Treating H1N1 – WHO recommends keeping antivirals for severe cases

In contrast to the H1N1 treatment protocols established by many developed nations, the World Health Organization recently announced that healthy patients who get H1N1 swine flu without suffering complications do not need to be treated with antivirals like Tamiflu.  Antiviral treatments are strongly recommended for pregnant women, patients with underlying medical conditions and children under 5, since they are at increased risk of more severe illness.

The concern with the WHO recommendation, as reported by Reuters, is that judging who will need antivirals is not easy for doctors since the risk of developing severe illness from the new flu strain is not restricted to people who have chronic conditions such as heart disease, diabetes or asthma.  Despite the WHO’s conclusion that underlying medical conditions do not predict a severe infection, the fact that 6 out of 10 patients suffering serious bouts of swine flu do have previous conditions chimes with other medical research.

Healthy living reduces risk of chronic disease by 80%

Leading a healthy lifestyle reduces the chance of developing common chronic diseases by nearly 80 per cent, according to recent research from the Centers for Disease Control and Prevention in Atlanta.

Those who exercised regularly, stayed slim, ate a healthy diet and never smoked were (as compared to those who adhered to none of the four factors):

• 93 per cent less likely to develop diabetes;
• 81 per cent less likely to have a heart attack;
• 50 per cent less likely to have a stroke; and
• 36 per cent less likely to develop cancer.

These results follow recently released data from the CDC that show obesity-related disease account for nearly 10% of medical spending in the U.S. These costs are likely to increase further as U.S. obesity rates rose 37% between 1998 and 2006.

To meet the study’s criteria for leading a healthy lifestyle, people had to exercise for at least three and a half hours a week, which is equivalent to just half an hour a day.  They also had to have a BMI lower than 30, above which they are considered obese.  Eating a diet high in fruit, vegetables and whole grain as well as being low in red meat was also a requirement. Finally, to maximize the chances of living a long life people must never have taken up smoking cigarettes.

Ethics, research and NGOs

The Global Bioethics Blog recently added a very interesting post about the ethical challenges faced by humanitarian organizations in conducting research, with a specific focus on MSF.  The following is an abbreviated version of the post, though the original is certainly worth reading:

Medecins sans Frontieres (MSF) is a humanitarian organization whose Nobel Prize winning work barely needs an introduction. They are well-known for their efforts in providing health care (among other services) to those in severe social crises and emergencies worldwide. What is less known is that MSF is increasingly conducting its own research among vulnerable communities where it does its humanitarian work.

The ethical challenges <of this dual role> abound: How can consent of participants be voluntary if MSF is doing clinical research and acting as the sole provider of medical care in a certain locale? How can consent be informed when there is a blurring of lines between MSF care and MSF research?

Some sentences in the article left me with the impression that the marriage between MSF and its ethics committee has been unhappy at times. The paper states that the ethical review board is “not accountable for any research which is carried out against its advice,” suggesting that there were cases of non-approved research.  The authors (themselves members of MSF’s ethics review board) indicate that their recommendations have only partly been taken into consideration in MSF’s research policies or procedures.

A bit strange, when you think about it: wouldn’t you expect a humanitarian organization, having decided to do research on vulnerable populations, to be the most aggressively concerned about the protection of research participants?

UN report on HIV transmission in Asia: more than 90% of HIV+ women in Asia were infected by husbands or long-term partners

A new UN report estimates that more than 90 per cent of the 1.7 million women living with HIV in Asia became infected from their husbands or partners while in long-term relationships.  A further 50 million women in Asia, who are either married or in long-term relationships with men who engage in high-risk sexual behaviours, are predicted to be at risk of becoming infected with HIV from their partners.

The report, HIV Transmission in Intimate Partner Relationships in Asia, was produced by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its partners.

In Cambodia, India and Thailand, the largest number of new HIV infections occur among married women.  The evidence from almost all the countries in Asia indicates that women are acquiring HIV not because of their own sexual behaviours but because of the unsafe behaviours that their partners engage in. The intimate partners of men who have sex with men, injecting drug users or clients of sex workers constitute the largest vulnerable population in Asia.

The UNAIDS report recommends four main strategies that should be implemented in addition to increased services for key populations:

1. HIV prevention interventions must be scaled-up for men who have sex with men, injecting drug users, and clients of female sex workers and should emphasize the importance of protecting their regular female partners.
2. Structural interventions should be initiated to address the needs of vulnerable women and their male sexual partners. This includes expanding reproductive health programmes to include services for male sexual health.
3. HIV prevention interventions among mobile populations and migrants must be scaled-up and include components to protect intimate partners.
4. Priority should be given to operations research to develop a better understanding of the dynamics of HIV transmission in intimate partner relationships.

Canada’s provincial drug plans and drug rebates – negotiating savings or creating tiered healthcare?

Canada’s health care system has come under increasing scrutiny as the debate on health reform intensifies in the U.S.  The National Post recently published an interesting article on Canada’s provincial drug plans and recent changes that have allowed some of them to negotiate prices directly with drug companies in exchange for having their products listed.  The benefits of this are the significant discounts that the Ministries of Health can reinvest in the health system and access to a greater choice of medicines for patients on provincial drug plans.  The downsides are the creation of tiered healthcare (pricing differences between public and private health plans as well as between provinces) and a lack of transparency.

Drug rebates raise questions on cost, transparency

In a controversial shake-up of Canada’s pharmaceutical marketplace, drug companies have been paying provincial drug plans millions of dollars in rebates in exchange for having their products listed.

In the past, the price of a brand-name drug was the same, regardless of who paid. If a new drug came on the market, drug plans either agreed to list it at that price, or not.

Some experts say the unprecedented deal-making is already saving the health-care system money and making a wider array of medications available to patients. Others worry about the lack of transparency and a new, two-tier drug pricing system that leaves private insurers and people without any coverage paying more than public plans for the same medication.

At least five provinces have begun negotiating with manufacturers to win price cuts for the medications they include on their benefit plans. Until about two years ago, provincial governments, private insurers and individuals from east to west all paid the same prices for brand-name prescription drugs.

In Ontario, where the whole trend began about two years ago, the head of the government drug plan says the process has enabled the province to sink hundreds of millions of dollars into covering drugs it otherwise would have had to leave off its formulary. The Ontario Public Drug Programs, which reimburse medication costs for about three million welfare recipients and senior citizens, negotiated $80-million in rebate savings over three years for one drug alone, said executive officer Helen Stevenson, without naming the product.

“We are compromising on transparency: we acknowledge that,” Ms. Stevenson said. “But if it means we’re getting tens of millions of dollars off the prices of drugs, and that money can be put directly back in the drug budget, we think this is a good step for Ontario.”

But some analysts say the process makes it difficult for organizations like the inter-provincial Common Drug Review to judge the cost-effectiveness of new products in a cash-strapped system.

“When you have individual provinces now doing secret, non-transparent pricing negotiations, it really sabotages the whole CDR initiative,” said Neil MacKinnon, a pharmacy professor at Dalhousie University. “Nobody knows what the final price is and it’s hard to keep governments accountable when you don’t know what the final price is.”

Ms. Stevenson said the secrecy around price arrangements is unavoidable, as the industry has said it would not enter into negotiations if the results were to become public.

About 45% of drug costs in Canada are covered by provincial plans, 35% by private insurers and 17% by individuals, according to the Canadian Institute for Health Information.

H1N1 vaccines close to approval says WHO

The World Health Organization recently stated that the first vaccines to combat H1N1 swine flu should be approved and ready for use in some countries from September, according to a recent article by Reuters.

Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research, also said vaccine production yields were improving, following a disappointing start that triggered some worries about supplies.

“I don’t want to say too early that the question has been resolved but it really seems that we have found a way to go round this problem,” Kieny told reporters. “We are on track in development.”

First results from clinical trials are expected early next month and these tests will show whether one or two doses are needed to provide immunity — another big swing factor in determining how many people can be vaccinated.

Once initial clinical trial results are in, regulators will be able to approve the vaccines from next month and the first countries are expected to start mass vaccination programmes, Kieny added.