Archive for the 'Column Inches' Category

Circumcising Africa…



When Zimbabwe’s most famous poet and musician, Albert Nyathi, decided to get circumcised, everyone had an opinion.

For Albert, poetry has always come first, but now he acts as a local champion of voluntary medical male circumcision (VMMC), hoping to inspire the men of his country — both sons and fathers alike — to undergo the procedure. When he was growing up, his father and uncle were polygamists, a characteristic of a much older society and one that flies in the face of a global HIV/AIDS epidemic.

Read the rest of my piece at HuffPo


Eradicating Sleeping Sickness…

After much stillness and quietness on the blog for a long time, scienceleftuntitled is back in action, this time in the digital pages of The Guardian…

Sleeping sickness: a health scourge that refuses to be put to rest

“This approach is in direct contrast to how the disease has been fought up until now – through an intensive and expensive system of detection and treatment. As the number of cases continues to fall, the elimination of sleeping sickness rests on the ability for control activities to be integrated into wider health systems. The challenge with integrated service delivery is that it reveals organisational, logistical and technical deficiences shortcomings.

Zambia too has be lauded for its success in fighting sleeping sickness but a recent study, which investigated the state of health care facilities for sleeping sickness management in the district of Mpika, showed that even here, where infection rates are low, much could still be improved. The country exemplifies what problems are faced by local health authorities, particularly when the disease begins to be forgotten.”

Australia’s evolving drug landscape


This year we saw Australia put into force a new patent law. An intellectual property system that was Australia’s most comprehensive in over two decades. It came into effect on 15 April 2013 and no one knew exactly what to expect from it.

We have seen with cases like India, how one country’s patent laws can send ripples and disrupt the entire system. And, in the case of Thailand, how a country can take matters into its own hands to enact a public good.

It really all centres around compulsory licensing. A compulsory license, in simple legalese, is the use of a patented innovation that has been licensed by a state without the permission of the patent title holder. This started over a decade ago, when the World Trade Organization adopted the “Declaration on the TRIPS Agreement and Public Health” at its 4th Ministerial Conference in Doha. At the time, many anticipated that this would lead nations to more frequently claim compulsory licenses for pharmaceutical products.

The TRIPS Agreement allows governments to license the use of patented inventions to someone else without the consent of the patent owner. It does not and should not prevent nations from taking measures to protect public health — that was the way it was billed and sold. In dealing with public health epidemics, such as HIV/AIDS, tuberculosis and malaria, countries such as Brazil, India, Thailand, Indonesia and Ecuador have used compulsory licensing to reduce the prices of pharmaceutical drugs for their citizens. What has been seen is a significant spike in use of compulsory licensing in years since Doha.

So where does Australia sit in this spectrum?

Last month, the Australian Parliament was debating a bill on patent law and public health called the Intellectual Property Laws Amendment Bill 2013. It is said that the legislation gives Australian governments greater powers to exploit patents without authorisation from the patent owner via stronger provisions for Crown use and compulsory licensing. Perhaps something more along the lines of what Thailand enacted in 2007. Thailand played the global system to their advantage, exploiting a clause in the 1995 World Trade Organisation agreement on intellectual property that gives governments a large amount of freedom to bypass patents on drugs if they face any kind of health crisis.

Begging the question; in this day and age — aren’t we always under a health crisis? Whether it be from the scourge of tropical diseases in developing countries or the rise of affluent afflictions like heart disease and cancer.

Recently, the Sydney Morning Herald reported that the bill was likely to pass. Going further to state that this would allow Australia to export generic versions of patented drugs to developing countries to tackle outbreaks of diseases such as malaria, HIV and TB. Perhaps becoming the second “pharmacy of the developing world” alongside India. It seems the right balance was achieved between helping people in poor countries and safeguarding intellectual property.

There is another side to outwardly-looking medicine laws in a country. And that is the inwardly looking.

Australia has a drug subsidy scheme, that provides subsidised prescription drugs to residents of Australia — ensuring that all Australians have affordable and reliable access to a wide range of necessary medicines. The scheme has come under some recent controversy.

In 2011 and in 2012, the number of new medicines placed on the nation’s drug subsidy scheme was the lowest seen in two decades. This drop, despite no reduction in new therapies being proposed but just because of a higher rate of rejection by the advisory committee in charge of approving subsidies.

The drop brings up the question of where does this leave patients? With the scheme put in place to ensure that even the poorest of patients can get life-saving medicines the whole “Access to Medicines” debate is revisited. In this case, a slightly shifted one than the usual Big Pharma profit story. Numerous examples exist where the inability to get drugs directly influences patients.

In the ever-increasingly complicated world of drugs, medicine, and economics… the right to a healthy well-being is also being tested.

Image — source

Predicting the next epidemic…

Emergency hospital during influenza epidemic, Camp Funston, Kansas.

Emergency hospital during influenza epidemic, Camp Funston, Kansas.

In some parts of this world the rains predict disease, and a hot, dry, dusty wind is the harbinger of a meningitis outbreak that is yet to come. Now, from where you sit, Google will soon predict the next great epidemic.

At this time of year, ever since that 2009 paper was published on flu trends, seasonal influenza and how we predict it, is a recurring topic.

It seems we are always moments away from the next great flu epidemic. This year saw a novel coronavirus make the rounds. A virus that usually causes nothing more serious and common than a cold, was the source of severe respiratory illnesses in the Middle East, with reported cases coming from Qatar, Saudi Arabia and Jordan, and resulting in 5 fatalities.

The curious case of the novel coronavirus is a new strain of virus that has not been previously identified in humans. The hypothesis is that it jumped the species barrier, but, as of yet, a definitive origin has not been identified.

When a disease will decide to jump the species barrier is hard to predict. Some of the most serious afflictions of humans in recent times have had their origin in animal diseases. HIV/AIDS and ebola being the prime example. Seasonal influenza is another — causing tens of millions of respiratory illnesses and up to half a million deaths worldwide each year.

In mankind’s eternal struggle against disease, as the adage goes, prevention is better than a cure. But how do we prevent disease? How do we mitigate for an oncoming plague or pestilence? A part of this prevention is predicting it.

Currently, we can only really predict an epidemic when it is currently in motion. Hospitalizations are the only way we can really track a disease. When it is possibly already too late. When people are already sick.

In the week the world was supposed to end, the European Centre for Disease Control (ECDC) released its weekly report on influenza surveillance, like it had done since week 40 of this year. The report aggregates data on influenza-like illnesses reported in primary health care facilities, as well as virological and clinical data.

Flu surveillance, in Europe and similarly in the US, is based on nationally organised sentinel networks of physicians, mostly general practitioners (the first person you go see when you’re ill), covering at least 1 to 5% of the population in their countries. Each sentinel physician reports the weekly number of patients seen with influenza-like illnesses and acute respiratory illnesses.

The report is essentially there to tell us when a flu epidemic is going to break out. In week 49, ECDC announced that the season of influenza transmission had begun.

Along with the direct methods of detecting and monitoring disease, in recent years new and innovative non-direct methods have been tested. From sales of over-the-counter medication to online activity. The idea is to try and record health-seeking behaviour… ie before the disease has taken hold in a population.

Emergency hospital during influenza epidemic, Camp Funston, Kansas.

Monitoring disease, 140 characters at a time…

Flu is a disease very amenable to being searched and turning up in social media. Health-seeking behaviour — in this day and age, we google every ailment. However, diseases which are more serious probably won’t follow this social pattern.

The concept is essentially trying to “predict the present”. Google flu trends isn’t the only one to mine social data. Mappyhealth mines twitter data, tracking 25 conditions from around 200 health related terms. Searching for the spikes in activity from those certain key terms. Spikes in activity above the social noise, pointing to a significant event associated with the term. In some places it has been shown to be a good indication of the real underlying movement of disease.

But what of diseases that are not as commonplace as the flu? How would google or twitter act as an early warning system for diseases of a tropical nature?

2.5 billion people are living in areas at risk of Dengue fever, otherwise known as breakbone fever — a painful and sometimes fatal viral disease characterized by headache, skin rash and debilitating muscle and joint pains. In some cases, it can lead to circulatory failure, shock, coma and death. There are up to 100 million infections a year — and it’s growing. Incidence and geographic distribution of dengue has gone up in many countries, spurred on by a changing climate.

So how do we predict a disease that is more complicated than simple person to person transmission? What if there is another step to overcome — namely, in the case of dengue, a mosquito? Early warning systems for vector borne diseases are incredibly complex.

Google Dengue aims to do the same thing flu trends did. And the results are remarkably similar. Google search volume for dengue-related queries were able to adequately estimate true the dengue activity and official reported cases. The realisation that disease can be tracked in this manner is a relatively new occurrence. Few have explored non-traditional settings for monitoring epidemics, dengue or otherwise.

The caveat, however, is obvious — a term turning up in a search term doesn’t necessarily point to the presence of the disease. “Now-casting” (as opposed to forecasting) using a web-query based surveillance depends on a few crucial factors. First and foremost is the evident internet availability — and in developing countries this might prove difficult.

Despite its limitations (panic-induced searching from the announcement of a novel outbreak, backed up by media sensationalism), it proves effective and, most importantly, low cost. Up-to-date and accurate estimations of disease lets the health professionals make an effective response to the moving disease. In the case of influenza, where a vaccine is available, it makes sense. In the case of dengue, all that remains is a working vaccine for this method to live up to potential.

Image — sourcesource

Originally appearing in Australian Science

After Sandy…

Before hurricane Sandy touched down on the east coast of America, it passed through the Caribbean, causing around 80 fatalities — 60 of them occurred in Haiti, 11 in Cuba, two in the Bahamas, two in the Dominican Republic and one in Jamaica.

Hurricane Sandy started life out over central America, nonchalantly, as a collection of winds that would eventually gather momentum, speed and energy. It began its non-discriminating path through the Caribbean, eventually to hit Puerto Rico and the Dominican Republic as well. As it hit Jamaica it was a category 1, destroying around 1500 hectares of farmland. In Cuba the next day it was a category 2, destroying banana, coffee, bean and sugar crops. Sandy destroyed roughly 30% of the nation’s coffee farms. Add to that the 200,000 damaged homes. The Bahamas archipelago was next, before it would set it sights on America’s eastern seaboard.

While most of the focus of western media centred on the damage Sandy caused in America, especially this close to a Presidential election; there were few news outlets that reported what had passed in the Caribbean — outside the death tolls and damaged infrastructure. Indeed, as it is becoming more and more apparent, it is always the blogosphere that provides an adequate source of information. Hurricane Sandy’s progression was followed by bloggers on the ground, giving another side of the story we don’t often get to see.

But it is in Haiti, a country that has yet to recover from tropical storm Isaac that hit in August of this year, as well as the earthquake of 2010, that felt the worst of Sandy’s wrath. 1.8 million people in Haiti are affected by the storm, according to the United Nations relief agency.

With everyone concerned with the numbers, damage, and brute destruction, there is the underlying problem that any disaster hit area has to deal with. Namely, the aftermath. It is the aftermath of the Caribbean region we must now think about. There will be the inevitable worry about food prices from this point on. Huge crop losses in southern Haiti raise famine worries.

Prime Minister Laurent Lamothe, after assessing the damage, said “Most of the agricultural crops that were left from Hurricane Isaac were destroyed during Sandy, so food security will be an issue.”

Three days of constant rain caused rivers to overflow and the floodwaters to rise. Most of southern Haiti is underwater. In the whole Caribbean region rainfall amounts as high as 250 millimeters were measured over eastern Cuba and some extreme southern areas of Hispaniola. Haiti experienced 20 inches. Port-au-Prince receives an average annual rainfall of 54 inches.

As the rains stopped the damage is only made worse to the tune of infectious diseases such as cholera. Haiti has been fighting a cholera epidemic since 2010. A cholera outbreak that has killed over 7400 people and left up to 600 000 sick across the country.

According to the Pan American Health Organization (PAHO) and the WHO, there is an increase in cholera cases in the south and south-east, where 49 cases and 9 deaths have been recorded.

The list of infectious disease outbreaks following natural disasters is long. Although, usually there are some that are more common than others. Diarrheal diseases, acute respiratory infections, malaria, leptospirosis, measles, dengue fever, viral hepatitis, typhoid fever, meningitis, as well as tetanus and cutaneous mucormycosis have all been documented as the incidence and magnitude of natural disasters increase.

Natural disasters and infectious diseases outbreaks represent a significant challenge. But they do not necessarily go hand in hand. Disasters do not transmit infectious diseases. But the risk of infectious disease is multiplied by the change in situation — populations displaced, overcrowding, limited access to food and water, and public health breakdown.

Haiti’s Prime Minister, Laurent Lamothe said “I am launching an appeal to international solidarity to come and help the population, to help support the completion of our efforts towards saving lives and property,”

Flood disasters are the most common natural disasters throughout the world, and diarrheal diseases are the leading cause of death from displaced populations living in camps. France has promised to rebuild seven destroyed bridges and Mexico has offered food. How Haiti deals with the aftermath of Sandy will be one to follow closely.

Image — source, source

Originally appearring in Australian Science

Arya SC, & Agarwal N (2012). Prevention and control of infections after natural disasters. Expert review of anti-infective therapy, 10 (5) PMID: 22702315

Kouadio IK, Aljunid S, Kamigaki T, Hammad K, & Oshitani H (2012). Infectious diseases following natural disasters: prevention and control measures. Expert review of anti-infective therapy, 10 (1), 95-104 PMID: 22149618

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