And with this year’s World Health Day (on 7 April) focused on “Health For All”, how exactly will these innovations change the future healthcare sector – and how can they create better access and benefit everyone?
These questions sit at the heart of the World Economic Forum’s Global Health and Healthcare Strategic Outlook report, which sets out a vision for global health and healthcare by 2035.15 March
Seeking Alzheimer’s clues from few who escape genetic fate
(AP) More than 6 million Americans, and an estimated 55 million people worldwide, have Alzheimer’s. Simply getting older is the main risk — it’s usually a disease of people over age 65.
Less than 1% of Alzheimer’s is caused by inheriting a single copy of a particular mutated gene. Children of an affected parent have a 50-50 chance of inheriting the family Alzheimer’s gene. If they do, they’re almost guaranteed to get sick at about the same age as their parent did.9 January
Global Health and Healthcare Strategic Outlook: Shaping the Future of Health and Healthcare
Unprecedented disruptions caused by the COVID-19 pandemic, followed by social, economic, geopolitical and environmental challenges, continue to place complex and interconnected threats on health and healthcare systems. But the past few years have also allowed for innovation in the way health and healthcare systems are designed and delivered. Now is the time to take forward key learnings from the pandemic response and align stakeholders, industries, countries, and sectors to a shared vision for health and healthcare by 2035.

2022

28 December
Scientists develop blood test for Alzheimer’s disease
Scientists say test could replace a costly brain scan or painful lumbar puncture and enable earlier detection of disease
The next step will be to validate the test in a broader range of patients, including those from varied racial and ethnic backgrounds, and those suffering from different stages of memory loss or other potential dementia symptoms.

30 November
Study: Alzheimer’s drug shows modest success slowing declines in memory, thinking
(NPR) About one in five people who got lecanemab in the study experienced an adverse event, such as swelling or bleeding in the brain. People also reported symptoms including headaches, visual disturbances, and confusion.
A drug for Alzheimer’s disease that seems to work
It is not perfect. And it has side-effects. But it may be the real deal
(The Economist) It is easy to be cynical about announcements of drugs that claim to slow the progress of Alzheimer’s disease, the most common form of dementia. Lecanemab, however, may be the real deal. Results of a clinical trial, conducted by its makers, Eisai, of Tokyo, and Biogen, of Cambridge, Massachusetts, have just been announced in the New England Journal of Medicine. After 18 months, it had slowed the progress of symptoms by a quarter.
26 November
Why there’s excitement and skepticism about new Alzheimer’s drug lecanemab
(CBC) While some experts say there is plenty of optimism to be found about lecanemab’s potential, other have cautions and questions: What will the full data reveal? How much will the drug cost? How long can it stave off the devastating effects of Alzheimer’s disease, which can include severe memory loss, mood changes and the inability to perform basic tasks.
Roughly translated, the results suggest lecanemab slowed the advance of Alzheimer’s disease in its early stages by four-to-five months over the 18-month period of the study.

17 October
One Health Joint Plan of Action launched to address health threats to humans, animals, plants and environment
(WHO) Today, a new One Health Joint Plan of Action was launched by the Quadripartite – the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), the World Health Organization (WHO), and the World Organisation for Animal Health (WOAH, founded as OIE).
This first joint plan on One Health aims to create a framework to integrate systems and capacity so that we can collectively better prevent, predict, detect, and respond to health threats. Ultimately, this initiative seeks to improve the health of humans, animals, plants, and the environment, while contributing to sustainable development.
The One Health Joint Plan of Action, developed through a participatory process, provides a set of activities that aim to strengthen collaboration, communication, capacity building, and coordination equally across all sectors responsible for addressing health concerns at the human-animal-plant-environment interface.
The One Health Joint Plan of Action (OH JPA)
The five-year plan (2022-2026) focuses on supporting and expanding capacities in six areas: One Health capacities for health systems, emerging and re-emerging zoonotic epidemics, endemic zoonotic, neglected tropical and vector-borne diseases, food safety risks, antimicrobial resistance and the environment.

Global leaders commit US$ 2.6 billion at World Health Summit to end polio
More than 3000 scientists and health experts from 115 countries urge the world to fully fund eradication strategy following resurgence of disease

24 August
Preventing delirium protects seniors in hospital, but could also ease overcrowding and emergency room backlogs
George A Heckman, Schlegel Research Chair in Geriatric Medicine, Associate Professor, University of Waterloo
(The Conversation) Delirium usually occurs during an acute illness and causes a rapid decline in cognition. Older persons, particularly those with pre-existing changes in cognition, are at risk.
Delirium is often triggered in hospital by enforced bed rest, misplaced or lost hearing and visual aids, sleep disruption from noisy and brightly lit wards at night, over-prescription of unnecessary and often sedating medications or overuse of “tethers” like bladder tubes or intravenous lines.
Delirium often leaves patients too disabled or confused to return home. Some eventually do so after a period of rehabilitation, but many others never fully regain their independence and are placed on wait lists for long-term care homes. Adding insult to injury, because these patients are stable enough to not require acute hospital care, they are designated “alternate level of care (ALC)” and are charged a daily co-payment.

10 August
Preliminary Study Suggests Active Cannabis Users Had Lower Rates Of ICU Admission When Hospitalized For Covid
(Forbes) A new study published in the Journal of Cannabis Research found that a small sample of cannabis users had less severe cases of Covid-19 during their hospital stay than non-users. Cannabis users had better outcomes, including a decreased need for ICU admission or mechanical ventilation. The study, however, was very limited and there is still a need for prospective and observational studies to draw stronger conclusions.
The study looked at two hospitals in the Los Angeles, California area. Out of the 1,831 Covid patients in the study, 69 patients reported active cannabis use, which was just 4% of the total patients. It is important to point out that differences in overall survival were not statistically significant between cannabis users and non-users, according to the study. Here is a breakdown of the patient’s individual characteristics.

21-29 July
What an Alzheimer’s Controversy Reveals About the Pressures of Academia
A prominent research paper is under review for possible fraud. Why is it so hard to correct the record?
By David Robert Grimes
(The Atlantic) Science may be self-correcting, but only in the long term. Meanwhile, the triumph of dubious results increases research waste, and entire careers may be spent on chasing phantoms. A 2021 analysis found that a dismally small proportion of the experiments described in cancer papers could be repeated. A 2009 analysis of multiple surveys in which scientists were asked about their own or others’ misbehavior found that a significant proportion of researchers—perhaps one-fourth or one-third—say they have observed colleagues engaging in at least one questionable research practice, such as ignoring an outlier without due cause. And when Elisabeth Bik, one of the investigators who has examined Lesné’s work, performed an audit of more than 20,000 papers from biomedical research journals, she and her colleagues found that 3.8 percent contained “problematic figures” bearing hallmarks of inappropriate image duplication or manipulation.
Whistleblower Lifts The Lid On “False” Alzheimer’s Research
It appears that critical research that’s formed the basis for treatments of the disease was fabricated.
Alzheimer’s drug trials are notoriously ineffective. Now we may know at least part of the reason why.
A neuroscientist at Vanderbilt University has tipped off the scientific community that critical findings that have formed the foundation of Alzheimer’s research for nearly two decades may have been fabricated.
Leading Alzheimer’s theory undermined: Did tampering waste 16 years of research?
Hundreds of millions of dollars and years of research across an entire field may have been wasted due to potentially falsified data that helped lay the foundation for the leading hypothesis of what causes Alzheimer’s disease.
Blots on a field?
(Science) A neuroscience image sleuth finds signs of fabrication in scores of Alzheimer’s articles, threatening a reigning theory of the disease
“The immediate, obvious damage is wasted NIH funding and wasted thinking in the field because people are using these results as a starting point for their own experiments.” – Nobel laureate Thomas Südhof

The Right’s view
The Future WHO (World Health Organization)
by Pete Hoekstra
(Gatestone) “The alarming amendments offered by the Biden Administration to the WHO’s International Health Regulations would grant new unilateral authority to [WHO] Director-General Tedros to declare a public health crisis in the United States or other sovereign nations, without any consultation with the U.S. or any other WHO member. Specifically, the Biden Amendment would strike the current regulation that requires the WHO to ‘consult with and attempt to obtain verification from the State Party in whose territory the event is allegedly occurring in,’ ceding the United States’ ability to declare and respond to an infectious disease outbreak within the United States, dependent on the judgment of a corrupt and complicit UN bureaucracy.” — Rep. Chris Smith, ranking member of the House Global Health Subcommittee, May 18, 2022.
The delay was declared by some to be a huge win…. I believe that the time will be used to develop and market even more diabolical policies. Now is not the time to take a victory lap, it is the time to be ever vigilant.

18 July
The promise of music therapy for Alzheimer’s disease: A review
Anna Maria Matziorinis, Stefan Koelsch
Abstract
Alzheimer’s disease (AD) is a progressive neurodegenerative disease associated with cognitive decline. Memory problems are typically among the first signs of cognitive impairment in AD, and they worsen considerably as the disease progresses. However, musical memory is partially spared in patients with AD, despite severe deficits in episodic (and partly semantic) memory. AD patients can learn new songs, encode novel verbal information, and react emotionally to music. These effects of music have encouraged the use and development of music therapy (MT) for AD management. MT is easy to implement and well-tolerated by most patients and their caregivers. Effects of MT in patients with AD include improved mood, reduced depressive scores and trait anxiety, enhanced autobiographical recall, verbal fluency, and cognition. Here, we review musical memory in AD, therapeutic effects of studies using MT on AD, and potential mechanisms underlying those therapeutic effects. We argue that, because AD begins decades before the presentation of clinical symptoms, music interventions might be a promising means to delay and decelerate the neurodegeneration in individuals at risk for AD, such as individuals with genetic risk or subjective cognitive decline.

15 July
Not the Covid consensus we needed
(Politico) “We have entered the “See no virus, Hear no virus, Speak no virus” stage of the coronavirus pandemic. … Yet the BA.5 variant, which looks to be the most adept yet at evading vaccine protection and antibodies from prior infections, is spreading voraciously. “The worst version of the virus” to date, is how Scripps Research virus expert Eric Topol summed it up.”
… Some medical experts think we may be hitting as many as a million cases a day, though it’s impossible to tell exactly since so many people now rely on at-home rapid tests, if they test at all.

20 May
Canadian study offers important clue to why some back pain becomes chronic
Many take anti-inflammatory drugs for acute pain, but study suggests inflammation is key to healing
(CBC) A study conducted by researchers at McGill University and scientists from Italy suggests that blocking inflammation after injury might make that pain chronic — a finding that challenges the standard approach to treating pain.
Chronic pain — especially in the lower back — is a common ailment, but scientists don’t know why some back injuries resolve themselves while others cause suffering for years.
In this study, researchers found that neutrophils, a type of white blood cell that helps the body fight infection and dominates the early stages of inflammation, play a key role in resolving pain.
Jeffrey Mogil, researcher of the study and professor of psychology at McGill University, says standard medical practice for treatment of short lasting pain after injury might be the opposite of what we should be doing.
“We think that chronic pain develops because of inflammation so we think inflammation is bad and we should stop it. But what this study suggests is that yes, but at the cost of increasing your chances to develop chronic pain,” Mogil said.
While the findings have not yet been tested on humans in a clinical trial, several pain experts that are not affiliated with the study say it suggests a new way to look at how the body heals.
… Researchers found those taking anti-inflammatory drugs, like ibuprofen, naproxen, and diclofenac to treat their pain were much more likely to have pain two to 10 years later — a correlation that’s consistent with their other findings, but can’t determine what caused the ongoing pain. They also found those who took other painkillers, such as acetaminophen (Tylenol), were less likely to have chronic pain compared to those who took anti-inflammatory medication.

10 April
Medicare was right to limit coverage for pricey new Alzheimer’s drug
We need to recommit to demanding strong proof that medical treatments work.
(WaPo) The decision by the Centers for Medicare and Medicaid Services to decline to pay for an expensive new Alzheimer’s drug unless people who take it are part of a clinical trial was taken as a defeat by some advocates for Alzheimer’s patients. In fact, the decision represents a triumph for the scientific process. That process held firm, despite intense lobbying efforts both by the drug’s maker and by many of those advocates (who are understandably desperate for any new treatment).
When Aduhelm first came before the FDA, its independent advisory committee of scientific experts decisively recommended against approval.
Despite the panel of experts’ view that the data wasn’t good enough, the FDA — perhaps keenly aware that no new Alzheimer’s drug had been approved in 18 years, and that families were looking for hope — gave it a bright green light. Three of the expert panelists promptly resigned.

10 February
Gene therapy could open the door to a preventive treatment for Alzheimer’s
Mutation found in 0.1 per cent of Iceland’s population prevents the formation of amyloid plaques in the brain.
A genetic mutation that seems to protect a small minority of the population of Iceland from Alzheimer’s disease could open the door to gene therapy to combat the neurodegenerative disorder, a researcher at Université Laval believes.
Using an improved version of the gene-editing tool CRISPR, Professor Jacques-P. Tremblay and his colleagues successfully edited human genomes in a laboratory to introduce the Icelandic mutation.

22 January
Public outrage over the unvaccinated is driving a crisis in bioethics
Pandemic brings ‘unprecedented disagreements’ among doctors over how to triage those who refused the shot
(CBC) As president of the International Association of Bioethics, [Vardit Ravitsky, who teaches bioethics at the Université de Montreal and Harvard Medical School] has seen how the pandemic has tested a longstanding consensus of bioethics.
“Usually, bioethics is all about protecting and promoting the right of each patient to make their own decisions,” she said. “And all of a sudden we find ourselves in a situation where the common good should sometimes be prioritized, and that has caused some unprecedented disagreements within the bioethics community.”
When demand for critical care surges beyond what hospitals can provide, triage is the process through which doctors decide who gets care first — a process that sometimes amounts to deciding who lives and who dies.

17 January
Loss of human touch: How pandemic isolation is taking another toll on health-care workers
Neuroscientists are just beginning to understand the impact of touch from others and what happens when it’s disrupted.
“The social aspect [of touch] has really not received so much attention in research at all,” says neuroscientist Rebecca Böhme, director of the Böhme Lab at Linköping University in Sweden. She and her colleagues found the sensation that comes from social touch activates significantly more areas of the brain than sensation from self touch. … Over the past few decades, researchers have observed how touch can help patients with certain medical conditions.
The Touch Research Institute at the University of Miami’s school of medicine has conducted more than 80 studies showing how touch can accelerate recovery.

13 January
Harvard Harvard T.H. Chan School of Public Health: Epstein-Barr virus may be leading cause of multiple sclerosis
Multiple sclerosis (MS), a progressive disease that affects 2.8 million people worldwide and for which there is no definitive cure, is likely caused by infection with the Epstein-Barr virus (EBV), according to a study led by Harvard T.H. Chan School of Public Health researchers. …this is the first study providing compelling evidence of causality,” said Alberto Ascherio, professor of epidemiology and nutrition at Harvard Chan School and senior author of the study. “This is a big step because it suggests that most MS cases could be prevented by stopping EBV infection, and that targeting EBV could lead to the discovery of a cure for MS.”

2021

16 November
First human trial of Alzheimer’s disease nasal vaccine to begin at Boston hospital
(CBS) Brigham and Women’s Hospital will test the safety and efficacy of a nasal vaccine aimed at preventing and slowing Alzheimer’s disease, the Boston hospital announced Tuesday. The start of the small, Phase I clinical trial comes after nearly 20 years of research led by Howard L. Weiner, MD, co-director of the Ann Romney Center for Neurologic Diseases at the hospital.
A Phase I clinical trial is designed to establish the safety and dosage for a potential new medication. If it goes well, a much larger trial would be needed to test its effectiveness.

1 November
The COVID-19 pandemic has now killed 5 million people around the world
(NPR) The U.S. leads the world in the number of confirmed deaths from the virus with more than 745,800 people dead from COVID-19. Brazil (with more than 607,000 deaths) and India (with more than 450,000 deaths) follow the U.S. in the number of lives lost since the start of the pandemic.
Yet another tragic milestone of the pandemic comes just as the U.S. prepares to start vaccinating children between the ages of 5 and 11.
But in other parts of the world, health officials are seeing worrying signs of a coronavirus surge — just as some nations are relaxing measures to international travelers.
This official global tally only accounts for confirmed cases around the world, according to Amber D’Souza, professor of epidemiology at the university’s Bloomberg School of Public Health, who spoke to National Geographic.
Prior to Johns Hopkins releasing the latest global data on Monday D’Souza told the outlet: “It’s quite possible that the number of deaths is double what we see.

18 October
Sleep loss affects how paramedics and health-care workers respond to patients’ feelings
Veronica Guadagni, Postdoctoral Fellow, Cognitive Neuroscience, University of Calgary
(The Conversation) My research focuses on how when you don’t sleep, you can’t react as quickly, remember information, solve problems, make plans, multi-task or regulate and understand emotions as well as you could if you were well rested.

6 October
Alzheimer’s: The heretical and hopeful role of infection
What if dormant microbes trigger the onset of Alzheimer’s? It’s a theory that could have profound implications for prevention of the disease, writes David Robson.
Lifestyle and genetic factors certainly play a role in the development of the illness. But it looks increasingly possible that some common viruses and bacteria – the kinds that give us cold sores and gum disease – may, over the long term, trigger the death of neural tissue and a steady cognitive decline. If so, infections may be one of the leading causes of the dementia.

14 June
Novavax: Large study finds COVID-19 shot about 90% effective
(AP) Vaccine maker Novavax said Monday its COVID-19 shot was highly effective against the disease and also protected against variants in a large study in the U.S. and Mexico, potentially offering the world yet another weapon against the virus at a time when developing countries are desperate for doses.
The two-shot vaccine was about 90% effective overall, and preliminary data showed it was safe, the American biotechnology company said. That would put the vaccine about on par with Pfizer’s and Moderna’s.
While demand for COVID-19 shots in the U.S. has dropped off dramatically and the country has more than enough doses to go around, the need for more vaccines around the world remains critical. The Novavax vaccine, which is easy to store and transport, is expected to play an important role in boosting vaccine supplies in the developing world.

31 May-12 June
An Alzheimer’s breakthrough? Hardly.
Joe Schwarcz PhD
What we have here is an incremental advance and a drug that has been approved by the FDA without meeting its own criteria of requiring proof of efficacy in at least two clinical trials. The approval was based more on offering some hope for desperate patients than on evidence, which is rather poor.
(McGill OSS) Recently approved Alzheimer’s drug Aduhelm (aducanumab) purports to treat not only the symptoms of the disease but the cause as well. Its approval, however, is riddled with controversy.
Now for the first time there is a medication that purports to treat not the symptoms, but the underlying cause of the disease by disassembling the amyloid plaques. This is done with an antibody that has been engineered to recognize the deposits as a foreign substance that should be eliminated.
The trials have documented with brain scans that aducanumab does indeed attack the amyloid proteins and reduces plaques. However, there is no clear evidence that these plaques are the cause rather than the consequence of the disease. The pertinent question is whether the drug has a significant effect on brain function. This does not appear to be the case.
FDA approves first drug to slow decline of Alzheimer’s disease
The highly consequential decision means a controversial drug will be the first new medication for the illness in 18 years, but a follow-up study is required.
31 May
Alzheimer’s drug sparks emotional battle as FDA nears deadline on whether to approve
If cleared, the drug would be the first for slowing cognitive decline, but critics say the data does not prove it works
(WaPo) By June 7, the FDA is expected to make one of its most important decisions in years: whether to approve the drug [Aducanumab] for mild cognitive impairment or early-stage dementia caused by Alzheimer’s. It would be the first treatment ever sold to slow the deterioration in brain function caused by the disease, not just to ease symptoms.
The medication is a monoclonal antibody, a protein made in the laboratory that can bind to substances — in this case, clumps of amyloid beta, a sticky plaque compound that many scientists believe damages communication between brain cells and eventually kills them. The treatment is designed to trigger an immune response that removes the plaques.
See also:
FDA advisers tear apart case for Biogen’s Alzheimer’s drug aducanumab ahead of final decision
Given the high unmet need in Alzheimer’s, there is an argument that the FDA should authorize aducanumab even if the evidence falls short of the normal standard for approval. The argument rests on the premise that the benefits of aducanumab, however uncertain they may be, outweigh the risks.
Aducanumab does carry some risks, though. The JAMA article highlights the rate of amyloid-related imaging abnormalities (ARIA) in aducanumab patients. Most cases of ARIA were asymptomatic, and advocates argue imaging and dosing management can mitigate the risk. However, the experts have doubts about “how consistently and comprehensively” the mitigating measures could be performed in clinical practice. (1 April 2021)

21 April
Merkel: EU ‘probably’ needs treaty changes, especially for health policy
(Politico.eu) Merkel said the World Health Organization had told the EU that it should not only see itself as a single market in economic terms but also when it comes to health policy. “Ideally, we should always have had a uniform European approach to lockdowns, shutdowns and other measures,” she said. “And that’s why I think it’s right that the president of the Commission, Ursula von der Leyen, says we need a health policy that is more strongly coordinated, at least for such supra-regional health hazards — be it at intergovernmental or at European level.”

1 April
Researchers find new links to Alzheimer’s
U.S. scientists find 13 new mutations that provide clues to the development of devastating neurological diseases
Researchers in Boston have made potentially ground-breaking discoveries that could lead to the development of new therapies for Alzheimer’s disease (AD).
In a first-of-its-kind study, researchers at Massachusetts General Hospital, the Harvard T. H. Chan School of Public Health, and Beth Israel Deaconess Medical Center used whole genome sequencing (WGS) to try and find rare genomic variants associated with AD and found 13 such variants (or mutations).
The study also established new genetic links between AD and synapses, which are the structures that transmit information between neurons, and neuroplasticity, or the ability of neurons to reorganize the brain’s neural network.
The genetic origins of AD have been studied for years and previous studies have uncovered the genes that cause early onset familial AD (the form that runs in families), and the genes that cause the buildup of amyloid plaques in the brain, a distinctive feature of AD. Dozens of other AD genes have been identified as well, most of those relating to inflammation in the brain, which increases the risk of developing the devastating neurological condition. But what sets this study apart is the discovery of a genetic link between the loss of synapses and the development of AD which had not been previously identified.

15 February
Fauci Awarded $1 Million Israeli Prize For ‘Speaking Truth To Power’ Amid Pandemic
(NPR) Fauci “is the consummate model of leadership and impact in public health,” the awards committee said in a statement.
The award sets aside 10% of the prize money for academic scholarships in each winner’s field. Fauci gets to determine the nature of the scholarships.
The Dan David Prize, established by the late Italian Israeli philanthropist Dan David, annually awards three prizes of $1 million honoring contributions to knowledge of the past, contributions to society in the present and advances for the future.
This year the three awards focused on health and medicine.
Historians Alison Bashford of the University of New South Wales in Sydney, Katharine Park of Harvard University and Keith Wailoo of Princeton University are sharing a $1 million prize for studying the history of health and medicine. Zelig Eshhar of Israel’s Weizmann Institute of Science, Carl June of the University of Pennsylvania and Steven Rosenberg of the NIH National Cancer Institute are sharing a $1 million prize for pioneering anti-cancer immunotherapy.

30 January
Coronavirus mutations add urgency to vaccination effort as experts warn of long battle ahead
The mutations have complicated and likely extended the timeline for crushing the pandemic. A truism among epidemiologists is that herd immunity from a more transmissible virus requires a higher percentage of immunized people. Early in the pandemic, scientists estimated that around 70 percent of people would need to be vaccinated or have developed natural immunity to reach the threshold at which the virus would not freely circulate. That number now seems too low.

27 January
Infectious disease research ‘alarmingly low’
(SciDev.Net) Leading pharmaceutical companies are neglecting to address many other infectious diseases that pose a pandemic risk, amid a surge in research into COVID-19, a report has found.
In the 20 drugs companies scrutinised by the Access to Medicine Foundation, there were empty R&D pipelines for ten out of 16 emerging diseases identified by the World Health Organization (WHO) as a threat to public health.
The number of experimental drugs and vaccines targeting COVID-19 swelled from zero to 63 since the start of the pandemic in early 2020, the report found. However, there were only 13 projects focused on all the other infectious diseases put together, including five for Ebola and four each for Zika and chikungunya.

2020

29 June
Although focused on the U.S. situation, many of the problems raised pertain equally to Canada and other nations
The Coronavirus Pandemic’s Wider Health-Care’s Crisis
The pandemic has shaken the industry’s unsteady foundation, siphoning attention and resources away from patients who need other types of care.
COVID-19 has disrupted patient care and hospital finances—and the problems could deepen as the disease spreads..
By Dhruv Khullar
(The New Yorker) …the coronavirus has shaken [American health care’s] unsteady foundation, siphoning attention and resources away from patients who need other types of care. We tend to follow the virus’s toll narrowly—cases, hospitalizations, deaths—but the damage to public health is also vast, and the longer the pandemic persists, the larger it will grow. Children go unvaccinated; blood pressure is left uncontrolled; cancer survivors miss their checkups. The extent of the collateral damage won’t be known for years, if ever
During the pandemic, … [s]ome people with chronic illnesses, fearful of entering a medical setting or even venturing outside, have stopped seeing doctors altogether. Others have tried to make appointments but found clinics closed and routine care suspended. At many hospitals, non-urgent or “elective” care has been postponed for months. It’s difficult to say for sure what the effects of such postponements have been and will be. But statistics show that, across the United States, so-called excess deaths—deaths beyond those that are historically typical—have surged. Although many of these deaths can be attributed to COVID-19, delayed or cancelled care is probably a contributing factor, too. An analysis of death certificates shows that a fifth of the twenty-four thousand excess deaths that occurred in New York City between March 11th and May 2nd were caused by factors other than COVID-19; according to a study currently in pre-publication review, hospitals saw a thirty-eight-per-cent drop in serious heart-attack cases in March alone, suggesting that even people with acute, life-threatening illnesses have been avoiding medical visits. (The American College of Cardiology has gone so far as to issue a statement urging people to seek medical attention if they’re having cardiac symptoms.) A nationwide survey conducted in April found that a quarter of cancer patients receiving active treatment had seen their care delayed. Ultimately, it’s not just people with COVID-19 who are suffering; those with other illnesses are affected by the pandemic, too.
On May 28th, the United States reached a sombre milestone: a hundred thousand COVID-19 deaths. In the days since, twenty-two thousand more people have died. And yet the virus’s harm extends to individuals whose lungs it never reaches, and who aren’t included in those grim totals: patients with diabetes, depression, cancer, and high blood pressure; people suffering heart attacks and strokes; families who can’t hold their dying loved ones, and the nurses who must hold the phones through which people say goodbye. There are doctors who can’t keep their COVID-19 patients alive, and others who can’t keep their practices open.

26 June

The American Nursing Home Is a Design Failure

(New York) … David Grabowski, a professor of health-care policy at Harvard Medical School, and a team of researchers analyzed the spread of COVID-19 in nursing homes, and concluded that it didn’t matter whether they were well or shoddily managed, or if the population was rich or poor; if the virus was circulating outside the doors, staff almost invariably brought it inside. This wasn’t a bad-apples problem; it was systemic dysfunction.
… Grabowski’s analysis revealed one variable in operation and design that afforded some protection from coronavirus: Intimate facilities fared far better than large ones. Fortunately, the country has a growing network of miniature nursing homes, certified by the Maryland organization the Green House Project. Typically, this is a cross between a graduate student house-share and a suburban development. Ten or 12 residents, each with a private room, share a sprawling ranch house. They take their meals together, at a long communal table, sharing their lives with a handful of staffers. “The kitchen is open, so you can see the food being prepared and smell it as it’s cooking,” says Green House’s senior director Susan Ryan. Daylight flows into the common areas and a few steps lead outdoors to a garden or patio.
… The goal is to make people feel like they are able to continue the life they have lived for decades, rather than be suddenly transformed into superannuated livestock. “You want a place to feel normal, which is the opposite of institutional,” says Martin Siefering, an architect at the firm Perkins Eastman. “Shiny vinyl floors are not normal. Loud mechanical systems, having meals served to you on a tray — these things aren’t normal.”
… The Danish architecture firm CF Møller and the landscape firm Tredje Natur (Third Nature) won a 2016 competition to reimagine a complex of nursing homes in the Norrebro neighborhood of Copenhagen. … A series of three linked courtyards is crisscrossed by paths and lined with stores, clinics, and social services. The goal is to fuse the complex with the city, to mix populations, and stimulate casual contact.
… In a segmented industry where the interests of nursing-home and assisted-living operators compete for meager government funds, reforming the system will involve rewriting rules and spending more. “If the government put $300 billion into elder care, they could transform it,” Reingold says. “That’s an investment, not an expense. Spending more on quality long-term care would save a fortune in hospital stays.” A night in a nursing home costs Medicaid $200 to $300, depending on the state, while a night in a hospital can cost ten times that much.

22 June
The Promise and the Peril of Virtual Health Care
During the coronavirus pandemic, telemedicine looks like the future of health care. Is it a future that we want?
By John Seabroo
Telemedicine and telehealth involve a myriad of remote-health-care technologies and services collectively known as “virtual care.” For years, virtual care played a minor role in the United States’ $3.6-trillion health-care industry; now, with the COVID-19 pandemic, millions of people are discovering its benefits and its shortcomings for the first time. If virtual care is the future of health care, is it a future that we want?
In a narrow sense, the word “telemedicine” can mean the type of hardwired hospital-to-clinic setup that allows workers in a large hub hospital to assist in complex emergency procedures in distant spokes. This approach is descended from NASA’s pioneering research, in the nineteen-sixties and seventies, into satellite communications and methods of monitoring astronauts’ well-being in space.
… Telehealth providers typically offer virtual urgent care for non-emergencies. And patients suffering from chronic conditions, such as diabetes and colitis, can conduct routine follow-ups online. Proponents of telehealth have long argued that fifty to seventy per cent of visits to the doctor’s office could be replaced by remote monitoring and checkups. But, until the pandemic, most Americans weren’t interested.
Many rural clinics and community hospitals in small American towns fear that their already meagre medical staffing, and the revenues generated from procedures that can be performed on-site, will be further hollowed out by remote medicine. And often the patients who need care the most—the old and the poor—don’t have smartphones or broadband connectivity, or can’t afford extra minutes on their wireless plans, placing one of telehealth’s greatest promises, of allowing old people to “age in place,” out of reach.

16 February
How bilingualism can hold back a flood of Alzheimer’s symptoms
A new study has found that while bilingualism can hold back the symptoms of Alzheimer’s disease, it can also lead to a faster decline down the track
(New Atlas) A long line of research projects have found a range of benefits of bilingualism when it comes to the brain, from shortening recovery times from stroke to staving off the cognitive decline associated with dementia and Alzheimer’s. Scientists looking into the latter have uncovered some interesting new insights, finding that while knowing a second language can delay the onset of the disease, it can also significantly accelerate the deterioration into severe Alzheimer’s thereafter.
The research was carried out at Canada’s York University, where scientists in the Department of Psychology set out to investigate how bilingualism can boost what is known as our cognitive reserve, and what that means for Alzheimer’s. This refers to the brain’s resilience to neurological damage, with previous studies finding that a greater cognitive reserve can, at least temporarily, mitigate the impacts of Alzheimer’s in our later years.
The research was published in the journal Alzheimer Disease and Associated Disorders.

3 February
Viral connectivity means we all have to accept the threat of disease and disaster
(SCMP) In an increasingly interconnected world, those of us who enjoy the fruits of globalisation must also bear its risks: climate crisis, drug resistance and emerging epidemics. As the Wuhan outbreak shows, we must work together
There is considerable fear and misinformation about viral pandemics. To put things in perspective, the current Ebola outbreak in West Africa has more than 3,000 confirmed infections and a mortality rate of about 66 per cent, compared to around 2 per cent for the Wuhan coronavirus.

The New Coronavirus Is a Truly Modern Epidemic
New diseases are mirrors that reflect how a society works—and where it fails.
…the World Health Organization recently declared a “public-health emergency of international concern” (PHEIC)—a designation that it has used on five previous occasions, for epidemics of H1N1 swine flu, polio, Ebola, Zika, and Ebola again. The invocation of a PHEIC is a sign that the new coronavirus should be taken seriously—and as the sixth such invocation in a little more than a decade, it is a reminder that we live in an age of epidemics.
Each new crisis follows a familiar playbook, as scientists, epidemiologists, health-care workers, and politicians race to characterize and contain the new threat. Each epidemic is also different, and each is a mirror that reflects the society it affects. In the new coronavirus, we see a world that is more connected than ever by international travel, but that has also succumbed to growing isolationism and xenophobia. We see a time when scientific research and the demand for news, the spread of misinformation and the spread of a virus, all happen at a relentless, blistering pace.

28 January
We Made the Coronavirus Epidemic
It may have started with a bat in a cave, but human activity set it loose.
By David Quammen, author of “Spillover: Animal Infections and the Next Human Pandemic.”
(NYT) Long term: We must remember, when the dust settles, that nCoV-2019 was not a novel event or a misfortune that befell us. It was — it is — part of a pattern of choices that we humans are making.

11-13 January
CBC The Current “neuroscientist Dan Levitin gives us his tips on how to age well, and why he thinks old age is a stage of life where we can still grow.”
A neuroscientist lays out the keys to aging well -complete transcript
(PBS) Daniel Levitin — a neuroscientist and professor emeritus of psychology at McGill University– has written extensively about the brain. Also a musician, he has written bestselling books examining the effect of music on the brain, as well as about how to think “straight” in an age of information overload. In Levitin’s latest book, “Successful Aging” he explores the questions: what happens in the brain as we age and what are the keys to aging well?

1 January
AI system outperforms experts in spotting breast cancer
(The Guardian) An artificial intelligence program has been developed that is better at spotting breast cancer in mammograms than expert radiologists.
The AI outperformed the specialists by detecting cancers that the radiologists missed in the images, while ignoring features they falsely flagged as possible tumours.
If the program proves its worth in clinical trials, the software, developed by Google Health, could make breast screening more effective and ease the burden on health services such as the NHS where radiologists are in short supply.
“This is a great demonstration of how these technologies can enable and augment the human expert,” said Dominic King, the UK lead at Google Health. “The AI system is saying ‘I think there may be an issue here, do you want to check?’”

2019

16 November
The most remote emergency room: Life and death in rural America
If anything defines the growing health gap between rural and urban America, it’s the rise of emergency telemedicine in the poorest, sickest, and most remote parts of the country, where the choice is increasingly to have a doctor on screen or no doctor at all.
(WaPo) As hospitals and physicians continue to disappear from rural America at record rates, here is the latest attempt to fill a widening void: a telemedicine center that provides remote emergency care for 179 hospitals across 30 states. Physicians for Avera eCare work out of high-tech cubicles instead of exam rooms. They wear scrubs to look the part of traditional doctors on camera, even though they never directly see or touch their patients. They respond to more than 15,000 emergencies each year by using remote-controlled cameras and computer screens at what has become rural America’s busiest emergency room, which is in fact a virtual ER located in a suburban industrial park.

2 October
Chronically Simple helping manage the chaos of living with chronic disease
The Chronic Disease Prevention Alliance of Canada puts the number of Canadian adults living with chronic disease at 60 per cent. According to Statistics Canada, 6.2 million Canadians over the age of 15 live with one or more disabilities. And nearly half of Canadians have cared for an aging, ill, or disabled family member or friend, according to the agency’s latest data. …
The result was the August 2018 launch of Chronically Simple, a cloud-based app that helps patients and caregivers manage the day-to-day logistics around living with chronic disease or disability, from medication and appointment tracking, to accounting and note taking, to lab results and medical records storage. … Among its many secure features, Chronically Simple offers appointment and scheduling functions, as well as medication and prescription tracking. It’s programmed to send reminders and connect appointment, doctor and prescription details. It also allows the patient to store their own medical records and keep copies of important test results. Users can store important incidentals like tax-deductible parking, travel, equipment, and prescription receipts by taking photos of the receipts. They can also enter appointment notes, manually or via talk-to-text, to be indexed for easy searching by the patient or healthcare provider.

23 September
Liberals, NDP promise increased health care spending
(Globe & Mail) Justin Trudeau promised a re-elected Liberal government would spend an additional $6-billion over four years on health care, describing the promise as a “down payment” to launch negotiations with provinces on pharmacare.
At an announcement in Hamilton, Mr. Trudeau said the increased funding would ensure that every Canadian can “easily” find a family doctor or primary-care team. He said the money would also lead to clear national standards for access to mental-health services, improve home care and implement a rare-disease drug strategy.
Mr. Trudeau gave very few details on the plans for a universal pharmacare system beyond interim measures that were announced in this year’s budget. He did not release a costing for the proposed plan, nor did he say when it would be implemented. Not to be outdone, Greens’ Elizabeth May commits to funding mental health, which she says is affected by the climate crisis
Federal leader outlines her health platform, which includes reducing wait times for assistance programs and putting more money into mental-health services in rural and remote areas.

19 September
Take down the barriers to telemedicine
By Patrick Déry, senior associate analyst at the Montreal Economic Institute.
Given that the technologies behind telemedicine exist and are proven, why do Canada’s health-care systems remain stuck in the past?
(Opinion Montreal Gazette) Because our governments, consciously or not, allow all sorts of obstacles to complicate the lives of patients.
For example, a doctor who provides care to people located in a certain province must hold a licence to practise in that province, even if he or she already holds a licence from another province. This outdated requirement prevents a better allocation of medical resources. If doctors are available to lend a hand in our part of the country, even just temporarily, why not welcome them with open arms?
In the case of telemedicine, the maintenance of this same requirement by the majority of provinces is completely ridiculous. More and more Canadian companies are offering their employees access to virtual consultations through their group insurance plans. A doctor who provides such a consultation could renew a prescription for an Alberta patient, then follow up with another from Manitoba suffering from a chronic illness, direct a Quebec patient to a consultation with a specialist, and give advice to a New Brunswick patient, all without leaving his or her office.
Why force this doctor to hold and renew a licence to practise in each of these places? The anatomy of Canadians does not vary a lot from province to province!
The provincial governments have also set out all sorts of conditions that restrict access to telemedicine within the public systems. It is often reserved for patients who live in remote regions or who suffer from particular conditions. Sometimes, the government even requires the patient or the doctor to go to an authorized health facility to receive or provide virtual care. This defeats at least some of the purpose of telemedicine!
The way we pay doctors doesn’t help, either. Fee-for-service payments, which represent around three-quarters of Canadian doctors’ incomes, do not encourage them to carry out actions for which there will be no payment. Unsurprisingly, the very large majority of our doctors are hesitant to write an email or pick up a phone to contact us, let alone have a smartphone consultation.
Finally, our health-care systems are still often far too centred on doctors. While their expertise is sometimes indispensable, there are many situations in which nurses and pharmacists can lend a hand. Allowing them to do more would liberate doctors, a scarce resource, to do other things.

18 September
Factbox: India becomes latest country to ban sale of e-cigarettes
(Reuters) – India became the latest country after Brazil and Thailand to ban the sale of e-cigarettes in what could potentially be the biggest move against vaping globally over growing health concerns.

6 September
Three more deaths and at least 450 illnesses linked to vaping nationwide
The Centers for Disease Control (CDC) said some type of chemical exposure is likely associated with the illnesses, but more information is needed to determine the exact cause. Many of those hospitalized reported recently vaping a THC product with chemicals from marijuana, while a smaller group reported using regular e-cigarettes.
The CDC did not identify any particular brand of e-cigarette, but expressed concern about any product sold on the street or tampered with by users.
“They’re really concerned about unknown substances people are buying on the street,” LaPook said. “They think it’s not an infection, it’s a probably some chemical irritation. When you think about it, these e-cigarette devices are really like chemistry sets. You put in this liquid, you lick it, you heat it up – there’s some kind of chemical reaction. You’re creating all these different chemicals. You’re not entirely sure what these chemicals are, but we are sure of one thing: You are sucking a lot of them.”

Ebola outbreak in the Democratic Republic of the Congo
(European Centre for Disease Prevention and Control) The 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) has been ongoing since August 2018. This is the largest-ever outbreak reported in the country and the world’s second largest in history. It has been declared a Public Health Emergency of International Concern on 17 July 2019.

4 September
Malaria breakthrough as scientists find ‘highly effective’ way to kill parasite
Drugs derived from Ivermectin, which makes human blood deadly to mosquitoes, could be available within two years

24 June
A vaccine for Alzheimer’s is on the verge of becoming a reality
For decades, research into Alzheimer’s has made slow progress, but now a mother and daughter team think they have finally found a solution – a vaccine that could inoculate potential sufferers
(Wired UK) Half the deaths in the US in 1900 were from infectious disease. By 2010, mortality related to infectious disease had been all but wiped out, leaving the two biggest killers as cancer and heart disease. Over the last 15 years, UK mortality statistics have shown a steady decline in deaths from heart disease, strokes and most major cancers – for men and women.
Over the same period the death rate from dementia – of which Alzheimer’s is the most common cause – has doubled: in part because lifespans have increased, and the effects of the disease increase with age. In the UK, there are currently 850,000 people living with dementia, and 500,000 – perhaps as many as two-thirds – have Alzheimer’s. In the UK, the Alzheimer’s Society expects dementia sufferers to exceed a million by 2025, with an unknown quantity of carers and family members affected.
A total of five drugs are available to relieve symptoms, but they cannot slow or stop the progression of the disease.
In the last ten years, over 100 anti-Alzheimer’s drugs have been abandoned in development or during clinical trials.
… researchers aren’t sure if high levels of beta-amyloid and tau cause Alzheimer’s or are symptoms of the condition. Both damaged versions of the proteins can cause neighbouring beta-amyloid and tau molecules to misfold as well – spreading the damaging tangles to other cells, breaking nerve cell connections with other neurons and slowly starving neurons to death.
The risks generally increase with age, but an inheritable form of the disease – early-onset Alzheimer’s – can affect people as young as 30. …  Some medications can reduce memory loss and aid concentration, but these just boost the performance of unaffected neurons, doing nothing to stop the kill-off of brain cells.
Chang Yi’s vaccine – UB-311 – couples a synthetic imitation of a common disease with a specific sequence of amino acids that are present only in the damaged beta-amyloid protein, and absent in the healthy form. This provokes an antibody response, clearing the tangled proteins away without provoking potentially damaging inflammation.
In January 2019, the company announced the first results from a phase IIa clinical trial in 42 human patients. “We were able to generate some antibodies in all patients, which is unusual for vaccines,” Chang Yi explains with a huge grin. “We’re talking about almost a 100 per cent response rate. So far, we have seen an improvement in three out of three measurements of cognitive performance for patients with mild Alzheimer’s disease.”
Because phase II trials are so small, there’s no statistically valid evidence yet that UB-311 has an impact on cognition and memory, but the lack of serious side-effects is a big step forward.