Medicine isn't simple (imagine that)

Stumbled upon this last week: Why Steve Jobs' Magic Doesn't Work in Medicine

My readings and ruminations regarding drugs and medicine have resulted in the notion that "surely if I just eat the right things, exercise, etc. I won't be battling ________ (fill in with heart disease, obesity, or any other rampant health condition) when I get older."

While in the back of my head I know that it can't be as simple as that, the belief arose out of the frustrations around the fact that we make and take drugs to address the side effects of other drugs. Obviously, medicine is sooo complicated and there are always unexpected consequences for the so-called solutions our industry manufactures. Rather than continue to delve deeper and deeper into the biology of it all, why don't we just get back to basics?

But, I digress...read the article and tell me what you think.

Death to Dollars Ratio

I haven't yet gone on my rant about how there are many legitimate reasons that drugs cost so much money (in that it takes so much to research, develop, and conduct clinical trials). And perhaps I have had an underlying assumption that the research dollars are spent with a certain priority. If anything, there might not be enough money to go around, but we, the "industry", spend it in the right places so that the most deaths are prevented and/or people live comfortably and in a healthy manner.

But then you come across an astounding piece of data such as this from a recent article in Wired: For every death from AIDS, the US federal research establishment awards approximately $69,000 in grant funds. And for every death from MRSA [Methicillin-resistant Staphylococcus aureus, virulent staph infection), it awards $570.

Wow.  The article goes on to say that the number of deaths from each infection is about the same, which further begs the question "why the disparity in funding?!" I know there are many different ways to look at this information (e.g. normalizing it against the number of people who do not die from infections), but it does remind me of discussions with research professors about how the "sexy" research gets the most funding. Yes, the emergence of AIDS demanded such developments in treatment, but why aren't we (in this case, society) catching on to the urgent need to combat these "superbugs" such as MRSA? After all, shouldn't we be striving for the greatest good?

Aristotle's Rhetoric (Book I, Chapter 7): "A thing productive of a greater good than another is productive of is itself a greater good than that other. For this conception of "productive of a greater" has been implied in our argument. Likewise, that which is produced by a greater good is itself a greater good; thus, if what is wholesome is more desirable and a greater good than what gives pleasure, health too must be a greater good than pleasure."

A new use for body piercings

I had a tongue ring once. Spur of the moment decision that was made in order to not be outdone by my best friend getting her first tattoo after we graduated high school. I ended up removing it a few years later,  thinking it might not be "professional" enough in my internships and future job interviews.

But, now there is a new technology on the horizon, in which such a piercing could be used to steer a wheelchair. I must say, it's pretty neat (yes, neat) that medicine and engineering combine to improve the quality of life of those affected by paralysis with a system that involves a tongue ring. And unlike other therapies that use chemicals to improve the quality of life, I do not know of any long term side effects!

Depression and Emo

This post on NPR's health blog piqued my interest, since I am an avid music fan, and certain songs have the ability to completely change my mood, for better or worse.

Those [teenagers] who listened to lots of music were 8 times more likely to be depressed than those who didn't listen very much.

While the author is very clear about the uncertainty of the causation versus correlation of this study, the data is the data...but why are 1 in 12 teenagers suffering from depression? That's the bigger question in my head. Is the incidence that high, or are we now more aware and therefore diagnosing more? Seems like an opportunity to get to the root cause rather than prescribe more drugs.

Cool Stuff = Nanoparticles

In addition to the ever-elusive, yet-to-be-discovered cures for cancer, AIDS, Alzheimer's, etc. (although there I hear they're not too far away), there is another important world health concern that needs addressing, and it seems to fall on and off the radar for most of us...especially when we're feeling "like a cold's coming on" and just want anything that will zap it.

The prevalent use of antibiotics over the past several decades has an unintended consequence: the emergence of "superbugs", infectious bacteria that have resistance to all available antibiotics on the market -- and there are few, if any, promising drugs in the pipeline.  "Some experts warn health-care provision is in danger of reverting back to a pre-antibiotic era in which hip replacements, care of preterm babies and advanced cancer treatment are no longer possible."

But, check it out!
IBM researchers created a new type of nanoparticles that are capable of destroying the membrane walls of certain drug-resistant bacteria strains, leaving the cells to harmlessly degrade without any trace. The new system works by using biodegradable plastic to engineer electrically charged nanoparticles that in turn attract to the bacteria’s opposite charge, in turn destroying the membrane walls hence the cell entirely.

Of course there are many more questions to consider regarding manufacturing of a nanoparticle type of drug (What would the dosage form be? How expensive is it to produce? etc), but I read these findings and just think "man, science is cool."

Adaptive Confidence

- the ability to bounce back from stress (both biological and psychological) i.e. dust yourself off and move on!

Although genetics play a role for those who live unusually long, NPR ran a short story about how the trait of adaptive confidence may have an even bigger impact. And scientific studies have shown this: people with the "glass half empty" mentality on average passed away 7.5 years earlier than their optimistic counterparts.

(http://transition4missions.files.wordpress.com/2010/08/glass_half_full.jpg)

 

The next question becomes...can one train to improve adaptive confidence, so that one wouldn't have to take medication for stress-induced high blood pressure? Talk about a more active patient!

Vitamins - the NUTRIceuticals

Over half of Americans take dietary supplements...supplements are taken to guard against the rare instance in which the proper amount of vitamins are not received in our typical diet. However, it is not typical to hear of many people who suffer from beriberi, pellagra, scurvy, or rickets anymore (caused by deficiencies of thiamine, niacin, vitamin C, and vitamin D, respectively).

I don't personally take a multi-vitamin or dietary supplement, the main reason being that my body has a horrible time trying to digest it, and I figure that that's NOT a good sign. Nonetheless, this notion that we can create a pill for everything (have you heard of the one that's the "next best thing to fruits and vegetables"?) and become passive patients is just not something I'm willing to accept. 

Designing Bodies

My friend posted a great TED talk today, and here are some cliff notes from Paul Root Wolpe's presentation:

There have been three stages of evolution:
1) Darwinian Evolution (passive i.e. natural selection)
2) Civilization (controlling the evolutionary environment, what led us to the present societal framework)
3) Directed Evolution (the current era): As we continue in this type of evolution, he is suggesting that we need to set some ground rules around what is considered ethical.

For instance, the crazy bioengineering stuff that is real now:

• Scientists have now been able to insert the gene for bioluminescence into all sorts of family pets, including monkeys...whoa. 
• The process of transgenic drugs and chemicals = "organic manufacturing machines", where a genetically modified animal produces a compound of interest, which can then be harvested from its blood or milk (and will be the topic of a separate post, I'm sure).
• Animal robots...cockroaches that can be used as surveillance agents, a monkey that can control its third (prosthetic) arm with its brain...

He asks, "Is it okay to manipulate and create whatever creatures we want?" As my friend and I discussed this video, the phrase "when you're a hammer, everything looks like a nail" was used, and it seems to fit. As we continue to understand life's biological processes, the more we want to use that knowledge in cool crazy ways (for lack of a better term). But, isn't that sometimes unnecessary, or even, wrong?

Orphan Drug Act

As part of the exploration that is the subject of this blog, I thought it imperative to explore the history of the industry; this has started with the reading of Shaping The Industrial Century - the remarkable story of the evolution of the modern chemical and pharmaceutical industries. Seems like a fairly unbiased account, right?

As I cracked it open and waded through the overview, there was a mention of the United States Orphan Drug Act (ODA) enacted in 1983, which is credited with a subsequent explosion of drug discovery. I had to take a further look...

An "orphan disease" is defined as one that affect less than 200,000 patients (Side note: I wonder if this number still has relevance given the population increase since 1983). The benefits of developing a drug that treats an orphan disease include tax incentives, enhanced patent protection, and subsidies for clinical trials, all in an effort to encourage pharmaceutical companies to apply resources to that development. Not only do we get new drugs for diseases that were previously considered untreatable (many in this category are for cancer treatment), but technological advances in this arena are good for R&D in general.

However, one interesting piece of information I noticed in an article on this topic from the Health Policy journal was that many of these orphan drugs do indeed become blockbusters! In fact "in 2006, a quarter of products which reached blockbuster status that year had one or more orphan designations" and one of them was Provigil (see previous post on Shift Work Disorder). Also of note, R&D for rare diseases has been stifled (as indicated in the number of new drug applications) in years when there has been political discussion around amending the ODA. Who wants to invest money if the incentives mentioned won't be available? It's great that legislation has the ability to spur such scientific breakthroughs, but it's no surprise that there are unintended results.

Hmm, just some food for thought :/

The Outlier

A closer look at how the United States compares to other countries with regards to health care spending. I love this form of data representation.

Shift Work - there's a pill for that

Shift work is not unique to pharmaceutical manufacturing (in fact, it is most prevalent in service occupations), but I have become somewhat familiar with it through my work. Full scale chemical reactions and fermentations have cycle times of hours, days, or even months, requiring employees to work around the clock. Even those of us who have pulled an "all-nighter" preparing for an exam know how severely this sort of activity can disrupt your life in terms of energy level, focus, etc.

Turns out that Shift Work Disorder (SWD), which results in excessive sleepiness during the day, is treatable by a host of prescription medications, such as Provigil and Nuvigil.

It would be unrealistic to say that we should eliminate shift work - let's be honest, it makes the economy go 'round. However, I wonder what more natural methods and strategies we could employ to decrease the risk of developing SWD or other serious health disorders. For instance, WebMD suggests controlling light, sound, and temperature during sleep, as well as....get this...taking care of yourself.

The Goal

The health care industry accounts for about 1/7th of the economy in the United States, and although that seems like a huge proportion, it actually makes sense me, because good health of our citizens is required before we are able to spend time on technological and cultural advancements. You may even argue that the idea of treating health conditions was a natural evolution for the human race.

With those technological advancements came the chemical and pharmaceutical industries, which are of particular interest to me since my current career path has led me to a position within "big pharma".  However, I am at once amazed and confused:

• I have always loved science, and the innovation that takes place in research AND manufacturing is just, in a word, cool. Plus, the fact that drugs and vaccines have the ability to save lives makes the work that much more important. 
• But then I think, "wait, is this really necessary?" Questions enter my head such as: 
• Why are we ingesting chemicals that our bodies aren't adapted to metabolize?
• Why are preventable diseases killing more and more people each year?
• How did the history of the industry play a role in the evolution of modern healthcare?

This first post is an attempt to actually identify the goal of this blog, and when trying to put a goal into words, the verb choice is important. So, the mission here is to explore the pharmaceutical industry's role within our society. In general, a collection of different facts, opinions, stories, histories and viewpoints.  Where that goes, what I glean from it...we shall see.