Saturday, June 28, 2008

Video Game Surgery – A New Way To Train Surgeons

Times have changed and the kids who grew up on video games are the budding surgeons of tomorrow. The researchers think that they may have stumbled upon a better technique to impart surgical skills to the new kids, by way of video games.

The whole idea of using computer animation for training stems from the need felt by trainers to give a comprehensive experience to the newbies. Till now, the basic ingredient in training was to show the learners how surgeries are performed, but this didn't allow them to do it themselves using surgical instruments.

The researchers thought that a surgeon doesn't just use her eyes, rather it's also about a great deal of information available from the touch that aids surgeons. The new system can enable the trainees to learn by touching or through the “haptic feedback.”

The learners would also get a virtually real feel of the surgery, as the advanced computer animation program, from the Ohio Super Computer Center simulates many essentials, like movement of surgical instruments like the drill, or the the density of the bone. What's more is that the virtual patients would even bleed.

It seems that the new age trainees wouldn't even have an hesitation whatsoever, as they're already familiar with video games and know the intricacies. For them the technology would appear to be truly cool and rocking!

Aside from making surgery training more life-like, computer aninmation aided training could also save a lot of money if it can provide an alternative to the present method of operating on bones from cadavers using medical instruments.

The researchers at the Ohio State University Medical Center and the Nationwide Children's Hospital plan go ahead with this novel approach for surgical training across hospitals in the country, and would then compare the effectiveness of conventional training with the new one. For now the computer allows training on the temporal bone.

The video game surgery, appears quite slick. But it shouldn't teach the new trainees to treat real life surgeries as video games. While in virtual reality you could score less or start over if you err, in real surgeries that facility isn't available!

Thursday, June 26, 2008

Fighting HIV/Aids – Many Means, One Goal

Amidst the pessimism springing from the recent failure of about 150 prevention trials that failed to shield subjects against HIV infection, there's the resolve to continue research on developing a vaccine, and battle through all the challenges the process poses.

On a pessimistic note, hope of a vaccine in the short term isn't anywhere in sight as France's National Agency for Research on AIDS and Viral Hepatitis (ANRS) has expressed. Though not in the short run, the Scripps Research Institute expressed optimism with a possibility of a vaccine in about 10 years. Till that time, the available HIV drugs need to reach one and all.

Apparently, HIV/Aids is quite a multi-headed monster. While efforts to curtail it continue, research reveals newer risky trends among people, and unravel findings that appear to be quite startling.

Risky Trends

Consider the case of India where and estimated 2 to 3.1 million HIV infected persons reside. Researchers inform that young call center workers are becoming a breeding ground for the infections because of unprotected sex with many partners amongst the staffers. About 1.3 million people graduate in India, many of whom choose to work in call centers due to good starting salaries of US$ 600 (from Indian standards).

But if you thought that India was alone, leading the trend, look at the trend in the UK, where about 33% men who have men as their sexual partners, and are aware of their HIV status, engage in unprotected and risky sexual behavior. The study was released by the Medical Research Council.

Sometimes, it's the governments who may appear to be immature on the issue. For instance, the Jamaican administration has announced that it wouldn't regulate commercial sex work or even decriminalize it. The move is being seen as a missed opportunity for the admin to raise about $43 million, in taxes by regulating sex work, and that this money could then be used to finance the nation's HIV/STI program.


Research, while it unravels mysteries, sometimes it does so at the cost of shaking you out of comfort zone. For instance, the report, from the International Federation of Red Cross and Red Crescent Societies, notices increasing HIV/AIDS infection rates among intravenous drug users, sex workers and gay men. Or that, as a study published in the Journal of Sexually Transmitted Diseases reveals, that many people think their partners aren't infected, even without an STD/HIV testing.

However, not all is grim about the HIV/Aids scenario, a lot of efforts to fight it are underway.

A Shining Workplace Program

Realizing the gravity, the corporate sector in Mozambique has stepped forward to take the bull by the horns. Mozambique's Confederation of Business Associations (CTA) has unveiled a program called EcoSIDA that's meant to address the malady in workplaces. The aim of the body is to test workers find their HIV status. Perhaps, there are lessons in the initiative, for Indian call center industry to learn from.


In Florida, US, with the National HIV Testing Day approaching on Friday, June 27, the health agencies and not-for-profit groups would host several educational events to inform and seek active participation Southwest Florida’s minority communities. Minorities have higher than average infection rates.

At the same time, in another part of the world, Yemen, a nongovernmental organization from the UK Pogressio and The Interaction in Development Foundation, organized a three day meet along with local religious leaders on combating HIV/AIDS linked discrimination.


An opinion column recently questioned America's unfair policy on HIV/AIDS of not allowing HIV infected people an entry into the country. The column includes a pointer to China which recently withdrew a similar ban.

On another front, the teenagers of the New York state made a request to the political leadership asking them to enact a Healthy Teens Act meant to provide fund for comprehensive sex education in schools. Similarly India's National AIDS Control Board has approved the country's National AIDS Control Organization (NACO) initiative to make care centers for kids with HIV.

Although it's heartening to see efforts on many fronts, however a lot remains to be done. While governmental policies do take time to take effect, education and initiatives to improve the reach of existing pharmaceutical drugs for HIV can perhaps be accomplished much faster.

Friday, June 20, 2008

The Teen Pregnancy Pacts, What's So Shocking?

About 16 girls, around 16 years old were reported to be pregnant in Gloucester, and at least 50% of those became pregnant by choice or made a pact to bring up kids. So, what's shocking about it?

Teens getting pregnant is hardly news. What's startling is perhaps the number of pregnancies shot up 4 times (in just one school!), it's also about the pacts that the girls reportedly made, and that some of the girl's partners are in their 20s. And the school administration seems to be shocked over the welfare of these kids.

Ironically, everyone seems to be shocked except for the girls who made the choice. Remember that some of the girls even got depressed when they found they hadn't yet conceived. It seems that only now, the girls might be shocked because everyone around them seems to be. But there's a contention that the girls are too young to apprise the reality, aren't they? So is it enough reason this one, because one of the parents (father) expressed that he let it be, because he cared for his girl's happiness!

So what it is that's so shocking? Is it that some of the girl's partners, who're in their 20s may have committed “statuary rape.” Or that, it's now a long hard road ahead for the girls. Or that quadrupling of the number of pregnancies is startling (is just one school's stats representative of the whole country?). Or are they the public costs that can be saved by curbing teenage pregnancies. As for costs, teenage childbearing public costs were $120 billion from 1985 to 1990, and that $48 billion would have been saved if the pregnancies came about, if mothers were in their 20s.

Another aspect that surprises me is that on the one hand, there are people who who have to depend on pharmaceuticals called fertility drugs to conceive, and on the other there are the teenage pregnancies (which are for the most part undesirable). Different people seem to think differently. What do you think about it?

Wednesday, June 18, 2008

Physician Shortage 2025, Is There Anything to Fear?

The University of Missouri researchers predict that in just about 16 years from now, the US would be lacking medics by a count of 44,000 family physicians and general internists.

Their concerns seem to be grave when you consider that about 50% of all visits to doctors are to physicians. In fact shortage of healthcare workers exists in many parts of the world.

Healthcare Workers Around The World

The number of healthcare workers has been estimated to be about 59 million the world over, and ironically most of them reside in regions and places where they're least needed. For instance, the North American continent, accounts for only 10% of the Global burden of disease, but is home to 37% of the world’s healthcare workers. Not only that but it also spends about 50% of the world's financial resources for health. The following figure shows the details.

On the contrary, the African continent is mired with 24% of the global burden of disease, has only only 3% of the world's health workers, and spends a meager 1% of world's financial resources.

The World Health Organization estimates the shortage of healthcare workers (viz doctors, nurses, midwives) worldwide. The are about 57 countries in the world with the shortage of medics and 37 of those are from Africa. The best state of affairs exists in Europe, where there isn't a shortage. The American continent ranks next, with about 5 countries facing shortage. Take a look at the numbers below.

So is there anything to fear?

To me it appears that there's no need to worry, because the researchers have not only apprised about the impending shortage well in advance (over 16 years), but have also identified the reasons for it, and have even recommended possible solutions.

For instance, inducing more incentives for primary care practitioners would make their “specialty” more rewarding, and would encourage more graduates to fill in the gaps.

Increasing The Number of Doctors:
Aside from increasing the number of graduates, the demand would perhaps also be met by influx of doctors from other countries to the US.

Increased Access through Technology and Alternatives:
Organized groups of medics would be able to handle the caseload through telephone, e-mail and electronic medical records. Recently, pharmacists in Canada were allowed to write prescriptions, reducing the patients need to visit doctor frequently. Perhaps, similar measures of training medics other than doctors could help. In fact, psychologists (who're not doctors) were allowed to prescribe pharmaceutical drugs in New Mexico, back in 2002.

On the whole, the projections might be startling for sure, but since the causes and solutions are known, with so much time to spare, there's a need to be concerned but not be worried.

Friday, June 13, 2008

Is Alternative Medicine Safe And Effective?

As a kid I remember that when I would get a tummy ache, my mom would ask me to lie down and slowly sip through a drink of homemade lemonade with a dash of black salt, before dad could take me to a physician.

Today when I look back and remember, I reckon that to treat my tummy ache I was put on a course of an integrative medicine Alternative Medicine (the lemonade) + Conventional Medicine (physician prescribed drugs).

Alternative Medicine & Its Usage

Complementary and Alternative Medicine or CAM, comprises a broad range of healthcare practices, products, and systems, which don't form a part of the conventional medicine. For instance, herbal materials, preparations and products used by Asian systems of medicine such as Ayurveda or Traditional Chinese medicine. It also includes practices viz. Acupressure, acupuncture, aromatherapy, or mind body approaches such as prayer, mental healing, meditation, etc.

Moreover, a lot of people around the world use Alternative medicines, for example in China it makes up for about 40% of healthcare delivered, in Africa 80% of the population uses it, about 48% Australians have used it at least once. In North America, 42% of USA and 70% of Canada have used it at least once. Usage is similar in Europe too, for instance 75% of France has used it at least once.

Is It Effective?

"It is," "it isn't," and "I can't say," all of these at the same time. Given the scientific research conducted on Alternative medicine till now, it appears that a sweeping statement would be a bit too far fetched.

For instance, evidence in support of acupuncture, many herbal medicines and manual treatments does exist. On the other hand St. John's wort didn't seem to have an affect on the symptoms of ADHD in children and adolescents (Weber W, Vander Stoep A, McCarty RL, et al, 2008). And that, "I can't say," because research on many such treatments is unavailable.

Is It Safe?

Today, a perception exists that if something is natural or organic, it can't be harmful. This belief might not be true in all cases, e.g. Snake venom is all natural and organic, but is it safe for human consumption?

Sometimes herbs can be harmful by their very nature, e.g. kava and comfrey are herbs but still have been associated with liver damage.

At other times inappropriate regulation or administration of herbs and therapeutic procedures could render highly effective alternative treatments hazardous. Consider acupuncture, though it's been found to be effective, but if unsterilized needles are used it could lead to infection. Similarly, an overdose of Ephedra, a herbal remedy of respiratory congestion may lead to heart attacks, strokes and even death.

Forget herbs, an overdose of water too can lead to water intoxication and even death. Herbs aren't an exception and some of them may even react undesirably with other conventional medication, or some might not be suitable for consumption during pregnancy.

However, undesirable consequences of alternative treatments due to inappropriate administration, by no means imply that alternative treatments are unsafe by themselves. Rather, proven alternative medicines when properly administered, are not only safe, potent and cost effective, but also offer patients a choice.

All in all, an absolute yes or no answer vis-a-vis safety and effectiveness of Alternative medicine doesn't exist. Assuming quality formulation of Alternative medicines, they can either be a boon or a bane depending upon which treatments are administered, as also when and how they're used.

BTW, I still relish the lemonade my mom makes, whether I have a tummy ache or not!

Wednesday, June 11, 2008

New Arthritis Drug Fares Well In Trials

A novel pharmaceutical drug for the treatment of rheumatoid arthritis (RA) has been found to be both safe and effective in its late Stage III trials. The drug is reportedly being developed by Johnson & Jonson and Schering-Plough.

Golimumab, the drug being tested is an immunosuppressive drug that targets tumor necrosis factor alpha (TNF-alpha), which is a pro-inflammatory molecule.

Objectives Met During Trials

During the first two trial the anti-TNF medicine was successful in reducing symptoms of (RA) by at least 20 percent, which was also the main objective of the trials.

Further, a unique result of the trial was that after 14 weeks of drug therapy, the drug provided relief even to those patients whose condition didn't respond well to some standard anti-TNF medicines.

This very fact raises hopes for some 20% of the patients whose conditions aren't controlled well by the existing drugs. The muslculoskeletal system drug once launched, is meant to be delivered to patients on a monthly basis. Eventhough it doesn't belong to a completely new class of drugs, the molecule is surely a freshman to the family of anti-TNF formulations.

The most commonly reported side effect of the drug was a mild irritation where it was injected, overall it was well accepted in patients.

Unmet Objectives During Trials

Despite the overall success of the drug, it fell short of meeting the objectives of another Stage III trial, wherein it couldn't relieve symptoms by at least 50% in patients who hadn't been treated previously with methotrexate, an old oral medicine. However, the symptomatic relief by at least 20 percent was replicated successfully.

The Concerns It seems that a point to watch out for, is that how the musculoskeletal system drug actually fares when compared to the already existing anti-TNF compounds? Reportedly, the trial hasn't been carried out "head to head" against other anti-TNF drugs.

Another concern pertains to the very mechanism that these drugs employ to provide relief. While they do provide relief, they do it at the expense of altering how the immune system behaves? So the relief is derived at the risk of infection. Finally, recently a more cautious and stringent FDA swung into action to test whether some widely available blockbuster anti-TNF drugs actually raise the risk of cancer in children and young adults or not?

Reportedly, the FDA had got about 30 reports of cancer in children and young adults who had been on these drugs for about 10 years. The cancers mostly included lymphomas, and the rest were leukemia, melanoma and also those affecting other organs.

According to the FDA, the drugs already carry a warning of potential linkage to cancer, the evidence isn't conclusive though. However, long-term studies are already underway by the Belgian pharma company UCB, but the results wouldn't be out till 2019.

Significance Of Novel Drugs For Drug Companies

The anti-TNF compounds are blockbuster drugs, reported to be worth upto US$ 3 billion in annual sales. Formulation of newer drugs is perhaps most important to the sustainability and profitability of drug makers, especially the big companies. More so because most of the patents of their blockbusters are slated to expire between 2010 – 2012.

On the whole, newer and more effective drugs are much needed by patients and drug companies alike, at the same time they need to be so devised that their side effects are reduced to a minimum if not completely eliminated.

Thursday, June 5, 2008

Fall In US Pharma Credit Ratings Likely

According to Moody's Investors Service semi-annual report for the US Pharmaceutical industry, the credit ratings for the industry could drop over the next year.

The reasons cited for the possibility include the upcoming expiry of patents, sluggish rate at which drugs are approved and finally the legislation that wouldn't favor the big brands.

Most patented drugs are scheduled to expire between the years 2010 and 2012. It's not that the companies aren't already in the process of developing new drugs, but even after considering the launch of novel drugs, the forces working against the industry are expected to overshadow any gains made through the new releases. This possibility looms large because the number of new drugs being developed is still less than the rate of expiring patents.

As far as legislation is concerned, in the US the FDA appears to be treading ahead steadily albeit slowly with respect to drug approvals. One instance of its high caution mode is the Sentinel Initiative.

On the one hand the pharma industry has its own challenges to overcome, an additional pressure would originate from the shareholders of pharmaceutical companies. Some are of the opinion, that such a pressure would cause these companies to take up aggressive share buying, achieve much larger acquisitions and even compel them to alter their business models at a more fundamental level.

Further it's also projected that the forces working against the credit ratings would continue to act throughout the period between 2010 and 2012, coinciding with the period when most patents expire.

However, not everything is gloomy about the US pharma industry as its cash flows and profits are still good and the number of suits against them have declined as well. Rather it's the uncertainty that's gripped the industry.

Moreover, the industry also isn't short of cash, the concern is that most of it rests offshore. Hence, this cash can't be considered to pay off the debts, and that it might very well be consumed to purchase shares or carry out aggressive acquisitions. Numerically, the US pharmaceutical companies had US$58 billion in the U.S. and $27 billion overseas in 2006, these numbers changed in 2007, when the companies held $29 billion in the United States and US$63 billion outside it, recounts the WSJ blog.

The new report aside, overall rating had already taken a hit in October 2007, moving the industry's credit rating over a 12-month period from from "Stable" to "Negative."

Now the question arises, how the industry faces the challenges?

Expiring Patents

Perhaps the most fundamental aspect to the sustainability of pharmaceutical industry is the rate at which it is able do innovate newer drugs. Apart from being fundamental, this seems to be an area of concern as well, because the upcoming patent expirations could have an impact on about 40% revenue for a majority of companies. Pricewaterhouse Coopers in their publication "Pharma 2020: The Vision," had declared the industry's drug development model as "economically unsustainable and operationally incapable of acting quickly enough to produce the types of innovative treatments demanded by global markets."

While the present model may lack the efficacy needed by the changing scenario, newer better models of drug development as they are devised would make the industry cope better and enable it to cash in on the opportunities. The PwC report also made a promising forecast that the worldwide sales of pharmaceutical drugs would double by 2020, and reach a US$1.3 trillion mark. An illustration of the pharm industry's market potential is reflected in the results of the latest HIV/AIDS progress report from the WHO, according to which HIV Drugs are yet to reach over 6.7 million people.

Further, as the world's population ages and more people get obese diseases would continue to grow, but the companies would to need include ROI in their R&D budgets as the General Accounting Office report highlighted, some time back.


Another challenge for companies is to keep themselves at bay from litigations, they can cost them a fortune, the case of a leading pain relief drug manufacturer is a glaring example.


Keeping the business strategies well synchronized with international legislations is yet another challenge. A better understanding of the legislation, and proactive and foresighted business operations should go a long way to protect companies against penalties. The recent European antitrust investigations seem to be an apt example.

All in all it seems that the industry may be up against some speed bumps ahead, the overall outlook would be a lot more brighter provided the bumps are tactfully treaded over.

Tuesday, June 3, 2008

HIV Drugs Yet To Reach Over 6.7 Million!

According to the latest progress report published by the by the World Health Organization (WHO), UNAIDS and UNICEF, about 3 million people in low and middle income countries have access to antiretroviral therapy (ART) drugs for HIV/AIDS, but 6.7 million are yet to get them.

Encouragingly, the number of people who now get HIV drugs is nearly is seven times higher than what it was four years ago. Furthermore, a larger number of women now get the life saving HIV drugs and are better equipped to prevent infecting their children during pregnancy.

Although the report brings up the good news of the progress made, it needs to be noted that the efforts to provide access of HIV drugs to 3 million people have lagged behind by two years. The initiative to accomplish this target is known as the “3 by 5” initiative, or to have 3 million individuals on treatment by 2005, hence it's late by 2 years.

Accomplishments aside, the report estimated that there were 9.7 million people who needed antiretrovirals at the end of 2007. Consequently with an estimated 3 million (or 31% of all the infected) already covered, the products HIV drug manufacturers still need to reach 6.7 million individuals (or 69%), who're in dire need of them. Not only are these drugs are to reach the remaining infected persons, but they also need to reach them fast, the press release states that, “In 2007, that target was achieved a scant two years after the 2005 deadline. Not only has the number of people receiving treatment increased dramatically, but the pace of scale-up has also accelerated.”

The reasons attributed to the progress are three fold:
  1. Availability of drugs mostly due to lower HIV drug prices.
  2. Better delivery due to simpler, standardized regimens, decentralized services, better staffing and lab resourcing.
  3. Greater number of diagnosed cases of HIV leading to a higher demand for drugs.
The Role Of The Pharmaceutical/Healthcare Industry

Amidst projections that the demand for HIV drugs would grow at a rate of over 10% till 2012, and that there are still 6.7 million people to be provided with HIV drugs, there isn't much to doubt that the market potential for the industry is quite large. Further, given the rise and spread of HIV infections, pharma companies have a big role to play and synchronize the objectives of achieving profitability for their businesses with the responsibility to help combat the infections. In 2007 alone an estimated 2.5 million people were newly infected with HIV.

Based on the report, it appears that the pharma and healthcare industry needs to devise pharmaceutical drugs, medical instruments and services on the following lines to effectively address the needs.
  1. Bring out cheaper drugs, as most of the demand exists in developing countries.
  2. Come up with drugs requiring simpler compliance regimens.
  3. Formulate more drugs to prevent mother-to-child infections during pregnancy.
  4. Improve integration of HIV and TB treatments.
  5. Reach out to high risk groups viz. sex workers, (IV) drug users, prisoners.
  6. Innovate preventive measures/products for HIV and other STDs.
  7. Promote of easier, faster, economical diagnostic tests, so that people can know their HIV status and know that much quicker.
  8. Improve retention in treatment programs and devise better patient monitoring systems.
  9. Bridge the manpower shortage for trained health workers.
  10. Build effective procurement/supply management systems.
  11. Achieve improved collection, analysis and communication of essential health information viz. descriptive epidemiology, HIV incidence, prevalence, etc.
With the industry, governments and public coming together to combat HIV, the next progress report could make everyone even prouder.