Healthcare, medicine & pharmaceuticals

Do swine flu vaccines work?

Fears of a flu pandemic have prompted the Center for Disease Control in America to recommend that 159 million adults and children receive a swine flu vaccination. The federal government has also spent more than $US3 billion stockpiling antivirals, such as Tamiflu. (Interestingly, it was stockpiled for the military when Donald Rumsfeld was Defense Secretary, and he was chairman for four years of Gilead Sciences, which had the patent on Tamiflu.) Even so, it is still not clear whether taking a vaccination or antiviral approach makes any difference and could even lower defences against a more lethal flu.

Influenza, or flu, is frequently overdiagnosed and kills about 36,000 in the US (smoking kills 440,000) and half a million in the world (smoking kills 5.4 million) each year. But the people who are most likely to get flu and die of it are the elderly and people with poor immune systems. Among Americans who died of swine flu, 70% had underlying conditions like cancer or AIDS. So the question is whether it is necessary to vaccinate everybody against a condition that only weaker people are susceptible to.

Flu vaccines are quoted to reduce mortality by 50%, based on cohort studies that compare death rates in large groups of people who choose vaccination. Yet people who choose vaccination might not be representative of all people. A 2004 study of 72,000 people aged 65+ found, outside the flu season, the baseline risk of death among people not vaccinated was 60% higher than among those who did. This was described as the “healthy user effect” and in fact, described the entire benefit other researchers attributed to the vaccine. Healthy people also respond vigorously to the vaccine, which may reduce their chances of getting the flu or having bad symptoms. But the elderly, who are most likely to die, have poor immune systems and don’t respond so well to the vaccine.

One way to address this is to offer placebo shots. But this is considered to be unethical, as it would be untenable to have someone die after receiving placebo when they could have received the vaccine. Of course, it could also be argued that it is unethical to keep giving vaccines that are not proven to make a measurable difference.

The question is what could be done instead to prevent a flu pandemic? Social distancing (keeping away from your neighbours) is one way to prevent pandemics, coupled with the opposite – having a friend on hand to deliver food and medicine if you do become sick. Another is hand washing. Unfortunately, people who are sick usually turn up in public places for treatment, or worse, continue to go to work. The argument for or against vaccination continues to rage. It will be interesting to see how advances in nanomedicine, where medicines can be given in minute doses directly where they are needed, will make the effectiveness of vaccinating less equivocal.

Digital bandages

Imagine a bandage that not only protected your wound, but was able to “talk” to your doctor about it. A UK company, Toumaz Technology, is developing wireless technology for monitoring the human body. The Sensium digital bandage looks like a regular one, but can transmit data from the patient’s body to the doctor urgently, for example, any changes in body temperature, heart rate or breathing. Medical records could also be updated instantly.

From the patient’s point of view, it would be non-intrusive and painless. They could still get out of bed, move about independently, and even reduce the length of time in hospital. For people with chronic diseases, such as diabetes or heart disease, it could even help to keep them away from hospital unless absolutely necessary. The Sensium bandage only needs to be replaced every two days.It would be fascinating to consider what other conditions might be monitored with such a bandage: alcohol levels, for example, or signs of excess anxiety before panic attacks. And what about telling lies? Not just a Band-Aid solution!

Health funding - raising, spending, and proving it

In 1990, more than two thirds of $US5.6 billion spent on world health came from governments and the rest from Gates Foundation, corporate donations and other private philanthropists. By 2007, it was $US22 billion and private money from corporations and charities was greater than the total from all sources in 1990. So what is next? Sir Robert Feachem, former boss of Global Fund, believes agencies can only raise money if they prove that they spend wisely. He suggests a combination of smart fund-raising, careful spending and accurate measurement of outcomes.

UNITAID, an agency founded in 2006 by Brazil, Chile, France, Norway and the UK, derived its income from a charge on airline tickets and cash. Passengers will now be invited to give a small donation each time they book a flight online. This is described as “building solidarity”, by involving the public directly. Advance Market Commitments (AMC) subsidises the initial purchase of drugs for the poor as long as these companies promise to sell them more cheaply in the future. This means that drug companies receive enough profit early to justify their investment in poorer countries. Yet, this method might also reward mediocre, or too rapid inventions, if not used carefully. One good example is GAVI alliance, a public-private partnership that has raised more than $US1 billion in short-term financing by issuing bonds backed by pledges of future aid money. This makes significant funds available now, rather than small amounts dribbling in later. Last year, it launched a $US1.5 billion AMC program to reward the first company to find a vaccine for pneumococcal disease. GAVI plans to launch an exchange-traded fund that tracks firms involved with health and development.

The question that every donor asks – where did my money go? – might soon be answered through online tracking systems. The MassiveGood charity is working with Google to find such a system within two years. Charities that are able to show how they are spending – and demonstrate the results of their spending – are likely to receive more traditional donations. While it is admirable that there are so many alternative ways of raising money, there is still no substitute for personal philanthropy and the warm glow that accompanies it.

Medibots

The Japanese are skilled at semiconductor fabrication and nanofabrication, so small wonder they are inventing microrobots for observation and potentially, delivering drugs and surgery inside the body. Last year, a research team placed a tiny robot inside a test tube full of water and manipulated it with a joystick to grab hold of yeast cells (only 15 microns in size). A 1cm movement with the joystick created a 1 micron movement of the robot, with a force of one-10 billionth of a gram that the researchers felt amplified 500 billion-fold in the joystick!

It is startling to imagine how this technique could be used. Olympus Medical Systems Corp has invented capsule endoscopy, where the miniature endoscope can be swallowed and provide information as it travels down the gastrointestinal tract (GIT). It is already being used in 300 hospitals in Japan. There is no reason why it could not be possible to treat disease in the future using a robot like this. RF Co is also developing a capsule endoscope that could be used initially for observing the problem and then for sending a treatment. This would be done via wireless technology.The only problem with these capsules is they are easy to swallow and excrete via the GIT, but how could they be removed from the circulatory system, for example, after injecting them? These are the kinds of questions that Japanese researchers will address. The thought of a microrobot staying inside the body does not seem nearly so disturbing as, say, a swab or a pair of scissors after surgery, but what if someone continued to wirelessly control it?!

You’re not in the mood

The smart bandage mentioned earlier may be out-smarted by a robot that can pick up the mood of people just by looking at their smiles, blushes or frowns. Computers are already able to sense the mood of actors using software with millions of combinations of facial expressions and head positions. They can identify fear, sadness, happiness, anger, surprise and disgust 90% of the time and even tell the difference between someone who is puzzled and someone who is drunk (hmm, have never thought a drunk looked puzzled).

Imagine if a robot were able to tell whether an elderly or mentally impaired person was distressed and respond immediately. Researchers at MIT have invented robots with a range of facial tricks, such as smiling, winking and eyebrow raising, and they can nod when the participant answers a question correctly. At the same time, researchers behind a mirror analysed and reduced the participant’s minute facial and bodily movements for the robot to use in later experiments.

We are acutely tuned to the mood of others even when we can’t see their faces. Through their general bearing, we are able to recognise fear, nervousness or anger and we know when it contradicts the expression on their faces. In future, robots will be equipped with this extreme sensitivity so they can deal with people who are less able to express themselves, for example, the autistic, or mentally impaired. Even, it seems, if they’re drunk!