Virtual Visits — Confronting the Challenges of Telemedicine – NEJM

telemedicine2

Telemedicine = high-quality care for a broader population but…

This article, written by Jeremy M. Kahn and published in the New England Journal of Medicine, details the profound implications for the healthcare system. There are 2 main positive impacts:

1. Potential to substantially expand access to high-quality health care. Geographic barriers will be overcome, community-based care will be easier to provide to the one in need, healthcare will be more convenient not only for patients but also for providers.

2. Capacity to substantially reduce health care costs. For every stakeholder, telemedicine has real cost-saving possibilities: for providers, it reduces the time and space needed (more patients can be seen); for patients, it dramatically lowers travel expenses and productivity losses; for payers, it leads to a double-impact with more productivity in one hand (and lower costs) and the ability to have better care for patients living in remote locations.

Despite these advantages, challenges remain:

1. Concerns about effectiveness and cost-effectiveness. Theory is nice (see above) but what about reality? Telemedicine studies are methodologically weak… none of them include patient-reported outcomes. Solution? Do more research in order to prove the real benefits of telemedicine.

2. Technology issues and implementation questions. Solution? Study the context and provide a roadmap.

3. Lack of regulatory and legal frame (especially liability). Solution? Health care régulations revision.

4. No understanding of unintended consequences: financial (more encounters = more costs); interprofessional relationships (lack of continuum between a nurse and a doctor, a team; difficult collaborations as they are not long-term oriented); change in doctor-patient relationship and trust building. Solution? Integrate telemedicine in the current healthcare system; mix telemedicine with traditional face-to-face encounters with patients.

Technology is key in improving efficiency but it has to be used widely and as a complement (and not substitution) to the traditional system.

NEJM Article

Another excellent article on WIRED: Video is about to become the way we all visit the doctor

More on Telemedicine: American Telemedicine Association

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Needle phobia could become history with new technologies – Fast Company

 syringes

Needle phobia is quite common but may be soon part of history!

Approximately 20% of the population don’t like to be jabbed with a needle… Students from Rice University found a solution by inventing the Comfortably Numb, a new device that makes getting an injection practically painless.

Have a look at how it works with this video:

The cost could be an issue but with scale-up production it could go down significantly (USD 2 per piece today vs USD 0.35 for syringe with needle). The extra cost is worth it, especially for people afraid of needle like children for example.

Fast Company Article

More about Needle Phobia

 

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Mental Health – Awareness and Care vs. Stigma

DepressionMental Health Awareness is Starting to win over Stigma

During the last week I read several articles on mental health (you can see the list at the bottom of my post). I think that there is something going on, more awareness on how sick or sad people feel and what can we do about it. It has been found by a recent study that if nothing is done, the burden would be unbearable in the coming years.

Marilyn Wedge has wonderful insights in her article. Some of her quotes are revealing the sick and sad truth about our society:

– “The notion of mental health or mental illness is relative to the values of a particular society at a particular time in history. Our hectic society paradoxically frowns on overly active children—even children as young as four or five years old. Our society wants children to be restrained, orderly, and eager to please adults.”

– “There is another aspect of ADHD that worries me. As stimulants have come to be prescribed for ever larger numbers of children, our society’s very perception of childhood has changed. Instead of seeing ADHD-type behaviors as part of the spectrum of normal childhood that most kids eventually grow out of, or as responses to bumps or rough patches in a child’s life, we cluster these behaviors into a discrete (and chronic) “illness” or “mental health condition” with clearly defined boundaries. And we are led to believe that this “illness” is rooted in the child’s genetic makeup and requires treatment with psychiatric medication.”

– “In Prozac Nation, Elizabeth Wurtzel also discusses the one drug/one disease phenomenon. She says that her doctors defined her illness as “depression” because she responded to a specific antidepressant drug, Prozac. The drug defined her disease. Like Kramer, Wurtzel also noticed that a psychiatric drug not only came to define a particular mental disorder, but the drug also expanded that disorder across society. She observed, too, that the process was driven by profits to drug companies. The discovery of a new drug to treat depression resulted in many more patients being diagnosed with depression.”

– “As Wurtzel points out, the process of defining a disease by a drug is illogical and backward. Medicine has traditionally defined diseases by their causes, not by the drugs to which patients with similar symptoms respond. If psychiatry aspires to be scientific, on a par with other branches of medicine, how can it be content with this peculiar practice of delineating the outlines of a disease by a drug treatment?”

In conclusion, we really need to change the perception of our human behaviors: normality doesn’t exist and will never exist. We are all different and we have to accept ourselves with our own personality and identity. Something is changing and I hope that more people will find relief by being accepted as they are (as a starting point!).

 

Out of the shadows – 2015 – The Economist

The ADHD Fallacy: It’s Time To Stop Treating Childhood as a Disease – 2015 – TIME

It’s Time To Stop Using These Phrases When It Comes To Mental Illness – 2015 – Huffington Post

Probiotics May One Day Be Used To Treat Depression – 2015 – Huffington Post

Mental Health and Integration – 2014 – The Economist Intelligence Unit & Janssen

Mental Health Atlas – 2011 – WHO

 

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Pharma’s getting savvier about social media – Fierce Pharma Marketing

SocialMedia

European companies seem more advanced in using social media to interact with key stakeholders

An extremely interesting report from Ogilvy Healthworld about the strategic use of social media by pharma companies has been published recently. It is possible to access the key points on SlideShare. Just 5 companies out of 14 are getting patients, doctors and the media interested, delivering relevant info, inspiring actual conversations.

Some aggregated trends spotted by Ogilvy:

– 1.3 million Facebook followers

– Average number of pharma tweets per week has gone up by 530% since 2013

– Number of Twitter followers has tripled to 790,000

Who are the best socially positioned companies?

1. Boehringer Ingelheim

2. Bayer

3. Novartis

Patricia Alves from Boehringer quote: “The conversation is already out there. People are talking about you, whether you’re active or not. Social media gives you the opportunity to engage in that conversation, to give your position and your statement, and maybe then hopefully change the opinion of one person or two.”

Some tips from Ogilvy in order to improve the social fingertip of a pharma company:

– Be Brave

– Get Personal

– Move Fast

– Back Yourself Up (from a regulatory point of view)

– Give Guidance

– Inform and Educate

Fierce Pharma Marketing Article

More resources:

Healthcare Marketers Trend Report 2014 – Ogilvy

Engaging patients through social media – 2014 – IMS Institute for Healthcare Informatics

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New genetic testing will be inexpensive and democratized – NYT

DNAextraction

New Genetic Tests Hold Promise

A new article published in the New York Times is really fascinating. A Silicon Valley start-up, Color Genomics, found a simple way to test for genetic mutations responsible for breast and ovarian cancers. They used saliva samples and full automation together with medical doctors interpreting the results for USD 250 per test, a tenth of the competitors’price. As women will be able to pay out-of-the-pocket themselves, the company will not even bother to negotiate with insurance companies. For women not able to finance the cost themselves, Color Genomics will give it for free.

It is only the starting point of a new trend. New diagnostics companies are emerging and finding new ways to deliver the same results but cheaper than the big firms. Illumina is one of the major companies understanding and capturing this trend with the launch of a low cost machine.

Another compelling example in the start-up world is Theranos, a firm able to perform a lot of lab tests on a single blood drop at very low prices; or Counsly, a company that develop low-cost genetic test for parents planning to have children.

However, some questions remain about the impact on healthcare costs, who should be tested,… Below are some recent resources bringing elements of response to these points.

Will lowering the price of genetic testing raise the cost of medical care? (Forbes Article)

What patients need to know about cancer genetic testing (American Cancer Society)

NYT Article

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Improvement in US doctors’s adoption of EHR (Electronic Health Records) – Accenture

ipad

A survey of US doctors created by Accenture shows improvement in EHR use. Good news!

An insightful survey has been conducted by Accenture on the use of EHR by US doctors. Have a look at the infographic!

5 take-home messages:

1. 79% of US doctors are more proficient using EHR. They use EHR to enter patient notes electronically, e-prescribe and receive clinical results

2. They communicate with their patient electronically more frequently and regularly use software-based clinical decision support systems

3. Patients are also engaged with these new tools for requesting prescription refills, email their doctors and access their medical information online

4. EHR lead to a lot of benefits: better patient engagement and satisfaction; improved understanding of their medical condition; more valuable communication with their GP; records accuracy

5. EHR challenges: more user-friendly EHR softwares need to be implemented as doctors complain about the use of EHR; doctors do not always think of accessing EHR of a new patient (seen by another doctor)

Conclusion: the progress shown by the report are good news but there is still work to do and improvements to implement.

Accenture Report

More resources on EHR:

My blog posts on digital health

Intro to EHR: Introduction_to_EHR_McGrawHill_2011

Implementing Electronic Health Records in Hospitals – 2014 – Albert Boonstra & al. – BioMedCentral

Integrating Electronic Health Records Into Clinical Workflow – 2014 – Svetlana Lowry & al. – US Department of Commerce

Using Electronic Health Records to Improve Quality & Efficiency – 2012 – Sharon Sillow-Carroll & al. – 2012 – Commonwealth Fund

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How to determine R&D’s productivity – McKinsey

Test tubesMcKinsey experts led by Eric Hannon, worked on a unique formula to help innovative companies value the productivity of R&D activities

They explained the issues in trying to estimate the performance of R&D. Some ratios like R&D in % of sales as well as the % of new products launched over the last two years can be used but unfortunately they are not capturing the reality.

They worked on this challenge, designed a unique formula and tested it in real corporate life.

The approach

R&D outcomes = multiplying a project’s total gross contribution by its rate of maturation and then dividing the result by the project’s R&D cost.

The advantages

1. A single metric

2. Goal to measure what R&D contributes within the sphere of what R&D can actually influence

3. By measuring productivity both at the project level and across the entire R&D organization (through simple aggregation), it endeavors to speak to the whole company

The ratio & its key components

McKinseyRDRatio

Total gross contribution is the product’s economic value to customers. It is best calculated, I think, with a NPV.

Achieved product maturity is how close it is to verifying and validating its technical and commercial requirements. The implication is that companies must be able to assess, in real time, how close their R&D projects are to full maturity (simply looks at critical dimensions (such as cost, functionality, and quality) during each of the quality gates a project passes through in its development).

For pharma companies, I think that the numerator of the formula could be the rNPV for a specific project (or the aggregation for all the projects of the company). Have a look at my lectures on valuation if you would like to find out more about rNPV.

Consumed R&D costs are easy to find.

Management impact

This formula will help the management in several fields:

1. Setting direction

2. Improving teams

3. Making objective décisions

4. Driving change

McKinsey Article

Other resources:

Is R&D earning its investment? – 2010 – Deloitte

Measuring the return from pharmaceutical innovation – 2014 – Deloitte

How to create value for drugs? Comparative effectiveness and improved patient consideration – Office of Health Economics

microscopeFuture expectations for new drugs – 3 new papers written by the experts from OHE

A series of three articles exploring future expectations for new drugs of evidence of relative effectiveness in Europe and comparative effectiveness in the USA in 2020 have been published in the Journal of Comparative Effectiveness Research.

In a value-based and outcomes-based health care environment, there is a mandatory requirement for pharmaceutical companies to demonstrate the value of their products not vs. placebo but vs. the current standard of care.

Key questions must be answered:

Market Access

Source: Bridgehead Oncology Workshop, London 2012.

As mentioned in our page on Strategy & Vision, an increasing focus and trend toward value-based healthcare initiated by M. E. Porter will really make a difference for our health systems. We will stop paying for me-too products and pay only for value-added products that will bring real outcomes for all the stakeholders.

We will also probably be much more patient-centric in the future and use patient value to better select relevant projects as described by Stuart Dollow in his recent blog post on Prioritising Projects by Predicting Patient Value. Considering the patient as a partner and valuing his/her opinion to target precisely his/her needs as well as the clinical requirements will push the pharmaceutical industry toward more value generation because of the integration of the related stakeholders in the development process.

OHE Article (where you can access all the articles and working papers) – To download working papers you have to register (it’s free).

Direct Access to the Articles

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Pop That Bubble: 5 Reasons Biotech Needs A Different Metaphor – Xconomy

SoapBubbleAlex Lash said that, this time, there will be a “soft landing” in biotech instead of a bubble burst… We’ll see…

“There are signs the sector is strong enough to make it a gentle correction”.

Let’s discuss his arguments.

Resilience

External pressures that would trigger a trend reversal is not present and, despite some adverse events (Sovaldi price questioning, overvaluation statement by the Federal Reserve, ExpressScript exclusive move with AbbVie in HCV), in 2014, the sector is stronger than ever.

My comment: that’s right. The biotech sector supported a lot of strain but it is maybe not over and there will still be investigations about drug pricing rationale (especially those molecules not bringing enough value for the patient and the society). Why paying for drugs that will only extend your life and not saving it?

Cancer Immunotherapy

Several immuno-oncology projects have already passed several important tests. Big drug makers are firing all cylinders by putting together big internal teams. Three products have been approved since 2011. Among them Yervoy (ipilimumab) and Keytruda (pembrolizumab).

My comment: competition is tough and the field is crowded. Some experts are doubtful about the commercial potential of this class of drugs despite very high prices. Let’s take the example of Yervoy. Yervoy dosing is 3mg/kg every 3 weeks. The average body weight for a patient in US is 80.7kg and 70.8kg in Europe leading to respective dosages of 242mg and 212mg. After a little calculation we reach prices per cycle of 21 days of USD 31’370 for the US patient and EUR 19’850 on average for a EU5 patient… with a median overall survival of 10 months. So for the whole treatment (for a patient treated during 10 months): USD 313’700 in USA and EUR 198’500 in 5EU. Is it reasonable?

Even oncologists are complaining about cancer drug prices. A growing number of patients have difficulty affording treatment and, if nothing is done, people will not be cured with the latest technology and commercial revenues as well as profitability for drug companies will not meet expectations, not covering all the R&D expenses incurred during the previous years.

More about cancer immunotherapy

The Crossovers

A different type of investor according to Alex Lash: “crossover investors—hedge funds and other public funds looking for an ownership foothold and a pole position for the IPO”. They tend to be specialists, not generalists.

My comment: according to Alex Lash, bubble fears come essentially from generalists, biotech investors that do not understand fully the technology and its potential applications. It may be the case, we will see in the future how these small companies develop their business models.

More about crossover investors

Venture is now different

The landscape is different with more selection made by investors and more maturity shown by companies. All this contributed to a healthier investment environment.

My comment: I totally agree with him, especially because as of today even big pharma have a dedicated VC arm to finance promising small companies.

Less regulatory risk

Today approval is not as difficult to obtain as before. Drugs are coming to market faster with Fast Track and Breakthrough Therapy Status. Incentives to drive development for unmet needs have been implemented such as the GAIN Act. The regulatory sky is much less cloudy…

My comment: that’s true but the challenge is next door as approval is just an official green light and it doesn’t mean that you will get reimbursed and adopted on the market. All the work has still to be done after approval (or even before as market access is prepared earlier now). 

Xconomy Article

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IBM strikes digital health deal with Apple, Medtronic and J&J – Financial Times

AppleWatchHealth data tracking and sharing is a reality

IBM teams up with Apple and other key health players to be in one of the hottest life sciences fields today: digital health. For more on this topic, check the dedicated category of my blog.

Using Apple’s HealthKit Platform, together with IBM app, will allow users to track their heart rate, calories burnt and cholesterol levels (and maybe much more data in the next future). The next step, if users are willing to do it, is to share these data with medical researchers, doctors and, why not, insurance companies (like in this NYT article). This emerging trend is called Data Philanthropy.

The current trend is now to have deeper ties between the life sciences and tech/IT fields.

It is fascinating to study health data trends from craddle to grave but the biggest challenge is to organize available data and electronic health records in order to better care for the patients and improve health outcomes without increasing costs.

IBM is fully committed as it also indicated it will commercialize dedicated tools for medical researchers, doctors and insurance companies with two goals in mind: support clinical trials (enrollment, data collection & analysis) AND contain healthcare costs. IBM already has a big data computing system named Watson, able to query this huge amount of data and spot trends.

The average patient will collect a terabyte of medical data in their lifetime. Our analytics will be able to find the dots, the clues that are eluding us, and find new breakthroughs,” said Michael Rhodin, senior vice-president of IBM Watson.

The two other deals done with J&J and Medtronic are showing the real life impact of digital health:

J&J has asked IBM to build a “coaching system” to ensure patients are fit enough to undergo spinal surgery or joint replacement, and to encourage them to do the right exercises after their operation.

– IBM is also working with Medtronic on a smart diabetes treatment system that would take readings from a patient’s glucose monitor and ensure their insulin pump dispenses the precise amount of drug required.

FT Article    Data For Health Report    38 Health Apps

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Fixing Health Care Will Require More than a New Payment System – HBR Blog

Nepal

Beyond the implementation of a new payment system, healthcare providers needs to change their behavior

A really interesting article from HBR about healthcare systems and how can we improve health outcomes and managing costs.

Here are the key points from the article:

– the example of Possible Health in rural Nepal

– managerial discipline implementation has been crucial in the success of worker behavior change and the delivery of high-quality care

– defining areas of responsibility to avoid conflicts that arise from lack of role clarity is very important and has been implemented

– 4 areas having a clear impact in healthcare:

  1. Let doctors be doctors – not managers. Administrative tasks and managerial functions were removed for them to focus on clinical skills.
  2. Develop standard protocols for care. The lack of protocols leads to lack of care efficacy and very often costs much more.
  3. Hold people accountable for the little things. Every tasks needs to be done and task attribution is a fundamental element in healthcare. Even small tasks are important and could be disruptive of a whole process if not done properly and on time.
  4. Invest in technologies that promote efficiency and transparency. The example of Asana used as their computer-based project management system leading to great results (less waste of time, energy, and resources).

HBR Article

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How medical technology can be hacked? – Wired

Drug Pump’s Security Flaws Lets Hackers Raise Dose Limits

hackerHealth data hacked, hospital system bugged… A lot of news are emerging every day about breaches into the safety and security of electronic medical devices.

In this article written by Kim Zetter in Wired, it is explained that drug infusion pumps could be controlled by anybody anywhere. “Hospira systems don’t use authentication for their internal drug libraries, which help set upper and lower boundaries for the dosages of various intravenous drugs that a pump can safely administer. As a result, anyone on the hospital’s network—including a patient in the hospital or a hacker accessing the pumps over the internet—can load a new drug library to the pumps that alters the limits, thereby potentially allowing the delivery of a deadly dosage.”

Awareness should be raised inside and outside the hospital but, more importantly, in the medical technology industry. They should hire experts in security as well as former hackers to make their devices safe enough to be used in any setting worldwide.

Wired Article

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Divestments: a fundamental tool in growth strategies

A lot of opportunities will come from divested assets. It will probably reshape the lifescience industry as it will force companies to optimize their portfolio. It will be crucial for acquirers to carefully choose the right assets that have the best fit from a value creation standpoint.

Mylan buying Perrigo – Broadening Product Range & Extending Geographic Reach – Reuters

The deal in 4 points

MoneyUSD 29 billion in cash and stock spent.

25% premium over the last closing price.

USD 15.3 billion of pro-forma combined sales in 2014.

Would be the biggest health care deal year to date, ahead of AbbVie-Pharmacyclics (USD 21bn) and Pfizer-Hospira (USD 16.7bn).

Reuters Article

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New Business Models for Antibiotics. What Can We Learn from Other Industries? – OHE

New solutions could emerge from incentivization models applied in other industries

ChangeThe Office of Health Economics held a workshop last year with companies that presented their business and incentivization models: BAE Systems (defence), Allianz (insurance), Barclays Bank (finance), EDF Energy (energy), Dun & Bradstreet (corporate information) and Knowledge Unlatched (academic publishing). These models were then explored further for their applicability to antibiotics R&D.

Key points & recommendations from the workshop:

– There is a need for consolidated and focused research of antibiotic R&D. “There is a need for a an entity that pools resources, science and compounds; one that is sustainable and independent with focus on the research and early development of antibiotics in line with predefined public health-need profiles. This entity should find a way to open up the science to all working in this area.”

– The creation of a global funding vehicle putting together the resources from multiple companies, academic institutions and public bodies, in order to fund the appropriate research, early development and good stewardship of antibiotics.

– The implementation of new commercial business model for antibiotics delinked from price/volume.

Find out more: New Business Models for Antibiotics

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Technology Trends Transforming Health Care – Deloitte Dbriefs Health Sciences series

Technology will drive more value, patient empowerment, care quality increase and more collaborations

eyesDeloitte top managers regularly host webcasts about health care trends. Yesterday they spoke about technology in health care and how it will transform the way we do business in this industry.

They talked about the landscape as an introduction and more specifically about 2014 digital health funding where Analytics and Big Data were one of the hottest spot together with Health care consumer engagement (see more on page 5 of the slide deck below) or by following this Rock Health link.

Big data is today unavoidable in health care. We need to manage all this amount of information in order to better care for the patients. The transformation will happen quickly as many science and technology breakthroughs are advancing faster than Moore’s law.

Deloitte spotted several trends:

Harnessing the real potential of the Internet of Things by connecting some of the available sensors and objects in order to create a chosen and deployed network.

Biosensing wearables allowing a more natural way to interact with the network to select services.

Cognitive computing augmenting human thinking for enhanced decision-making and quicker data processing.

Amplified intelligence to increase productivity of workers and helping them.

Cheap and Good Complexity. No more financial barrier for product design and customization.

Cyberdefense will be crucial with increased connectivity. Machine learning and predictive analytics will help in this field.

New roles in top management: Chief Digital Officer, Chief Data Officer, Chief Innovation Officer,… and the need of a Chief Integration Officer to promote collaboration between these functions and the more traditional responsibilities.

Technologies are fundamentally changing the health care landscape. It has implications for all the stakeholders: patients, payers, health care providers, researchers, life sciences and technology companies, governement… But in the end, it will enable the whole system to evolve toward more value (instead of volume), to empower patients/customers, to increase the quality of care and to encourage more collaborations.

Slide Deck: TechnologyTrendsTransformingHealthCare_Deloitte_April2015

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Big biopharma deals we might see in 2015 – BioPharmaDive

Merger mania is alive and well – what could we expect in the coming months?

HandshakeA very interesting article from BioPharmaDive is analyzing the last trends in M&A. 2014 as well as the start of the year have been exciting as we mentioned in a dedicated post. For more on what happened in 2014, have a look at the Evaluate Pharma 2014 Year in Review below.

Some speculation and trends have been deduced from the past by the editor of BPD. He thinks that there is more to come and here what he’s anticipating:

1. Merck & Jazz Pharma backed by a very nice business fit with complementary franchises and products.

2. Shire & BioMarin would be the perfect combo between rare diseases and orphan drugs.

3. Gilead & Seattle Genetics to make a great use of the mountain of cash accumulated by Gilead.

4. Pfizer & Celgene to help Pfizer grab some market shares in oncology.

BioPharmaDive Article

EvaluatePharma2014inReview

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Emotions are driving our physical health – 2 TED Talks

Beautiful examples of our mental wellbeing affecting our health

The first talk from Nadine Burke Harris: How childhood trauma affects health across a lifetime. It is inspiring and providing us with a better understanding about the real impact of childhood trauma and toxic stress on children’s health.

She is a pediatrician raising awareness about childhood trauma and its impact on global health. “In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed.”

How to measure it and how to see the impact all life long? It has been done by the ACE Study. Two conclusions from this study: 1. childhood trauma is common and 2. the more trauma you suffered from, the more at risk you are to develop COPD, cancer, depression, heart disease… “We now understand better than we ever have before how exposure to early adversity affects the developing brains and bodies of children.”

She created the Center for Youth Wellness to prevent, screen and heal the impacts of toxic stress.

Adverse Childhood Experiences Study    Center for Youth Wellness

************

The second talk from Guy Winch: Why we all need to practice emotional first aid. Taking care of our emotions and our minds is crucial for our global health.

His talk is full of hints to live better like: “By taking action when you’re lonely, by changing your responses to failure, by protecting your self-esteem, by battling negative thinking, you won’t just heal your psychological wounds, you will build emotional resilience, you will thrive.”

This talk showed us why it is necessary to be conscious about our emotional health and why we need to take care of it. If we don’t, it can have devastating effects and even lead to premature death. We need to teach these tips to children to help them cope better with failure, rejection, lack of conviction and rumination.

Guy Winch Book

Evidence-based medicine: Save blood, save lives – Nature

Transfusions are overused in modern medicine – How can we limit their utilization to save blood and lives?

BloodTransfusionSeveral billions of dollars are spent on blood orders and transfusion procedures. It is not only the cost associated with it but also patient outcomes. Two studies detailed in the Nature article show that reducing the number of transfusions is leading to huge savings and to a decreased mortality. Even tough transfusions can be lifesaving, they are often unnecessary and are sometimes even harmful.

If a patient is healthy enough to get by without a transfusion, the doctor will not order blood for him. Less is more.

Using less transfusion is now globally recommended but changing established medical practice is a real challenge as sometimes doctors do not follow recommendations.

Nature Article (free access)    Transfusion Medicine History

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Antibiotic Resistance From Unexpected Sources – Herbicides, Dust And Metals – Forbes

New sources of bacterial antibiotic resistance discovered by researchers

crops3 new sources:

1. Herbicide: as described in the article, “while a bacteria alone might have been killed by an antibiotic, when exposed to an herbicide, a resistance gene is turned on, in effect “‘immunizing’ the bacteria to the antibiotic.””

2. Dust: “antibiotic-resistant bacteria are being spread from cattle yards through dust laden with excrement. Given the winds and droughts in some areas, dust bowls could spread the resistant bugs for hundreds of miles.”

3. Heavy metals: “heavy metals, added to feed as growth promoters, can also select for antibiotic resistance. Pollution with heavy metals—even at  very low levels— can promote bacteria with multiresistance plasmids (small bits of extrachromosomal DNA)”.

Additionally, some emerging markets are the home of companies without environmental consideration. It is known that some India-based drug companies are dumping waste in water. Without proper sanitation, it is a huge health concern for the population.

This Forbes article is informative and insightful about what might cause antibiotic resistance and how we could modify our behaviors in order to control this issue.

Forbes Article

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