Archive for January, 2010

Open Source In The Pharmaceutical Industry

January 20th, 2010 No comments

[Jose's comment]

You may find this older (2003) paper of interest.

New innovation and development models may be needed as the pharma industry faces a “patent cliff” {}.

The role of Open Source-like development and business models are not limited to software development any more. Cheers.


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Download full paper from:


Neil B. Niman, University of New Hampshire
Brian T. Kench, University of Tampa


Recent evidence suggests that pharmaceutical companies focus more on managing their intellectual property rights than in developing drugs that cure medical problems. The open source movement offers alternate rules for the process of developing new drugs and managing intellectual property rights. The essence of open source is to radically change the development process before there exists something worthy of being assigned a set of rights.  Open source in the pharmaceutical industry also offers the potential to reduce the time it takes to develop breakthroughs, test their viability and safety, and bring them to market.

Categories: Health IT, Open Access Tags:

[EU] Economic arguments for addressing the social determinants of health inequalities.

January 16th, 2010 No comments

[Jose's Comments]

The paper below makes the argument that the health status of a population has a measurable economic impact.

It would seem beyond dispute and self-evident that a healthy population leads to strong, productive workers that can then earn good salaries with which to become robust consumers of products and services.

From a purely capitalistic point of view, you’d expect industry to strongly support activities and programs that deliver a strong consumer base for their wares.

What we know for a fact is that the current illness-focused care system is both very expensive and fails to improve the health of our population.

Maybe we should ask new questions (i.e. “how do we improve e/a family’s health?”) instead of throwing more money at new answers to the failed old questions (i.e. “let’s automate the treatment of poor health”)?


Economic arguments for addressing the social determinants of health inequalities.

Working Document No.4 – 2009
DETERMINE – EU Consortium for Action on the Socioeconomic Determinants of Health (SDH).

2. Making the case: Establishing economic arguments


This chapter presents the findings of a literature review conducted in June 2008 together with further research in April 2009. The review was undertaken to help inform and shape further data collection by establishing the main economic arguments for addressing social determinants of health inequalities.

Health can be considered in economic terms as both a capital and a consumption good. In the case of health as a capital good, people in good health attract a higher value than those in poor health due to their greater ability to be economically productive. Health as a consumption good is concerned with the contribution that good health makes to an individual’s wellbeing, happiness or satisfaction.

Targeted investment to address health inequalities by action on social determinants of health is more cost effective than paying later for the consequences of these inequalities. It follows then that addressing health inequalities is not only a matter of social justice but also contributes to economic growth.

The economic benefits of better health

There are strong economic arguments for investing in health at population level. In 2001, the WHO Commission on Macroeconomics and Health demonstrated that a healthier population can bring substantial economic benefits to countries with developing economies. The authors estimated that 50% of the growth differential  between rich and poor countries was due to ill health and shorter life expectancy. Increasing life expectancy at birth by 10% through targeted investment to tackle the major causes of premature deaths could increase the economic growth rate by 0.35% per year. (1)

Benefits to the economy may not be limited to developing countries. In 2005, a review of evidence in high income countries concluded that “there is considerable and convincing evidence that significant economic benefits can be achieved by improving health not only in developing but also in developed countries.” The report outlines four channels through which this may occur: higher productivity, higher labour supply, improved skills as a result of greater education and training and increased savings available for investment in physical and intellectual capital. (2) However more recent work suggests that the evidence is less conclusive about the links between health and the economy particularly at the macro level. (3)

These issues have been considered in the development of a health strategy for the EU which commenced with a reflection process in 2004. (4) The second of four principles in the strategy Together for Health “Health is the greatest wealth” states that health is a prerequisite for economic productivity and prosperity.

It also emphasises that healthy life expectancy not merely life expectancy is the key factor for economic growth and points to the inclusion of Healthy Life Years as a Lisbon Structural Indicator to underline this distinction. (5) The role of healthcare systems in supporting growth and employment has been recognised in a report commissioned as part of the mid-term review of the Lisbon strategy. Facing the challenge: The Lisbon strategy for growth and employment notes the importance of healthcare systems “… in generating social cohesion, a productive workforce, employment and hence economic growth.” (6)

The economic costs of ill health

Clear understanding of the cost of ill health is a prerequisite for assessing the economic returns of investing in health. While healthcare costs are substantial and increasing, these represent only one part of the overall picture.

Failure to include the welfare costs of ill health risks understating the true economic benefits derived from health interventions. Three perspectives have been identified to gain a more complete picture of the costs of ill health. The broad perspective encompasses social welfare costs; the limited perspective considers micro- and macroeconomic costs; while the very limited perspective focuses on healthcare costs. (7)

Cost of illness studies separate costs into three components: direct costs, i.e. those associated with treating illness; indirect costs, i.e. costs associated with loss of productivity due to morbidity or premature death and; intangible costs which include the psychological dimensions of illness. However in many cases only the first two are measured. A review of cost of illness studies found that the cost of chronic diseases ranged from 0.02% to 6.77% of a country’s GDP. Cardiovascular disease in particular was found to account for between 1-3% of GDP in most developed countries. (8)

The cost of health inequalities

Health inequalities are understood to be the difference in health outcomes between different population groups, including socioeconomic groups. Such inequalities are estimated to reduce average life expectancy across the EU252 by 1.84 years which equates to approximately 11.4 million life years lost. At the same time, healthy life expectancy is reduced due to the existence of inequalities by an average of 5.14 years or approximately 33 million healthy life years lost. (9) While these figures represent the EU25 as a whole, the large variation in the magnitude of health inequalities within member states is well recognised, with some southern European countries having smaller inequalities and most countries in the East and Baltic regions having larger inequalities than the European average. (10)

These inequalities have significant economic implications for the EU and for member states. When health is valued as a capital good, inequalities related losses have been estimated to cost around Euro$141 billion in 2004 or 1.4% of GDP. This rises sharply to Euro$1,000 billion or 9.5% of GDP when health is valued as a consumption good. (9)

Why more equal societies almost always do better

January 13th, 2010 No comments

Why more equal societies almost always do better

Richard Wilkinson, Professor Emeritus at the University of Nottingham Medical School and Honorary Professor at University College London.

Kate Pickett, Professor of Epidemiology at the University of York and a National Institute for Health Research Career Scientist.

Tuesday, 19th January 2010, at 3:00- 5:00 pm Washington DC time

Please check the local time in your own town:

Where: in front of your personal or work computer anywhere in the world or at:
PAHO HQ Room 1017
525 23Rd  St. NW Washington DC 20037

Link to participants – Via Internet

We will broadcast this session in English via the Elluminate Live!® software using integrated VoIP for the audio component

Please connect a few minutes before 3 pm Washington DC time. You must have a headset or speaker and microphone

The event is free and open to interested people. You may attend virtually from your personal or work computer anywhere in the world. In addition to watching live presentations, you will have the option to ask questions and provide comments.

This conference will enable the sharing of good practices and lessons learned.


3:00 – 3:20pm
* Juan Manuel Sotelo, Manager, External Relations, Resource Mobilization, and Partnerships PAHO/WHO
* Jarbas Barbosa, Manager, Health Surveillance and Disease Prevention and Control (HSD) PAHO/WHO
* Theresa Bernardo, Manager, Knowledge Management and Communications (KMC) PAHO/WHO


3:20 – 4:00pm
Why more equal societies almost always do better
Where in the developed world do people live the longest? Where do people born at the bottom of the economic ladder have the best shot at climbing up?
In which nations do children do best in school? Which countries send the most people to prison?  Have the teenage pregnancies?  Suffer the most homicides?
The answers matter and are indicative of a society’s overall health and the quality of life for its citizens.
That is the contention of eminent British epidemiologists Richard Wilkinson and Kate Pickett, authors of The Spirit Level: Why Greater Equality Makes Societies Stronger.


Richard Wilkinson has played a formative role in international research and his work has been published in 10 languages. He studied economic history at the London School of Economics before training in epidemiology and is Professor Emeritus at the University of Nottingham Medical School and Honorary Professor at University College London.

Kate Pickett, Professor of Epidemiology at the University of York and a National Institute for Health Research Career Scientist. She studied physical anthropology at Cambridge, nutritional sciences at Cornell and epidemiology at Berkeley before spending four years as an Assistant Professor at the University of Chicago.

4:00 – 5:00pm
Q&A from Participants

Contact Information:

Pan American Health Organization PAHO/WHO – Washington D.C.

- – - – Further reading – - -

The theory of everything

These two British academics argue that almost every social problem, from crime to obesity, stems from one root cause: inequality. John Crace meets the authors of what might be the most important book of the year

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Black Report

The Black report was a 1980 document published [1] by the Department of Health and Social Security (now the Department of Health) in the United Kingdom, which was the report of the expert committee into health inequality chaired by Sir Douglas Black. It was demonstrated that although overall health had improved since the introduction of the welfare state, there were widespread health inequalities. It also found that the main cause of these inequalities was economic inequality. The report showed that the death rate for men in social class V was twice that for men in social class I and that gap between the two was increasing not reducing as was expected.

The Black report was commissioned in March 1977 by David Ennals, Labour Secretary of State, following publication of a two-page article by Richard Wilkinson in New Society, on 16 December 1976, entitled ‘Dear David Ennals’. The report was nearly ready for publication in early 1979.

However, in the General Election on 3 May 1979, the Conservatives were elected. The Black Report was not issued until 1980 by the Conservative Government. The Black report was published on August Bank Holiday with only 260 copies made available on the day for the media. However, the report had a huge impact on political thought in the United Kingdom and overseas. It led to an assessment by the Office for Economic Co-Operation and Development and the World Health Organization of health inequalities in 13 countries -though not on UK government policy [2].

Penguin Books published a shortened version of the Report in 1982, making it widely available [3]

The Whitehead Report published in 1987 came to the same conclusions as the Black report, as did the Acheson Report later in 1998.

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The Black Report 1980

The publication of the Black Report over the Bank Holiday Weekend of 1980 by the Thatcher Government signalled the end of the hopes of improvement in public health for twenty years. It was clear that the Government would have preferred to suppress the whole thing, and it is greatly to the authors’ credit that this did not happen. However you do not need to read very much to see why the Conservatives wanted to suppress it. Redistribution, increased public expenditure and taxation and unashamed socialism are flaunted on almost every page.

FTC reminds us that storing data in the cloud has drawbacks

January 6th, 2010 No comments

FTC reminds us that storing data in the cloud has drawbacks

[Editor's Note]

This point raised by the article below re: risks to consumer’s private data being “in the cloud” is very applicable to the entire Health IT / EMR / Personal Health Record discussion.

It’s not clear to me if in the rush to “digitize healthcare” enough attention (and priority) has been paid to protecting consumers’ privacy.

If somebody hacks into your bank account and steals US$1,000 from you that is clearly a bad outcome. But you can recover from that. Money is replaceable via a bank refund or a credit card protection plan.
But if your electronic medical record (“EMR”) is hacked whereby all future employers (and significant others) can find out about your {mental health issues} / {abortion while in college} / {paternity test results} that is not a recoverable incident.

Using paper-based records it would take a bit of work to illegally copy the records of 100 patients. Using an EMR, you can copy the records of thousands of patients in minutes onto a USB drive.

“Private information about accident victims treated at University Medical Center has apparently been leaking for months, the Sun has learned, allegedly so ambulance-chasing attorneys could mine for clients.
Sources say someone at UMC is selling a compilation of the hospital’s daily registration forms for accident patients. This is confidential information – including names, birth dates, Social Security numbers and injuries – that could also be used for identity theft.
Hospital officials knew of rumors of the leaks since the summer, but doubted them until provided evidence Thursday by the Sun. Now they’re scrambling to catch up to a crisis that may affect hundreds, if not thousands, of patients….”


The Federal Trade Commission worries that consumers don’t really understand the privacy implications to storing some of their most crucial data in the cloud, and it wants the FCC to think about such issues when finalizing its national broadband plan.

By Nate Anderson | Last updated January 6, 2010 11:47 AM

Take Google’s new Nexus One phone as a case study of the pros and cons of storing life details on remote servers. Nexus One phones can back up their complete settings to Google’s servers, including data such as “Wi-Fi passwords, bookmarks, a list of the applications you’ve installed, the words you’ve added to the dictionary used by the onscreen keyboard, and most of the settings that you configure with the Settings application.” Get a new phone and the data transfers easily.

But that data is now sitting on servers outside of your control, where it can be accessed far more easily by Google itself, hackers, and law enforcement than it ever could if kept within the device. Once data passes over the network, it gets much easier to access in realtime; once it is stored on a remote server, it gets much easier to access at any time.

And those are just the phone settings. Google also has access to search history data, anything stored in Google Docs or Spreadsheets, complete schedules stored in Google Calendar, and recent Maps searches. Combine them all, and companies like Google become one-stop shops for authorities looking for personal information.

Such issues have raised concerns at the Federal Trade Commission (FTC), especially since many consumers aren’t really aware of the data security issues raised by storing information on remote servers. “For example, the ability of cloud computing services to collect and centrally store increasing amounts of consumer data, combined with the ease with which such centrally stored data may be shared with others, create a risk that larger amounts of data may be used by entities in ways not originally intended or understood by consumers,” said the FTC in a letter (PDF) this week. {}

That letter was directed at the Federal Communications Commission (FCC), which is currently drawing up a national broadband plan that will be submitted to Congress next month. In advance of the plan’s release, the FTC wants to make sure that the FCC “considers technologies such as cloud computing and identity management in implementing a national broadband plan.”

That means publicly recognizing the FTC’s growing expertise on issues on online privacy and data security. “Accordingly, we recommend that the Broadband Plan recognize the FTC’s law enforcement, consumer education, and ongoing policy development efforts in light of its years of experience in online, and offline, consumer protection,” concludes the letter.

The FTC is in the middle of a set of hearings on these issues; the next one takes place on January 28.

Categories: Health IT, Personalized Health Tags:

Solution to killer superbug found in Norway.

January 3rd, 2010 No comments

[Editor's Note]

This article provides additional evidence that just spending more money on healthcare’s potions, lotions, and treatments does not necessarily lead to better population health.

As per the article: Norway is better able to control drug-resistant infections because they stopped taking so many drugs. The World Health Organization says antibiotic resistance is one of the leading public health threats on the planet.

There are way too many antibiotics used in the US already, plus those we all ingest through the food supply. {}

Sometimes less (healthcare) is definitively more (health). Read the classic book by Ivan Illich:


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Solution to killer superbug found in Norway


Associated Press Writers Martha Mendoza And Margie Mason, Associated Press Writers – Thu Dec 31, 12:01 am ET

OSLO, Norway – Aker University Hospital is a dingy place to heal. The floors are streaked and scratched. A light layer of dust coats the blood pressure monitors. A faint stench of urine and bleach wafts from a pile of soiled bedsheets dropped in a corner.

Look closer, however, at a microscopic level, and this place is pristine. There is no sign of a dangerous and contagious staph infection that killed tens of thousands of patients in the most sophisticated hospitals of Europe, North America and Asia this year, soaring virtually unchecked.

The reason: Norwegians stopped taking so many drugs.

Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway’s public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

Now a spate of new studies from around the world prove that Norway’s model can be replicated with extraordinary success, and public health experts are saying these deaths – 19,000 in the U.S. each year alone, more than from AIDS – are unnecessary.

“It’s a very sad situation that in some places so many are dying from this, because we have shown here in Norway that Methicillin-resistant Staphylococcus aureus (MRSA) can be controlled, and with not too much effort,” said Jan Hendrik-Binder, Oslo’s MRSA medical adviser. “But you have to take it seriously, you have to give it attention, and you must not give up.”

The World Health Organization says antibiotic resistance is one of the leading public health threats on the planet. A six-month investigation by The Associated Press found overuse and misuse of medicines has led to mutations in once curable diseases like tuberculosis and malaria, making them harder and in some cases impossible to treat.

Now, in Norway’s simple solution, there’s a glimmer of hope.

Dr. John Birger Haug shuffles down Aker’s scuffed corridors, patting the pocket of his baggy white scrubs. “My bible,” the infectious disease specialist says, pulling out a little red Antibiotic Guide that details this country’s impressive MRSA solution.

It’s what’s missing from this book – an array of antibiotics – that makes it so remarkable.

“There are times I must show these golden rules to our doctors and tell them they cannot prescribe something, but our patients do not suffer more and our nation, as a result, is mostly infection free,” he says.

Norway’s model is surprisingly straightforward.

* Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.

* Patients with MRSA are isolated and medical staff who test positive stay at home.

* Doctors track each case of MRSA by its individual strain, interviewing patients about where they’ve been and who they’ve been with, testing anyone who has been in contact with them.

Haug unlocks the dispensary, a small room lined with boxes of pills, bottles of syrups and tubes of ointment. What’s here? Medicines considered obsolete in many developed countries. What’s not? Some of the newest, most expensive antibiotics, which aren’t even registered for use in Norway, “because if we have them here, doctors will use them,” he says.

He points to an antibiotic. “If I treated someone with an infection in Spain with this penicillin I would probably be thrown in jail,” he says, “and rightly so because it’s useless there.”

Norwegians are sanguine about their coughs and colds, toughing it out through low-grade infections.

“We don’t throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better,” says Haug.

Convenience stores in downtown Oslo are stocked with an amazing and colorful array – 42 different brands at one downtown 7-Eleven – of soothing, but non-medicated, lozenges, sprays and tablets. All workers are paid on days they, or their children, stay home sick. And drug makers aren’t allowed to advertise, reducing patient demands for prescription drugs.

In fact, most marketing here sends the opposite message: “Penicillin is not a cough medicine,” says the tissue packet on the desk of Norway’s MRSA control director, Dr. Petter Elstrom.

He recognizes his country is “unique in the world and best in the world” when it comes to MRSA. Less than 1 percent of health care providers are positive carriers of MRSA staph.

But Elstrom worries about the bacteria slipping in through other countries. Last year almost every diagnosed case in Norway came from someone who had been abroad.

“So far we’ve managed to contain it, but if we lose this, it will be a huge problem,” he said. “To be very depressing about it, we might in some years be in a situation where MRSA is so endemic that we have to stop doing advanced surgeries, things like organ transplants, if we can’t prevent infections. In the worst case scenario we are back to 1913, before we had antibiotics.”

Forty years ago, a new spectrum of antibiotics enchanted public health officials, quickly quelling one infection after another. In wealthier countries that could afford them, patients and providers came to depend on antibiotics. Trouble was, the more antibiotics are consumed, the more resistant bacteria develop.

Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind.

In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.

In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004. And in the United Kingdom, they rose from about 2 percent in the early 1990s to about 45 percent, although an aggressive control program is now starting to work.

About 1 percent of people in developed countries carry MRSA on their skin. Usually harmless, the bacteria can be deadly when they enter a body, often through a scratch. MRSA spreads rapidly in hospitals where sick people are more vulnerable, but there have been outbreaks in prisons, gyms, even on beaches. When dormant, the bacteria are easily detected by a quick nasal swab and destroyed by antibiotics.

Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention said they incorporate some of Norway’s solutions in varying degrees, and his agency “requires hospitals to move the needle, to show improvement, and if they don’t show improvement they need to do more.”

And if they don’t?

“Nobody is accountable to our recommendations,” he said, “but I assume hospitals and institutions are interested in doing the right thing.”

Dr. Barry Farr, a retired epidemiologist who watched a successful MRSA control program launched 30 years ago at the University of Virginia’s hospitals, blamed the CDC for clinging to past beliefs that hand washing is the best way to stop the spread of infections like MRSA. He says it’s time to add screening and isolation methods to their controls.

The CDC needs to “eat a little crow and say, ‘Yeah, it does work,’” he said. “There’s example after example. We don’t need another study. We need somebody to just do the right thing.”

But can Norway’s program really work elsewhere?

The answer lies in the busy laboratory of an aging little public hospital about 100 miles outside of London. It’s here that microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while facing her own burgeoning cases.

So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish, asking doctors to almost completely stop using two antibiotics known for provoking MRSA infections.

One month later, the results were in: MRSA rates were tumbling. And they’ve continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream infections. This year they’ve had one.

“I was shocked, shocked,” says Liebowitz, bouncing onto her toes and grinning as colleagues nearby drip blood onto slides and peer through microscopes in the hospital laboratory.

When word spread of her success, Liebowitz’s phone began to ring. So far she has replicated her experiment at four other hospitals, all with the same dramatic results.

“It’s really very upsetting that some patients are dying from infections which could be prevented,” she says. “It’s wrong.”

Around the world, various medical providers have also successfully adapted Norway’s program with encouraging results. A medical center in Billings, Mont., cut MRSA infections by 89 percent by increasing screening, isolating patients and making all staff – not just doctors – responsible for increasing hygiene.

In Japan, with its cutting-edge technology and modern hospitals, about 17,000 people die from MRSA every year.

Dr. Satoshi Hori, chief infection control doctor at Juntendo University Hospital in Tokyo, says doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.

Hori now limits antibiotics only to patients who really need them and screens and isolates high-risk patients. So far his hospital has cut the number of MRSA cases by two-thirds.

In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.

“It’s kind of a no-brainer,” he said. “You save people pain, you save people the work of taking care of them, you save money, you save lives and you can export what you learn to other hospital-acquired infections.”

Pittsburgh’s program has prompted all other major hospital-acquired infections to plummet as well, saving roughly $1 million a year.

“So, how do you pay for it?” Muder asked. “Well, we just don’t pay for MRSA infections, that’s all.”

Beth Reimer of Batavia, Ill., became an advocate for MRSA precautions after her 5-week-old daughter Madeline caught a cold that took a fatal turn. One day her beautiful baby had the sniffles. The next?

“She wasn’t breathing. She was limp,” the mother recalled. “Something was terribly wrong.”

MRSA had invaded her little lungs. The antibiotics were useless. Maddie struggled to breathe, swallow, survive, for two weeks.

“For me to sit and watch Madeline pass away from such an aggressive form of something, to watch her fight for her little life – it was too much,” Reimer said.

Since Madeline’s death, Reimer has become outspoken about the need for better precautions, pushing for methods successfully used in Norway. She’s stunned, she said, that anyone disputes the need for change.

“Why are they fighting for this not to take place?” she said.


Martha Mendoza is an AP national writer who reported from Norway and England. Margie Mason is an AP medical writer based in Vietnam, who reported while on a fellowship from The Nieman Foundation at Harvard University.