ju Y-E, Ooms SJ, Sutphen C, Macauley SL, Zangrilli M, Jerome G, Fagan AM, Mignot E, Zempel JM, Claassen JAHR, Holtzman DM. Slow wave sleep disruption increases cerebrospinal fluid amyloid-beta levels. Brain. July 10, 2017.

This study was funded by the National Institutes of Health, grant numbers K23-NS089922, UL1RR024992 Sub-Award KL2-TR000450, P01NS074969, P01-AG026276, P01-NS074969, and P01-AG03991; the J.P.B Foundation; Alzheimer Nederland, grant number 15040; and the Washington University Institute of Clinical and Translational Sciences, grant number UL1TR000448, from the National Center for Advancing Translational Sciences of the National Institutes of Health.

Washington University School of Medicines 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked seventh in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

Read more:

Sleep, Alzheimer's link explained - Washington University School of Medicine in St. Louis

Brenda Fitzgerald. Photo: Branden Camp/AP

On first glance, the most startling thing about Donald Trumps pick to lead the Centers for Disease Control (CDC) and Prevention was its propriety: Brenda Fitzgerald is a trained obstetrician-gynecologist who worked for three decades in private practice before becoming Georgias public health commissioner in 2011. In her time in the post, Fitzgerald won the respect of her peers in other states, and they recently elected her president of the nonprofit group that represents Americas state and territorial public-health agencies. Her appointment was praised by Barack Obamas former CDC director Tom Frieden.

Fizgerald is a staunch believer in the mission of her agency, and has said that the private sector is incapable of performing its core functions. While she has longstanding ties to the Republican Party having twice run unsuccessfully for Congress she has proven willing to subordinate conservative orthodoxy to her convictions as a medical professional: In her first House run, Fitzgerald argued that decisions about abortion should be left to women and their doctors.

Finally, as the first female OB/GYN ever tapped to run the CDC, Fitzgerald brings a unique (and historically marginalized) perspective with her to the federal government.

All this makes her a bizarre addition to the Trump cabinet. Thus far, the president has evinced a deep commitment to stocking his administrations domestic agencies with appointees who are eithercomically unqualified for their assignments (Ben Carson), hostile to the very purpose of the department theyre meant to direct (Scott Pruitt, Betsy DeVos), or rich, white men who bring ethical baggage and/or flagrant conflicts of interest to their posts (Tom Price, Rex Tillerson, Wilbur Ross, Gary Cohn, etc.).

But fear not the fundamental laws of our political universe have not been rewritten. Once you read this dispatch from Forbess Rita Rubin, everything will fall back into place:

Dr. Brenda Fitzgerald, appointed Friday as director of the U.S. Centers for Disease Control and Prevention, is a board-certified obstetrician/gynecologist who saw patients for 30 years in private practice.

Unlike any OB/GYN I know, Fitzgerald treated men as well as women. Thats because besides being board-certified in obstetrics and gynecology, she is a fellow in anti-aging medicine.

Among her credentialslisted on [her gynecological practices] website: board certification in Anti-Aging and Regenerative Medicine by theAmerican Academy of Anti-Aging Medicine. However, the American Board of Medical Specialties, made up of the specialty boards that certify physicians,doesnt recognize the American Academy of Anti-Aging Medicine(A4M), which promotes the use of intravenous nutritional therapy, bioidentical hormone replacement therapy (BHRT) and pellet therapy, in which tiny pellets that contain hormones are placed under the skin.

[B]ioridiculous is how Dr. Nanette Santoro, chair of obstetrics and gynecology at the University of Colorado School of Medicine, described the use of bio-identical hormones in a recent guest post on the North American Menopause Societys MenoPause blog. Santoro described a patient whose hair had fallen out because she had been rubbing testosterone cream into her skin every day and overdosed. Another patient, age 52, had estrogen levels higher than when she was pregnant, due to estrogen pellets that had been inserted under her skin months earlier.

Now, a snake-oil saleswoman fits perfectly into the Trump cabinet. The president and secretary of Housing and Urban Development have both dabbled in peddling scientifically dubious supplements, while the secretary of Education owes her fortune to one of the most successful pyramid schemes in world history.

Fitzgerald wasnt shy about her antiaging expertise, touting that rsum item in her bio on the Georgia Department of Public Health website. Further, her private practices old homepage included the following frequently asked questions.

What is anti-aging medicine?

It is a new specialty of medicine that studies the changes that occur in all of us as we age. It is dedicated to treating the cause of problems, not just the symptoms.

How do I know I am taking the right supplements?

We can now measure the vitamins, antioxidants, necessary fats and proteins in your cells with a simple blood test. If you like the supplements you are taking (Juice Plus, for example), we can tell you what you need to add.

Can you treat my husband?

I have taken additional training in male hormones so that I may treat male hormone deficiencies as well as female deficiencies.

Why did you become interested in anti-aging medicine?

I got older! The life expectancy for women in 1900 was 48. The majority of women never reached the hormone depleted state of menopause just 100 years ago. Now most of us can expect to live half of our lives without natural optimal hormone production.

The Food and Drug Administration has warned that it has no evidence that the bio-identical hormones central to anti-aging medicine are safer or more effective than other hormone products.

All that said, even with her scientifically dubious side-hustle, Fitzgerald is still among the most defensible appointments Trump has made. Whatever her unorthodox views on the virtues of antiaging hormone therapy, she does have a significant body of experience in managing public health. It seems likely that the former will have more bearing on her capacity to combat the threat that Ebola, Zika, antibiotic-resistant bacteria, and other infectious diseases pose to the country and globe.

Which is to say: At least we arent relying on Ben Carson to coordinate the federal governments response to the next pandemic.

More concerning than Trumps appointment of Fitzgerald is his administrations proposal to cut the CDCs budget by $1.2 billion.

Heres hoping that bubonic plague doesnt emerge from melting Siberian ice anytime soon.

The first rule of Tautology Club is the first rule of Tautology Club.

Protesters promised to greet him if he made his official state visit.

An unedited Q&A with the prominent climatologist, who took issue with New Yorks latest cover story for being overly doomist.

The Kremlin-linked lawyer who met with Donald Trump Jr. claims that he was desperate for dirt on Clinton but she had none to give.

Hua Haifeng was investigating factories where the First Daughters shoes were made before his arrest.

In their desire to see Trump banished, theyve embraced some unusual bedfellows, like Benjamin Wittes.

It involves a beauty pageant, a Russian pop star, and Trumps decades-old dream of building in Moscow.

Sources say before meeting with a Kremlin-connected lawyer, he was told the dirt she had on Hillary Clinton was part of a larger Russian effort.

The pro-Trump local-news giant has tripled the number of Boris Epshteyn segments that all its affiliates must air each week.

He could tap McConnells favorite Luther Strange or Hannitys favorite Mo Brooks. Theocrat Roy Moores in the mix, too.

Alan Futerfas is a criminal attorney whos worked with some high-profile defendants.

The rookie right-fielder doesnt just hit a lot of home runs, he hits them a long way.

Go ahead and put this on loop.

After that deal fell through, the presidents son-in-law pushed for the U.S. to support the Saudis blockade of Qatar.

Maybe its not a coincidence that he was chosen by the party that almost put Sarah Palin in the White House.

Were going to have to do something that we probably never dreamed wed do.

The brutal, months-long offensive has finally liberated Iraqs second-largest city after three years of ISIS control.

Before going into public health, Brenda Fitzgerald sold (scientifically dubious) anti-aging hormone treatments to patients.

Lots of crowds and some new routes for regional commuters but things have been worse.

More here:

Trump's CDC Pick Peddled 'Anti-Aging' Medicine to Her Gynecologic Patients - New York Magazine

SNELLVILLE The Georgia High School Associations summer dead period ended Monday, yet dozens of Gwinnett County football coaches waited one more day before returning to summer workouts.

Thats because the eighth-annual Sports Medicine South and Gwinnett Touchdown Club Fellowship Golf Tournament took place Monday at Summit Chase Country Club.

The tournament featured 27 foursomes made up of four coaches from the majority of Gwinnett schools, a group of retired Gwinnett coaches (Dave Hunter, Kevin Maloof, Tally Johnson and Charlie Jordan) and a handful of tournament corporate sponsors with scoring at each hole mercifully capped at par to keep up the pace of play.

The money raised by the annual event goes toward the Linda Jones $1,000 scholarships handed out to each school in December at the Rivalries of Gwinnett All-Star Game. In total, Sports Medicine Souths event has now given away over $150,000 in scholarships to local football players, according to founder Dr. Gary Levengood.

Monday also served as an opportunity for new South Gwinnett head coach Steve Davenport to get acquainted with his county peers. Davenport is one of eight new head coaches in Gwinnett this fall, but one of the few who came from outside the county lines without any previous Gwinnett ties.

A lot of the guys I already knew, but the camaraderie was outstanding, Davenport said. Obviously you like to get out and play a little bit of golf, but the camaraderie and being amongst your fellow coaches is really special. Its an opportunity to meet each other and talk to each other outside of competition with each other. Its outstanding.

Im excited about the opportunity to be in Gwinnett. I understand the competitive nature that Ive entered, but apart form all of that, Im really excited about being a part of a group of guys that really care for, not only the game of football, but care for each other as well.

The true winners of the tournament each year are determined not by the scorecards, but during the luncheon raffle once play is finished.

Levengood and Sports Medicine South gave away prizes to the coaches that included iPads, hunting and fishing trips and Atlanta Braves tickets. Only head coaches were up for this years top prizes of a big screen 4K television and a Big Green Egg grill.

Parkview head coach Eric Godfree took home the TV for the second straight year, while Meadowcreeks Jason Carrera won the Big Green Egg.

Now teams will turn their attention to something more than just door prizes with the season only a month away.

This is the exciting time now, Davenport said. Obviously weve got to get prepared and everybody starts the season with tremendous expectations. It was good to get away, but Im looking forward to getting back with the guys.

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County coaches hit the links for annual Sports Medicine South and Gwinnett Touchdown Club Fellowship Golf ... - Gwinnett Prep Sports

Blogs | Jul. 11, 2017

An interview with Wesley J. Smith of the Discovery Institutes Center on Human Exceptionalism.

For most parents, the Charlie Gard casethe 11-month-old baby in the U.K. who has been refused experimental treatment that could prolong his lifeis cut and dry. Fit parents are the ones to make informed decisions regarding their childs health. Watching what is unfolding with Charlie and his parents has provoked a number of questions about medical kidnapping, doctors refusing care, parental rights, and why Charlie cant seek treatment elsewhere or go home to die in the peace of his home?

To answer these questions, I consulted via phone with the author of Culture of Death: The Age of Do Harm Medicine,Wesley J. Smith, who is a lawyer and a senior fellow at the Discovery Institutes Center on Human Exceptionalism and a consultant to the Patients Rights Council.

Why wouldnt you call what is happening to Charlie Gard a medical kidnapping considering the hospital wont let his parents transfer or take him home to die?

I think that the language is too provocative. This is a very sensitive thing. I use strong language, but I dont want to use overly provocative language. Kidnapping is a crime; this is not a crime. In fact, its more disturbing because it appears to be done under the rule of law.

I call [what happened to Charlie] a bioethical aggression, By which I mean that the value beliefs of mainstream Bioethics and the medical intelligentsia are being imposed on people who have a more traditional sanctity of life value system. The quality of life ethic is now aggressive. Its not just these doctors saying, This is against my ethics to keep this baby alive because I dont think this is right for the baby. Theyre saying that the parents dont have a right to make a different choice, and thats an aggressive act. It is expanding the power of Bioethics, doctors, and courts, into areas of intimate decision making and family life where they do not belong

Why do you think the hospital wont let Charlie have treatment elsewhere?

Disputes between doctors and families about treatment options are not unusual and occasionally they end up in court. Whatisunusual in this case is that Charlies parents are not being allowed to transfer his care to other doctors in a different hospital or to take the child home.

Its very disturbing these parents are being deprived of fundamental parental rights. I understand that in the UK the law is different. My understanding is that the best interests of the child are supposed to come first in every circumstance, particularly in the medical context. that gives doctors more power than our laws here. But when you have this kind of dispute about whats in the best interest of this little babywhich is a subject questionabsent a finding that the parents are unsuited to make decisions, it seems to me thattheyshould have the right to make this kind of ultimately decision about their own child. As the people most intimately involved with Charlie and as his parents, they should have the authority over the childnot hospital and not the court.

Until the courts rule that someone else should be Charlies decision maker, I dont understand how a transfer to different doctors or his discharge home can be stopped. There are two conflicting moral values at work here. The mainstream view in Bioethics has discarded the sanctity of human life. They judge value based on a quality of life ethic, and if the quality of life is too low, the predominate view is that it in the best interestsand in some cases, of societyfor the very ill or disabled patient to die.

Charlies parents obviously disagree; that until every option for care has been exhausted, it is in the best interests for Charlie to be alive. I think they said, As long as he is fighting, we will fight.

The quality of life ethic ethic turns medicine on its head because the quintessentialpurpose of medicine has been to help keep people alivewhen thats what they want. under the Bioethics view, that may not be true. Indeed, in this case life itself is being declared a harm to Charlie because he is so ill. That is why we are beginning to see more cases involving injustices such as this.

Why do you think the hospital wont let the Charlie go home to die?

Because they think that its in Charlies best interest to diethey believe that. The doctors believe that by taking him, the parents are going to cause needless suffering for the child.

I think its [also] an issue of control and whose values are to rule in these very difficult cases. What the courts are saying is that doctors values should overrule the parents. I want to remind you that this is the United Kingdom where they may have different laws than here in the United States.

Its a slippery slope though. If they can do this to Charlie, then whos next?

Thats the whole problem with what I call futile care,which is a bioethics view that permits doctors to refuse wantedemphasize wantedlife extending treatment that the patient or his family wants. And this bioethics meme also brings in the question of costs. A lot of this is not only about the quality of life; its about saving resources. Futile care impositions of the kind being imposed on Charlie dont just involve sick babies, but also to varying degrees to very ill, disabled, and elderly people.

Part of the issue is saving resources. [] I once asked a futile care supporter, Youre not going to save enough money in these kinds of futile cases to really make a dent. What comes next? This personthis is in my bookCulture of Deathresponded, Then we should have the right to refuse marginally beneficial care. Then I said, Give me an example. He said, An 80-year-old woman who wants a mammogram.

Once the principal is established that doctors can refuse wanted efficacious interventions based ontheirvalues or the cost of care, its going to spread from these very difficult end of life cases into more commonplace circumstances.

Do you think hospitals have too much power over patientseven in United States?

In some places, yes. For example, Texas has a law that allows a hospital bioethics committee to determine that wanted life-extending treatment should be withdrawn. Once that determination has been made, the patient or family have only 10 days to find an alternative source of care before the treatment will be stopped.

And thats a real problem because it introduces coercion into healthcare. It subverts trust. These bioethics committees can serve a tremendously important function in helping mediate disputes and helping people work through difficult conundrums, but they should never be made quasi-judicial bodies with decision-making power. Thats not their job. It can lead to tremendous injustices and denies people due process of law.

I hope legislatures will pass laws limiting medical futility or futile care, and ensure that such disputes that do occur should be within the court systemwith the right of appeal, with the right of publicity, with the right of cross-examination, and so forth. The burden of proof should be on the hospital and doctors who want to interfere with family decision making and want to deny treatment that is working.

Remember, in futile care disputes, treatments are not being taken away because they dont work; theyre being taken away because theydowork. The life support is being removed from Charlie precisely because its keeping him alive. Its actually not futile because its providing the result that his parents want and perceive as a benefit. In a sense, what is being declared futile is the patient. Thats what so dangerous here. You are talking about efficacious treatmentthat at one time would have been thought of as not electivethat is going to be removed because it works. That is a tremendously perilous line to cross. Bluntly stated, the attitude is that the patients life is futile because its not worth living based on pain and suffering, the costs of care, or whatever it might be.

What if the care is against the doctors ethics?

When these disputes occurand i am not saying they cant be in good faiththe life-sustaining treatments should be maintained as long as it takes for another caregiver to be found. I am certainly not against a doctor saying, Look, this is against my ethics; I think that we are drawing this out in a way that is unduly burdensome to the patient, and I cant sleep at night because I think this person is suffering. The doctor shouldnt be able to say, So, I am stopping care. Instead, the doctor should say, Please find another doctor to take over this case. The care should be maintained until another doctor is found. This is not elective treatment.

And this is where bioethics committees, chaplains, and others can help find common ground between families, patients, and doctors who are in disagreement. For example, there might be an agreement to give a patient more time to improve before deciding to remove life support. Or, an agreement can be reached to, say, not provide antibiotics to treat an infection, but to maintain life support.

Whats really ironic is some of the same bioethicists who say choice and autonomy should rule on assisted suicide, then say that choice has its limits when it comes to wanted treatment that doctors dont want to provide because it violates their values. Well, their values are not the issue here.

Were you disturbed by what the letter Vatican initially put out?

Yes, I am not Catholic, but I understand and deeply respect Catholic moral teaching. [] The idea of deciding that continuing treatment will cause undue burden or suffering that doesnt match the benefitthats part of Catholic moral teaching. But the people who possess the decision-makingare the patients and thefamily, not doctors and government. What I found disturbing about that was they were taking that very valuable Catholic moral teaching and expanding into an area whereother peopleget to make that choice. If its a religious doctrine, which is when the Vatican releases a statement; its a religious choice. That statement at least implied that religious choices about the extent of medical treatments can be made by the doctors; thats not what the doctors are there for. I was very happy that Pope Francis said, Wait a minute.

See the article here:

Charlie Gard and the Age of Do Harm Medicine - National Catholic Register (blog)

Whenever biopharmaceutical experts and policymakers discuss medical innovation, they seem to focus only on drug discovery and development and access. While these aspects of innovation are critical to ensuring patients have safe and effective treatments, they dont provide a complete picture of the biopharmaceutical innovation model and the total investment needed to get the right medicine to the right patient at the right time. Whats missing? An understanding of the role of biopharmaceutical manufacturing and the need for a supportive policy environment in order to ensure the United States maintains its place as the leader in discovering, developing and delivering innovative medicines.

In the past decade, manufacturing has become an even more complex element of the biopharmaceutical innovation ecosystem as there have been several paradigm shifts in clinical treatments and pharmacology that make drug manufacturing significantly more challenging. First, therapeutic innovations previously developed to treat millions of patients the so-called blockbuster medicines have been replaced by the precision medicine model. This model integrates genetic information to help researchers understand which particular subgroup of patients will most likely benefit from a specific treatment. This scientific progress is leading to the development of medicines targeted for much smaller patient populations. Thus, biopharmaceutical companies now need to manufacture smaller batches and incorporate shorter production lines into their manufacturing process, which means they need to be more nimble and think beyond just efficiency to ensure production levels match the new innovative landscape in their manufacturing practices.

Second, diseases today are more often managed with medicines administered through intricate delivery systems. Complex therapies deliver important drugs directly to the site of the disease by bypassing traditional modes of delivery through oral intake. So now manufacturers have to think about how to make both the delivery device as well as the medicine.

Third, certain diseases are managed or prevented through biologics or vaccines. Unlike synthesized medicines which are made by combining specific chemical ingredients in a laboratory environment, these therapies are derived from living cell lines which cannot be fully characterized by traditional methods in a lab. For biologics and vaccines, the final product is influenced by the manufacturing process as the product is the process. An example of a therapy that requires this type of manufacturing complexity is a breakthrough vaccine for pneumococcal diseases. You may wonder what does it take to manufacture a single dose of that vaccine? It takes no less than 2.5 years, the collaboration of 1,700 researchers, engineers and other manufacturing experts, more than 400 raw materials and 678 quality tests in 581 steps to produce a single dose. Any minute deficiency in this long and laborious manufacturing process and/or ingredient integrity could possibly lead to failure.

Beyond better health, the benefit of manufacturing excellence is also captured in the economic value it generates for local communities in states all across the country. In the United States alone, there are close to 300,000 biopharmaceutical manufacturing jobs, with an average salary of close to $100,000 annually. This average salary is in the top 2 percent of all manufacturing jobs in the U.S. Pfizer currently has 17 manufacturing sites in 11 states and Puerto Rico that employ more than 12,000 people, and has invested $2 billion in these sites over the past five years. Estimates put Pfizers contribution to both direct and indirect jobs in the U.S. at 51,000.

The Pfizer facilities are not only responsible for manufacturing safe and innovative medicines, but some of the sites also produce active product ingredients. The API is the actual substance or raw material used to produce the medicine that patients consume. In fact, the Pfizer facility in Kalamazoo, Mich., is so cost-efficient that it manufactures APIs for methylprednisolone that Pfizer then sells to manufacturers in China and India, something not commonly observed in other traditional manufacturing sectors.

To make biopharmaceutical manufacturing a centerpiece of U.S. economic growth, policymakers need to address a few policy hurdles. First, they need to reform the U.S. tax code to encourage companies to further invest in U.S. pharmaceutical manufacturing. Next, the Food and Drug Administration ought to forge a proactive partnership with industry to develop practical regulatory solutions to advance and encourage domestic biopharmaceutical manufacturing expertise while protecting world-class quality control and good manufacturing processes. Lastly, the federal government needs to ensure appropriate and timely implementation of Section 3016 of the 21st Century Cures Act, which allows the FDA to issue grants to further the study of continuous manufacturing of drugs and biologics.

In an effort to get important medicines to patients in need, biopharmaceutical companies discover, develop, manage access and manufacture medicines. The innovation cycle is not complete if a company is not able to appropriately navigate the complicated yet crucial manufacturing process. A pro-active, supportive policy environment is the linchpin to ensuring the United States remains at the forefront of biopharmaceutical innovation and manufacturing.

Robert Popovian is the vice president of Pfizer U.S. Government Relations. He has two decades of experience in the biopharmaceutical health care industry and has published and presented extensively on the impact of pharmaceuticals and health care policies on health care costs and clinical outcomes.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be foundhere.

Go here to read the rest:

The Future of Manufacturing a Medicine in America - Morning Consult

Bottled bear bile originating from Jilin, China for sale

in mandarin

Kuala Lumpur, Malaysia, 9th July 2017Malaysias traditional Chinese medicine (TCM) practitioners and TRAFFIC, the wildlife trade monitoring network, have come together to find solutions to reduce the use of threatened wildlife in traditional medicines.

Through a joint one-day conference, the Federation of Chinese Physicians and Medicine Dealers Associations of Malaysia (FCPMDAM) and TRAFFIC highlighted substitutes to wildlife parts used in traditional medicine, discussed laws and enforcement aspects that govern wildlife use and the threats posed by the demand for wildlife-based medicines.

Powdered bear bile available for sale by weight in a traditional medicine shop in Malaysia

A major focus of the Alternatively Effective conference was the ongoing use of bear bile and gall bladder in the countrys TCM industry and the threat this posed to Asias wild bears.

Previous TRAFFIC surveys have shown the high availability of bear bile and gall bladder in the countrys TCM shops. Analysis of bear-related seizures across Asia from 20002011 also found the country to be a key source and consumer of bear parts and derivatives.

The TCM community of practitioners and users in Malaysia can be one of the strongest allies to ending illegal wildlife trade, and we are very glad to be partnering with Malaysias largest TCM community. The good news is that effective substitutes for bear-based products are available and being used worldwide and its important for the Malaysian community to know of these alternatives and work towards incorporating them into practice, said Kanitha Krishnasamy, Acting Regional Director for TRAFFIC in Southeast Asia.

As part of the conference, practitioners were also invited to make a pledge to use only wildlife permitted under Malaysias laws, use only legally-sourced ingredients and support efforts to reduce the demand for wildlife-based medicinal products involving threatened species.

This community of practitioners and physicians plays such a critical role in the sourcing and dispensing of wild plants and animals for medicines. A commitment to use only legal wildlife resources and educate their customers about sustainable alternatives will help reduce the tremendous pressure on bears and many other wild animals now in demand as cures, said Lalita Gomez, Programme Officer for TRAFFIC in Southeast Asia.

Federation President Mr Ting Ka Hua, who signed the pledge said:

It is the responsibility of each of us to cherish and protect wild resources. Chinese medicine practitioners and retailers should choose the legitimately produced medicines, pay attention to the contents of the products, do not buy medicinal ingredients of unknown provenance, and consciously resist illegal items.

Chinese medicine practitioners have the obligation to correct unfounded and inaccurate concepts of the use of wildlife in traditional medicine.

Under the leadership of the Federation, we will drive support for the effort to end the use of illegal and endangered wildlife products in traditional medicine, within the Malaysian Chinese Traditional Medicine community, while maintaining the highest, safest and most reliable services.

Over the past year, FCPMDAM has distributed information prepared by TRAFFIC on wildlife species threatened by demand for traditional medicine, to its member associations.

About 80 practitioners, physicians, TCM lecturers and government officials attended the conference that also saw presentations from Dr Yibin Feng, Associate Director at the University of Hong Kongs School of Chinese Medicine; Salman Saaban, Enforcement Director of Peninsular Malaysias Department of Wildlife and National Parks and Gloria Ganang, Environmental Education Executive at the Bornean Sun Bear Conservation Centre.

Funding for the Alternatively Effective - A Conference on Substitutes to Bear Bile in Traditional Chinese Medicine meeting was kindly provided by Hauser Bears.

For further information, please contact: Elizabeth John, Senior Communications Officer, TRAFFIC. Email: elizabeth.john@traffic.org Tel: +60122079790

Alex Choo, Secretary-General, Federation of Chinese Physicians and Medicine Dealers Associations of Malaysia (FCPMDAM) Email: tlchoo@tg.my Tel: +60122185212

Read this article:

Malaysia's traditional Chinese medicine practitioners support use of alternatives to threatened wildlife - TRAFFIC - Wildlife Trade News

Keith Roach, To Your Health Published 11:46 p.m. ET July 9, 2017 | Updated 11:46 p.m. ET July 9, 2017

Dear Dr. Roach: In a recent column, you discussed an antihistamine and montelukast for allergies. We use pure essential oil. Lavender is better than drugs.

J.O.S.

Dear J.O.S.: I consider any substance that is taken to relieve a medical symptom or to cure or prevent a disease to be medication, or a drug.

For centuries, if not millennia, the drugs in the pharmacopeia mostly were derived from plants. This might mean the whole plant leaf (such as foxglove) or powdered bark (from the willow tree), both of which still are valued and commonly used medications, only they have been purified and standardized as digoxin and aspirin, respectively.

Lavender essential oils can be made several ways, including steam distillation and enfleurage (using a solvent fat to capture the essential oil, then extracting the plant oil with alcohol). All of the methods capture chemicals of interest from within the plant: With lavender, there are over 100 known compounds; among the most sought-after are linalool, perillyl alcohol and linalyl acetate.

If used on the skin, they are quickly absorbed into the blood. So, when you are using lavender essential oil as a medication, you are using an unregulated and largely unstudied mixture of compounds. That isnt necessarily a bad thing: Humans have been using essential oils medicinally for centuries, and lavender is considered generally safe. Lavender as aromatherapy has been tested and found to be effective in reducing anxiety, for example.

However, dont think that natural products like lavender oil are free of side effects. Any substance has the potential for harm, in the right person and at the right concentration. Lavender oil contains compounds that have female hormone (estrogen) activity and inhibit male hormones (androgens), so use of lavender oil on the skin has been reported to cause gynecomastia (breast development) in boys near puberty. Lavender also has coumarins (naturally occurring chemicals that are also found in clover, from which warfarin, or Coumadin, originally was derived), which in theory might lead to bleeding complications in people so predisposed.

Dear Dr. Roach: A recent column included details about Type 2 diabetes. As a precaution for older guys like me (over 80), please explain the testing to ascertain whether that disease is present or not. I know that tests A1C, for instance can give some guidance.

What are the test levels (normal, borderline, high)? I am always careful about things that may eventually lead to Type 2, which I want to avoid.

G.M.

Dear G.M.: There are now several ways to make the diagnosis of diabetes, but the A1C test, a measurement of the amount of sugar on hemoglobin, is probably the most common. It is also how we monitor its control. There is no universally accepted cutoff point for the A1C level, but the American Diabetes Association has guidelines that are widely used. Normal is 5.6 percent or less. Increased risk, also called prediabetes or impaired glucose tolerance, is 5.7 percent to 6.4 percent. Diabetes is 6.5 percent and above.

Regular exercise, meaning weight-training or aerobic exercise for at least 150 minutes per week, reduces the risk of diabetes. There are several types of diets that also reduce diabetes risk: All of these avoid excessive sweets and processed starches. A few pounds of weight loss can make a dramatic difference in risk, as well.

Email questions to ToYourGoodHealth @med.cornell.edu.

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Doc: Essential oils considered medicine in treatment - The Detroit News

Written by ZEESHAN SHAIKH | Malegaon | Published:July 10, 2017 5:45 am Dr Yusuf Ansari has authored over two dozen books which are used by Unani and MBBS students across India. Mayur Bargaje

The Unani system of medicine, which was introduced by the Arabs and Persians sometime in the 11th century, is said to be dying a slow death. Though India is still one of the leading countries in Unani medicine today, with the largest number of educational, research and healthcare institutions, the number of Unani practitioners here is far less than what it was in the past. In Maharashtra, a doctor has been making efforts to make Unani medicine system more relevant and accessible in contemporary India. Dr Yusuf Ansari, a 62-year-old resident of Malegaon, has authored over two dozen books in the past two decades which are used by Unani students across the country. The books are based on the Unani medical curricula laid down by the government, but some of them, like the ones on physiology, surgery and pathology, are also referred by MBBS students.

The systems beginnings can be traced to the teachings of ancient Greek physicians like Hippocrates, and its principle revolves around strengthening the Quwwat-e-Mudabbira-e-Badan (immunity). The foremost book on Unani The Canon of Medicine was written by Avicenna in the ninth century. While Avicennas works were followed by other writers as well, the content and language of these books made them a bit difficult for students to follow. All these books are scholarly pieces, but seeing that many students found these books a little difficult to follow, I attempted to write a book which would be in tune with the contemporary times and would be lucid and understandable for students as well, said Ansari.

Ansaris first attempt was a book called Tahafuzz-e-Tibb, or preventive and social medicine. The idea was to link the concept of Unani medicine with contemporary medical problems. I wrote the book to make this effective medical form understandable and more relevant. The book, however, was published only in 1996 after which I was asked to write more on the subject, said Ansari.

Interestingly, Ansaris primary degree has not been in Unani medicine. Coming from a very humble background, Ansari gained an MA in English, and for a time used to work for Rs 20 per week. He eventually joined a Unani college as an English language teacher to make ends meet. It was only in his 30s that Ansaris interest in Unani medicine peaked and he decided to pursue a degree in it at the same college where he taught English.

Apart from Unani medicine, Ansari also writes in various science journals on subjects such as electronics and information technology. Ansari believes that education is the only way to empower communities in the country. His son Mohammad is the first IITian to emerge out of Malegaon. His sister Dr Zubaida Ansari was the first female scientist from Malegaon and is now a part of Jamia Millia Islamias Centre for Interdisciplinary Research in Basic Sciences. His nephew Aleem Faizee runs a popular community website in Malegaon. Today, this medicinal system is suffering because it is seen to be associated with a certain community. My attempts have been to ensure that people open their minds and see things for what they are really worth, says Ansari.

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A faculty member in Mississippi States Department of Psychology has been recognized nationally for significant contributions to the field of behavioral sleep medicine.

Michael R. Nadorff, PhD, an assistant professor of psychology who oversees the universitys Sleep, Suicide and Aging Laboratory, is a 2017 recipient of the Art Spielman Early Career Distinguished Achievement Award from the Society of Behavioral Sleep Medicine.

Nadorff officially accepted the award during the annual SLEEP 2017 in Boston. His trip to the conference was made possible in part by a travel grant from the universitys Office of Research and Economic Development.

The conference was very helpful for getting a sense of where the (behavioral sleep medicine) field is going, as well as where funding will be available, Nadorff says in a release.

At the conference, Nadorff gave a poster presentation on sleep and suicide, showing that insomnia is a proximal risk factor of suicidal behavior and thus may be particularly helpful in judging current clinical risk.

This was a hot topic at the conference, and the presentation gave me an opportunity to discuss collaborations with other research teams, Nadorff says. My next step will be looking at sleep deprivation in relation to short-term suicide risk.

Nadorff holds a bachelors degree in psychology and computer applications from the University of Notre Dame, along with masters and doctoral degrees in clinical psychology from West Virginia University. He also completed a doctoral internship at the Baylor College of Medicine.

In addition to behavioral sleep medicineparticularly assessment and interventions for insomnia and nightmare disordersNadorffs research interests include the etiology, assessment and treatment of suicidal behavior, clinical geropsychology, and the use of technology for psychological treatment.

Since 2014, Nadorff has served as a co-principal investigator for Substance Perception of Positive Information, Psychopathology and Impaired Functioning, a project funded through the end of the year by a $416,388 R15 AREA Grant from the National Institutes of Health.

Nadorff is a licensed psychologist on the Behavioral Sleep Medicine roster of practitioners in Mississippi.

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MSU Researcher Earns Society of Behavioral Sleep Medicine's Art Spielman Early Career Distinguished Achievement ... - Sleep Review

Last month, The New England Journal of Medicine published an editorial by R. Alta Charo, a law professor at the University of Wisconsin. In the editorial, Charo sharply criticizesDepartment of Health and Human Services (HHS) appointees Valerie Huber, Teresa Manning, Charmaine Yoest, and Katy Talento.Charo takes particular issue with Yoests past assertions that abortion increases the risk of breast cancer. She also criticizes Mannings concerns about the efficacy of contraception programs and Hubers support of abstinence-only sex education.Charo states that these four appointees use alternative facts and are also known for a disregard for rigorous research.

None of these critiques are particularly inventive.Similar attacks onPresident Trumps HHS appointees have been published by a range of left-wing publications, including HuffPost, the Washington Post, and the New York Times. More importantly, none of thesefourwomen have even slightly unreasonable views on public-health issues.

For instance, backing up Yoests view is a body of peer-reviewed research dating back to the 1950s findingthat abortion increases the risk of breast cancer. Skeptics of the abortionbreast cancer link frequently cite the Danish study by Melbye et al.,published in TheNew England Journal of Medicine in 1997,arguing that itis the methodologically strongest study on the topic. But even that studyfound that abortions after 18 weeks of gestation are correlated with a statistically significant increase in the risk of breast cancer.

Regarding contraception, there are many studies in both economics and public-health journals, from a variety of authors, showing that expanded access to contraception by means of legalization, distribution, or subsidies fails to reduce unintended-pregnancy rates. Just this summer, economists David Paton and Liam Wright published a thorough study in the Journal of Health Economics,finding that recent cuts to sex-education and contraception programs in Great Britain led to reductions in teen pregnancy rates.

The notion that these four HHS appointees are anti-science or have policy views outside the mainstream is, to put it charitably, absurd. What is perhaps more disturbing, though, is thegrowing politicization of The New England Journal of Medicine.During the debate over the Affordable Care Act in 2010, the journal published a superficial analysis of abortion trends in Massachusetts to arguethat wider health-care coverage could reduce the abortion rate. In reality, abortion numbers in Massachusetts had been falling for a long time as they are virtually everywhere and the enactment of Commonwealth Care in 2006 had very little effect on the trend.

Additionally, prior to the oral arguments in Zubik v. Burwell overthe HHS contraception mandate, The New England Journal of Medicine released a study analyzing the impact of funding cuts to Planned Parenthood in Texas. The media pounced, claiming that the cuts led to a sharp increase in Medicaid-funded births. However, a closer look at the findings showed that in the affected counties, only 37 additional women had a Medicaid-funded birth.

With Charos latest article, it is unfortunate to see a prestigious journal like The New England Journal of Medicine once again placing a higher priority on scoring political points than publishing high-quality medical research.

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The paradox that is India is most apparent in its health and pharma sector, which provides life-saving medicines and services to the world but denies the same quality of care to its population of 1.3 billion.

The window-dressing is impressive. Indias strong pharmaceutical sector and 21 major vaccine-manufacturing companies have made it the worlds biggest supplier of quality medicines and vaccines. The high quality of products has ensured that India was the top supplier to the United Nations last year, with sales touching $804 million in pharmaceuticals and medical services.

Health accounted for 80% of the goods and services worth $1.06 billion procured by the UN in 2016, which made India the second largest provider to agencies such as Unicef, Pan American Health Organization (PAHO), UNDP and WFP.

All the exported drugs meet stringent unified international standards of quality, safety and efficacy. Those that are sold in India do not.

Substandard drugs

Substandard and contaminated drugs killed five women in Hyderabads Niloufer Hospital in February, concluded an inquiry committee report released this week. Clinically there is a strong case for suspicion on the questionable quality of drugs and sterile nature of intravenous fluids especially dextrose containing solutions, which might be the cause for all the maternal deaths that occurred at Niloufer Hospital from January 28 to February 4, 2017, the report stated.

The committee ruled out hospital infection as a cause of death after culture reports showed all operation theatres were sterile.

Indias drug regulation laws are strong, but implementation often isnt. Over the past year, the Centre has made an effort to improve quality by approving a Rs 1,750-crore scheme to strengthen drug regulatory structures and by notifying the Medical Devices Rules of 2017, which provide for risk-based classification, licensing and regulation of medical devices.

India has banned 344 irrational drug combinations, including popular brands such as Corex, while expanding the National List of Essential Medicines to 376, to be made available free at government hospitals and health centres.

These efforts, however, fall flat when there is poor quality control in manufacturing, packaging, storage and distribution of bulk drugs, about 30% of which are manufactured by small-scale-sector companies.

Fake doctors

People using fake medical degrees to practice medicine makes news every few months, with West Bengal making news most recently for having an estimated 500 unqualified persons working illegally in the public and private sectors. These doctors, said the CBI officials investigating the case, work using fake degrees and registration numbers of doctors who have retired, left the country or died.

Doctors in West Bengal are not the only ones faking it. More than half (57.3%) of Indias allopathic doctors dont have a medical qualification and close to one in three (31%) are educated only up to the secondary school level, said the World Health Organisations Health Workforce in India report for 2016. Among nurses and midwives, 67.1% had studied only up to secondary school level.

Though urban doctors have more education and medical qualifications than rural doctors, the number of those working without a medical qualification is shocking. Only 58.4% allopathic doctors in urban centres have a medical qualification, and only 18.8% of rural doctors.

In every health-worker category except ancillary health professionals, women are more educated and better qualified medically than men, found the WHO report. Among allopathic doctors, 67.2% of women have a medical qualification compared to 37.7% of men. Among nurses and midwives, 11.3% of women have a medical qualification compared to just 2.9% of men.

Apathetic providers

Thirteen women died and many more were hospitalised because negligence resulted in their getting infected during sterilisation surgeries at a makeshift camp in Chattisgarh in November 2014. The surgeon who did the laparoscopic tubectomies was qualified but used the same gloves, syringes and sutures to operate on 83 women in an unsterilised, abandoned building.

Keen to set a record, he abandoned infection-control protocols and spent less than 3 minutes on each patient.

The Chattisgarh tragedy made news because of the high number of deaths, but such deaths are not at all uncommon in India. The Clinical Establishment Act that prescribes infrastructure and services standards and provides for the registration and regulation of all clinical establishments has been adopted by all UTs and only 10 states since 2010. Unless states get serious about providing quality care, people will continue to die of avoidable causes.

As it is, most of us are struggling to stay healthy. If resistant bacteria and devious viruses dont get you, heart disease, diabetes and cancers might. We cant escape infection and disease, but we can minimise their impact and improve treatment outcomes by following quality standards in healthcare at home as stringently as we do when we are dealing with the rest of the world.

sanchita.sharma@hindustantimes.com

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We're a global leader in pharma, medicine. So why do we let down our own? - Hindustan Times

I would have written something lighter or something funny for today, but moral medicine is necessary if we are to solve the shameful inadequacy of our medical system. Giving a few rooms for poor patients in big hospitals is not enough. These are palliatives and will never solve the problem. An entire system has to be changed with new values and principles.

Let us hear from the poor countries that adopted the Cuban way and why it works.

When I heard the Cubans were participating, I expected something quite different a form of supervision or control by them, one Salvadorian health promoter said. I did not expect a team in which we were all fully integrated, working side by side as we went door-to-door together advising people about the means of eradicatingdengue.

We do not have a system that would cultivate such at attitudes and work habits. What is the key to Cubas success? The system is based upon medical training in which ethical considerations and the responsibilities of professionals are emphasized far more than in medical schools of the industrialized world.

Cuban medical personnel serving abroad go where the need is greatest, and where the host government assigns them responsibilities. The result is that the Cuban system has developed a cost-effective, pragmatic, highly ethical and sustainable system of public healthcare. It is this basic framework which is shared with the host country, and which has been remarkably successful fordecades.

Cubans have shown what it means to offer relief beforepolitics.

Opinion ( Article MRec ), pagematch: 1, sectionmatch: 1

Cubas medical internationalism program gained its reputation when the country offered to send 1,500 medical professionals to support the disaster relief effort after Hurricane Katrina pounded New Orleans in 2005. But US President George W Bush rejected the offer.

Other countries saw the virtues of what the authors called moral medicine and what they could gain from it. Little by little it came to be known that Cuba has been sending medical teams abroad since 1960, when an earthquake occurred in Chile. This was followed by a large medical delegation sent to Algeria in 1963 to help the construction of the national healthcare program following its independence from France.

Paradoxically it was at the time of its greatest need that Cubas moral medicine came about.

The revolutionary government headed by Fidel Castro came to power on 1 January 1959 after the authoritarian Batista regime was overthrown. By 1961 almost half of Cubas medical personnel had fled, most to Miami; approximately 3,000 were left. Yet despite the pressing situation in Cuba, the government saw the need to provide internationalist support. Since then, medical contingents have been sent around the globe to help in emergency situations regardless of ideological differences with the hostcountry.

Several hundred Cuban medical personnel are working in Honduras, for example, despite Havanas protests against the coup which overthrew democratically elected president Zelaya in 2009. Likewise, while Havana condemned the removal of President Fernando Lugo in Paraguay in June 2012, Cuban doctors remain there. Perhaps no greater enemy of the Cuban revolutionary process in the region was Nicaraguas Anastasio Somoza. Yet when a massive earthquake occurred in Managua in 1972, the Cuban contingent was among the first to arrive. In 1998 the disastrous impact of Hurricane Mitch in Central America (over 20,000 were either killed or declared missing) led to a number of missions. Significantly, Cuba did not have diplomatic relations with the countries that were worst affected, yet did not hesitate in sending large delegations to the affected areas (424 specialists arrived within days, peaking at 2,000).

Humanitarian considerations rather than political sympathies remain key to Cubasapproach.

A major initiative came from Cubas role in Central America the foundation in 1999 of the worlds largest medical university, the Latin American School of Medicine (ELAM), in Havana. The national naval academy was converted into a medical school, principally for students from the regions devastated by Hurricane Mitch. The idea was simple to provide enough medical personnel for theregion.

Students were generally selected from impoverished backgrounds, as it was thought that they would have more buy in to their local under-served communities than their wealthier peers, and would want to assist after graduation. The plan was to develop a policy of brain gain rather than brain drain, and to have medical support where it was needed. There is, however, a basic stipulation: students make a moral commitment to work with the underprivileged and those most in need of medical care aftergraduation.

From this significant contribution a variety of other medical education initiatives has grown. The largest is in Venezuela, where over 25,000 students are being trained as doctors by Cuban medical professors. The first graduating class of some 8,000 comprehensive community doctors (77 percent of whom are women) finished their training in February 2012. Cuban professors have helped to found medical schools in Yemen, Guyana, Ethiopia, Uganda, Ghana, Gambia, Equatorial Guinea, Haiti, Guinea Bissau andTimor-Leste.

Sam Loewenberga journalist who covers the intersection of global health, business, government and politics asksif Cuban medicine can help solve American inequality? His website iswww.samloewenberg.com.

American doctors may have the expertise but its system addresses the needs of patients with money or insurance. The example of Cuba was developed for poor folk. It was not focused on expertise but primary care.

Nearly a hundred Americans are studying medicine at Cubas Latin American School of Medicine (ELAM), where they are taught preventive medicine to treat the underserved.

Globally, the need for doctors is urgent. We will need some seven million doctors, nurses, and other health care workers in developing countriesand that number is expected to nearly double in the next 20 years. The WHO warns that the United Nations Sustainable Development Goals, like reducing maternal and infant mortality, will not happen without more health care workers.

Just a few days after the PAGCOR board approved the building of more health care centers, a group of Chinese businessmen (nottaipans) and doctors came forward to offer their help. Like the Cuban model, their work will concentrate on primary care to reach as many rural communities. Their approach, they told us, would be on preventive rather than curative medicine. With them were trainers for the program. It could be a good start of moral medicine, the Cuban way in the Philippines.

I was finishing this column when I received a text from Louie Sarmiento of Philippine Mines Safety and Environment Group asking for volunteers for the Leyte quake disaster. We can start making the list for studying primary care in ELAM.

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NEWS RELEASE

ROYAL VICTORIA REGIONAL HEALTH CENTRE

************************* Royal Victoria Regional Health Centre (RVH) continues its important work of training new family doctors as another group of family medicine resident physicians begin their final two years of training in the health centres Family Medicine Teaching Unit (FMTU). The program, which is affiliated with the University of Toronto Department of Family and Community Medicine, recently welcomed nine new residents, which helps to ease the burden of a shortage of family physicians in the area as many stay and open their own practices in this community once they are finished their residency.

Since the program began in 2009, 54 family medicine residents have trained at RVH, with 31 staying in the area to set up their own practices, provide temporary coverage for area physicians or work in the health centres Emergency and Hospitalist departments.

As a teaching hospital we merge education and healthcare excellence in such a way that we have a significant, positive impact on our community, says Janice Skot, RVH president and CEO. Many physicians who have completed their training at RVH have gone on to establish practices in the area which has helped meet some of the demand for family physicians. As we focus our efforts on increasing the teaching and research opportunities available at RVH, we plan to continue growing, and hopefully keeping, exceptional physicians in this region.

RVH welcomes Drs. Stephanie Duquette, Mouhanned El-Youssef, Jeremy Gross, Rong Amy Huang; Terence Lynd, Anastasiya Nelyubina, Cameron Spence, Joshua Yuen and Laura Zuccaro.

In addition to welcoming the new residents, RVH also extends congratulations to the residents who graduated from the program this year including Drs. Chris Blake, Emilie Beyls, Lauren Fruchter, Sarah Foohey, Pinky Gaidhu, Jacky Lai, Damien Yohn, Natasha Stribbell and Caitlin Moran.

When the program first began we talked a lot about it being the opportunity for us to grow our own doctors, and now with more than 30 physicians staying in this area to practice medicine, we are definitely reaping what we have sown, says Dr. Stuart Murdoch,Academic Chief of Family Medicine and newly appointed Director, Postgraduate Education, University of Toronto, Department of Family & Community Medicine.

In fact, last year five FMTU residents Drs. Chris Blake, Caitlin Moran, Emilie Beyls, Pinky Gaidhu and Sarah Foohey all received awards throughUniversity of Torontos Department of Family and Community Medicine (DFCM).

We have seen some exceptional new doctors come through the FMTUs doors and as faculty, we are so proud to play a part in shaping their careers and passing along our knowledge and skills. And the residents bring such enthusiasm and passion for their patients and their work - it is contagious and they remind us of why we became physicians, says Dr. Murdoch.

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