Archive for the ‘News and Trends’ Category

Emerging Antimalarial Drug Resistance – Cause for Alarm

Tuesday, February 9th, 2010 by Frank Gillingham, MD

A report released yesterday by a United States Pharmacopeia program, in partnership with the World Health Organization, cited an increasing level of resistance to Artemisinin – the last affordable drug in the global arsenal against malaria.  The drug resistance is emerging in Uganda, Senegal, Madagascar, Cambodia, Thailand and Vietnam, and is thought to be due in large part to the sale of poor quality versions of Artemisinin in those countries.

The report indicated that between 16 and 40 percent of the drugs marketed as Artemisinin had impurities or did not contain enough active ingredient to be effective.  Drugs will typically lose effectiveness and allow parasites to develop resistance if not given at full strength or for the full recommended course. In the case of malaria, there is no useful replacement for Artemisinin currently available, and many could die or become gravely ill if the current trend continues.

“It is worrisome that almost all of the poor quality data that was obtained was a result of inadequate amounts of active ingredient or the presence of impurities in the product” said Patrick Lukulay, the director of the study.  Senegal had the most disturbing results, with over 40% of the Artemesisin based samples failing quality testing. Lukulay added “There are some countries where donated medicines are not subjected to quality controls, they are just accepted”.  This includes countries in Africa where Chinese products have been given and found later to be unacceptable.

Although results from other countries in the ten country study have not been released, preliminary evidence from the other countries surveyed – Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania suggest that failure rates in at least three of those countries were also high. 

Traditional antimalarial drugs such as malarone, doxycycline, chloroquin and mefloquin are still effective in many parts of the world where the malaria parasite is endemic.  In recent years, Artemesinin has been the last resort in areas where the parasite has developed resistance to these medications. However, for those travelling to sub Sahara Africa or southeast Asia, the risk of contacting Artemesinin resistant malaria is growing.  Although resistance is not yet widespread, it behooves the careful traveler to make sure that any Artemesinin based medication taken for treatment of a malaria infection is of good quality.

Photo info: http://www.flickr.com/photos/lonqueta/ / CC BY-NC-SA 2.0
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Notes from an HTH Physician in Port-au-Prince

Friday, January 15th, 2010 by Laura Hilton

Dr. Scott Nelson, a U.S. Board Certified Orthopedic Surgeon and HTH provider, has been practicing in Santo Domingo, Dominican Republic for several years.  In conjunction with CURE International, he is leading a team of Dominican orthopedic surgeons to provide  medical services to victims of the earthquake.  Dr. Nelson and his colleagues arrived in Port-au-Prince January 14th

January 20, 2010

FYI: the aftershock was a big one, but all is still ok with our CURE team!

January 19, 2010

Our team has done 75 surgeries so far at the Hôpital de la Communauté Haitienne. The entire CURE International group, from the headquarters all the way to the team on the ground in Port-au-Prince is organized and working well.

CURE has also facilitated an 18 person team from Texas to work at the Centre Hospitalier du Sacre-Coeur in Port-au-Prince. Due to the concern of aftershocks toppling certain sections of the hospital, additional ORs had to be created. This team divided an open room ER into 3 ORs; literally set up an OR in the hallway and also set up an OR using a radiology room. Overall, this team performed over 300 operations, including 40 amputations and more than 100 cast/splintings in just 48 hours.

Tomorrow and Thursday, CURE will be sending more than 25 medical, anesthesia, nursing and administrative professionals and a substantial amount of donated orthopedic equipment and supplies to further care for the Haitian people.

There are now hundreds of medical volunteers in Port au Prince – many independent, from a wide range of countries, organizations and backgrounds. There are now many medical supplies in at least 3 hospital sites in Port-au-Prince, where most of these volunteers are. There is no centralized coordination mechanism for administering medical care at this point in time – everyone is working together, working hard and doing everything they can.

January 18, 2010

The electric company of the Dominican Republic has donated a generator and a container, which the CURE hospital in Santo Domingo is filling with supplies and clean clothes for Dr. Nelson and the team.

In the last 48 hours, we were able to take the Hôpital de la Communauté Haitienne from an indescribable battlefield state, with almost no doctors and nurses and supplies, 2 ORs not doing surgery, and utter chaos…to over 100 foreign docs and nurses, 7 ORs, an ICU, stocked supply room and life-saving surgery 24 hours around the clock!

January 15, 2010

“The first hospital we visited was not equipped to do orthopedic surgery even under normal conditions. We then went to Hôpital de la Communauté Haitienne, a 75 bed community hospital in Freres near Delma. There are many orthopedic cases filling the parking lot and patio, as everyone is too scared to be inside a building.  We are mobilizing now.”

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Haiti In Agony

Wednesday, January 13th, 2010 by Moira Bishop

Just take a moment.

We woke up this morning to the horrifying images of the earthquake that hit Haiti last night. The scope of it is too large to grasp, and many people are trying to make sense of the loss and destruction, wondering whether any hope lingers over the city of Port-au-Prince today.

Some people are scrambling to find information on family members living in Haiti, and others are struggling to find a way to help.  The Haitians who survived the earthquake and the aftershocks are now grappling with loss on an enormous scale, grieving for friends and family and exposed to the elements without clean water or shelter.  So today and in the days ahead, take a moment to reflect that regardless of your situation, you should be grateful for what you have. Take a moment to pray that these people will find comfort and hope. Take a moment to donate more than you may be comfortable giving.   Just take a moment.

(A quick search on the internet turned up several outlets for donations such as The Red Cross, Global Giving and this detailed list from ItsJustLight.com.)

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Jet Lag — the Target of the Latest Lifestyle Drug

Friday, January 8th, 2010 by Moira Bishop

If you could take a pill to manage your jet lag, would you?  Would it be worth the possibility of dealing with headaches, nausea, dizziness or insomnia as side effects?   Would you be willing to pay more than $9 per dose for this remedy?

Healthy travel takes more than packing a first aid kit and getting the destination-specific vaccinations that you need.  It also includes putting into practice some preventative measures that will keep the journey from wearing down your body and immune system.  This is particularly important if you are traveling overseas, as jet lag can leave your mind fighting to catch up with your body’s cycle the whole duration of your trip.

Now, pharmaceutical company, Cephalon, Frazer, PA, has submitted a jet lag solution to the Food and Drug Administration (FDA) for approval.  The drug is an existing product, Nuvigil, which is used to treat serious sleep disorders and requires a prescription.  According to a news release from Cephalon, this drug offers “improved wakefulness in patients with excessive sleepiness associated with jet lag disorder due to eastbound travel.”   The New York Times reports that clinical trials did show improved levels of wakefulness for those given Nuvigil and that Cephalon is only seeking approval for this as a solution for eastbound travelers because the adjustment for westbound travelers is generally easier.  

Those travelers who only occasionally take an overseas flight might fight the effects of jet lag by following the common practices of upping their post-flight caffeine intake and taking melatonin supplements.  Business travelers and others who frequently travel overseas, however, might see Nuvigil as a valuable traveling companion.  The FDA is expected to complete its review by March 29, 2010; stay tuned for updates.

Photo by Heart Industry http://www.flickr.com/photos/heartindustry/ / CC BY-NC 2.0

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The Year, I mean, Decade In Review

Thursday, December 31st, 2009 by Andy Orr

I guess I drew the short straw.  Here it is the last day of the year, and I have been tasked with writing the pivotal year-end post.  Except that this year, it is the pivotal decade-ending post.  I realize that today is not the last day of the first decade of the third millennium.  As many others have pointed out, there was no year 0, so technically the year 2000 was the end of the second millennium, and we won’t complete the first decade of the third until the last day of 2010.  I will, however, go with the flow and cave in to the lower standard that seems to prevail in the mainstream media.

This decade was marked by many changes.  The Wall Street Journal’s article by Alan Murray titled “A 10-Year Dose of Reality” offered up a view focused on the economy and business with bubbles, scandals and global upheaval, but also highlighted that this decade saw the largest reduction in poverty ever, the emergence and growth of world-changing new technologies and the election of our first black president.  He also threw in Susan Boyle for good measure.

Given that the Healthy Travel Blog has somewhat of a focus (I have been accused of trying to derail this sometimes), I will address the advances we have seen in medicine in this decade.  I could also choose terrorism, travel security (somewhat in the news today), pandemics, climate change and natural disasters, but didn’t.

I am not going to reinvent the wheel when ABC News, in collaboration with MedPage Today, has already conducted a large survey and process to figure out the top 10 medical advances of the decade.  Their authoritative list is:

  1. Human Genome Mapping
  2. Doctors and Patients Harness Information Technology
  3. Anti-Smoking Laws and Campaigns Reduce Public Smoking
  4. Heart Disease Deaths Drop by 40 Percent
  5. Stem Cell Research: Laboratory Breakthroughs and Some Clinical Advances
  6. Targeted Therapies for Cancer Expand With New Drugs
  7. Combination Drug Therapy Extends HIV Survival
  8. Minimally Invasive Techniques Revolutionize Surgery
  9. Study Finds Heart, Cancer Risk With Hormone Replacement Therapy
  10. Scientists Peer Into Mind With Functional MRI

Items 1, 2, 5, 6 and 10 seem mostly focused on the future.  3, 4, 7 and 8 are in full force now, and 9 is really a finding that past practices had big unknown risks.  Number 7 stands out for me through a personal connection.  My brother-in-law, an internist in Philadelphia, has told me how great the change has been in the United States for patients with HIV/AIDS.  Instead of a ward filled with dying patients, he now treats patients with a chronic condition well-managed by a pharmaceutical cocktail.  Outside of the U.S. the biggest advances have been in the reduction of transmission rates.  New advances are being worked on with vaccines and gene therapy.

What do you think was the biggest advance in the last decade?  How about the biggest challenge for the future?  Let us know by leaving a comment, and we will follow up in more detail.

Here’s hoping that the next decade brings peace to the world and progress for all.  Happy New Year!

Photo: http://www.flickr.com/photos/wohinauswandern/4231050474CC BY 2.0

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More Happiness Data by Destination: Study Ranks States

Tuesday, December 22nd, 2009 by Mike Hartung

Louisiana is one of the happiest states in the U.S.The latest investigation into happiness by destination comes from Andrew Oswald of the University of Warwick (UK) and Stephen Wu of Hamilton College (NY) who have ranked all fifty states and DC using two data sets. One from the Centers for Disease Control compiles responses from 1.3 million Americans who were asked this: “How satisfied are you with your life?” The other is research conducted at the University of Southern California on indicators of quality of life such as sunshine, crime and environmental health. Surprisingly, Louisiana came out on top even in the aftermath of the Katrina disaster. And Mississippi is in the top six. At the bottom of the list? New York and Connecticut. There’s clearly little or no correlation with income per capita. The authors found a high degree of correlation between the subjective survey responses and the more objective indices. They speculate that “liberal angst” might be playing a role.

I’ve spent time in both New York City and New Orleans, and if we could measure the velocity of life, I think it would go a long way toward explaining these findings.

Photo: http://www.flickr.com/photos/philippeleroyer/ / CC BY-NC-ND 2.0
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Discover the Developing World’s Ten Best Ethical Destinations

Monday, December 21st, 2009 by Mike Hartung

The Earth Island Institute has published its 2010 Ethical Destinations Report at ethicaltraveler.org, shedding some light on the developing countries that have demonstrated the strongest commitment to environmental protection, social welfare and human rights. The report is a serious research effort to promote ethical travel: gaining an awareness of our impact and responsibilities as we explore the world. By all accounts it’s worth the trip. According to the authors, the countries cited represent “opportunities to experience nature at its most pristine, and to interact with local people and cultures in a meaningful, mutually enlightening way.” 

The authors have mined some of the best published data available to come up with this year’s Top Ten (see chart below). It’s interesting to find four South American countries, four African countries and two eastern European countries. Developing Asian nations did not make the list because of irresponsible development policies, human rights abuses and weak environmental policies. The comments we included in the chart are research findings measured against all countries of the world. These achievements are particularly impressive for nations without a long history of democracy. Though fledglings, these countries are ready to take flight as destinations for responsible travelers.

A handful of countries fell out of last year’s Top Ten: Costa Rica, Bolivia and Bulgaria have a growing reputation for child trafficking, and Nicaragua’s human rights record took a major step backward.

Do you have first-hand experience as an ethical traveler? The Healthy Travel Blog would like you contribute to this conversation.

ethicaltravelerchart

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The 787 Dreamliner – maybe not just in your dreams anymore

Wednesday, December 16th, 2009 by Andy Orr

787 DreamlinerToday is follow-up post day! 

Boeing’s hope for the future successfully completed its maiden flight yesterday.   The 787 Dreamliner, as mentioned here in November, has many new features that will improve passenger comfort.  We were most excited about the change in how it maintains cabin air pressure and how this benefits passengers through improved air quality.

Just as with the Fitbit Tracker, but infinitely more important to our economy, the Dreamliner has been beset by delay after delay during its development and testing period.  I hope that this first flight will help them get through the final testing phase and into ramped-up production.   They have a backlog of 865 on order – that’s equivalent to a little over 1.5 billion Fitbits (in dollars) and will definitely help put some people back to work.

Photo by: marada http://www.flickr.com/photos/marada/ / CC BY-ND 2.0

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Airline Safety for the Educated Consumer

Wednesday, December 16th, 2009 by Moira Bishop

airline safety2009 has not been a great year for air travel anywhere in the world.  Too often the headlines told of tragic accidents and not enough miracles.  This news is surely weighing on millions of global citizens booking flights for their holiday visits and vacations. 

We’ve offered perspective on travel associated risks in the past and the Book of Odds reminds us that the likelihood of being involved in any plane accident, let alone a fatal one, is extremely low.  However, the events of this year have even the most reasonable people wondering if there is something they should know before choosing their air carrier.

For those people, the Wall Street Journal recently published the results of the aviation safety reports published by the European Union (EU) and by the U.S. Federal Aviation Administration (FAA).  The data collection and evaluation processes are very different for each of these organizations. For instance the EU rates the safety of individual airlines, while the FAA evaluates countries as a whole. Overall, both reports take into account the history of accidents, policies and procedures, equipment and maintenance, but their criteria in each of these areas differ.

So if you want to feel like you have a little more control of your destiny, check the reports and book your flights accordingly. The Encyclopedia Britannica Blog reports, “airline safety declining, but still good.”  But it’s statistics like these that lead to the safety improvements necessary to create a safer product for everyone.  Remember that as you book your next trip.  By the way, if you happen to be planning a flight on British Airways for the holiday, you might want to monitor the status of the rumored strike set to take place December 22nd.

Photo by Tristan in Ottawa http://www.flickr.com/photos/tsmith22/ / CC BY-NC-ND 2.0
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Your Cerebral Leanings – Which Way Do You List?

Wednesday, December 2nd, 2009 by Andy Orr

Make a list!I started out today with the task of posting a short note about a cool new use for one’s mobile phone.  As Sarah Perez recently wrote at ReadWriteWeb, STAR Analytical Services received a Grand Challenges Explorations grant from the Bill & Melinda Gates Foundation to develop software that can make a diagnosis based on the sound of a cough on a mobile phone.  This will be especially useful in countries where mobile phones are rampant but doctors are not.

I thought I would make a quick connection between this mobile application and our posts on the Fitbit Tracker (and here) and telehealth, something vague about the intersection of technology and health care and the exciting new ways our lives will be affected by all this.

However, one twist led to another, and before I knew it, the kernel of an entirely new essay had developed.  As Paul Graham said in an essay titled The List of N Things:

“The main point of essay writing, when done right, is the new ideas you have while doing it. A real essay, as the name implies, is dynamic: you don’t know what you’re going to write when you start. It will be about whatever you discover in the course of writing it. “

It may be more than coincidental, but this essay turns out to be about lists.  The Grand Challenges grant is part of a program that has funded over 300 projects, all focused on a list of 14 major global health challenges.  This list is modeled after the famous list of 23 unsolved mathematical problems that David Hilbert posed back in 1900.  Just as Hilbert’s list encouraged innovation in mathematics research, the Grand Challenges is aimed at “engaging creative minds across scientific disciplines — including those who have not traditionally taken part in health research — to work on solutions that could lead to breakthrough advances for those in the developing world.”

These “unsolved problems” lists are diametric to what Umberto Eco recently wrote about in The Vertigo of Lists: mankind’s desire to catalog and list in an attempt to create order and understanding.  Or are they?  While one consists of questions (Hilbert et. al) and the other of answers (Eco), they mirror each other.  What is implied in a list of unsolved problems are the solved ones.  On the other hand, a “catalog” list is supposed to be all-encompassing, but can it ever be?  Its ostensible completeness is inherently incomplete.

Where is this going?  I have strayed from a relatively concrete concept (analyze the sound of a cough on a cell phone) to an abstract discussion that for me yields a simple conclusion: great things can be achieved through the simple use of lists.  By developing a list of 14 challenges focused on seven goals, the Gates Foundation has succeeded in catalyzing hundreds of projects with contributions from creative minds that had previously never worked on global health issues.

How can we solve the U.S. health care problem today?  Create a list of challenges or objectives, and let creative minds come together to solve them.  These problems will not be solved through legislation in a combative, political arena.  How can we clean up our planet and end war?  Make a list.

Photo by Kristian D. http://www.flickr.com/photos/kristiand/ / CC BY 2.0

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