Category Archives: International

Vaccine Delivery: Reaching New Heights

By Tiffany Pham

Whether used as high-tech toys, weapons of war, or eyes in the sky for videography, drones have demonstrated much versatility and potential. These aerial machines have expanded the limits of technology and the parameters of industrial science. It comes as no surprise, then, that drones have extended their influence to the field of healthcare.

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Is Surgery the Stepchild of Global Public Health?

By Nina Rodriguez

Surgery is a medical service typically not on the agenda for global healthcare advocates.  However, inadequate surgical care and scarce access to anesthesia is a serious issue in low-income and middle-income countries, such as Uganda.  It is a matter that is severely overshadowed by other more discussed crises.  In fact, Paul E. Farmer and Jim U. Kim even went so far as to name surgery the neglected stepchild of global public health in their 2008 article “Surgery and Global Health: A View from beyond the OR.”

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The Food Paradox: An Augmenting Connection Between Obesity and Malnutrition in Developing Countries

By Mimi Chung

Obesity, a growing problem in industrial and post-industrial countries, is in many areas intertwined with malnutrition. Though many industrial nations have seen a sharp increase in the number of people facing problems stemming from obesity, such as heart disease and diabetes, hunger and undernutrition still persist in wide swaths of the same nation. In China, 100 million citizens faced obesity in 2009, while 200 million suffered from undernutrition. Increasingly, developing countries face the double threat of the food paradox: confronting over and undernutrition at the same time.

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Exorbitant Drug Prices in the US: Why They Don’t Exist in Other Countries?

By Moses Im

From the scandal filled US elections to Michael Phelps’ record breaking twenty-third Olympic gold medal, 2016 has been full of big and unexpected news. Unfortunately, included in all this is the steep price hike of the Epipen (auto-injecting medicine for allergy emergencies). A set which cost $103.50 in 2009 now cost $608.61 this past May. The Epipen situation is hardly the first time when drug prices have risen to ridiculous levels in America. The alarming fact about the issue of drug prices is that it is unique to the US; most other European nations and Canada have established systems and regulations that allow the government to maintain moderate drug prices.

The alarming fact about the issue of drug prices is that it is unique to the U.S.

According to Wall Street Journal, 93% of the 40 branded drugs shared in both America and Norway are more expensive in the U.S. A vial of Rituxan, a cancer drug, costs $1,527 with Norway’s tax-funded healthcare while it costs $3,678 with America’s Medicare program. In countries such as Norway, governments are able to negotiate pricing and therefore maintain low drug prices. Often times, government established health services purchase the country’s supply of drugs and thus have enormous bargaining power. They can set their own drug prices and refuse to buy drugs from companies if they do not meet their standard or pricing. Many countries often have an NGO or government agency that reviews the cost effectiveness of drugs. Canada, for instance, has a drug review board that according to CNN, gives recommendation that helps providers determine a price they are willing to pay for the drug.” With massive negotiating power through bulk buying and drug efficacy reviews, the governments in other nations can effectively limit prices, and forcing pharmaceutical companies to oblige.

America’s health care systems, on the other hand, does not work this way. In America, pharmaceutical companies sell to numerous different consumers such as  Medicare, private insurance companies, and hospitals. As a result, each consumer has little bargaining power and thus the range of drug prices can fluctuate at the ease of the companies. In fact, Medicare is the largest consumer of pharmaceutical drugs in America, yet by law it cannot negotiate prices or gauge effectiveness of drugs. The U.S. also lacks an NGO or agency that does drug reviews like other countries. Consequently, pharmaceutical companies can set their own prices, resulting in branded drugs  being 300% more expensive in the US than in other countries.

Some argue that international price comparisons are inaccurate because they do not factor potential discounts American consumers receive when purchasing drugs. However, Bloomberg News did an analysis of drug prices accounting for these discounts, and the U.S. still constantly had the more expensive prices for top selling drugs. Pharmaceutical companies justify their dramatic price hikes as necessary to fund research and development.  Despite these justifications, Director Dr. Peter B. Bach from Memorial Sloan Kettering’s Center for Health Policy and Outcomes says that Americans are charged high prices for drugs because the companies simply can and that “we have no rational system in the U.S. for managing prices of drugs.”  

The current drug pricing situation may seem bleak in America, but to address these issues Democrats Hillary Clinton and Bernie Sanders have proposed to give Medicare the ability to negotiate drug prices much like its counterparts in other nations. This policy alone may be able to reduce about 16 billion dollars a year in spending. Perhaps it may prove to be beneficial to take inspiration or learn more from other nations’ policies as we continue our debate over healthcare and health policy here in America.

 

 

Image Reference:

http://worldofdtcmarketing.com/assault-drug-prices/cost-of-healthcare-in-the-u-s/ 

Why Expectant Mothers Shouldn’t be the Only People Concerned About Zika

BY LILY REISINGER

Recent news headlines regarding Zika parade photos of mothers with microcephalic babies, demonstrating the visible consequences of Zika infection during pregnancy. Because of these detrimental deficits, most Zika prevention campaigns have been aimed at preventing infection via sexual transmission as well as during pregnancy. With women in the spotlight, men generally feel that they are free from Zika’s most severe prognoses; Zika fever is typically mild and limited to a fever, perhaps rashes, joint pain, and red eyes. However, a recent discovery has provided evidence that Zika virus can cause harmful outcomes for everyone—not just women and their unborn children.

Zika virus can cause harmful outcomes for everyone—not just women and their unborn children.

Said evidence points to Guillain-Barré syndrome as a side-effect of the virus. Cases of Guillain-Barré syndrome more than tripled in areas struck with Zika epidemics. Health officials, including members of the Pan American Health Organization in Washington D.C. and the Brazilian Ministry of Health, outlined their concerns in a letter to The New England Journal of Medicine.

According to these officials, “During the weeks of Zika virus transmission, there were significant increases in the incidence of the Guillain-Barré syndrome, as compared with the pre-Zika virus baseline incidence, in (Brazil’s) Bahia State (an increase of 172 percent), Colombia (211 percent), the Dominican Republic (150 percent), El Salvador (100 percent), Honduras (144 percent), Suriname (400 percent), and Venezuela (877 percent).” “When the incidence of Zika virus disease increased, so did the incidence of the Guillain-Barré syndrome”—a markedly strong case for causality.

Doctors are confident that Zika virus triggers the onset of Guillain-Barré syndrome, a condition characterized by “a little understood reaction in which the immune system attacks the nerves” that results in severe paralysis, although temporary. Paralysis is potentially fatal; epidemiologist Brenda Rivera reported that a Costa Rican man died from a Zika-related Guillain-Barré case. “What does this tell us? That all of us are susceptible,” Rivera preaches as she advises that Puerto Ricans take precautionary measures to avoid the mosquito-borne virus.

A World Health Organization report published on November 3rd states that no countries or territories reported “Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week.” This should not discredit the fact that “nineteen countries and territories have reported an increased incidence of GBS and/or laboratory confirmation of a Zika virus infection among GBS cases. Guatemala, which has previously reported GBS cases with confirmed Zika virus infections, has reported an increase in incidence of GBS cases in the last week.”

Currently, there are no available treatments to prevent Zika-induced Guillain-Barré syndrome. However, health officials advise “watching for Guillain-Barré cases might be one way to spot Zika outbreaks.” While there have been no reported instances of Zika-induced Guillain-Barré in the United States, people must be aware of this risk and take the necessary precautions.

Sources:

http://www.cdc.gov/zika/

http://www.nejm.org/doi/full/10.1056/NEJMc1609015

http://www.nbcnews.com/storyline/zika-virus-outbreak/study-finds-strong-link-between-zika-paralyzing-guillain-barr-syndrome-n641276

http://www.nbcnews.com/storyline/zika-virus-outbreak/man-dies-zika-related-paralysis-puerto-rico-n634776

http://reliefweb.int/report/world/zika-virus-microcephaly-and-guillain-barr-syndrome-situation-report-3-november-2016

https://www.consumeraffairs.com/news/study-zika-virus-can-lead-some-patients-to-contract-guillain-barre-syndrome-030216.html

Air Pollution: A Rising Danger to Global Health

BY AVA TORJANI

On September 27, 2016, the World Health Organization (WHO) released data on air pollution levels across different countries and their impact on human health. Air pollution includes the presence of particulates in the air that can have detrimental effects on the environment and health. These particulates include black carbon and methane, which are produced by vehicle engines, agriculture, waste, oil, and gas sectors. Given the prevalent presence of these particulate manufacturers in today’s society, it is to no surprise that the data released by WHO was nothing short of unsettling.

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Figure 1: Air pollution levels based on WHO data. Green-yellow-orange-red spectrum represent low-medium-high levels respectively.

First, the facts:

  • Globally, the level of air pollution has risen by 8% in the last 5 years.
  • 92% of the world’s population live in areas that don’t meet WHO’s standards for air quality.
  • The three cities with the highest levels of air pollution are Onitsha (Nigeria), Peshawar (Pakistan), and Zabol (Iran) respectively.
  • Nearly 90% of deaths associated with air pollution occur in low and middle income countries.
  • Almost 1 in 7 children live in areas with the highest levels of air pollution.

These not only outline the current state of our world, but also pertain to many detrimental consequences to human health, particularly in younger generations. According to a recent article, air pollution is associated with increased blood vessel damage. Aruni Bhavnagar (Ph.D.), a co-author and Chairman of medicine at the University of Louisville, claimed that it “promotes the development of high blood pressure, heart disease and stroke more pervasively and at an earlier stage than previously thought.”

The UNICEF executive director further extends on this disturbing finding by claiming that air pollution can permanently damage both children’s developing lungs and brains through inhalation and crossing of the blood-brain barrier.” Since air pollution has been found to cause 3 million pre-mature deaths per year, it is evident that these claims are not mere speculation, rather an urge to address an environmental issue that could destroy the future of younger generations.

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So, have actions been taken to resolve this issue? WHO has already devised a list of interventions to reduce air pollution including substituting fossil fuels for renewable energy and improving ventilation for cooking. There also exist country-specific NGOs such as Greenpeace, which strives to reduce sources of air pollution in China by campaigning against the use of coal and in favor of renewable energy. Moreover, the World Bank has announced that it will launch a Pollution Management and Environmental Health program (PMEH) to improve air quality among low-income countries including Nigeria, Egypt, and South Africa.

Nonetheless, such programs have not yet been implemented effectively and are not emphasized across all countries with high levels of air pollution. In fact, very recently, New Delhi reported a level of 750 micrograms per cubic meter of air particulates, which is 30 times greater than limit set by WHO. Although the city attempted to ban the entry of trucks and daily use of private vehicles, it lacks a long-term solution that is required to improve air quality.

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All in all, it is distinctly clear that air pollution is a critical global issue that can cause extensive damage to human health and the environment. The most disturbing levels are found within low-income and economically growing countries, which indicates the need to establish long-term effective solutions within these areas. More urgently, there needs to be greater awareness and emphasis on the detrimental consequences of not addressing air pollution. This may lead one to question, can this be achieved universally? If not, perhaps we can always attempt to make use of air pollution like this.

 

Image References

https://www.sciencedaily.com/releases/2016/09/160927144248.htm

Landmark study lies buried: How Delhi’s poisonous air is damaging its children for life

http://www.freemalaysiatoday.com/category/leisure/2016/01/18/air-pollution-and-traffic-fumes-tied-to-infertility-risk/

 

Zika Virus: From Past to Present

By Ava Torjani

By now, you’ve probably heard of Zika—a virus that has gained substantial attention due to its recent rapid spread worldwide and the increasingly concerning findings regarding its method of transmission and fatal consequences. We have been warned about its symptoms, its pandemic potential, and its incurability at this point in time. But perhaps what is truly worrying is the sudden and unpredictable nature of this dangerous virus. You may be wondering, where did Zika even come from? How did it become so dangerous? Below, a description of the key developments and discoveries of the Zika virus is given from its conception till today.

Timeline       

  • 1947: The Zika virus is first discovered in a Rhesus monkey and named after the Zika Forest of Uganda.
  • 1948: Researchers identify the mosquito Aedes africanus as the vector for the Zika virus.

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  • 1950s: Humans are reported to be infected with the Zika virus in Uganda and Tanzania. Meanwhile, two new strains of the virus are also discovered in the Zika forest.

Different strains of the Zika virus have different genetic make-ups, which leads to differences among their infectious abilities and levels of threat to us, just like influenza.

  • 1964: A researcher working in Uganda who had been infected with the Zika virus experienced a mild illness accompanied by a pink, non-itchy rash. This is the first case of a human illness associated with the virus.
  • Mid 1960s-1980s: There is an increase in the number of reported human cases as the Zika virus spreads across mid-Africa and certain regions in Asia including Malaysia, India, and Pakistan. Nonetheless, the disease is not given much attention since the reported symptoms are mild and do not require extensive medical care.
  • 2007: The first outbreak of the Zika virus occurs in the Island of Yap located in the Pacific Ocean, manifested by a disconcerting increase in symptoms including joint pain, rashes, and eye inflammation.

It is interesting to note that this increase may be due to not only the virus itself, but also the lack of accurate diagnosis. This is because the Zika infection, Dengue fever, and chikungunya virus share the same vector (mosquito) and have very similar symptoms. Since the latter two are more common and more thoroughly understood, they are often given as a diagnosis over Zika. Before blood sample analysis, the doctors had no idea what the disease could have been. “There was some thought it might be a dengue outbreak,” stated by Mark Duffy, US Air Force public health officer working for CDC’s epidemic intelligence service.

  • 2013-2014: More outbreaks occur across other Pacific islands including French Polynesia. In March of 2014, infants were diagnosed with Zika virus according to post-birth serum analysis, suggesting vertical transmission (via placenta). Blood samples are now tested for Zika virus, identifying as positive for 1505 blood donors.
  • 2015 (May): Research intensity on the Zika virus has extensively increased. Following several months of investigation, Brazil confirms presence of Zika infection. In July and October respectively, Brazil confirms a link between Zika and Guillain-Barre syndrome and microcephaly. However, no causal relation has yet been established. The Zika infection also has begun to spread to other regions in South America including Guatemala, Paraguay, Honduras and Panama.
  • 2016: More cases of fetal microcephaly are linked to the Zika virus. Countries including Haiti, France, United States, Jamaica report Zika infections. After examining medical reports of patients in French Polynesia from 2014, researchers found that an increase in reported Zika infections was associated with an increase in neurological complications and Guillain-Barre syndrome. Zika virus is confirmed to be transmitted via blood transfusion, and also via sexual intercourse.

Over time, it seems as though the Zika virus may have gotten stronger and more dangerous. Is it due to the evolution of the viral strains? Possibly. However, it is equally important to consider other factors. For example, outbreaks could be occurring more rapidly and frequently due to constant travelling and immigration in today’s world. Moreover, an increase in the number of reported Zika cases and findings may be associated with an increase in the attention given to it. This suggests that the epidemiology of the disease must incorporate biological and social factors in order to understand how to effectively control and eradicate the disease.

In any case, it is important to remain alert in avoiding the virus, especially since there is no specific cure or treatment. In the meantime, if you do have plans to travel to South America, check this to see how you can best avoid the Zika virus.