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

Video: How We Think About Death And Honor Life

It is long been observed that it is not so much death that scares people, but the act of dying. Whereas the moment of our demise is, far as we can tell, painless, the hours, days, or even months leading up to that point can be painful in both a physical and emotional sense.

To that end, palliative care expert and physician BJ Miller leads a powerful TEDTalk that challenges us to think about how we handle those approaching death — namely, by making the medical system less focused on curing diseases and more oriented towards the overall wellness of patients. That means providing more comfort, dignity, and even “play” to the lives of the dying.

The seminar is well worth viewing in its entirety below.

To read a transcript of the above TED Talk, click here.

Given the rapidly growing ranks of the world’s elderly, who will make up the bulk of those requiring palliative care, Miller’s point could not be any more salient. I imagine that as populations around the world continue to age, matters of death and how we ease into it will become more prevalent topics of discussion.

What are your thoughts?

The Unknown Chinese Woman Who Helped Find a Treatment for Malaria

Among the three scientists awarded the 2015 Nobel Prize in Physiology or Medicine for work against parasites was Tu Youyou, an octogenarian pharmacologist whose work led to the development of the most effective treatment against malaria. But despite her invaluable role in saving millions of lives from this public health scourge, her contributions remained largely unknown, even in her own homeland.

Vox.com recounts the amazing story that led up to her breakthrough discovery.

In 1967, Chairman Mao Zedong set up a secret mission (“Project 523”) to find a cure for malaria. Hundreds of communist soldiers, fighting in the mosquito-infested jungles of Vietnam, were falling ill from malaria, and the disease was also killing thousands in southern China.

After Chinese scientists were initially unable to use synthetic chemicals to treat the mosquito-borne disease, Chairman Mao’s government turned to traditional medicine. Tu, a researcher at the Academy of Traditional Chinese Medicine in Beijing, had studied both Chinese and Western medicine, according to a New Scientist profile, and was hand-plucked to search for an herbal cure.

By the time I started my search [in 1969] over 240,000 compounds had been screened in the US and China without any positive results,” she told the magazine. But, she added: “The work was the top priority, so I was certainly willing to sacrifice my personal life.”

Tu’s dedication included first testing the promising treatment on herself, to ensure that it was safe. Once it was proven to have no side effects, she organized clinical trials for people with malaria, all of whom were incredibly cured of the disease within no more than a day. Continue reading

Cancers Cells Programmed Back to Normal

News about the next big breakthrough in cancer treatments are a dime a dozen. But this particular achievement seems worthy of hype and attention. Here is hoping its results can be further verified and replicated.

According to the Telegraph:

For the first time aggressive breast, lung and bladder cancer cells have been turned back into harmless benign cells by restoring the function which prevents them from multiplying excessively and forming dangerous growths.

Scientists at the Mayo Clinic in Florida, US, said it was like applying the brakes to a speeding car.

So far it has only been tested on human cells in the lab, but the researchers are hopeful that the technique could one day be used to target tumours so that cancer could be ‘switched off’ without the need for harsh chemotherapy or surgery.

“We should be able to re-establish the brakes and restore normal cell function,” said Professor Panos Anastasiadis, of the Department for Cancer Biology.

The scientists discovered that the glue which holds cells together is regulated by biological microprocessors called microRNAs. When everything is working normally the microRNAs instruct the cells to stop dividing when they have replicated sufficiently. They do this by triggering production of a protein called PLEKHA7 which breaks the cell bonds. But in cancer that process does not work.

Scientists discovered they could switch on cancer in cells by removing the microRNAs from cells and preventing them from producing the protein.

And, crucially they found that they could reverse the process switching the brakes back on and stopping cancer. MicroRNAs are small molecules which can be delivered directly to cells or tumours so an injection to increase levels could switch off disease.

As always, medical experts are rightly cautious about the results, noting that there is still quite a gap between cells grown in a laboratory and those of a human with cancer. Nevertheless, this is a big step forward, and presents yet another promising approach to consider in combating this scourge.

The Ice Bucket Challenge Bears Fruit

Amid a fair amount of skepticism and uncertainty — including, to some degree, by yours truly — it appears that the ALS ice bucket challenge that went viral some months ago has literally paid off:

According to Vice’s Mike Pearl, the $100 million in funding the challenge generated has led to breakthroughs in our understanding of what causes ALS and how it can be treated. Researchers now report that ALS — a fatal neurodegenerative disease that causes the muscles in the body to deteriorate — is caused by a defective protein, and stem cell therapy has shown promising results in lab tests.

Jonathan Ling, medical researcher at Johns Hopkins, stated in a Reddit AMA that funding from the ALS Ice Bucket Challenge has been instrumental in helping scientists break new scientific ground.

“All of your donations have been amazingly helpful and we have been working tirelessly to find a cure,” Ling wrote.

An infographic from The ALS Association, the global leader in ALS research that received the funds, breaks it down thusly. Continue reading

Less Than a Minute of Nature Can Boost Health

The Atlantic reports on yet another study confirming the benefits of exposure oneself to nature, even for literally a glimpse.

A nice walk through a city park can do wonders for a work-weary brain, reducing mental fatigue and improving attention. But if you’re trapped on the high floors of an office tower all day, you can’t exactly break for a long stroll and a picnic. Well, fear not. If you have a view of a nearby green space, like say a green roof, and even just a minute to spare, you can reap some of the same refreshing benefits of urban nature.

That’s the upshot of a new paper from an Australia-based research team set for publication in the Journal of Environmental Psychology. Their work has found that even taking just 40 seconds to focus on a view of nature can boost “multiple networks of attention”—sharpening your mind to handle the next task dealt by the work day. They call it a “micro-break,” and it turns out your brain loves it:

You can read the details and methodology of the study in the article, but it is certainly not the only research to confirm the importance of nature to human well-being:

The findings certainly fit with all that social science has found in recent years about the restorative power of nature. Whether it’s a walk through a park, a stand of trees out the window, or a mere desk plant, natural views give the working brain a breather—to varying degrees—by engaging our involuntary attention centers. The new conclusion that greenery might work its magic in mere minutes is an especially intriguing prospect in a fast-paced work world. And if green roof simulations were replaced with the real thing, the performance outcomes in the current study might even have been stronger.

I can certainly vouch for this by personal experience. From my regular bouts of anxiety and depression, to good old fashioned work-related stress, pausing for just a moment to focus on my desk plant, visit my garden, or take a stroll through a nearby park has done wonders.

I am glad to work just blocks away from a beautiful public park (and more glad that my job lets me take regular walk breaks). Since I have incorporated this practice into my daily routine, I have seen a notable decline in both the frequency and severity of stress, fatigue, and sadness (although other lifestyle and dietary changes have continued to that as well).

But a few minutes is all it takes to try this out and see the difference.

How Mindfulness Can Help Depression

Mindfulness meditation is one of the biggest trends in both medical and New Age circles. It broadly describes a form of mental training in which one deliberately focuses on emotions, thoughts, and sensory experiences of the present moment. Though it has roots in various religious traditions both Western and Eastern (especially Buddhism), it has long been observed to have secular applications as well, and the practice itself does not require any particular religious ritual or component.

There has been a lot of research showing that mindfulness, like meditation as a whole, has tangible mental and physical health benefits. The most recent study to confirm the benefits of “mindfulness-based cognitive therapy (MBCT)”, as it is known in medical parlance, was published in The Lancet, a leading medical journal. As Al Jazeera reported:

In this study, 424 adults in England with recurrent major depression, who were on maintenance antidepressant drugs, were randomly assigned to go off their antidepressants slowly and receive MBCT or to stay on their medication.

Study results published showed that after two years, relapse rates were similar in both groups — 44 percent in the therapy group versus 47 percent in the antidepressant drug group.

“Mindfulness gives me a set of skills which I use to keep well in the long term”, Nigel Reed, a participant in the study, said in a statement. “Rather than relying on the continuing use of antidepressants, mindfulness puts me in charge, allowing me to take control of my own future, to spot when I am at risk and to make the changes I need to stay well”.

The researchers said that while they found no evidence that [mindfulness] was superior to the use of antidepressants in preventing relapse, they said “both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms and quality of life”.

“We believe these results suggest a new choice for the millions of people with recurrent depression on repeat prescriptions”, Kuyken said.

I can personally vouch for the effectiveness of this approach, although it is worth reiterating that this is just one of several ways to combat depression, and by no means is it a wholesale replacement of other therapies (indeed, it is usually complementary).

Solutions will always vary from individual to individual, but with the rate of depression growing across the world, any new options on the table will certainly help; moreover, mindfulness techniques are beneficial to overall wellness, not just as a therapy for depression.

Study: Sixty Is Now Middle Age

As humans live longer than ever, it is not surprising that what we define as middle age is also shifting upwards.

A study conducted by researchers from the International Institute for Applied Systems Analysis (IIASA) and Stony Brook University confirmed this, as HuffPo reports:

The researchers used projections of Europe’s population until the year 2050 to look at how an increasing life expectancy changes the definition of “old.” They used different rates of increases, ranging from a stagnant life expectancy to one which grew 1.4 years per decade, to look at the portion of the population who was considered to be old. They looked at both the conventional definition, which considers people over age 65 old, and a new measure, which advances the threshold for old age as overall life expectancy grows.

The findings, published in the journal PLOS ONE, say that as the life expectancy increased with the new measure of old age, the proportion of older people in the population continually fell. The researchers say that we must adjust the threshold we use to determine old age, otherwise the proportion of older people will grow as life expectancy increases.

“What we think of as old has changed over time, and it will need to continue changing in the future as people live longer, healthier lives,” Scherbov said.

It is amazing to live in a time when humans are pushing the limits of both longevity and quality of life: not only are we adding more years to our time on Earth, but we are increasingly managing to maintain relatively healthy mental and physical faculties (especially with regards to Blue Zones and other countries where centenarians are increasingly common).

Given the rapid gains in medicine, nutrition, and public health, who knows how much longer and better people will continue living over the course of the 21st century.

The Shortcomings of Nutritional Science

It seems we cannot go a week without scientific and medical institutions (or even the wider public) flip-flopping on the healthiness or unhealthiness of particular foods. Slate explores what this often chaotic and confusing state of affairs says about nutrition science and its present limitations.

The takeaway from the potato controversy is not that lobbyists sometimes base their campaigns on real science. Rather it’s that the David-and-Goliath narrative of science versus Big Ag may be blinding us to another, even bigger problem: the fact that there is often very little solid science backing recommendations about what we eat.

Most of our devout beliefs about nutrition have not been subjected to a robust, experimental, controlled clinical trial, the type of study that shows cause and effect, which may be why Americans are pummeled with contradictory and confounding nutritional advice. Nutritional bad guys that have fallen from grace in the national consciousness—white potatoes, eggs, nuts, iceberg lettuce—have been redeemed years later. Onetime good guys, like margarine and pasta, have been recast as villains. Cholesterol is back in the probably-won’t-kill-you column after being shunned for 40 years, as of the latest nutritional advice from the Dietary Guidelines Advisory Committee in February. (That advice was still too timid, according to Cleveland Clinic cardiologist Steve Nissen, who also wants the nutritional guidelines to admit our best evidence suggests fat isn’t bad for you either). And then there’s salt—don’t eat too little, says the newest research. You could die…

…Many nutritional studies are observational studies, including massive ones like the Nurses’ Health Study. Researchers like Willett try to suss out how changes in diet affect health by looking at associations between what people report they eat and how long they live. When many observational studies reach the same conclusions, Willett says, there is enough evidence to support dietary recommendations. Even though they only show correlation, not cause and effect, observational studies direct what we eat.

Apart from their inability to determine cause and effect, there’s another problem with observational studies: The data they’re based on—surveys where people report what they ate the day (or week) before—are notoriously unreliable. Researchers have long known that people (even nurses) misreport, intentionally and unintentionally, what they eat. Scientists politely call this “recall bias”.

The coupling of observational studies and self-reported data leads some observers to the conclusion that we know neither how Americans do eat nor how they should eat. A recent PLOS One article even suggests that several national studies use data that is so wildly off base that the self-reported caloric intake is “incompatible with survival”. If people had eaten as little as they reported, in other words, they would be starving.

Peter Attia, a medical researcher and doctor, started questioning the basis of dietary guidelines when he saw that following them didn’t work for his patients. They didn’t lose weight, even when they virtuously stuck with their diets. When he took a look at the research supporting the advice he was giving to his patients, he saw shoddy science. Attia estimates that 16,000 nutritional studies are published each year, but the majority of them are deeply flawed: either poorly controlled clinical trials, observational studies, or animal studies. “Those studies wouldn’t pass muster in another field”, he told me.

It is little wonder that quackery, ignorance, and deceit are increasingly taking hold of people’s health decisions. Not only does all this contradictory or ambiguous evidence make room for all sorts of unverified or dangerous claims, but they erode public trust in science and medicine — even if specialists finally get something right with certainty, they will likely be met with incredulity or apathy.

It is not unlike how the inefficiencies of the U.S. health care system, combined with the predations of big pharmaceutical companies, taints evidence-backed medicine as a whole and sends people into the arms of frauds and scammers. With distrust of institutions and authoritative bodies — political, academic, and religious — at an all time high, it seems health and lifestyle choice will be increasingly determined by individual fiat, errors in reasoning, anecdote, or other unreliable bases.

Of course, this is not to condemn all scientific bodies or the scientific approach as a whole. The article makes clear that while a lot of the misconceptions around nutrition and health are attributed to “shoddy” research, various psychological biases, as well as the sheer complexity of measuring all the variables involved with health, make the endeavor a difficult one to pursue in itself.

Ultimately, nutrition science is still a new and burgeoning field of study, and I trust that it will be self-correcting in time, especially now that both the public and establishment are scrutinizing these problems. But while we try to work out better and more reliable ways to learn about what is good for our bodies, there are going to be a lot of mistakes — and outright fakery — made.

Moreover, let us not overstate the problem: while the minutiae and other details are an open questions, there are still general rules that seem to hold true: smoking cigarettes is broadly unhealthy, a plant-centered diet is generally the healthiest, regular physical activity is beneficial, and so on. Of course, we will have to see what more can be said about such conventional health wisdom.

The Greedy Hospitals That Drive Up Healthcare Costs

There are no shortage of culprits in America’s expensive yet, at best, average healthcare outcomes. But chief among them, despite getting comparatively less attention compared to insurers, are hospitals. As Slate reports:

The health sector employs more than a tenth of all U.S. workers, most of whom are working- and middle-class people who serve as human shields for those who profit most from America’s obscenely high medical prices and an epidemic of overtreatment. If you aim for the crooks responsible for bleeding us dry, you risk hitting the nurses, technicians, and orderlies they employ. This is why politicians are so quick to bash insurers while catering to the powerful hospital systems, which dictate terms to insurers and have mastered the art of gaming Medicare and Medicaid to their advantage. Whether you’re for Obamacare or against it, you can’t afford to ignore the fact that America’s hospitals have become predatory monopolies. We have to break them before they break us.

What do I mean by that? Last fall, Mark Warshawsky and Andrew Biggs made a striking observation: From 1999 to 2013, the cost to employers of an average family health policy increased from $4,200 to $12,000 per year. In an alternative universe in which employer premiums had remained flat, salaries would have been $7,800 higher, a life-changing difference for most low- and middle-income families. To protect these families, many people want the government to pick up a bigger share of our hospital bills. But this just shifts the burden from employers to taxpayers. The Congressional Budget Office expects federal health spending to almost double as a share of GDP between now and 2039. With the exception of interest on the debt, all other federal spending will shrink. What this means in practice is that high medical prices charged by hospitals will gobble up taxpayer dollars that might otherwise have gone to giving poor people more cash assistance, welfare-to-work programs, and Pell grants; fixing potholes; sending missions to Mars; and who knows what else.

When you survey the health systems of other rich countries, you’ll find some that rely a bit more on private insurance markets than ours (like Switzerland) and others that rely a bit more on centralized bureaucracies (like Britain), but what you won’t find is a country where hospitals dare to charge such obscenely high prices. Avik Roy, a senior fellow at the Manhattan Institute and a conservative health reform guru, has observed that although the average hospital stay in the world’s rich countries is $6,222, it costs $18,142 in the U.S. Guess what? Spending three times as much doesn’t appear to yield three times the benefit.

And while both private and public insurance schemes are far from flawless, their efficiencies and improprieties are also, at least in part, driven by the power of hospitals:

When insurers have tried to play hardball with the hospitals that gouge them, as in the 1990s, when managed-care organizations kept rising healthcare costs in check for a few short years, hospitals pressured state legislatures to enact “selective contracting” and “any willing provider” laws that impeded MCOs from steering patients to facilities where they could negotiate good rates. Moreover, MCOs can’t do much if a local hospital buys up all of the nearby medical providers.

But wait a second. How is it that hospitals are also gouging Medicare? Medicare alone accounts for 20 percent of all national health expenditures, a number that, if anything, understates the extent of its influence. Shouldn’t Medicare be able to use its pricing power to get hospitals to play ball? Medicare offers standardized reimbursement rates for different services, which hospitals always insist are far too low. Yet for some routine medical procedures, the reimbursement rate is higher than the cost of performing the procedure (which, once you already have the equipment and the personnel, can be pretty low), meaning the hospital makes money off of the procedures. For other services, like giving a patient personal attention, the reimbursement rate is lower than the cost of providing the service, so this is where hospitals skimp. The unsurprising result is that we have a health system that is increasingly devoid of personal attention while at the same time generating an ever-higher volume of the medical procedures for which Medicare is willing to overcompensate.

As hospitals continue to merge and acquire competitors (including the less expensive office-based practices), this problem is likely to only get worse in the coming years. The solution? Well, here are two offered by a law professor cited in the Slate piece:

Our government can simply accept that the market power of hospitals will continue to increase while making more of an effort to force them to accept low reimbursement rates. This approach is certainly worth trying, yet it ignores the fact that because hospitals are big employers, they wield a great deal of political influence. Whenever bureaucrats try to tame hospitals, lawmakers ride to the rescue of the big medical providers.

The second path is to rely on antitrust enforcement to crack down on hospital mergers and acquisitions and, more importantly in the long run, to make it easier for new medical providers to enter the business and to compete with hospitals. Naturally, hospitals hate this kind of competition, particularly from specialized providers that focus exclusively on providing one or two medical services inexpensively. To the hospitals, these providers “cherry-pick” and “cannibalize” their most profitable business lines without ever having to take on the larger burdens of running hospitals. There’s some truth to these complaints, which is why governments should compensate hospitals directly for care that it wishes to subsidize. But we need smaller, more efficient competitors to keep the big hospitals in check and to drive down medical costs for society as a whole.

Curbing the power of the big hospitals isn’t a left-wing or a right-wing issue. Getting this right will make solving all of our health care woes much easier, regardless of where you fall on the wisdom of Obamacare. Let’s get to it.

Indeed, everyone should have an interest in reigning in on these oligarchic and predatory practices, whether to create a freer and more cost-effective market for medical care, or to subsequently expand access to such care among the less wealthy. Granted, hospitals are but one of several factors, but judging from the data cited in this article, they are a major player.

Thoughts?