The Incredible Promise of CRISPR

Clustered regularly interspaced short palindromic repeats / Cas9, better known as just CRISPR, is a form of genetic modification that utilizes the immune system of bacteria to selectively remove or replace individual genes. As you can imagine, it is a very complex concept — I recommend this great full explainer – but it has vast implications for the future of human health and prosperity, Continue reading

The World As 100 People

To better grasp just how much human conditions have improved only over the past two hundred years, consider the following summation, which imagines humanity as just a hundred people.

world-as-100-people-2-centuries-1

Imagine if you were surrounded by abject poverty and misery, but only years later find most people lifted out of deprivation and living comfortable lives; imagine nearly half of all the kids around you dying before their fifth birthday, but over the span of just a couple of years, such tragedies are virtually unheard of.

When you consider that these conditions were the norm for most of our 200,000 year history, and that only in the last two centuries — a relatively small blip in the timescale — have they reversed so rapidly, it is astounding how so many of us fail to realize how incredibly far our species has come.

Learn more about human progress from the source of this infographic.

An Effective Ebola Vaccine Has Been Developed

Following a horrific epidemic in West Africa that claimed the lives of over 11,000 people — the deadliest the world had ever seen — we finally have a breakthrough vaccine against Ebola. As Vox.com reported:

Today, the same researchers — who hail from the World Health Organization, Guinea’s Ministry of Health, Public Health England, and other international partners — have unveiled their final results in the Lancet, and they’re just as remarkable. The vaccine was tested in a trial involving nearly 12,000 people in Guinea and Sierra Leone during 2015 and 2016. Among the 5,837 people who got the vaccine, no Ebola cases were recorded. By comparison, there were 23 Ebola cases in the control group that had not gotten the vaccine.

“This trial, confirming the 100 percent efficacy of the rVSV Ebola vaccine, is a simply remarkable outcome”, Dr. Jeremy Farrar, the director of the Wellcome Trust, said of the research. “We’ve shown that by working collaboratively, across international borders and sectors, we can develop and test vaccines rapidly and use them to help bring epidemics to an end”.

You can read the published study here. It was one of fifteen clinical trials for an Ebola vaccine conducted around the world in a single year, and is a vindication of what collective action and responsibility by the international community — including the U.N., NGOs, and national governments — can accomplish. It is a shame it took so many deaths spanning a nearly three year period to finally come up with a promising form of prevention, although the vaccine is far from ready to hit the market.  Continue reading

The Most Efficient Healthcare Systems in the World

According to the most recent Bloomberg Health-Care Efficiency Index, Hong Kong has the most efficient healthcare system in the world, a position it and close runner up Singapore have held since 2009. During the same span of time, Spain and South Korea climbed up to third and fourth place respectively, with Japan dropping two places but remaining at a very respectable fifth.

Here are the full results of all fifty-five countries measured.  Continue reading

The Problem With How We Treat Drug Addicts

The United States is facing an opioid and heroin epidemic that is killing and harming record numbers of people; more people died of overdoses in 2014 than in any other year on record.

One of the latest and most troubling images of this problem was a widely circulated photo of a couple passed out in their car with their four year old left watching from the back city. The City of East Liverpool, Ohio saw fit to share the photo on its Facebook profile to “show the other side of this horrible drug”. Continue reading

A Handy, Interactive Guide to Health Supplements

There has been a lot of hubbub over the last few years about most health supplements being useless, or at the very least irrelevant if one eats and lives healthy. If you want a quick and easy way to sort through all the different claims and misconceptions about purportedly health foods, herbs, and supplements, check out the “Snake Oil Superfoods” infographic over at Information is Beautiful, a website specializing in summarizing data of all kinds through gorgeous visuals.

screenshot-www.informationisbeautiful.net 2016-08-31 22-02-02

The efficacy of certain foods for certain conditions ranges from no evidence to strong evidence, with vast majority spanning the spectrum between slight evidence to inconclusive. The brighter the bubble, the better the evidence, with blue signifying items that are worth watching due to ongoing or game changing research. Depending  on  which category you choose, the size of the bubble reflects the superfoods popularity among either scientists or the general public. Clicking on each bubble will yield additional information and a link to the data, though you can find all the data utilized in the chart in this nifty spreadsheet here.

Of course, it is always better to consult as many varied sources as possible, but this is definitely a comprehensive — and more stimulating — place to start.

 

 

What’s Healthy and What’s Not?

As many fellow health buffs will no doubt attest to, it is often very difficult to get a consistent idea of what is healthy and what isn’t. Not only do laymen often disagree vehemently with one another — everyone has their own anecdote or folk remedy to swear by, science be damned — but it seems that not a month goes by without some study finding contradictory evidence about the healthiness of a particular food or beverage, often turning back years or even decades of nutrition science (e.g., the recent revelation that fat may not be so bad after all, that eggs and coffee are good for you, and that salt and sugar are far worse than previously believed).

The New York Times drives home this point with an article about a study that polled both nutritionists and a sample of the American public to compare their thoughts regarding some common nutrition battlegrounds. Unsurprisingly, the results showed a big gap between experts and everyone else, as well as revealing divisive views within each community, too.  Continue reading

The Problem With Early School Days

The vast majority of public schools in the U.S. start earlier than 8:30 a.m. Like most American students, I took this as a given, albeit begrudgingly — we all struggled to get up and get focused for school, and it only got harder with each passing year. Naturally, many people chalk this up to the laziness and entitlement of adolescence. But mounting scientific research is finding that getting up really early, and being thrown into a cognitively-intensive bloc schedule, is bad for both the health and education of youth. Various leading public health authorities are urging an end to this practice. Continue reading

Can and Should Governments Promote Happiness?

Back in February, the United Arab Emirates announced the creation of a “minister of state for happiness” that would “align and drive government policy to create social good and satisfaction”, whatever that means. (The same statement announced the creation of minister for tolerance, perhaps in response to the country’s rapidly growing multicultural population.)

Needless to say, the idea of a “happiness minister” was met with a lot of confusion and amusement, both from within the country and beyond. What does it means to promote happiness on a policy level? What would this entail? And should governments even take it upon themselves to worry about this?

As The Washington Post points out, the U.A.E. is only the latest of several countries to go this route. Both Ecuador and Venezuela announced similar initiatives in 2013 — a state secretary of “good living / well-being” and a “vice ministry of supreme social happiness”, respectively — and the small Himalayan nation of Bhutan pioneering the concept back in 1972 with its “gross national happiness” (GNH) index.

In theory, these ministries work to try to improve the levels of happiness in the countries through a variety of policies. David Smilde, a senior fellow at the Washington Office on Latin America, says that despite its grandiose name, Venezuela’s ministry actually has a “pretty reasonable mandate” – measuring the effectiveness of the government’s various social welfare programs. In Ecuador, Ehlers has implemented or plans to implement a variety of policies that included both labeling foods based on their health values and meditation classes for schoolchildren, the Miami Herald reported last year.

Bhutan’s GNH measure is especially interesting, as it was devised to shift public policy focus away from economic concerns — as signified by the near-universal interest in gross domestic product (GDP) and towards promoting several components of happiness, such as mental and physical health, leisure time, and standard of living.

While there is no minister directly responsible for happiness in the tiny Himalayan nation, the Gross National Happiness Commission is tasked with surveying the levels of happiness in the nation. The information they gather is then used by the government to make decisions.

Butan’s big idea has since proven popular around the world and now a variety of countries all around the world – including Thailand and the United Kingdom – have begun measuring happiness with an aim to using it to devise policy. Dubai actually announced plans for its own Happiness Index in 2014, with Hussain Lootah, director general of the municipality, telling the National newspaper that it would be designed to “create an excellent city that provides the essence of success and comfort of sustainable living.”

Interestingly, despite leading the way in prioritizing social well being as government policy, Bhutan’s performance has been mixed at best: according to the most recent U.N. World Happiness Report, which was inspired by the GNH idea, the country ranks only 79th out of 158, not terrible but not all that great. Bhutan has also dealt with faced issues such as pervasive poverty and discrimination against non-Buddhist minorities.

Believe it or not, the same U.N. report ranked Venezuela a respectable 44th in 2016, a significant drop since 19th in 2012, when the Orwellian-sounding “vice ministry of supreme social happiness” was created. Given the country’s plethora of social, economic, and political problems — ranging from food shortages to high crime — this decline is unsurprising, though still not as damaging as one would think.

For their part, Bhutan ranked 84th, the U.A.E. 28th, and Ecuador 51st. (Wikipedia has a great breakdown of the report’s results and methodology here.) As The Post points out, the top ten countries — all of which were northern European states and small Anglophone nations — had another thing in common besides being wealthy liberal democracies:

None of the top 10 countries rated “happiest” in the U.N. report have a government ministry devoted to happiness – although given the rarity of such ministries, it’d be very surprising if they did. There’s certainly little doubt that government policies can influence levels of happiness, but whether an entire ministry is needed is not so certain. Generally, when it comes to improving levels of happiness, “what matters is how things are done across government as a whole,” says John Helliwell, a co-editor of the World Happiness Report and a senior fellow at the Canadian Institute for Advanced Research. And Carol Graham, a fellow at the Brookings Institution who has studied attempts to measure well-being, says that the creation of ministries for happiness can be a “diversion” and may even “border on the government telling people how to be happy or that they should be happy.”

And while most of the top nations were indeed highly developed, broadly prosperous states, there was a smattering or poorer or middle-income countries, such as Costa Rica (14th place), Puerto Rico (15th), Mexico (21st), Chile (24th), and Panama (25th). It goes to show that, as with individuals, there is no magic bullet when it comes to well-being and life satisfaction.

Granted, it seems to be the general rule that financial wealth, stability, and freedom — both on an individual and societal level — generally correlates with happiness. But values, community life, leisure time, and culture count for a lot, too; people or places that are lacking in some factors, but excel in others, might still end up happier on the whole.

In my view, the best thing governments can do is create the proper conditions within which happiness can thrive — effective rule of law that safeguards personal safety and stability, less intrusion into civil liberties, more public spaces for leisure and community engagement, and so on. In other words, cultivate a physical and social environment that maximizes the individual’s ability to improve their own well being. More proactive measures, such as making healthcare and education more accessible, would certainly help, too, but this could be politically unpalatable in places wary of government intrusion, like the U.S. (which, by the way, ranked a good 13th place in the U.N. happiness report.)

What are your thoughts?

 

The Absurd Inefficiency of American Healthcare

If you want an idea of just how absurdly unjust and inefficient the U.S. healthcare system is, read this breakdown by Seth Ackerman of Jacobin of what the average American must navigate in order to access a high-tier but vital drug.

The bestselling blockbuster drug on the U.S. market is Humira, an anti-inflammatory biologic manufactured by Abbott Laboratories and approved by the FDA in 2008. Humira is classified as a “fourth-tier drug” (a cutting-edge specialty drug); it’s used for inflammatory conditions like rheumatoid arthritis and Crohn’s disease. It goes without saying that these can be awful and stressful illnesses to live with.

Currently the U.S. retail price of Humira (2 syringes of 40mg/0.8ml) is around $3,500. That’s how much you’ll have to pay for the drug if you don’t have insurance. Good luck.

But what if you do have insurance? (And remember, 27 million will still be left uninsured when Obamacare is fully implemented.) Well, you might be among the 15 percent of workers with employer-provided insurance whose plans nevertheless don’t cover specialty drugs at all. If so, again, you’re out of luck.

Or you might be one of the 34 percent of employer-covered workers who face “co-insurance” for fourth-tier drugs, which means you’ll have to pay a certain percentage of the drug’s cost. The average co-insurance rate for these workers is 32 percent. So, absent any overriding plan provisions, the Humira would cost you $1,120.

Then there are the 40 percent of covered workers whose plans charge co-payments for fourth-tier drugs, rather than co-insurance — a fixed dollar amount, rather than a percentage of the cost. The good news here is that the average copayment is $93. (Though, of course, some plans have much higher copayments.) That doesn’t sound so bad, right?

Don’t get too excited, though. After all, you might be one of the 12 percent with a separate prescription drug deductible, which means you have to foot the entire bill until you reach a certain threshold. The average drug deductible is $231 per year — but, again, your mileage may vary considerably. And although your insurance will kick in once you’ve paid that much, in almost all cases you’ll still have to cough up co-payments or co-insurance.

And don’t forget, you’re also paying premiums every month — $521 for single coverage on average. That’s more than 20 percent of the average wage for single, childless workers with employer insurance.

And that’s not all. Almost half of employer plans that cover specialty drugs employ a variety of additional special strategies for “saying no” when it comes to fourth-tier medicines. Some have an additional cost-sharing tier for these drugs. Others impose “tight limits on the number of units administered at a single time”, or mandate “step therapies”, where they make you take cheaper treatments before they’ll pay for the expensive drug  — even if your doctor is sure it’s the best one for you.

Then there’s the infinite variety of “utilization management programs” that appear the instant you request such drugs: special surveillance regimes that find creative and innovative ways of making sure you don’t splurge too much on your life-saving medicine. Often these make people’s lives a living hell.

Contrast this confusing, costly, and inequitable arrangement with that faced by the average French citizen, who enjoys the benefit of what many analysts identify as the world’s best healthcare system (a mix of private and public sector providers).

The French equivalent of the “retail” drug price is called the prix public, or public price — the sum that Abbott is actually paid for the drug, plus sales tax. The public price of Humira in France (same dose, same strength) is not $3,500 (as it is here) but €940.90 ($1,028).

Why the difference? Here’s an explainer from the website of a French online pharmacy directory:

“The price of medications covered by national insurance is not a free-market price, it is set partly by the Economic Committee for Medical Products (ECMP), after negotiations with the manufacturing pharmaceutical laboratory. In case of disagreement, the ECMP, which is a government body, has the final say.”

In reality, though, no one in France pays even $1,028. National insurance covers, at minimum, 65 percent of the public price. Thus, the most a French patient would pay for Humira is $360.

Now, that’s still a lot of money for a person of modest means. But we’re not done yet. Patients who need drugs to treat serious, chronic illnesses like diabetes, hypertension, or cancer don’t have to pay a thing. A full 6.8 percent of the French population fall into this category, and another 1.7 percent are exempted for other reasons (newborns, pregnant women, the disabled, nursing home residents, etc.).

And, as it happens, rheumatoid arthritis and Crohn’s disease, two of the main chronic conditions Humira is used to treat, appear on the list of diseases that qualify for an exemption.

[…]

The “no” imposed on Abbott saved French taxpayers about $2,500 per Humira prescription – the difference between the “market price” (i.e. the U.S. retail price) and the price fixed by the French Health Ministry. By comparison, the “no” handed down to you, the patient, requiring you pay 35 percent, saved taxpayers only an additional $360.

By this (admittedly partial) reckoning, more than 87 percent of the taxpayer savings generated by France’s “Saying No Apparatus” (as it were) came out of the pockets of Abbott’s shareholders. Only 13 percent came out of the patient’s.

This sobering tidbit is part of a much longer and somewhat meandering piece analyzing the viability of a single-payer healthcare system in the U.S., including some of the weak critiques and counter-arguments of such an approach. The whole article is well worth your time if you care about healthcare reform and want to know how and why a better alternative would work.