Who will invest in the clinical development of drugs that offer limited commercial opportunities?(scottchan/Fotolia.com)
The desire to impact areas of great need drives many academic medical researchers. Unfortunately, a variety of challenges can prevent even the most promising innovations and technologies from reaching the patients who would benefit most. When the target population is primarily in the developing world, these challenges are magnified. Only a fraction of research and development funding goes toward treatments that target neglected diseases and the needs of low- and middle-income countries
, posing a particularly frustrating situation.
The Universities Allied for Essential Medicines (UAEM)’s recent forum on Global Access Licensing of Biomedically Relevant Technologies delved into this pressing issue. According to the UAEM philosophy, the accessibility of medicine to developing nations “depends critically on how universities manage their intellectual property.” Further, the UAEM suggests that obtaining patents means that “anyone who can’t afford the asking price will be unable to access the product” and that “further innovation is hampered or outright blocked.”
In contrast, many of the panelists at the forum didn’t see intellectual property licensing as the primary obstacle—rather, they viewed it as a requirement to attract industry partners. Full story »
This 1802 British cartoon skewers the cowpox vaccine, newly introduced against smallpox. Read more at http://en.wikipedia.org/wiki/File:The_cow_pock.jpg#file
Fifty years after Boston Children’s Hospital faculty developed a vaccine against measles, the United Kingdom is seeing a surge of cases. Last year, it tracked a record 2,000 measles diagnoses—unusual for a country that used to average only a dozen cases every year. With 1,200 cases reported this year so far, that record could be broken.
The cases are the legacy of parents who decided to forgo vaccinating at least 1 million children against measles, based on a 1998 study in The Lancet linking the measles vaccine to autism. That now-retracted study became the origin of its own epidemic, carrying misinformation through a network of parents and media outlets that believed the author had discovered the cause of autism.
Until recently, tracking the spread of vaccine-related rumors was even more difficult than tracking the outbreaks such misinformation engenders. A study in The Lancet Infectious Diseases, involving Boston Children’s Hospital’s HealthMap data collection system and funded by the Bill & Melinda Gates Foundation, has taken a huge step toward turning that around. Full story »
Nguyen and his Italian colleagues prepare for robotic surgery.
As the benefits become clear, robotic surgery is getting more popular. Since it’s done laparoscopically, it requires smaller incisions, allowing patients to recover faster and resume normal activity within one to two weeks, as compared with a six- to eight-week recovery time for open surgery.
“This is an obvious upside for patients, but for hospitals too,” says Hiep Nguyen, MD, director of Boston Children’s Hospitals’ Robotic Surgery Research and Training Program. “If a patient leaves the hospital in one day rather than in four, then doctors can help more patients and reduce their wait time for treatment.”
Robotic surgery has not yet been embraced on a global scale. In Europe, for example, doctors have hesitated to practice it in children. But with Nguyen as their mentor, that reluctance may soon change. Full story »
Newborns like this child have a high risk of hypothermia, even in warm climates. An innovative warming pad could be one potential fix. (Courtesy of Anne Hansen)
In the United States, we rarely worry about newborn babies getting dangerously cold, but in poorer countries the basic provision of warmth can be extremely challenging. Although the World Health Organization (WHO) considers newborn thermal care
a critical part of neonatal care, hypothermia remains a leading cause of sickness and death globally.
Even in places with warm climates such as sub-Saharan Africa and South Asia, babies can quickly lose heat, and how hypothermia in newborns is treated reveals a dramatic contrast with the developed world.
The playing field may soon get more level, thanks to a device Boston Children’s Hospital’s Anne Hansen, MD, MPH, has been developing with collaborators at Lawrence Berkeley National Laboratory’s Institute for Globally Transformative Technology (LIGTT) since visiting Rwanda in 2010. That device is a warming pad that can keep a newborn warm for hours at a time with no electricity, and which can be used in a home, clinic, hospital or transport setting. Full story »
A Queens College gymnasium served as an evacuation center after Hurricane Sandy.
Shannon Manzi, PharmD, chief pharmacist for the Massachusetts–1 Disaster Medical Assistance Team, directs the Clinical Pharmacogenomics Service at Boston Children’s Hospital and is team leader for Emergency and Combined Services in the hospital’s Department of Pharmacy. With MA-1 DMAT, she has deployed to Louisiana after Hurricane Katrina in 2005 and Hurricane Gustav in 2008 and to Haiti after the 2010 earthquake.
As I watch the Arizona-1 and Texas-3 Disaster Medical Assistance Teams (DMATs) respond to the tornado in Moore, Okla., I know they will serve with great skill and caring. But I wish the Massachusetts-1 DMAT was the team on call this month. Although we’re unlikely to be deployed for this disaster, our hearts are with the people of Moore and all our fellow responders.
Thirteen years ago, I was asked to join the MA-1 DMAT as the pediatric pharmacist. It’s been one of the most grueling and difficult commitments of my life, but I’ve never looked back. I love it.
I have slept for weeks on the ground, not being able to shower or eat anything other than MREs (meals-ready-to-eat)—all while working 18- to 20-hour days. However, I hold no illusions that what we do is heroic. I can go home in two to three weeks to an intact house and family. This is not the case for the people we serve. Full story »
In the developing world, health care providers often don’t have access to diagnostic technologies like the automated lab tests taken for granted in the resource-rich United States. Specimens often have to be sent to a distant central lab, and it can be weeks before an answer wends its way back.
That’s a tough situation when you’re, say, trying to assess whether a patient is having liver toxicity from a drug, such as drugs used to treat tuberculosis (TB) and HIV. By the time the results come back and indicate you need to stop or switch medications, the patient may be long gone, unable to travel back to the clinic.
For the past four years, Nira Pollock, MD, PhD, associate medical director of the Infectious Diseases Diagnostics Lab at Boston Children’s Hospital, has been working with Diagnostics For All (DFA), a nonprofit organization based in Cambridge, Mass., to develop and test a low-cost diagnostic device that works on the spot, involving just a finger-stick and a square of paper. The technology is all in the paper square—using wax printing and microfluidics techniques Full story »
Babies with newborn jaundice need phototherapy. In the developed world that's easy; in the developing world, not so much. (Bruce R. Wahl/Beth Israel Deaconess Medical Center)
Family lore has it that when I was born, I had to spend a couple of extra days in the hospital for jaundice
, the distinctive yellow tint to the skin that shows that a baby’s liver isn’t fully up and running yet. For me—and most of the newborns that develop jaundice every year in the developed world—the treatment was simple: spending some time lying under bright blue lights (aka phototherapy
Note that I said “developed world.” The story in the developing world is quite different. Sometimes the nearest hospital with phototherapy equipment is hours’ or days’ travel away. Even though it’s simple, phototherapy is power intensive; no power, no treatment.
And untreated jaundice can have devastating consequences. The yellow pigment, called bilirubin, can accumulate in the brain and cause permanent brain damage or death.
The best solution for regions with few resources would have to be small and portable, run on batteries or other off-grid power sources, cost little, but still be safe and deliver the right wavelength and intensity of light. This is where Donna Brezinski, MD, wants to make a difference. And the Bili-Hut is her answer. Full story »
If we could immunize infants at birth, far more could be protected from infections.(DFID-UK Dept for International Development)
Right now, immunizations against most infections begin at 2 months of age. But that leaves newborns at risk for infections like rotavirus, whooping cough and pneumococcus during a highly vulnerable time.
In resource-poor countries, this is a serious problem: Many children see a health care provider only at birth, so may miss their chance to be protected. Worldwide, each year, more than 2 million infants under 6 months old die from infections, especially pneumonia. If we could immunize infants at birth, it would be a huge win for global health.
Unfortunately, though, newborns don’t respond to most vaccines. Their immune systems are too immature—which is why few vaccines for newborns exist. Full story »