Confirmed Link Between Chronic Infection And Immune-System Protein

The reason deadly infections like human immunodeficiency virus (HIV) and hepatitis C never go away is because these viruses disarm the body’s defense system. Researchers at the University of Alabama at Birmingham (UAB) have discovered that a key immunity protein must be present for this defense system to have a chance against chronic infection.

Research up to now has tried but failed to decipher the cross-talk between ‘killer T-cells’ and ‘helper T-cells’ in the fight against viruses. The new UAB study finds this cross-talk can only happen in the presence of interleukin-21, a powerful immune system protein. If interleukin-21 is missing for whatever reason, then the immune system’s anti-viral efforts fail, said Allan Zajac, Ph.D., an associate professor in UAB’s Department of Microbiology and lead author on the study.

The findings are published in the journal Science through its Science Express service.

“Adding interleukin-21 back in stimulates the immune response and controls the infection,” Zajac said. “We demonstrate that the loss of this protein prevents the control of the infection and diminishes the function of the killer T-cells, specifically CD8 T-cells.”

The study mice were treated for lymphocytic choriomeningitis, a viral infection of the membranes surrounding the brain and spinal cord. Measurements were taken for two types of T-cells, CD4 and CD8 T-cells, before and after the mice were treated with interleukin-21.

“Interleukin-21 served as the key messenger between the T-cells, whereas before we didn’t know exactly how the two types of cells communicated with each other,” Zajac said. The CD4 T-cells help the immune system do its job by boosting CD8 T-cells’ ability to fight and kill viruses.

Co-authors on the study include John Yi and Ming Du, Ph.D., both of UAB’s Department of Microbiology. Research funds came from the National Institutes of Health.

Source:
Troy Goodman

University of Alabama at Birmingham Continue reading

This World Aids Day, Demand National Leadership On HIV

This World AIDS Day (1 December) NAT is campaigning for the Prime Minister to fulfil the UK’s UN commitment and put in place a national strategy on HIV from 2011.

By the end of 2011 there will be more than 100,000 people living with HIV in the UK. However, the current national strategy for HIV and sexual health in England expires at the end of 2010 – with no current plans to replace it. NAT is asking people to sign our e-petition calling for a national strategy to combat HIV.

Scotland, Wales and Northern Ireland have all recently agreed strategic approaches for the next few years to address HIV in devolved policy areas, but there needs to be UK-wide leadership to ensure equity across the four nations. Therefore we are asking the UK Government to fulfil its UN commitment and put in place from 2011 a national strategy to combat HIV in the UK, in collaboration with the devolved administrations.

Deborah Jack, Chief Executive of NAT (National AIDS Trust) comments:

‘Without strategic, political leadership on HIV, the issue will become sidelined and silenced by stigma. Or at best, HIV will be only addressed as a health issue – disregarding the social context which must also be tackled if we are to respond effectively to the epidemic.

‘A new national strategy is needed which takes account of the significant changes in the last decade in HIV testing and treatment, in health and social care provision, in legal rights, and in the epidemic itself. New HIV diagnoses are now three times what they were ten years ago and we have yet to see evidence of a decline in rates of new infection.’

Source:

NAT Continue reading

House Rules Committee Takes Action On PEPFAR Reauthorization Bill Ahead Of Floor Consideration

The House Rules Committee on Tuesday took action on a bill (HR 5501) that would reauthorize the President’s Emergency Plan for AIDS Relief ahead of floor consideration of the measure, which is scheduled for Wednesday, CQ Today reports (Graham-Silverman, CQ Today, 4/1). The measure, which was approved in February by the House Foreign Affairs Committee, would allocate $50 billion for PEPFAR over the next five years. President Bush had called on Congress to authorize a $30 billion, five-year extension of PEPFAR. The bill also would remove a requirement that at least one-third of HIV prevention funds that focus countries receive through PEPFAR be used for abstinence-until-marriage programs. It would require “balanced funding” for abstinence, fidelity and condom programs based on evidence in each PEPFAR focus country. In addition, the bill would retain the requirement that PEPFAR recipients pledge opposition to commercial sex work.

The bill would allow groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services. The bill also would require reports to Congress if abstinence and fidelity programs compose less than half of country-level spending on programs aimed at preventing sexual transmission of the virus. In addition, the bill would allocate about $9 billion to fight tuberculosis and malaria, which often affect HIV-positive people in Africa. That amount also would underwrite food supplements for people living with HIV/AIDS. The bill would provide loans to women widowed by the disease or ostracized because of their HIV-positive status (Kaiser Daily HIV/AIDS Report, 3/31).

The Rules Committee on Tuesday approved by voice vote a structured rule (HR 1065) for floor consideration of the bill. During the Rules Committee consideration, Reps. John Campbell (R-Calif.) and Dave Weldon (R-Fla.) attempted to decrease the $50 billion funding amount allocated in the bill to $15 billion and $38 billion, respectively. The committee ruled the representatives’ amendments out of order. Any changes to funding levels would “unravel” compromises, Foreign Affairs Committee Chair Howard Berman (D-Calif.) said, adding, “Part of the balance that was achieved with this bill was the funding level.”

Rep. Betty McCollum (D-Minn.) attempted to gain Rules Committee approval to offer an amendment during floor consideration to eliminate a phrase in the bill that some advocates say could remove funding for family planning groups that currently receive PEPFAR money. According to CQ Today, 45 HIV/AIDS groups last week sent a letter to lawmakers in support of such efforts. “The effect of the language as it is could be interpreted to actually restrict access to those services,” Jennie Quick — the government affairs manager at Population Services International, one of the groups that signed the letter — said. The Rules Committee did not allow the amendment, CQ Today reports.

The Rules Committee also rejected an amendment that would have changed a reference to “health care professionals and workers” to “health care professionals.” The committee did approve four amendments to:
Add Lesotho, Malawi and Swaziland as PEPFAR focus countries;

Include clean water programs in the program;

Encourage countries to work with historically black colleges to improve their health infrastructures; and

Expand inspector general authority.

The White House in a policy statement said that it supports the PEPFAR reauthorization bill but hopes to resolve some concerns about provisions in the bill that it says would limit the president’s authority to conduct foreign policy (CQ Today, 4/1).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading

Children Affected By HIV/AIDS Neglected, UNAIDS Says

Children affected by HIV/AIDS do not receive enough care and support, UNAIDS said Thursday ahead of the third Global Partners’ Forum in London, Reuters reports. The forum, hosted by UNICEF and the U.K. Department for International Development, is bringing together advocates from 50 countries and 90 international organizations to address ways to improve policies that support children affected by HIV/AIDS. According to UNAIDS, less than 10% of children who have lost a parent to AIDS-related causes receive support (Reuters, 2/9). In addition, pediatric antiretroviral drugs can cost six times as much as antiretrovirals for adults, UNAIDS Executive Director Peter Piot said. Peter McDermott, head of UNICEF’s HIV/AIDS department, said drug companies have ignored pediatric antiretrovirals because the market for them is too small and because it is difficult to predict how much will be needed. Also, drug companies know that if programs to prevent mother-to-child transmission are successful, the demand for pediatric HIV drugs will dwindle, McDermott said (Batha, Reuters AlertNet, 2/9). The forum will focus on ways to strengthen the capacity of families of children orphaned by or made vulnerable to HIV/AIDS; mobilize community-based efforts to support families affected by the disease; ensure equal and universal access to education; and push for universal access to HIV prevention, treatment and care (UNAIDS release, 2/9). DFID said it plans to meet with pharmaceutical companies to examine ways to accelerate the development of low-cost and effective pediatric antiretroviral drugs (Reuters AlertNet, 2/9).

Vietnam News/Asia News Network Examines Street Children in Vietnam
Vietnam News/Asia News Network on Wednesday examined community efforts to support street children in Vietnam who are living with or vulnerable to HIV/AIDS. UNICEF, the Vietnamese government and other international organizations have helped to establish rehabilitation centers and social welfare institutions that provide medical treatment, support and job training for HIV-positive youth, Vietnam News/Asia News Network reports. Voluntary testing and counseling centers also have been established to provide communication and education services to help vulnerable young people avoid contracting the disease. However, UNICEF says children, particularly street children, still are neglected in Vietnam’s fight against HIV/AIDS, according to Vietnam News/Asia News Network. To address the issue, UNICEF — along with the Community for Population, Family and Children and other partners — in March will host the first East Asia and Pacific Regional Consultation on Children and AIDS in the Vietnamese capital of Hanoi, Vietnam News/Asia News Network reports (Van/Dung, Vietnam News/Asia News Network, 2/8).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . ?© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading

HIV-Positive People In Zambia React To Recall Of Roche Antiretroviral Viracept

The recent recall of Roche’s antiretroviral drug Viracept has “created panic” among HIV-positive people taking antiretrovirals in Zambia, some of whom believe that other drugs might not be safe, IRIN News reports (IRIN News, 6/19).

The European Medicines Agency earlier this month recalled Viracept because of contamination. Roche in a statement said that it is recalling all batches of the drug in cooperation with EMA and Swissmedic, Switzerland’s drug regulator, in Europe and other undisclosed countries. According to Roche, the drug was recalled after tests indicated that certain batches were contaminated with higher-than-normal levels of methane sulfonic acid ethyl ester — a chemical normally used in the drug in small quantities.

William Burns, CEO of Roche’s pharmaceutical division, said the impurity had been caused by the interaction of two chemicals in a vessel where the drug is produced. Investigators still are trying to determine what occurred in the Swiss plant where the drug is manufactured. It is believed that the contamination might have occurred in March and has affected supplies of the drug for three months (Kaiser Daily HIV/AIDS Report, 6/8).

Zambia’s Health Minister Brian Chituwo last week announced that the country immediately will discontinue Viracept, which primarily is used in second-line treatments in Zambia. He also ordered health care workers to explain the situation to people affected by the recall. The Zambian government estimates that fewer than 1,000 of the 100,000 HIV-positive people in the country receiving antiretroviral treatment are taking Viracept. Some independent analysts said the number of HIV-positive people taking the drug could be much higher, IRIN reports. Nkandu Luo, an HIV/AIDS consultant and former health minister, said, “There could be more people affected by this because some of them take Viracept as part of a combination therapy.” He added that the government should be “speaking to Roche because the damage has been done. Roche should take responsibility for distributing contaminated drugs.”

Chituwo said that all HIV-positive people taking Viracept will be examined by health care providers before being switched to other antiretrovirals. He added that HIV-positive people “should not unilaterally decide to change drugs on their own” (IRIN News, 6/19).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

View drug information on VIRACEPT. Continue reading

Studies Detail Triumphs, Troubles Of African Innovators Creating Products For Local Health Needs

Global health experts have published a landmark collection of papers that together provide a unique microscope on the experience of countries, companies and organizations in sub-Saharan Africa addressing neglected health problems with homegrown drugs, vaccines, diagnostics and other creative scientific and business solutions.

The first-of-its kind study chronicles the triumphs and troubles of entrepreneurs, institutes and firms in Africa creating innovative, affordable technologies that bring hope to many sufferers of local diseases. While some have yet to succeed, several organizations cleared major hurdles to finance and create products, some of which may expand into global markets one day.

It is the first research offering a broad range of evidence and concrete examples of African innovation to address local health concerns. The papers draw on the experiences of authorities, researchers and entrepreneurs in Ghana, Kenya, Madagascar, Nigeria, Rwanda, South Africa, Tanzania, and Uganda. In addition to efforts involving health products, the experiences of health venture capital funds in African and other developed countries are profiled.

The papers were produced by Canada’s McLaughlin-Rotman Center for Global Health (MRC), at the University Health Network and University of Toronto, and published as a special supplement in the UK-based open-access journal publisher BioMed Central Dec. 12 (with full public access at here). One of the papers was published earlier in the journal Science.

The authors hope their work helps scale up and sustain work underway, while inspiring other organizations and countries to follow suit with the benefit of lessons learned by these African pioneers.

Says MRC Director Peter Singer: “If Africans are to prevail over diseases that kill and maim millions each year, they must do so by unleashing the formidable talents of their own African scientists and entrepreneurs. In the long term, the sustainable solutions to Africa’s health problems rest with the home team.”

“The large firms of the developed world producing drugs, vaccines, diagnostics and other health products are a great resource and partner. But many people will die if we wait for scientists from elsewhere to invent and market the health products Africa needs. These studies demonstrate that, with the right partners and incentives along with support from governments at home and abroad, Africans have the scientific creativity and entrepreneurial talent to improve local health and prosper at the same time.”

“Our message to international agencies, donors and African governments: support these enterprises and nurture their potential, because they can make a major contribution to better health in developing countries – and to their own health. At the end of the day, this is about enabling people to solve their own problems, not only using science but also combining it with entrepreneurship.”

Since it began in 2004, the MRC has focused extensively on how low-income countries themselves can remedy diseases of poverty. With relatively little profit incentive, firms in rich, developed countries largely neglect such diseases. The MRC has documented the benefits of the homegrown science approach to health problems, which include, beyond affordable products, less dependency on international donor programs and much-needed new economic opportunities and job creation. This collection represents the MRC’s largest contribution to date on product commercialization for improving health in Africa.

Examples of African innovation:
In Tanzania, local funding, economies of scale, technology transfer, and partnerships all helped the A to Z Textile Company become one of the world’s largest producers of long-lasting insecticide treated bed nets, cost-effectively producing tens of millions of nets in an area where malaria is a critical problem. The company succeeded despite regulatory issues, procurement rules, and other barriers.
In Madagascar, The Malagasy Institute of Applied Research (IMRA) has created Madeglucyl, a treatment for diabetes management based on a traditional remedy;
In Nigeria, the National Institute for Pharmaceutical Research and Development has a plant-based drug for sickle-cell anemia – one of the few low-toxicity drugs available anywhere to treat the debilitating chronic blood disorder – but has yet to overcome barriers to its commercialization;

“Concern over access to essential medicines have dominated international health policy debates over the last two decades,” Harvard professor Calestous Juma says in a preface to the work. The debates, centered on intellectual property rights, wrongly assume that Africa will remain “a marginal player in the world of health innovation and will continue to rely on imported solutions.

“This collection of original papers provides a different prognosis. They reveal an emergent ‘health innovation system’ in Africa that is driven by a combination of local research, entrepreneurship and institutional adaptations.”

The research complements a related MRC paper, published Dec. 10 in Science, about so-called “stagnant technologies” in sub-Saharan Africa – products with the potential to save many lives, but which exist only in a lab due to a failure of commercialization or support.

Led by researcher Ken Simiyu, some 25 such products were identified languishing in health research institutions in Africa, some already validated but not yet converted to a product or service. Of the 25 stagnant technologies found, 16 involved traditional plant products; the rest were new drug molecules, diagnostics, vaccines and medical devices.

They include:
A low-cost dipstick technology developed at the Noguchi Memorial Institute for Medical Research in Accra, Ghana, for quick, easy, village diagnosis of schistosoma, a parasitic disease that affects more than 50% of people in some areas of Africa.
An herbal, anti-malarial medicine, Nibima, from a traditional plant Cryptolepis sanguinolenta, under development at the Centre for Scientific Research into Plant Medicines, Ghana
A product called Sunguprot in Kenya from the plant Tylosema Fassoglensis, whose developers claim it can help manage HIV symptoms. Lack of advanced scientific equipment to isolate compounds and funding to carry out clinical trials have affected further development and validation; and
An easy-to-use, inexpensive, WHO-approved portable medical-waste incinerator, developed at Makerere University, Uganda, that could solve the problem of hospital waste management in rural areas, especially during mass polio immunization and similar programmes. The incinerator uses no fuel other than the medical waste and achieves temperatures of 800 degrees C.

Meanwhile, at the International Centre for Insect Physiology and Ecology in Kenya, researchers have patented human odors that effectively repel mosquitoes. While there is a need to determine formulations through further research, negotiations are underway with a multinational company.

Among conclusions of the MRC research teams:
Despite challenges, components of health innovation exist in Africa and, though limited, diverse activity in health innovation is occurring;
The emerging innovation systems are driven by local health concerns, not external interests. Local, regional and global dynamics affect health innovation;
Institutions used innovative financing mechanisms and partnerships to their benefit;
All countries put strong emphasis on plant medicine as a local asset for innovation;
Fundamental to success are investing in research and development to generate solution-oriented knowledge, providing incentives for entrepreneurs, and building institutional strength to help facilitate commercialization of research results;
Africa’s health innovation systems are increasingly integrated into the global knowledge ecology, and benefit from extensive international partnerships;
Linkages between groups are sparse to date, but hold potential for building stronger health innovation systems. Business incubation through facilities such as science innovation centers will be an important mechanism for fostering industrial clustering and raising economic productivity.

“Driven largely by entrepreneurs, innovative and affordable technologies to improve health in Africa are under development throughout the continent, with firms using a variety of business models in a range of political environments,” says MRC researcher Ken Simiyu.

“Clearly, many Africans have the needed talent and know-how. However, the seeds of their efforts need careful nurturing by both donors and African governments at all levels. Required are creative institutions and coherent policies that reduce risk, build on local strengths, and promote the effective use of local health research.”

Says Abdallah S. Daar, MRC Senior Scientist and Director of Ethics and Commercialization: “We are all affected in one way or another by the health and well-being of everyone else on Earth. What we present is a look at many African companies and countries striving to create local health products for local needs. Understanding all aspects of their experiences – what worked, what didn’t, and what could have been done better – is a huge leg up for other firms and governments who wish to stand on the shoulders of these pioneers.”

The papers in full, to be published (with open public access) were published as a special open-access BMC supplement here.

A 25-minute interview on this topic with MRC Director Peter Singer and researcher Ken Simiyu is available online here

Company studies in brief

Africa’s largest long-lasting insecticide-treated net producer:
Lessons from A to Z Textiles

Authors Hassan Masum, Ronak Shah, Karl Schroeder, Abdallah S. Daar and Peter A. Singer say A to Z Textiles exemplifies how large-scale production of an important health product, Long-Lasting Insecticide Treated Nets (LLINs), can succeed in a low income setting.

One of the largest sources of bed nets for Africa, and the largest manufacturer in Africa itself, A to Z Textiles of Tanzania cost-effectively produces tens of millions high-quality LLINs where malaria is most endemic, and the World Health Organization certifies its product.

Local funding, economies of scale, technology transfer, and partnerships all played important roles in A to Z’s success, as did perceived benefits of local employment and capacity-building. Regulatory issues and procurement rules were barriers.

The company’s success was achieved without tariffs or other protectionist measures. Many such opportunities have been documented in the African context, such as manufacturing common medical supplies.

“Ultimately, success is enabled by responsiveness to opportunities, willingness to invest and take risks, ability to execute, and strong leadership,” the authors say. “A to Z and its partners have not only successfully created an African source for public health goods, but have demonstrated tremendous commitment to the endeavor.”

Continued success is not assured, they add, due to the looming plateau in demand for LLINs, competition from LLINs from Asia, and the entry of more African LLIN manufacturers. “All suggest the need for continued innovation to stay in business.”

Can incubators work in Africa?
Acorn Technologies and the entrepreneur-centric model

Authors Justin Chakma, Hassan Masum and Peter A. Singer define business “incubators” as organizations that support the growth of new and typically technology-based enterprises, and the confluence of human and financial capital.

Although traditionally incubators have been used for economic development, they can also help improve global health by fostering the development and delivery of local innovation in developing countries.

The study describes the success of South Africa’s Acorn Technologies in establishing Real World Diagnostics, a biomedical device firm that developed rapid strip tests for local diseases, including schistosomiasis and HIV, and reported $2 million (USD) in revenue in 2009.

Acorn achieved this while operating as a non-profit and with little physical infrastructure. A virtual business model effectively reduced fixed costs and Acorn focused on mentoring entrepreneurship, offering training, and networking.

Key to Acorn’s achievement: identify entrepreneurs with technologies offering both health and economic impact, and provide them flexible support from an early stage. Where needed experience did not exist locally, they sought out international networking and mentorship.

“With the right policies and business models, incubators have the potential to generate economic and health benefits for Africa.”

Among other recommendations: Pool the resources of African countries with scientific strengths to create regional innovation centers and communities, which bring together science, networks of practice, entrepreneurship, and capital.

Venture capital on a shoestring: Bioventures’ pioneering life sciences fund in South Africa

Authors Hassan Masum and Peter A. Singer examined the modest but promising success of Cape Town’s Bioventures, a rare life sciences venture capital firm in sub-Saharan Africa, operating on a relative “shoestring” of US$12 million.

It has supported eight innovative South African firms since 2002, notably Disa Vascular, a creator of stents for heart patients.

Beyond providing funds, Bioventures’ support to investees included board participation, contacts, and strategic services.

“Bioventures had to be proactive in finding and supporting good R&D, and not merely wait for the ideal company to walk through the door,” the authors say.

“Providing hands-on support to early-stage health ventures posed problems – due to the fund’s relatively small size, overhead and management expenses were tightly constrained. Bioventures sometimes wasn’t able to make follow-on investments, being forced instead to give up equity to raise follow-on investment capital.”

The firm nonetheless “represents a significant accomplishment: creating a life sciences investment fund in Africa,” the authors say. It has shown how a small African venture capital firm can successfully help create research and development-based health technology companies.

Among hurdles to be overcome by Disa Vascular: finding local people experienced in taking a new biomedical device through the European regulatory process, as well as breaking into international markets.

Partnering with a larger fund is among the recommendations, with local venture capital firms perhaps acting “as a sort of technology scout and early stage developer, with the larger fund being available for follow-on investments as successful investees grow.”

The Bioventures experience also suggests that future health care technology funds targeting ailments of the poor might require investors to accept health benefits as part of their overall “return.”

Harnessing biodiversity:
The Malagasy Institute of Applied Research (IMRA)

Biopiracy – the use of a people’s long-established medical knowledge without acknowledgement or compensation – has been a disturbing historical reality and exacerbates the global rich-poor divide.

Bioprospecting, however, describes the commercialization of indigenous medicines in a manner acceptable to the local people. Bioprospectors seeking to develop traditional medicines in a quality-controlled manner face several challenges, however: a lack of skilled labor and high-tech infrastructure, adapting developed world R&D protocols to developing world settings, keeping products affordable locally, and managing the threat of biopiracy.

The Malagasy Institute of Applied Research (IMRA) has employed bioprospecting to develop new health treatments for conditions such as diabetes and burns. It has found a balance between Western science and Malagasy cultural traditions and offers a useful example for African and other organizations interested in bioprospecting.

IMRA follows four guiding principles:
Understand and respect local practices, and use them rather than resist them.
Engage the local community early in the drug development process, and ensure local people have a stake in its success.
Actively collaborate with local and international partners to increase credibility and research capacity.
Obtain foreign research funds targeting the “diseases of civilization” to cross-fund the development of drugs for conditions that affect the Malagasy population.

Using these principles, IMRA developed products like Madeglucyl, a treatment for diabetes management based on a traditional remedy.

Say the authors: “Stoked by identity politics and a broader debate about the degree to which traditional knowledge should be protected, a number of local actors have called for increased protection. In reality, the middle ground as represented by organizations like IMRA between complete protectionism and unfettered access to ethno-medical knowledge may represent the best hope of pushing forward the boundaries of medical research.”

Turning science into health solutions: KEMRI’s challenges as Kenya’s health product pathfinder

According to authors Ken Simiyu, Hassan Masum, Justin Chakma and Peter A. Singer, the private sector in sub-Saharan Africa is ill-prepared to commercialize ideas emerging from public research institutes. The institutes, therefore, often take up the tricky task themselves.

The Kenya Medical Research Institute (KEMRI), for example, constructed a full-scale manufacturing facility to produce HIV and Hepatitis B diagnostic kits.

The researchers detail a slew of problems that eventually left KEMRI’s factory idled.

A limited product line — diagnostics — proved dangerous as it relied on government purchasing. Shortly after construction of a production unit, an abrupt change occurred in Kenyan regulatory requirements and the government stopped purchasing KEMRI’s products.

Others among the challenges KEMRI faced in trying to develop products: lack of infrastructure, inadequate financing, and little experience with respect to innovation.

However, the institute overcame them through diversification, partnerships and changes in culture.

KEMRI diversified its product line to include a disinfectant as well as modified rapid HIV and Hepatitis B test kits. It adopted an open innovation business model, which linked it with investors, research partnerships, licensing opportunities, and revenue from contract manufacturing. It has established a marketing division, developed an institutional IP policy, and trained its scientists on innovation management.

KEMRI has shown how research institutes in Africa “can turn science into health solutions for local health problems, thus reducing Africa’s health burden,” the authors say. “The findings could have implications for other research institutes in Sub-Saharan Africa seeking to develop health products.”

Among the lessons learned:
Investments in research need to be accompanied by investments in innovation management;
Institutions may wish to initially focus on local markets to generate immediate health and financial benefits;
A volatile business environment in Africa implies a need for proper strategic planning; open business models can help institutions leverage outside strengths to develop products.

The road to commercialization in Africa:
Lessons from developing the sickle-cell drug Niprisan

One of the few low-toxicity drugs available anywhere to treat sickle-cell anemia — a debilitating chronic blood disorder — is derived from medicinal plants in Nigeria. Authors Kumar Perampaladas, Hassan Masum, Andrew Kapoor, Ronak Shah, Abdallah S. Daar and Peter A. Singer looked at barriers faced by Nigeria’s National Institute for Pharmaceutical Research and Development (NIPRD) while bringing this important product to market. They also chronicle many significant achievements in this drug’s development process, even though it ultimately failed.

Nigeria alone has more than 4 million sickle-cell anemia patients, and every year an estimated 150,000 children are born with the condition, which also afflicts many North Americans and Europeans of African descent.

NIPRD developed the herbal medicine Niprisan from a combination of certain seeds, stems, fruit and leaves. Formal agreements entitled the traditional practitioners whose knowledge was used in the development program to product sale royalties.

The drug developers won regulatory approval in Nigeria, partnered with US-based firm XeChem, demonstrated clinical efficacy and safety, and were awarded valuable “orphan” drug status by the US Food and Drug Administration.

Niprisan failed to achieve mainstream success, however, due to a number of problems, such as insufficient manufacturing capacity, quality control issues, pricing and distribution, and lack of financing. Today, NIPRD is considering options for another commercial partner to take the drug forward.

The paper cites five key lessons learned for policy-makers and entrepreneurs:
Make benefit-sharing agreements with traditional medical healers whose knowledge is used.
Seek partners to fill gaps in knowledge and technical expertise.
Subsidize clinically-proven new drugs derived from traditional medicines, where the disease is endemic to a region and good alternative treatments are lacking.
Institute standardization and quality control measures in drug manufacturing, especially for traditional medicines, the potency and effectiveness of which can be influenced by the raw materials involved (i.e. plant material quality, age, time of harvest, location, soil quality, preparation, handling, etc.).
Train skilled entrepreneurial leaders to manage partnerships, recruit talented professionals, approach government for funding, and handle the missteps and breakthroughs that go along with early stage drug development.

Venture funding for science-based African health innovation

Authors Hassan Masum, Justin Chakma, Ken Simiyu, Wesley Ronoh, Abdallah S Daar and Peter A. Singer describe case studies of five health venture funds based in the developing world, and suggest lessons.

The five funds included publicly-owned organizations, corporations, social enterprises, and subsidiaries of foreign venture firms. Three funds aimed primarily for financial returns, one for social and health returns, and one had mixed aims. (One of the funds, Bioventures, is discussed above.)

Lessons learned include
The importance of measuring and supporting both social and financial returns;
The need to engage both upstream capital such as government funding and downstream capital from the private sector; and
The existence of many challenges including difficulty of raising capital, low human resource capacity, regulatory barriers, and risky business environments.

The authors suggest that those looking to design venture funding for African science-based health innovation with significant impact should structure funds for long-term sustainability and attract for-profit private sector funds.

The proposed venture approach can complement existing initiatives to encourage local scientific and economic development while tapping new funding sources.

The authors conclude that there is a case for venture funding as one support mechanism for science-based African health innovation, with opportunities for risk-tolerant investors to make financial as well as social returns.

Country studies in brief

Science-based health innovation in Uganda: creative strategies for applying research to development

According to authors Sheila Kamunyori, Nelson Sewankambo, Abdallah S. Daar, and Peter A. Singer, Uganda has a long history of health research. And it has moved recently to build its science and technology capacity.

They detail Uganda’s capacity in health and biotechnology innovation and highlight examples of indigenous innovation, challenges for the future, and areas of strength on which to build.

Uganda has a range of institutions influencing science-based health innovation, with varying degrees of success. It has developed biosafety regulations and intellectual property policies, and has put before Parliament a coherent science and technology policy to coordinate efforts.

Uganda is unique in Africa by establishing its own Millennium Science Initiative – an ambitious $30 million project to build science capacity and encourage entrepreneurship through funding industry-research collaboration.

Two universities – Makerere and Mbarara – stand out in terms of health research, though as yet technology development is weak. Nevertheless, Uganda has several incubators producing low-tech products and moving into higher-tech product like diagnostics. Uganda’s pharmaceutical industry has started creating partnerships to encourage health product innovation.

The authors say the personal initiatives of the President (the annual Presidential Science Awards and the Presidential Support Fund, for example), and his government’s willingness to fund participation in the Millennium Science Initiative clearly demonstrate political will in Uganda to develop science and technology innovation. As well, activities to support technology transfer and private-public collaboration have been put in motion. In the private sector of Uganda are examples of innovation driven by entrepreneurs and South-South collaboration, to address neglected disease. Lessons can be drawn from their pioneering efforts.

The authors urge the government to put more focus on development of biotechnology, disseminate lessons from innovative initiatives, and support human resource development in health innovation.

Science-based health innovation in Tanzania: bednets and a base for invention

Authors Ronak Shah, Abdallah S. Daar and Peter A. Singer note that Tanzania has gradually undertaken economic reforms that have increased private sector activity and opened the economy to global competition.

However, despite Tanzania’s economic growth and its status as one of Africa’s biggest aid recipients, health in the country remains poor.

The public sector drives Tanzania’s science and technology innovation agenda through a myriad of institutions and organizations dedicated to various aspects of health and other sciences.

It has some of the leading health research on the continent, with strong donor support, such as the University of Dar es Salaam, Muhimbili University of Health and Applied Sciences and the Ifakara Medical Institute. All are involved with international projects on infectious disease, though none with substantial technological spin-offs.

Perhaps more than the other countries studied, Tanzania – politically socialist until recently – has found developing an entrepreneurial culture difficult.

Nevertheless, one private generics company has developed a South-South collaboration to enable technology transfer and local production of anti-retrovirals. And a long-established textile company, A to Z Textiles described earlier, manufactures 25 million bed nets a year – a fascinating example of local innovation.

To achieve greater innovation in general and for health in particular, the authors urge the government to coordinate different stakeholders involved with health research, increase graduates in health-related disciplines, and build technological capabilities in such areas as biological testing, preclinical testing, formulation and standardization – the absence of which hinders the transition from basic research to product development.

Other recommended reforms: Encourage the private sector to move towards innovation through improved access to financing, and incentives for R&D. And a mechanism to bring the public and private sector together around specific projects could help unblock some of the country’s innovative potential.

At a December, 2007 national life sciences workshop in Dar es Salaam, co-hosted by the McLaughlin Rotman Center, local stakeholders – including government, private sector, and research community representatives – strongly supported the need to increase knowledge flow and other recommendations. The group also formed a local steering committee to plan development of a life sciences innovation center. Since then, the local steering committee, MRC and partners have developed business and operational plans, land has been obtained, and next steps are being considered by the Tanzanian cabinet.

The proposed center would offer tenant space and serve as a business incubator and collaboration office. It will network with research institutions across Tanzania and operate a specialized seed fund to support promising, pre-commercial ideas.

“This innovation centre embodies a new approach,” the authors say, “and involves bringing together for the first time in Tanzania science, business and capital under one roof to create a dynamic environment where scientific knowledge, the demands of the marketplace, and the realities of funders exist together.”

Science-based health innovation in Rwanda: unlocking the potential of a late bloomer

Authors Kenneth Simiyu, Peter A. Singer, Abdallah S. Daar and Mike Hughes say Rwanda’s indigenous science-based health product innovation system is under-developed due to the destruction of the country’s scientific infrastructure and human capital during the 1994 genocide. What it has, though, offers examples of good practice.

Government policy, research institutes and universities, the private sector and NGOs are involved in health product innovation in Rwanda. And they say the country shows strong political will to support health innovation through both leadership and government policy. However, Rwanda has a weak scientific base and regulatory agency, and its nascent private sector is ill equipped to drive health innovation.

In addition, there are few linkages between the various actors in the country’s health innovation system i.e. between research institutions, universities, the private sector, and government bureaucrats.

For a country with limited natural resources, transformation into a knowledge-based economy is the only route to economic development for Rwanda, the authors say. This requires further appropriate investments in domestic knowledge as acquisition of knowledge from abroad is very expensive. Of foremost importance is the establishment of a platform to link the various actors in the health innovation system.

Since the study’s completion, the researchers have continued work with the Ministry of Science and Technology and the Ministry of Education to address key challenges. Stakeholders agreed with the study’s results and recommendations, including the life sciences innovation center concept. A local steering committee was created to lead planning and business and operational plans have been initiated with the help of the MRC and others.

The virtual platform will network the center to various research institutions across the nation, and a product development fund will nourish promising pre-commercial ideas. The innovation centre embodies a new approach, convening Rwanda’s science, business and capital under one roof — a one-stop shop for investors in technology opportunities.

Science-based health innovation in Ghana: health entrepreneurs point the way to a new development path

Authors Sara Al-Bader, Abdallah S. Daar and Peter A. Singer say Ghana has well-recognized growth potential, It has plentiful natural resources (cocoa, gold, timber, and recently-discovered oil), a stable governance situation, long-standing universities and research institutions, and improving communications infrastructure.

Little research has been conducted on Ghana’s capacity for health innovation to address local diseases, however. The research maps out key actors, highlights examples of indigenous innovation, sets out future challenges and outlines recommendations.

The fundamentals for a science-based health innovation system in Ghana already exist, according to the study: research organizations, regulatory bodies, health delivery systems and a well-established pharmaceutical industry, for example.

And Ghana can boast of examples of knowledge translation by public institutions that have made a major impact on local diseases such as river blindness.

However, links within the public sector are poor, as is knowledge sharing between the public and private sectors.

Low-tech technology transfer from research groups into local communities has occurred for decades, but these initiatives rarely if ever involve the private sector. As such, they are not scaled up, and have had limited economic effect.

Some small, entrepreneurial firms, largely focused on producing essential medicines such as affordable anti-retrovirals, appear to be shaping the science-based health innovation landscape most strongly.

The firms address undersupplied markets, tackling new parts of the value chain, or creating easy-to-use formulations. Plant medicine also plays a vital part in the health sector in Ghana, and increasing attention and resources are being directed towards the standardization and ultimately the scientific testing of the efficacy of these medicines.

Producing pediatric, one-dose formulations of generic drugs, as the company DanAdams has done, is an important step in building capacity and reaching new customers. In general, these pharmaceutical firms are accessing foreign knowledge – through licensing, technology transfer or tacit knowledge acquired overseas – and adapting it locally.

Among recommendations: Ghana should increase science and technology funding to the 1% of GDP suggested by the African Union; improve morale and remain linked to the international science community; create, publicize and implement a plan which coordinates across government and sets realistic targets for applying science and technology innovation to improve health; continue efforts to attract students to biomedical and health degrees; better link courses with opportunities for practical experience within the health system and private sector (which would help prevent brain drain); and remove barriers, such as outdated investment policy, to the entrepreneurial health sector.

As well, it should address intellectual property protection and access to international markets.

After their initial fieldwork in Ghana, MRC researchers helped create a working group on health and biotechnology innovation, with representation from government, the research community and the private sector, to consider how to build a sustainable hub in Ghana that would link stakeholders, overcome barriers to collaboration, and stimulate locally-relevant health innovation.

The group identified some key activities like setting up a virtual network to convene stakeholders through the Internet and regular meetings, a technology road show to showcase Ghanaian technologies to financiers and others, and creating a database of technologies, infrastructure and equipment within Ghana that could be accessed easily and help identify potential areas of cooperation.

Source:
Terry Collins
McLaughlin-Rotman Centre for Global Health Continue reading

Kaiser Daily HIV/AIDS Report Highlights Editorials, Opinion Pieces Related To XVII International AIDS Conference, Other Topics

Several newspapers have published opinion pieces this week addressing the XVII International AIDS Conference, the reauthorization of the President’s Emergency Plan for AIDS Relief, a CDC report updating HIV incidence in the U.S. and related issues. Summaries appear below.

Editorials
Baltimore Sun: Baltimore health officials “monitoring the [HIV/AIDS] epidemic would be wise to become more vigilant” in addressing the issue after CDC released its report updating the number of annual new HIV infections in the U.S., a Sun editorial states. According to the editorial, Baltimore has launched several initiatives — including rapid HIV testing in emergency departments and outreach programs that seek to reduce the risk of contracting the virus and help those newly diagnosed receive treatment — that “appear to be working.” However, the editorial states that the uncertainty regarding the scope of the epidemic “is troubling, and it suggests that eventually more may have to be done — and probably sooner than later.” The editorial concludes, “The city must be prepared for the worst even as it continues to hope for the best” (Baltimore Sun, 8/6).

Bergen Record: The CDC report is “chilling” because the nation’s “attention had been largely focused on sub-Saharan Africa and other places where [HIV/AIDS] treatment is far less accessible and awareness of the risks of infection is supposedly lower,” the Record editorial states. Meanwhile, “federal funding for domestic AIDS programs has stalled during the Bush presidency,” the editorial adds, noting that the “Bush administration has been less focused on domestic AIDS needs, particularly regarding minorities.” The editorial concludes, “The world, the United States and New Jersey cannot afford to underestimate the threat and the suffering caused by AIDS” (Bergen Record, 8/6).

Boston Globe: The federal government, through its Medicare and Federal Employees Health Benefit Plan, “needs to be a part of th[e] effort” to reduce the number of new HIV/AIDS infections, according to a Globe editorial. According to the Globe, while CDC two years ago recommended routine HIV testing, neither Medicare nor FEHBP cover the cost of routine HIV/AIDS testing. The editorial concludes, “More routine testing could bring [the rate of new infections] down by alerting those who test positive that they are infectious” (Boston Globe, 8/6).

Cox News Service/Greenville Daily Reflector: The U.S. “should divert some funding toward domestic” HIV/ADS prevention and education campaigns, “particularly those that gain traction among those most at risk of infection,” a Cox/Daily Reflector editorial states. “Successful education programs and other initiatives aimed at slowing the spread of HIV/AIDS should be credited for keeping the infection rate static” in the U.S., the editorial states, adding, “But if those programs work, their expansion could help to lower the infection rate … especially among at-risk populations” (Cox News Service/Greenville Daily Reflector, 8/6).

Newark Star-Ledger: The U.S., which has made “major economic contributions to the fight” against HIV/AIDS worldwide, must “make attacking its own AIDS problem a priority” through a “new national AIDS initiative,” a Star-Ledger editorial states. However, efforts to fight HIV/AIDS in the U.S. face a number of “obstacles,” such as the “notion that those leading the national battle don’t know what they are doing or are not telling the whole truth,” the editorial states. It adds, “Suspicion and denial conspire to stop people from doing what is best for them — getting tested and treated and stopping risky behaviors, such as unprotected sex and sharing needles for drug use or tattoos or anything” (Newark Star-Ledger, 8/6).

Opinion Pieces
George Katito, AllAfrica: “Clearly, achieving an AIDS-free generation in Africa will call for a substantial investment of financial, human and other resources,” but “[m]ore importantly, it will require of African governments that they muster the political will to implement the governance reforms and foster the change in political culture needed to tackle the pandemic effectively,” Katito, a researcher at the South African Institute of International Affairs, writes in an AllAfrica opinion piece. African legislatures need to boost oversight of government expenditures to “ensur[e] HIV/AIDS funding is put to its intended use,” Katito writes (Katito, AllAfrica, 8/4).

Craig Dodds, Cape Times: The world is “hopelessly short” of achieving the United Nations Millennium Development Goals of universal access to antiretrovirals by 2010, Times columnist Dodds writes in an opinion piece. “Extraordinary efforts are needed to address the shortfall,” Dodds writes, adding that universal access “cannot be done without an investment in the health care systems of poorer countries, particularly in health workers.” He concludes that a new campaign to curb the pandemic headed by former Botswana President Festus Mogae “should be embraced” (Dodds, Cape Times, 8/5).

Andre Picard, Globe and Mail: “There is a realization of late that, if AIDS is ever going to be stopped, … marginalized groups” like “girls and women in countries where they have few rights; men who have sex with men where that is taboo; sex workers; intravenous drug users; [and] members of minority groups” must “be targeted for prevention and treatment efforts,” columnist Picard writes in Toronto’s Globe and Mail. “Yet, for all the good intentions of the world’s scientists, clinicians, community workers and activists, for all the grand statements about human rights, the largest of the marginalized groups has been callously ignored: people with disabilities,” he adds. Picard writes, “In most societies, the disabled are shunned, at best hidden away and pitied,” adding, “There is no reason to believe that their HIV/AIDS infection rate is any less than other groups’.” He concludes, “It is time for the AIDS world to open its eyes” (Picard, Globe and Mail, 8/7).

Helen Epstein, Los Angeles Times: “You can’t fight AIDS without medicine, but you also can’t fight AIDS with medicine alone,” Epstein, author of “The Invisible Cure: Why We Are Losing the Fight Against AIDS in Africa,” writes in a Times opinion piece. According to Epstein, HIV spreads “rapidly” in Africa “not because Africans have so many sexual partners, but because African men and women are more likely than people elsewhere to have more than one long-term partner at a time.” She adds that “even small reductions in the fraction of people with multiple sexual partners can have a dramatic effect on the epidemic” (Epstein, Los Angeles Times, 8/3).

Kyung-Wha Kang, Miami Herald: “The tenaciousness of AIDS stems in part from the fact that measures to counter it underestimate and even ignore the human rights context in which it thrives,” Kang, the United Nations acting high commissioner for human rights, writes in a Herald opinion piece. According to Kang, “millions of people who experience human rights violations” — such as discrimination, gender inequality, marginalization, poverty, violence, and lack of access to education and information — “are also more vulnerable to HIV infection and more likely to die” of an AIDS-related condition. Therefore, “any approach to HIV must also respond to the human rights issues fueling the epidemic and emanating from it,” Kang writes (Kang, Miami Herald, 8/6).

Lorraine Teel, Minneapolis Star Tribune: The U.S. needs “a unified strategy and comprehensive ongoing dialogue” to curb the epidemic in the country, Teel, executive director of the Minnesota AIDS Project, writes in a Star Tribune opinion piece. “This isn’t a moral issue; this isn’t a political debate: this is a public health problem,” Teel writes, concluding, “Now more than ever we need to call upon all segments of the community — from civic leaders, elected officials, faith-based institutions, schools, health care providers, social service agencies and, frankly, our neighbors. Let’s all talk about AIDS and about how to stop it. United, we can achieve that goal” (Teel, Minneapolis Star Tribune, 8/4).

Thompson Ayodele, New York Post: The “true obstacle” to getting HIV/AIDS treatment to people in developing countries is “local policies,” including tariffs and infrastructure issues, Ayodele, executive director of Initiative for Public Policy Analysis in Nigeria, writes in a Post opinion piece. Some African countries have duties, taxes and government regulations on medicines that can “drive the costs through the roof,” he writes. In addition, a lack of roads and electricity in some nations serve as obstacles to delivering medications to patients and properly storing the drugs. Ayodele concludes, “If [the XVII International AIDS Conference] is to have an impact on the growing AIDS pandemic, the participants need to get their priorities straight. Improving medical infrastructure and lowering tariffs should be their chief concern — not weakening drug patents” (Ayodele, New York Post, 8/4).

George Curry, Philadelphia Inquirer: “There is no question that African-Americans are disproportionately represented among the ranks of those with HIV and AIDS,” Curry, a columnist for the Inquirer, writes. In the column, Curry discusses a report released by the Black AIDS Institute that “paints a portrait of what black America would look like if it were a separate country.” According to Curry, the report showed that there are more blacks living with HIV in the U.S. than the total HIV-positive populations in seven of the 15 nations in the President’s Emergency Plan for AIDS Relief program, which provides $3 billion annually to nations most affected by the virus. Curry writes, “Some worry that not enough money is being spent at home.” He says that PEPFAR spending, for example, increased by 46% in 2007 compared with a 2.5% increase for domestic HIV/AIDS spending. For 2008, global HIV/AIDS spending is expected to increase by 34%, while domestic spending will increase by 1.2%, he adds (Curry, Philadelphia Inquirer, 8/7).

Don Bruner/Jackie Dozier, Rochester Democrat and Chronicle: The U.S. “is falling short on its commitment to curb HIV/AIDS,” Bruner and Dozier, executive director and executive assistant and director, respectively, of the Women HIV/AIDS Initiatives at the Black Men Latino Men Health Crisis, write in a Democrat and Chronicle opinion piece, adding, “We still see huge racial and economic disparities in HIV infection rates.” Bruner and Dozier write that CDC has been unable to “accurately estimate the annual new HIV infection rates,” which has “exposed a fatal flaw in the CDC HIV/AIDS data collection and monitoring, funding allocation and prevention programs.” The lack of accuracy means “state and federal funding for HIV prevention and AIDS services is less likely to reach populations who most need it,” they write. They conclude that the “need for increased prevention services for women, especially women of color, has been clearly demonstrated and documented” (Bruner/Dozier, Democrat and Chronicle, 8/7).

Henrietta Fore, Washington Times: With the reauthorization of PEPFAR, President Bush and U.S. lawmakers have kept the country “boldly at the forefront of efforts to reduce poverty and enhance the lives of people around the world for years to come,” Fore, administrator for USAID, writes in a Times opinion piece. The U.S. is “not only investing in the prevention and treatment of HIV/AIDS, malaria and tuberculosis today, but we also are focusing on tomorrow by training people to manage, deliver and support the distribution of health services, which will be critical for sustained successes against infectious diseases,” she continues. “Improving the health of populations and reducing the spread and impact of diseases … result in greater productivity and economic growth, and contribute to peace and stability,” Fore writes. She concludes, “We will save countless lives by expanding proven approaches and interventions until we reach all who are in need” (Fore, Washington Times, 8/5).

Richard Elliott, Winnipeg Free Press: Ahead of the XVII International AIDS Conference, Elliott, executive director of the Canadian HIV/AIDS Legal Network, suggests three areas on which Canada should focus in the fight against HIV/AIDS. He says that Canada should address issues with the Access to Medicines Regime, which aims to help developing countries obtain access to more affordable generic medications; support health services that treat drug addictions and prevent “associated harms”; and recommit to a scaling up of funding for HIV/AIDS in the country, as well as ensure that new funding supports HIV vaccine research (Elliott, Winnipeg Free Press, 8/2).

Kaisernetwork is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading

Delaying Surgical Procedures Increases Infection Risk And Health Care Costs

Delaying elective surgical procedures after a patient has been admitted to the hospital significantly increases the risk of infectious complications and raises hospital costs, according to the results of a new study in the December issue of the Journal of the American College of Surgeons.

The occurrence of infection following surgical procedures continues to be a major source of morbidity and expense despite extensive prevention efforts that have been implemented through educational programs, clinical guidelines, and hospital-based policies. The authors of the study queried a nationwide sample of 163,006 patients, 40 years of age and older, from 2003 to 2007. They evaluated patients who developed postoperative complications following one of three high-volume elective surgical procedures: 87,318 coronary artery bypass graft (CABG) procedures, 46,728 colon resections, and 28,960 lung resections.

The infectious complications evaluated included pneumonia, urinary tract infections, postoperative sepsis and surgical site infections. Researchers found that for each type of procedure, infection rates increased significantly from those performed on the day of admission to those performed one, two to five, and six to 10 days later. Total infection rates after CABG increased from 5.7 percent on the day of admission to 18.2 percent at six to 10 days. Similar increases were noted after colon resection (from 8.4 to 21.6 percent) and after lung resection (from 10.2 to 20.6 percent; p < 0.0001 for all trends). The delays significantly inflated total hospital costs. Mean cost significantly increased with delays for all procedures evaluated: CABG: $36,079 to $47,527; colon resections: $20,265 to $29,887; and lung resections: $26,323 to $30,571.

“Multiple factors can contribute to postsurgical complications, including age and coexisting health issues,” said lead study author Todd R. Vogel, MD, MPH, FACS, assistant professor of surgery at the University of Medicine & Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick. “This analysis, however, confirms a direct correlation between delaying procedures and negative patient outcomes. As pay-for-performance models become increasingly prevalent, it will be imperative for hospitals to consider policies aimed at preventing delays and thereby reducing infection rates.”

Factors associated with in-hospital procedure delays included advanced age (80 years and older), female gender, minority status, and existing health issues including congestive heart failure, chronic pulmonary disease, and renal failure. Postoperative complications most associated with delay in CABG and colon resection were urinary tract infections and pneumonia, while delayed lung resections increased rates of sepsis and pneumonia. Mortality was significantly greater when CABG procedures and lung resections were postponed more than five days.

The study analyzed data collected from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), the largest publicly available all-payer inpatient care database in the U.S. and was sponsored by the Agency for Healthcare Research and Quality (AHRQ). The database includes all inpatient stay records from approximately 20 percent of U.S. community short-stay hospitals.

Source:
Sally Garneski
Weber Shandwick Worldwide Continue reading

Noted St. Jude Virologist Presents Lecture On Pandemic Influenza To The Royal Society

Acclaimed virologist Robert Webster, Ph.D., of St. Jude Children’s Research Hospital, presented the 2010 Leeuwenhoek prize lecture, a prestigious recognition awarded by the Royal Society in London.

The Leeuwenhoek Lecture, named after microscopist Antony van Leeuwenhoek, was established to recognize excellence in the field of microbiology. The Royal Society, founded in 1660, is the world’s oldest scientific academy in continuous existence.

“I am deeply honored to be invited to present the 2010 Leeuwenhoek Lecture on the 350th anniversary of the Royal Society,” Webster said at the start of his presentation, “Pandemic Influenza: One Flu over the Cuckoo’s Nest.”

Webster provided an overview on pandemic influenza viruses, including a discussion of origins as well as response to the 2009 H1N1 strain worldwide. “Overall, we have been extremely fortunate. But we simply can’t predict severity,” Webster said stressing that strong global surveillance is key moving forward.

The prize lecture acknowledges Webster’s many contributions to the field of virology.

His research into the structure and function of influenza virus proteins has added volumes to the world’s knowledge of influenza as an emerging pathogen. Webster’s work has explored the development of new vaccines and antivirals as well as the role that wild birds play as major reservoirs for influenza viruses and their function in the evolution of new pandemic strains for humans and lower animals.

A native of New Zealand, Webster joined St. Jude in 1968 and holds the Rose Marie Thomas Chair in Infectious Diseases. St. Jude is home to the only World Health Organization collaborating center focusing on the transmission of animal influenza viruses to humans. The hospital also hosts one of six Centers of Excellence for Influenza Research and Surveillance funded by the National Institute of Allergy and Infectious Diseases, a part of the National Institutes of Health.

Webster has received numerous honors throughout his career, including election to the Royal Society, London; the Royal Society of New Zealand; and the U.S. National Academy of Sciences.

“The Leeuwenhoek Lecture is a well-deserved acknowledgement for Dr. Webster, whose life’s work has greatly progressed influenza research worldwide,” said Dr. William E. Evans, St. Jude director and CEO. “The Royal Society honor is a reflection of an esteemed career that has provided significant advancements to the field of virology.”

The Royal Society’s members are some of the most eminent scientists of the day, including more than 60 Nobel laureates. Throughout its history, the organization has promoted excellence in science through its Fellowship and Foreign Membership, which has included Isaac Newton, Charles Darwin, Ernest Rutherford, Albert Einstein, Dorothy Hodgkin, Francis Crick, James Watson and Stephen Hawking.

St. Jude Children’s Research Hospital

St. Jude Children’s Research Hospital is internationally recognized for its pioneering research and treatment of children with cancer and other catastrophic diseases. Ranked the No. 1 pediatric cancer hospital by Parents magazine and the No. 1 children’s cancer hospital by U.S. News & World Report, St. Jude is the first and only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. St. Jude has treated children from all 50 states and from around the world, serving as a trusted resource for physicians and researchers. St. Jude has developed research protocols that helped push overall survival rates for childhood cancer from less than 20 percent when the hospital opened to almost 80 percent today. St. Jude is the national coordinating center for the Pediatric Brain Tumor Consortium and the Childhood Cancer Survivor Study. In addition to pediatric cancer research, St. Jude is also a leader in sickle cell disease research and is a globally prominent research center for influenza.

Founded in 1962 by the late entertainer Danny Thomas, St. Jude freely shares its discoveries with scientific and medical communities around the world, publishing more research articles than any other pediatric cancer research center in the United States. St. Jude treats more than 5,700 patients each year and is the only pediatric cancer research center where families never pay for treatment not covered by insurance. St. Jude is financially supported by thousands of individual donors, organizations and corporations without which the hospital’s work would not be possible. In 2010, St. Jude was ranked the most trusted charity in the nation in a public survey conducted by Harris Interactive, a highly respected international polling and research firm.

Source: St. Jude Children’s Research Hospital Continue reading

Professor Says Humans More Likely To Spread Disease Than Insects In Gulf

Diseases that are transmitted human-to-human are more of a concern for health officials in New Orleans than diseases humans can get from insects and other animals, according to a veterinarian and epidemiologist at the Purdue University School of Veterinary Medicine.

Larry Glickman, professor of epidemiology and environmental health, says the threat of humans spreading diseases among humans has been underestimated.

“We need to focus our concern on the diseases people will get from contact with other people who are moving from place to place,” Glickman said.

During the first month or so after the flooding, mosquito-borne diseases such as West Nile present little problem because the waters will actually destroy most of the breeding areas. Mosquitoes do not feed on dead bodies, Glickman said. Diseases like cholera, dysentery or malaria are unlikely to be a problem because they were not prevalent in the Gulf Coast prior to the disaster.

“The most serious threats will be measles, whooping cough, common colds or the flu due to the unusual amount of interaction among strangers,” Glickman said.

Writer: Maggie Morris

School of Veterinary Medicine: vet.purdue.edu

PURDUE UNIVERSITY
purdue.edu Continue reading