Science Policy For All

Because science policy affects everyone.

Posts Tagged ‘public health

Science Policy Around the Web September 13th, 2019

leave a comment »

By Neetu M. Gulati PhD

Image by mika mamy from Pixabay 

Genetically modified mosquitoes breed in Brazil

An experiment to curb the population of tropical disease-carrying mosquitoes in Brazil may have failed. In 2013 and 2015, mosquitoes with a modification called OX513A, which prevents these mosquitoes from reaching adulthood and being able to reproduce, were released into a region of Brazil. This experiment was meant to limit the spread of mosquito-borne infectious diseases that plague the area, including zika, dengue, and yellow fever. 

Initially, the goal of the genetic modification experiment was to reduce the mosquito population by 90%, which was successful during the field trial. Only about 4% of genetically modified mosquitoes were expected to be able to reach adulthood, and it was hypothesized that these mosquitoes would be too weak to reproduce. However, about 18 months after the experimental trial period ended, the mosquito population has returned to pre-trial levels. A recent study has revealed that the gene modification has been passed on in 10-60% of the mosquitoes in the area, suggesting they were able to reproduce. Furthermore, modified mosquitoes are as able to carry infectious diseases as non-modified mosquitoes. Critics of the experiment warn that not enough was known about these mosquitoes and there may be unintended consequences to the genetic modification, including a possibility of making the species more robust. The authors of the new study posited “These results demonstrate the importance of having in place a genetic monitoring program during releases of transgenic organisms to detect unanticipated consequences.”

(Fabian Schmidt, Deutsche Welle

America is in danger of losing its “measles-free” status

In 2000 the United States was declared measles-free, 37 years after the introduction of the measles vaccine in the US and Canada. Now, almost two decades later, the US is at risk of losing an official designation of “measles-elimination” status in October. This status is only given to countries without continuous measles transmission for at least one year, where cases of the disease can be linked back to a traveler who brought the virus from another place where it has been circulating. An outbreak of measles in New York state now jeopardizes this. The CDC reported over 1,200 measles cases in the US, with over 75% of the cases occurring in the state of New York. 

This is occurring because it is common in some groups to opt out of the measles vaccine. And it is not just the US; measles cases have increased around the world, and some other countries have also lost measles-free status in the last year.

The outbreak in New York can be traced back to Ukraine, which has had tens of thousands of measles cases in the last year. It then spread throughout a tight-knit community of people who chose not to vaccinate for perceived safety concerns. So while this outbreak can be linked to a traveler, many are concerned that if vaccine coverage rates continue to decline, the virus could spread enough, especially in under-vaccinated communities, that the outbreaks will begin to be “homegrown.”

(Julia Belluz, Vox)

Advertisements

Written by sciencepolicyforall

September 13, 2019 at 10:53 am

Science Policy Around the Web – July 3rd, 2019

leave a comment »

By Neetu Gulati, Ph.D.

Image by Arek Socha from Pixabay 

The US opioid epidemic is driving a spike in infectious diseases

Opioid use has skyrocketed in the US in the past 20 years, and addiction kills tens of thousands of people each year. Now, opioid use has been linked to an increase in infectious diseases as well, which may pile on to an already extreme public health concern.

One cause for concern is that opioids themselves may be making people more susceptible to infection, though the reason for this is unclear. One study found that people treated at veterans’ health facilities who took medium or high doses of prescribed opioids for pain management were more susceptible to pneumonia, for example. Another cause for concern is that unsafe injection practices may mean that users of illicit opioids could lead to an increase of infections. Bacterial infections, such as those caused by Staphyloccocus aureus, can enter the bloodstream of opioid users through non-sterile needle usage or unclean sites of injection. If these bacteria reach the heart, it can lead to damage and possibly the need for a transplant. For example, a study done in North Carolina found a tenfold increase in heart infections among drug users in the state over a 10-year period.

As if the increase in infections was not bad enough, another major challenge is that the pattern of outbreaks associated with drug use may not be the same as that of non-drug-affiliated outbreaks, meaning it is difficult to predict where and when infections might occur. Furthermore, as Georgiy Bobashev, a data scientist at RTI International, pointed out, drug users “don’t have good practices and they don’t have good connections with people who have been injecting drugs for a long time.” In tackling the problem, it will be important to consider the social component of predicting outbreak patterns among drug users. It will also be important to treat opioid use as a disease without stigmatizing drug users, commented Carlos Del Rio, a global-health researcher at Emory University.

(Sara Reardon, Nature)

Have an interesting science policy link? Share it in the comments!

Written by sciencepolicyforall

July 3, 2019 at 3:13 pm

Science Policy Around the Web – June 25th, 2019

leave a comment »

By Ben Wolfson, Ph.D.

Image by Darwin Laganzon from Pixabay 

North Korea claimed to be free of HIV. But infections appear to be surging

Since its first diagnosis 1981, HIV/AIDS (Human immunodeficiency virus infection and acquired immune deficiency syndrome) has infected more than 70 million individuals worldwide and resulted in 35 million deaths.

HIV/AIDS is classified as a pandemic, with infected individuals found throughout the world. However, as of a December, 2018 World AIDS Day event, North Korea reported no known cases, crediting this to widespread testing and prevention methods.

A new paper has reported that these data were false, and that in fact following a North Korean “patient zero” in 1999, HIV/AIDS infections have slowly ballooned. These findings come from a collaboration between North Korean scientists and DoDaum, a nonprofit in North America that runs health and education projects in North Korea. While officials originally asked DoDaum not to discuss the increasing prevalence of HIV/AIDS in North Korea, the North Korean Ministry of Public Health felt they had to overcome traditional reticence in order to seek help in targeting HIV/AIDS.

While both a cure and vaccine remain elusive, widening usage of Pre-Exposure Prophylaxis (PrEP), also called Truvada, has the potential to significantly reduce new HIV infection. PrEP has been shown to be more than 90% effective at preventing new HIV infections, and remains underutilized in most countries, including the USA. This is in part due to cost, a factor which is the subject of a new bill introduced in the Senate that would make PrEP free to most patients.

(Richard Stone, Science)

Have an interesting science policy link? Share it in the comments!

Written by sciencepolicyforall

June 25, 2019 at 5:37 pm

Science Policy Around the Web – June 21st, 2019

leave a comment »

By Neetu Gulati Ph.D.

Image by Kathy Bugajsky from Pixabay 

Tech disorder? Smartphones linked to bizarre horn-like skull bumps

Two Australian researchers published a study inScientific Reports this year with an unusual discovery: people are growing horn-like bone spurs at the base of their skulls. They found these protrusions on around 400 adults aged 18 to 86, and larger growths were found among younger people. Bone spurs usually do not cause pain or require treatment, but if they become too large can become a problem.

While the study originally did not get much press, it has broken headlines recently after a BBC article covering how modern life is transforming the human body. The authors in the original research article hypothesized these bone spurs could be due to “sustained aberrant postures associated with the emergence and extensive use of hand-held contemporary technologies, such as smartphones and tablets.”

While the article has led to sensationalized media accounts, some experts have questioned the validity of the conclusions, saying the study lacks a control group and cannot prove cause and effect between the spurs and technology. Furthermore, there may be bias in the study because the subjects are people with enough neck problems to warrant visiting a chiropractic clinic, where the authors of the study work.

Regardless of the exact cause of the bone spurs, numerous cases of “texting neck” ailments and similar problems have occurred as technology use as increased since the early 2000s. Dr. David Geier, an orthopedic surgeon, commented that the study “isn’t going to convince people not to use their phone. But small changes like putting pillows under our laptops and holding the phone or tablet higher up and away from our laps can promote better posture.” Others, such as Dr. Evan Johnson, an assistant professor and director of physical therapy at the New York-Presbyterian Och Spine Hospital, commented that the bone spur “is a really big ‘So what?’ moment… The fact that you have this little bony projection in your skull, that means nothing.” It will be important to see if these projections get worse over time, to the point of leading to pain.

(Dr. Shamard Charles, NBC News

Type A blood converted to universal donor blood with help from bacterial enzymes

Donor blood plays a critical role in the healthcare system. However, there is a constant shortage of blood for transfusions around the world. Blood shortages are made more complicated because blood transfusions cannot be done with just any blood, the patient and donor blood types must be compatible or else the recipient’s body can have a deadly immune response to the donor blood. The immune system recognizes specific sugar molecules on the surface of red blood cells, which denote blood as one of the four types: A, B, AB, or O. Blood type O is coveted as universal donor blood, because it lacks these unique sugar molecules, also known as antigens, so they are not recognized as “foreign” in a patient’s body, even when given to people with other blood types. 

Now, researchers have discovered a way to convert type A blood to type O, using a combination of two bacterial enzymes to remove the “A-defining” antigens. Harvey Klein, a blood transfusion expert at the National Institutes of Health, commented on the work, “this is a first, and if these data can be replicated, it is certainly a major advance.”

Previous attempts by researchers to remove the A-defining antigens from blood have had limited success, because the enzymes used were not very efficient. In the most recent study, bacterial enzymes identified from a human stool sample removed the sugars in human blood efficiently using only tiny amounts of the enzymes. If these findings can be translated to practical application, the amount of universal donor blood could nearly double, as type A blood makes up approximately 1/3 of the blood supply. To get to that point, more work needs to be done to confirm that these enzymes are not altering anything else in the blood.

(Elizabeth Pennisi, Science)

Have an interesting science policy link? Share it in the comments!

Written by sciencepolicyforall

June 21, 2019 at 2:59 pm

Science Policy Around the Web – June 18th, 2019

leave a comment »

By Allison Dennis, B.S.

Source

Congress is debating-again-whether genes can be patented

The last time the U.S. government issued an official guidance on human gene patenting, it was from the Judicial Branch in 2013. By a unanimous decision, the Supreme Court ruled that two genes whose DNA sequence can be used to predict the probability of a patient developing breast or ovarian cancer, BRCA1 and BRCA2, could not be patented. Companies are still free to pursue patents manipulating or mitigating the effects of specific genes, but the ruling invalidated the patents held by Myriad Genetics for these two genes and opened the door for clinical labs to begin widely testing patient samples for mutations across a wide variety of disease predicting genes that might have otherwise been patented.

Insurance claims filed in 2004 indicate that only one in four women received a BRCA mutation test before being diagnosed with cancer. By 2014, more than 60% of these tests were administered diagnostically, allowing women confirmed to be at risk to pursue prevention and early detection of breast and ovarian cancer before developing either. The effect of the 2013 Supreme Court ruling to dramatically reduce testing costs in combination with technological developments and public health awareness have been attributed to this shift.

Now lawmakers in the legislative branch are weighing in. Senators Thom Tills and Chris Coons filed a bipartisan draft bill that would expand the types of inventions eligible for a U.S. patent to include previously restricted subject matter falling under “abstract ideas,” “laws or nature,” or “natural phenomenon,” which could be interpreted to include human genes. While Tillis has since made clear that it was “was never the intent” to again give companies ownership over single human genes, the changes could allow companies to limit examination of specific genetic variants like those most likely to cause disease. Supporters of the bill feel it is necessary to provide companies with sufficient intellectual property to incentivize their research into isolated natural products. Many point to less-restrictive patent codes abroad, which they feel put the U.S. at a disadvantage.  

Following two weeks of Congressional hearings, and a letter signed by 170 scientific organizations, nine nobel prize winners along with 74 leading physicians and scientists have weighed in by urging lawmakers to more carefully consider the proposed changes. The level of concern or eagerness expressed for the bill seems largely up to the interpretation of the reader, suggesting that much more work is needed for the bill to achieve its stated goal of reducing frustration and confusion generated by the Supreme Court rulings.

(Megan Molteni, Wired Magazine)

Federal Grants Restricted To Fighting Opioids Miss The Mark, States Say

Of the 70,237 drug overdose deaths captured by the CDC in 2017, nearly a third involved cocaine, psychostimulants, which include MDMA and methamphetamine, or both. The CDC cites “changes in the drug supply, mixing of substances with or without the user’s knowledge, and polysubstance use” as emerging threats. Yet the opioid-focused way grant money is allocated may be restricting the ability of states to adapt.

At the frontlines of the opioid epidemic are state officials dedicated to making the most of federal grants designed to offer struggling states a financial lifeline. For example in 2017, Arizona used funds from a State Targeted Response grant to train 9,197 individuals in Naloxone usage and purchase 8,798 Naloxone kits, allowing first responders to perform 5,649 overdose reversals. Many states are using the money to implement the hub-and-spoke model, first developed and demonstrated to be effective by Vermont, in which intensive addiction treatment is offered at a limited number of hubs connected by a local network of outpatient addiction programs and primary care physicians. Through this structure, the hub-and-spoke model can make at least one licensed mental health or addiction counselor accessible per 100 patients.

While the framework provided by the hub-and-spoke model may intuitively help address addiction beyond the specific use of opioids, they rely on Medication Assisted Treatment, an intervention that has only been approved for opioid addiction. Similarly the use of Novaxalone is only effective in reversing opioid overdoses, in the case of cocaine overdose it is ineffective. Additional research is underway to develop parallel treatments for other substances, but these efforts have been eclipsed by the national focus on opioids.  

In 2017, opioids accounted for less than half of the overdoses suffered in eleven states, including Pennsylvania, Texas, and California. This may point to the effectiveness in opioid specific treatment, but it also the persistent dangers of drug-use. Currently, the funding opportunities are insufficient to address the gaps in the mental health system needed to more completely help patients living with addiction. The pathways leading to drug-abuse, no matter the current drug of choice, may provide a common point of intervention resilient against the so called “emerging threats” of substance abuse.

However, similar to the shift seen as users transitioned from OxyContin to Heroin, public health fear that the next shift will turn to drugs not classified as opiods and therefore ineligible to be combated with the funds. In 2017, eleven states

(Carmen Heredia Rodriguez, Elizabeth Lucos, and Orion Donovan-Smith, Kaiser Health News)

Have an interesting science policy link? Share it in the comments!

Written by sciencepolicyforall

June 18, 2019 at 5:22 pm

The worst humanitarian crisis in the world: war, disease outbreaks and famine in Yemen

leave a comment »

By: Silvia Preite, Ph.D.

Source: Wikimedia

War and natural emergencies in low and middle-income countries often result in the weakening of health systems and relaxation of disease surveillance and prevention, leading to increased risk of infectious disease outbreaks. The over four-year civil war in Yemen continues today and, according to the United Nations (UN), has resulted in the worst on-going humanitarian crisis in the world. Hunger and the spread of communicable diseases affects the vast majority of the Yemeni population.

Overview of the ongoing war in Yemen

Before the start of the conflict in 2015, Yemen was already the poorest country in the Middle East, with debilitated health care systems and poor infrastructures. In March 2015, the Houthi movement took over the government in Sana’a (the capital). In response, a Saudi Arabia and United Arab Emirates-led coalition (supported by several other nations including the United States, the United Kingdom and France) started a military intervention in Yemen, with the intention of restoring the Yemeni government. Overall, this conflict resulted in devastation of agriculture, services, and industry in Yemen. Moreover, in more than four years of air strikes, over 50% of Yemeni hospitals, clinics, water treatment plants and sewage have been continuously bombed. The situation is further worsened by restrictions on food and medicines and limited access to fuel, leaving many essential facilities non-functional, including water sanitation centers. These conditions have led to extreme famine and spreading of diseases, including massive cholera outbreaks among the population. 

Cholera outbreaks

Cholera is a bacterial disease leading to severe diarrhea and dehydration, usually caused by the consumption of contaminated water or food. World-wide, an estimated 2.9 million cases and 95,000 deaths occur each year. It has been estimated that cholera has affected more than 1 million people in Yemen, with more than 2000 deaths, becoming the worst cholera outbreak in the world. According to Médecins sans Frontières (MSF) (known in English as Doctors Without Border) and Physicians for Human Rights, hospitals, mobile clinics, ambulances, and cholera treatment centers continue to be bombed, despite the fact that they have been marked as medical centers and the GPS coordinates have been communicated to the Saudi coalition. In addition to cholera, as a consequence of dropping immunization rates, more than 3000 cases of measles have been reported. Cholera and measles can be prevented by vaccinations and proper health infrastructure. Global eradication efforts have been adopted over the years to eliminate these infections, making the spreading of these diseases in Yemen a significant setback. 

Humanitarian violations

The Fourth Geneva Convention concerns the protection of civilians during conflicts, and has been ratified by 196 states, including parties involved and supporting the war in Yemen. The air strikes on medical centers violate the principles of medical neutrality established by the convention that protects hospitals and health care workers from being attacked. Within the standards of this international law, there is also the right of free mobility of medical personnel within a conflict zone. In contrast, during the civil war in Yemen restrictions have been applied by all involved parties on the activity of medical staff, delivery of health care equipment, essential medicines and vaccines. 

Latest UN report on the Yemen crisis

According to the UN, an estimated 24.1 million people (80% of the total population) need assistance and protection in Yemen, and of those, 14.3 million are in acute need (need help to survive). More than 3 million people are currently internally displaced (IDP), living in desperate conditions in Yemen or elsewhere in the region. It is estimated that 20.1 million people need food assistance, 19.7 million people need basic health care services, and 17.8 million people lack potable water, sanitation and hygiene (WASH). 

Children

An estimated 7.4 million children are in need of humanitarian assistance. Severe children’s rights violations are taking place in Yemen, affecting more than 4000 children and including the risk of being armed and recruited in the war for the boys and child marriage for girls. An estimate of 2 million children are deprived of an education, with around 2,000 schools made unusable by air strikes or occupied by IDPs or armed groups. Upwards of 85.000 children under the age of 5 may have died from severe hunger or other diseases. Overall, according to the UN, at least one child dies every ten minutes in Yemen because of diseases that could be normally prevented, hunger and respiratory infections. 

Urgent need for plans and resolutions

Both famine and disease outbreaks are threatening the Yemeni population and their survival currently relies only on international aid. In February 2019, the United Nations and the Governments of Sweden and Switzerland converged in Geneva to face and discuss the “High-Level Pledging Event for the Humanitarian Crisis in Yemen”. The aim of this meeting was to request international support to alleviate the suffering of the Yemeni people, and they requested $4 billion to provide life-saving assistance. Up to now, 6.3% of the requested budget has been funded; it is encouraging to note that last year UN was able to raise almost 100% of what was initially requested through multiple world-wide donations. 

Along with new funding, the OCHA (UN Office for the Coordination of Humanitarian Affairs), argues that urgent action is needed to prevent any exacerbation of the crisis. The most urgent action to resolve this unprecedented, man-made, medical and humanitarian emergency should come from all the parties involved to end the war and allow the re-establishment of food imports and adequate health services.

As the world barely watches, with only intermittent attention given by the international media, the conflicts and emergency remain. Non-profit and humanitarian organizations (UNICEFMSFWFPSave the Children) have greatly aided the Yemeni population, despite challenging operational environments and the import and circulation restrictions. Moreover, when millions of people, including children, die from hunger and preventable diseases every day, the ethical responsibility of this disaster becomes global and concerns all of us. 

Global implications and future perspectives 

The on-going conflict in Yemen, illustrates how the support of research into innovative global-health solutions is highly needed. When the traditional healthcare system has collapsed and human rights are suspended, we need technologies which further support the victims of war-torn countries to achieve basic sanitary and health standards, beside disease monitoring and vaccination strategies.

We live in an increasingly interconnected world where outbreaks of neglected or re-emerging infectious diseases know no boundaries. Therefore, the consequences of conflicts and disasters in low-middle income countries pose a significant global threat and may affect even stable healthcare systems. Proper evaluation of the causes and consequences of infection outbreaks during the Yemeni conflict is therefore critical for two reasons: devise new strategies to more effectively control and prevent the spread in war-torn areas, and proactively encourage and support countries in regions of conflict to take the necessary measures to minimize the risk of similar humanitarian disasters in the future.

Have an interesting science policy link? Share it in the comments!

Written by sciencepolicyforall

April 11, 2019 at 4:29 pm

Science Policy Around the Web – March 12, 2019

leave a comment »

By Andrew Wright, BSc

Source: Pixabay

The war on ‘prediabetes’ could be a boon for pharma—but is it good medicine?

Diabetes is highly prevalent in the United States, affectingnearly 10% of the US populationand accounting for approximately 80,000 deaths every year. While the pursuit to reduce or mollify the societal and economic impact of this disease is undoubtedly necessary in a country where fully 39.8% of adults are obese, there are some who wonder if such efforts have slipped into problematic territory. 

            Similar to how the introduction of pain as a fifth vital signhelped to unintentionally spur on the devastating opioid crisis, there is fear that the expanding diagnostic criterion of prediabetes could lead to the familiar territory of unnecessary treatment. For one, the risk of prediabetic patients developing diabetes from year to year is low: just under 2% according to the Centers for Disease Control (CDC).  At the same time the methods of treatment for prediabetes, designed to prevent progression to the full disease, are not particularly effective in achieving that goal. While a 2009 study demonstrated that exercise intervention or metformin, a common drug used to treat diabetes, did prevent some prediabetic patients from transitioning to full diabetes, methodological concerns have been raised with the authors’ results. One of the major issues is that the study used high risk patients at the upper end of the prediabetic spectrum, which is significant given that the American Diabetes Association (ADA) reduced the lower threshold of what counts as prediabetes around the same time. Of these “less” prediabetic patients, many never transition to the full disease. This suggests at the very least that treating these patients, especially pharmacologically, is not necessary or beneficial.

            Despite these issues being raised, there is a worrying trend of medical professionals doing just that. While no drug has been approved to treat prediabetes, doctors are continuing to treat prediabetic patients with diabetes drugs by prescribing them off-label at the recommendation of the ADA. Not only does this include metformin, which has its own difficult side-effects, but also several medications with “black box” labels that denote severe risks. Particularly when one considers that those who progress to full diabetes will be treated with these same drugs as their condition worsens, using them prophylactically is likely overzealous.

            Finally, there have been concerns raised about financial conflicts of interest, to which the medical and pharmaceutical industry are certainly not strangers. The companies behind the most prominent diabetes drugs have gifted millions of dollars to those in positions of influence at the ADA and other medical institutions. Perhaps as a result, while international groups such as the World Health Organization (WHO) have rejected prediabetes as a condition outright, the American medical community seems to be falling in line with the diagnosis. When top-down societal changes to reduce obesity may a be more effective means to reduce diabetes according to the WHO, the over-medicalization of prediabetes could ultimately do more harm than good.

(Charles Piller, Science)

Microplastic pollution revealed ‘absolutely everywhere’ by new research

With estimates that the ocean will have more plastic than fishby weight by 2050, it should come as no surprise that global plastic pollution is becoming rapidly untenable.  It is well understood that plastic does not biodegrade, but rather breaks down into increasingly smaller pieces know as microplastics. These pieces of plastic can become so small that they can be ingested by zooplankton, one of the fundamental building blocks of the marine food chain, which means they eventually make their way to the human digestive system.  

            While the problem was previously thought to be relegated to the worst polluted waterways and places like pacific vortexes (colloquially known as the “Great Pacific Garbage Patch”), recent studies have shown that microplastic pollution is so pervasive that pieces are found in every area tested. This includes freshwater bodies in the United Kingdom, groundwater supplies in the United States, the Yangtze river, off the coast of Spain, and in tap water around the world.

            The problem is not relegated to shallow water bodies either, with microplastics being found at the bottom of the Mariana Trench at levels of up to 2,200 pieces per liter of sediment. While these levels of contamination are undoubtedly perilous to wildlife, the affect they might have on humans is unclear. However, research from the National University of Singapore has demonstrated that microplastics harbor both bacteria that cause coral bleaching and those that cause gastroenteritis.  Further,  the possibility remains for chemicals contained in microplastics such as polychlorinated biphenyls (PCBs), which are carcinogenic, to cause deleterious health effects as chronic exposure leads to cumulative effects. What is clear is that without some method of reducing plastic pollution or monumental cleanup efforts, microplastics will become a troubling global burden in the years to come.

(Damian Carrington, The Guardian)

Have an interesting science policy link? Share it in the comments!

Written by sciencepolicyforall

March 12, 2019 at 4:53 pm