Healthcare, medicine & pharmaceuticals

Sunny outlook for cancer treatment

We’ve known for years that excessive exposure to the sun is harmful and we should cover up. For example, experts in the UK point out that 1,600 deaths every year are caused by the sun (largely melanoma skin cancers). But a new theory suggests that we might have got things the wrong way around. According to Professor William Grant, 25,000 other deaths in the UK could be caused each year because we are not getting enough exposure to the sun. The evidence for this alternative theory is largely based on population studies that show an geographical correlation between sun exposure and disease rates – the sunnier your climate the less likely you are to get breast cancer, colon cancer, ovarian cancer or multiple sclerosis. Work patterns are also likely to be involved because most people now work indoors and exposure to the sun is short and often sharp.
The theory has drawn guarded support from the likes of Dr Michael Thun at the American Cancer Society, whilst in Australia the Cancer Council has amended its guidelines to suggest that exposure to Vitamin D (produced by sunshine) is not as dangerous as previously thought. The theory also coincides with various studies that suggest that there is a linkage between recovery rates for operations and time of year. For example, a study by researchers at the Harvard Medical School (US) discovered that the five-year survival rate for lung cancer patients doubled if patients were operated on during the sunny summer months.
This is thought to be because vitamin D causes cell growth to slow down and causes abnormal cells to commit ‘suicide’.
However, as with any new idea it’s caused resistance. Prof. Grant is not a medic but a retired NASA scientist experienced in lasers, jet engines and the chemistry of the earth’s atmosphere. As a result some researchers are not taking this theory as seriously as they would if it had come from a medical specialist. Then again, if the history of innovation teaches us anything, it’s usually that breakthrough thinking comes from people on the outside.

Ref: The Times (UK), 14 May 2005, ‘Decent exposure’, S. Crompton’. See also Weekly Telegraph (UK) issue #722, “Doctors see a sunnier outlook on cancer front’, P. Pallot.


A future pill for every ill

A report by Foresight, a UK think-tank, says that as society speeds up and becomes more competitive, many healthy people will use pills to enhance their daily performance.
This in turn will create a host of practical and ethical issues ranging from whether such pills should be commonly available to how much they should cost. An example of such a pill moving from specialist areas of medicine to common usage for people who are not ill is Ritalin (methylphenidate) – used by some students to improve test results and some business people to improve performance in presentations. In addition, in the US, the military has used Modafinil to help soldiers stay awake and improve concentation and planning skills and it looks likely that various Alzheimer’s drugs will eventually be used to improve the memory of otherwise healthy people. There are also a number of ‘vaccinations’ being discussed to ‘cure’ substance abuse ranging from alcoholism and smoking to cocaine use.

Ref: Sydney Morning Herald (Aus), 16-17 July 2005, ‘Scientists predict a pill for every ill’.


Future epidemics (part 2)

According to some observers we are on the cusp of a future osteoporosis epidemic. The disease already affects 30% of women aged over fifty in the UK and about 8% of men. That’s considerably more than the number of women who get breast cancer, but breast cancer receives far more atttention. More worryingly, these figures may rise significantly in the future due to poor diet and lack of exercise. Traditional wisdom says that drinking more milk and eating more dairy products is the way to prevent osteoporosis, but this could actually be contributing to the problem according to some experts. According to Dr Marilyn Glenville, a highly respected UK nutrionalist and member of the Royal Society of Medicine, high protein diets and foods, which are highly acidic (meat for instance), may cause a leaching effect that removes calcium from bones. This so called ‘acid-alkali theory’ is backed up by some credible research including a study published in the Archives of Paediatric and Adolescent Medicine. The study suggested that teenage girls are suffering from bone fractures because they are drinking too many soft drinks, which contain phosphoric acid, which again leaches bones of calcium. And if you think that broken bones are the only result of brittle bones, think again. Osteoporosis means that something as innocent as a cough can fracture a rib, which could have a number of serious and sometimes fatal consequences. According to the National Osteoporosis Society (UK) nobody has yet proven beyond all reasonable doubt that there is a link between a high protein diet and osteoporosis but evidence is certainly building up.

Ref: The Times (UK), 7 May 2005, ‘The lovely bones diet’, S. Crompton.
See also ‘Osteoporosis, the silent killer’, by M. Glenville.


Patient simulators

You can’t get a job as an airline pilot unless you’ve spent hours on a flight simulator, so why can you get a job as a doctor without similar training? In medicine, training typically starts with textbooks and then moves on to the bedside in years two and three. This is known as ‘see one, do one, teach one’. However, the traditional apprentice model in many professions is under threat because training is not generally revenue-generating. Medicine is expensive and hospitals want to focus on treatment rather than teaching wherever possible. Add to this the legal issues surrounding misdiagnosis or wrongful treatment and you have a situation where students are spending less and less time with patients. One solution is a ‘model’ patient. About 20 years ago David Gaba built a dummy patient (mannequin) with help from Abe DeAnda Jr. The original dummy patient was little more than an inert box, but things are now much more sophisticated. The latest versions include a lifelike mannequin that utilises software produced by a company that trains fighter pilots. The software allows physiological settings to be adjusted to mimic real life cases. Pupils can dilate, the chest can expand and contract and there’s a heartbeat if you listen in the right place. X-rays can be provided from real cases and ‘voice’ can be provided from doctors in a nearby room working from real life scripts. The US military even uses a mannequin that spurts fake blood to simulate battle conditions. Less than 50% of medical schools in the US currently use simulators but this might be about to change. In the US, the Federal Drug Administration (F.D.A.) has just approved the use of a carotid artery stent that can only be used if doctors undergo training on a simulator in accordance with the manufacturers instructions. Is this the ‘tipping point’ for simulators? We’ll see.

Ref: The New Yorker (US), 2 May 2005, ‘A model patient’, J. Groopman.


The future of pharmaceuticals

Is the pharmaceuticals industry in trouble? On the face of it you’d think not. Drug sales have doubled globally since 1997 and are predicted to rise to US $700 billion by 2008. Operating margins are healthy too: typically 25% compared to 15% in other industries. Moreover, global trends like ageing and rising disposable incomes should be a bonanza for drug companies. But the industry is fragmented. The largest drug maker, Pfizer, only holds 10% of the market, the cost of bringing new drugs to market is skyrocketing and the number of new drugs being launched is falling. Moreover, the industry (which makes life-enhancing products) is widely seen as ‘the next tobacco’ when it comes to legislation and public trust. Transparency is part of the problem. Drug companies operate in secret and many of their practices (eg, marketing and the use of research studies) are viewed with suspicion in some quarters. Moreover, the relationship between patients and doctors is changing. Patients are now prepared (with the help of the Internet) to question their doctor and to seek alternatives (like travelling abroad for treatment). Some critics, who presumably feel uncomfortable with the idea of people capitalising on medicine, have suggested that pharmaceuticals should be taken out of private hands altogether, but this seems unlikely. A more likely scenario is simply that these questions and ideas run in cycles.
At the moment it’s pharmaceuticals (and food companies) that are in the firing line. But the cycle will probably turn again soon – possibly to banks, automobiles or oil companies. The structure of the industry and how their R&D operates may also change, but the demand for the industry’s products is unlikely to diminish.

Ref: The Economist (UK), 18 June 2005, ‘Prescription for change: a survey of pharmaceuticals’.  See also ‘Pharmaceuticals: a long term outlook’, 2004, Global Business Network.