Saturday, July 30, 2011

Can Stem Cells Stop MS?

Later this year, a small clinical trial will begin in Europe to test the use of stem cells to manage or possibly reverse the progress of multiple sclerosis, a disease in which a patient's immune system attacks the myelin sheath that protects nerve cells from damage. The disease tends to first strike when a patient is in their 20s and 30s, and it causes a range of symptoms (which vary widely by patient) such as fatigue, numbness, and balance problems.

For the trial, stem cells will be taken from patients' bone marrow and then injected into their blood, Pallab Ghosh reported for BBC News Health ("Doctors begin major stem cell trial for MS patients"). Promising earlier studies have used these stem cells to "retrain" the patient's immune system not to attack the myelin sheath.

Multiple sclerosis is more common in areas farther from the equator, such as the UK and the northern United States, as this fascinating geographic map of cases illustrates. The incidence of MS appears to be increasing, particularly among women, with some blaming the Western diet and vitamin D deficiency.

Ghosh points out that this trial also aims to address the problem of medical tourism among MS patients, who sometimes seek expensive and unproven stem cell treatments outside the UK. The trial will provide scientific evidence of the efficacy of stem cell treatment.

The phase II trial begins at the end of the year, investigating whether stem cell treatment is effective in human subjects and what side effects it might cause. The trial includes 150 patients and is predicted to take five years, with a possible phase III trial (comparing stem cell treatment to standard MS treatments) to follow before any new treatment can be brought to market.

Sunday, July 24, 2011

The Business of Health Care Can Make You Sick

The business of health care is not always good for your health, at least if you look at the ongoing problems at Johnson & Johnson (J&J). I've written before about problems with the company's McNeil division, which manufactures many household medicines such as children's Tylenol. Over the past two years, some products manufactured at McNeil have been recalled due to musty odors, inadequate active and inactive ingredients, or metal particles found in some of the bottles.

Ultimately, J&J shareholders sued the company. In response, board members recently filed a 122-page report in federal court that examined what they believe went wrong at the company.

In an article about the report earlier this week, Businessweek's Alex Nussbaum and David Voreacos explained that the trouble seemed to begin when J&J acquired Pfizer's consumer health-care unit in 2006, which added many products to the company and strained manufacturing facilities. Management turnover, staffing cuts, and squabbles between different groups of staff contributed to quality control issues as well, Businessweek reported ("J&J Blames Staff Cuts, Pfizer Deal for Tylenol Recall Flood").

Businessweek pointed out that Johnson & Johnson has recalled a range of products over the past year, including "contact lenses, artificial hips, insulin cartridges and prescription drugs across J&J's 250 subsidiaries." Because so many people use their products, the problems at Johnson & Johnson are everyone's problems. What exactly is in that bottle of Tylenol in your medicine cabinet? That depends on how J&J makes and implements its business decisions.

Wednesday, July 13, 2011

The Fi ve Percent

A recent study found that about half of U.S. health care expenses are incurred by just five percent of U.S. patients. These 2009 figures were just released in a data brief by the nonprofit National Institute for Health Care Management Research Foundation. The data brief found that the U.S. spent an average of $8,086 per person on health care in 2009, almost twice the $4,166 per-capita cost in 1997. Ranked by expense, the top 5% of patients (civilian and non-institutionalized) cost a mean of $35,820 per year, and the top 1% of patients cost $76,476 per year in 2009, according to the brief.

Who are these high-cost patients, the five percent? The brief stated that they tend to be 55 or older and have at least one chronic condition. (I've read elsewhere that  patients with chronic conditions consume 75% of the health care budget.). Many of them have hypertension, high cholesterol, or diabetes. Increasing obesity rates are driving the increase in many costly chronic conditions.

Other factors are also driving up health care costs. These factors include costly new medical technologies, the increased use of defensive medicine to avoid malpractice suits, and economic incentives such as fee-for-service payments that discourage adequate management of chronic conditions, according to the brief.

The brief did not have any suggestions about how to curb health care expenses. Clearly, the rate of chronic conditions in the U.S. is one of the roots of the problem (although other reforms are also needed in the health care system). But the time and energy it takes for an individual to prevent or adequately manage a chronic condition are at odds with our culture, which rewards unhealthy workaholism and weakens the community ties that can foster healthy choices.