Science Policy For All

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Science Policy Around the Web – December 8, 2015

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By: Ian McWilliams, Ph.D.

Drug Policy and Public Heath

Applying Public Health Principles to the HIV Epidemic — How Are We Doing?

December 1st marked World AIDS Day and a time to raise awareness about the fight against HIV and AIDS. With approximately 1.2 million people in the United States alone affected by the disease, much focus is given to the prevention and control of HIV. Significant progress has been made over the last two decades towards controlling the epidemic. More sensitive diagnostic tests that can detect the virus earlier and better treatments has improved the health of HIV patients and allowed them to live longer. Although US public health departments, community organizations, and other groups have made concerted efforts to provide access to treatment and eliminate transmission of this disease (as evidenced by a 36.5% decrease in deaths related to AIDS), many hurdles still remain. There are currently 45,000 new HIV infections every year and 65 percent of all Americans diagnosed with HIV are not currently on treatment.

To further combat the HIV epidemic, Thomas R. Frieden, director of the Centers for Disease Control and Prevention (CDC),  and other public health leaders recommend applying public health principles of communicable diseases such as prompt diagnosis, systematic partner notification, and accountability for treatment for all patients. In the same issue of the New England Journal of Medicine, renowned HIV/AIDS expert Anthony Fauci emphasized the importance of antiretroviral therapy (ART) in the treatment and prevention of transmission of HIV. By calling for patient empowerment, community engagement, clinical excellence, and focus on outcomes these leaders hope to unite groups with a common cause against HIV and AIDS. (Thomas R. Frieden, Kathryn E. Foti, and Jonathan Mermin, New England Journal of Medicine)

Bioethics in Research

Scientists Debate How Far To Go In Editing Human Gene

The CRISPR-Cas9 gene editing system has garnered attention for the unprecedented ease by which DNA manipulation can occur. This powerful technique has possibly opened the door to treating hereditary diseases such as Huntington’s disease, cystic fibrosis, and Tay-Sachs disease. Although this could be a potent treatment modality, germline editing of sperm, eggs, and embryos raises many ethical and safety concerns. Further compounding these concerns are reports that CRISPR can have off-target effects that could result in unintended deleterious consequences. Geneticist George Church weighed in on this matter to suggest these effects are manageable and not as dangerous as we think. Adding to the complexity of this issue are fears that the ease by which this technology can alter DNA will allow for “designer babies” and “eugenics,” where individuals will try to manipulate germline DNA to create super humans.

In an effort to address these dilemmas, the International Summit on Human Gene Editing recently convened “to discuss the scientific, ethical, and governance issues associated with human gene-editing research.” The consensus of the committee, chaired by David Baltimore, call for more “intensive basic and preclinical research” and “the creation of a ongoing forum to continue to assess the state of the research and society’s readiness.” Of note, the committee cautioned “there is a need to understand the risks” and “it would be irresponsible to proceed” in reference to somatic and germline gene editing respectively. This certainly wasn’t a ringing endorsement for human gene editing, but does allow the scientific community to further develop these gene-editing tools while actively engaging with the communities to assuage fears and define care. (Rob Stein, NPR)

Health IT and EHRs

“Unsexy Plumbing,” Integrated Data And The Future Of The Healthcare System

Electronic health records (EHR) will be an important component of a modernized health care system. Improved connectivity within health organizations will provide better access to more useful data and can support larger public health programs, such as the Precision Medicine Initiative. However, the implementation of these systems has faced many hurdles such as outdated technology that is time-consuming and incompatible with newer systems and privacy-related regulations. Many initiatives have been made to share health data in order to reduce costs, increase efficiency, and improve quality of care, but currently, less than half of doctors surveyed think that EHRs have improved patient outcomes.

To address these shortfalls, efforts from government and the private sector are attempting to ease integration of EHRs. Because the Affordable Care Act limits the amount insurance companies can spend on administrative costs, and EHRs would reduce administrative burden, many insurance providers are introducing payment incentives to healthcare providers that use EHRs. Additionally, the private sector could further drive the transition to EHRs with cloud-based solutions and improved wearable devices for data gathering. These changes will lead to better payment solutions, data analytic tools, and even better insurance plan selection. (Jason T. Andrew, techcrunch.com)

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Written by sciencepolicyforall

December 8, 2015 at 9:00 am

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