Monthly Archives: May, 2010

The Greek Tragedy & Healthcare

If there’s any lesson to show that healthcare today is an industry, take a look at Greece. With the economy heading south, even healthcare is affected just like any of the other industries in Greece – production  problems, delivery issues and lack of supplies are for real. What with the current economic turmoil, a leading global pharma company has even decided to pull the rug and stop supplying a state-of-the-art medication to the beleaguered country.

Novo Nordisk is planning to withdraw the sales of its Novopen insulin syringe in Greece

Novo Nordisk, a Danish company and the world’s leading supplier of  insulin (a drug used for treating diabetes) is withdrawing the Novopen from Greece as it objects to a government decree ordering a 25% price cut in all medicines (see here).A spokesman for the Danish pharmaceutical company said it was withdrawing the product from the Greek market because the price cut would force its business in Greece to run at a loss.

This has resulted in local action groups condemning the move as brutal, bad timing and a neglect of corporate social responsibility. Novo Nordisc on the other hand claims that  it is owed $36m (£24.9m) dollars already by the Greek state, whose coffers are now empty.

Most likely, many other big pharmas will follow suit soon and is likely going to cause a crisis within a crisis soon. (Doctor2008: its now reported that another  firm, Leo Pharma is also withdrawing sales). Which is a shame, because Greece in recent times ensured everyone of its citizens received free healthcare services and at the same time had one of the most admired private healthcare services in Europe, the so-called “Greek Paradox”.

Back to my opening sentence – its all very well for some activist groups to proclaim universal healthcare rights for all, but this has to be tempered with the realities of the economics of modern healthcare delivery. No country in the world can afford a liver transplant for every patient with advanced cirrhosis of the liver; so I beg to differ with those who say healthcare is a basic human right…I would amend it to say that basic healthcare is a basic human right.

Developing countries like Malaysia could do well looking at what’s happening to Greece, because when   push comes to shove, healthcare, like any other industry, will be subject to ups and downs of economic forces and suffer the same consequences as any other industry.

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The Right To Die..The Way You Want It

Walking out of the ICU the other day, my mind was occupied by the thought of the patient who had just passed away . A proud, self-made man, he had leapt from obscurity to popularity on his own blood,sweat and tears. Surrounded by drips,  lines and pumps he laid helplessly in the ICU bed, knowing  that the end was nigh and that his will to survive had drawn on the last straw. The nurses sensed that and the doctors knew that; but we were all trained to keep him going. Deep inside, we were wondering if he knew about  living wills

A Living Will determines how medical staff will manage end-of-life care

A living will is quite different from a last will and testament which specifies beneficiaries and funeral arrangements. Quite simply, a living will speaks on your behalf when you are medically seriously ill and unable to communicate,such as when in a coma, and is a healthcare directive made in advance instructing medical personnel and family as to what medical treatment you wish to receive at end of life, including matters such as organ donation.

For doctors in attendance and family members, this relieves them from making agonizing decisions like when to turn off the respirator at end of life; or for that matter, whether to use that life support machine in the first place.

Living wills can also stipulate whether blood transfusions can be used, artificial feeding implemented or even the use of organ transplantation.

To make your living will legally binding:

* It must be witnessed by two people who are legal adults

* Witnesses must not be related to you in any way

* They cannot be beneficiaries of your estate

* They are not directly involved with your health care providers

* They have not been named as your agent in a medical power of attorney document or in your living will.

Signed copies of the living will should be handed to one’s personal doctor as well as close family members and need to be seen by the attending doctors at any possible end-of-life scenario. Take a look at a typical living will here.

Doctors encountering patients with living wills vary. In New Jersey,USA 1 in 6 adults have one. In Asia, the exception is the rule. But with increasing awareness of patient rights, an egalitarian society and the rising costs of end-of-life care, it would not be surprising, in the near future, to see more patients with a living will in hand. The dying, not doctors, should have the final say in the type of treatment they receive.

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Here We Go Again..

The volcanic ash is set to force major airports like Heathrow to close again today Monday 17 May,2010..

To know about the health effects of the ash, see here.

Full-Body Airport Scanners – A Hazard to Health?

When it was reported in several news websites on May 7th that a US airport security screener allegedly beat up his colleague for poking fun at the size of his private parts during testing of full-body image scanners (see here), it brought up the question many have been asking..are these scanners (there are aready 450 in US airports alone) a violation of privacy and human rights?

Body-Scanners take only 30 secs - privacy issues aside, how safe are they?

No, say US airport security. That’s because the personnel that guide you in the booth are not privy to the images seen on the screen, which is in a remote site. Furthermore, the images blur out the face to enhance privacy and the images cannot be stored.  Human rights activists still scream foul play – what’s to prevent these assurances from being surreptitiously removed in future?

It all started when an Ethiopian passenger on a domestic US flight supposedly linked to terrorists strapped explosives in his underwear on Christmas Day which escaped detection by airport security. Since then, these full-body airport scanners have been introduced in all major US airports.

Privacy issues aside, are these scanners a health hazard, in particular in terms of radiation?

These full-body scanners fall into two main categories: millimeter wave and backscatter. The first directs radio waves over a body and measures the energy reflected back to render a 3D image. The latter is a low-level X-ray machine that creates 2D images. These scanners are electronic versions of a body search and can detect non-metallic weapons & explosives on body surfaces. They cannot detect stuff placed in body cavities, so look out for intrarectal devices next!!

The millimeter wave scanners emit less radiation than a typical cellphone while the backscatter device exposes the body to as much radiation as 2 minutes of flying. Both these devices are approved by FDA to meet health and safety standards, so there appears to be no health issues involved.

Millimeter Scanners -images are in 3D

Backscatter Scans -the 2D images show less resolution

So what if a passenger is still not willing to submit to the scan on privacy reasons or on religious grounds? The US Transport Security Administration maintains that the scan is optional, those not willing to undergo them can opt to choose a body search instead. Which is not much of an option, really!

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The First Vaccine For The Treatment of Cancer – More Hype Than Reality

In a week of plenty of bad news, it was heartening to find out that the FDA  approved the first-ever vaccine to treat cancer. The treatment is called Provenge, and was developed by a small company named Dendrion for the treatment of advanced prostate cancer.

Prostate Cancer Cell - the second most common cancer in men

How it works: by growing the ‘harmless’ part of a tumour cell extracted from an affected person and mixing it with a special cell called a ‘dendritic cell’ in the lab, several antigens are produced which is then injected back into the affected person. This then alerts the person’s immune system to the presence of these foreign antigens, causing it to attack just the cancer cells, leaving alone the normal cells.

Why did I say there’s a lot of hype? Well, most news reports called it an anti-cancer vaccine, giving many the impression that it was a cure or that it could prevent cancer. Nothing can be further than the truth. Firstly, its meant only for prostate cancer (read,men only) and even then its for advanced prostate cancer (read, terminal). All it does is it gives an additional survival time of 4 months.(1)

And the cost? Dendrion announced that it will charge US$93,000 per patient, because, get this, it assumed that people will pay US$23,000 for every extra month of life based on current costs of other cancer drugs. Read more here. At this price, it would be out of reach to many, taking into consideration that insurance companies have not yet confirmed that they would underwrite the costs.

Provenge,injected over 3 times, makes use of one's white blood cells to fight cancer cells

By the way, if we’re talking about anti-cancer vaccines, there are several already on the market – a typical example is Gardasil, used to prevent cancer of the cervix. Provenge is the first therapeutic vaccine – the first vaccine used for treatment, and not prevention.

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Healthcare Nowadays..

If you’re bored doing the same stuff on the treadmill, here’s an innovative way to get your daily fix!

[About the video: American rock band Ok Go ‘s video is probably one of the top favorite videos of all time on You Tube, being viewed more than 50 million times. Known for their creativity, the group just  had their latest video released March 1 this year. Its worth watching here ].

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