Antivaccination backlash: The sad legacy of Wakefield's False Science

The LA Times is covering this month's news of the Lancet's retraction of Andrew Wakefield's infamous paper linking autism and MMR shots. We applaud the journal in doing the right thing. It's a sad day to think that kids in all sorts of countries have been subject to suffering because of an irresponsible "scientist" set on pushing an agenda.

The LA Times

In 1998, Wakefield wrote and then vociferously hawked an article in the British medical journal Lancet linking autism to the MMR vaccine (measles, mumps and rubella). After the council's decision, Lancet this week retracted the article. Among the facts that have come out of the inquiry into Wakefield's research is that two years before his paper appeared, lawyers seeking to sue vaccine makers paid Wakefield the equivalent of $700,000.

After Wakefield's article appeared, vaccination levels plummeted in Britain and declined in the United States, and the diseases they prevented surged. Measles cases increased sevenfold in the U.S.

"One person's research set us back a decade, and we're just now recovering from that," Mark Sawyer, a pediatrician and infectious disease specialist at Radey Children's Hospital in San Diego, told me in an interview.

The article also covers Hollywood crackpots who take advantage of their status and well positioned voices to spread falsehoods:

Romaguera is especially upset by "celebrity science," as exemplified by Jenny McCarthy. The actress and former Playboy playmate claims vaccines made her son autistic but that she "cured" him. There is no cure. McCarthy's antics include yelling at three physicians on "Larry King Live," and exclaiming: "My son died in front of me from a vaccine injury!" Her son is alive, as she later acknowledged.

Yet she'd be little more than an opinionated pinup girl but for being invited to share her "expertise" on "Larry King," ABC's "20/20," "Good Morning America" and other popular shows. All this has helped propel McCarthy's two books on autism to bestsellerdom.

"Celebrities are entitled to support a cause," said Sawyer. "But when they give professional advice, I think that's dangerous."

Smart pills for health – look familiar?

The latest issue of the Economist magazine describes “smart pill” technology – the pill has an embedded chip that, once ingested, can transmit data to an external receiver such as a skin patch or a cell phone.

“…… the coupling of smart pills with wireless networks and mobile phones, allowing the information the pills capture to be beamed to doctors, patients and relatives, turns the technology into “a disruptive innovation about to happen”. Vitality, an American firm, has come up with a cap for pill bottles that telephones hapless patients if they fail to take their medicine on time. Vodafone, a mobile-phone operator, has just set up a mobile health unit in Britain. Orange, a French rival, already offers a service that records measurements from implanted heart monitors and transmits them to doctors via the internet. In Mexico, TelCel, the country’s biggest mobile operator, plans this month to launch a service that allows customers to determine whether they have flu using their mobile phones. Kalorama, a research group, estimates that sales of such services will leap from perhaps $4.3 billion last year to $9.6 billion by 2012.”

We have been talking for some time about the idea of using cell phones as enabling devices to collect and transmit health data. Especially since 4 billion people of the world now possess cell phones. We encourage the students in our medical device design class at MIT to consider incorporating cell phones and ICT to enhance the reach of their global health solutions.

“…There are some potential pitfalls, however. Stephen Oesterle of Medtronic, a devices firm involved in remote patient monitoring, thinks it a bit Orwellian for drug makers to keep such intimate tabs on their customers. He wonders whether spooked patients might disable all this clever kit. Tim van Biesen of Bain, a consultancy, believes that patients will need some kind of financial incentive to use smart pills.”

This is the idea behind XoutTB – our smart global health solution for ensuring drug compliance that combines the learnings of research on economic incentives research with science and technology. Evidently this idea has far-ranging applications.

Pesticide Detecting Paper Strip

The Times Science section reports on a novel water testing strip developed by scientists at McMaster University in Canada. Instead of having to a fancy analytical assay to see if the water is good, you simply expose the lateral flow test which activates what is essentially a water diagnostic.

The New York Times:

...But scientists at McMaster University in Hamilton, Ontario, are reporting the development of a simple paper sensor — a “laboratory on a strip” — that can be dunked in a sample and give a reading a short time later, like a litmus test.

The sensor, developed by John D. Brennan and colleagues, makes use of the fact that organophosphate pesticides like diazinon inhibit the action of acetylcholinesterase, an enzyme involved in nervous system function.

More at the Journal of Analytical Chemistry

Photoessay: A Day in the Life of a Midwife

BBC has a fantastic short photoessay on midwives in Congo

Music video using cardiograph-like instruments

Sometimes people definitely come up with a better use for an old piece of equipment.

I'll be gone from KORB on Vimeo.

Got Clomiphene? Let's have a baby--in Africa!

Alright, don't get too excited. The October issue of the New Scientist write about a great new opportunity for infertile couples in the continent. We would normally think of Africa and fertility rates as a field that the focus of contraception endeavors given its high birth rate. 10 to 30 per cent of African couples are infertile however, which is higher than other parts of the world. That's twice the rate of Europe for instance. So a parallel group of scientists have developed schemes that bring affordable IVF to the continent---for about $350. Traditional IVF in the United States runs abour $12,000. How they are doing is the focus of an article in The New Scientist October issue.

By using generic drugs, modularizing the processes to essential steps, and using fewer eggs to start with they've produced an affordable approach to natural conception for couples.

The table below illustrates an example of how each approach saves money and achieves comparable results
New Scientist:

If successful, such efforts could lower the cost of IVF everywhere. In the US, the price of one round of treatment can be up to $12,000 and is rarely covered by health insurance. In the UK, it costs about £5000 ($8000), which the National Health Service may or may not pay for, depending on where a couple lives.

"Most of what we do in the western world is overkill," says Jonathan Van Blerkom of the University of Colorado at Boulder, a member of the ESHRE team. "If you get these procedures down to a low cost and they are successful, you cannot justify charging $12,000 for an IVF cycle."

The conclusion that is really interested here is the possibility of IVF latching on to a growing trend of South-North technology transfer: solutions aimed at the developing world that may very be useful for industrialized countries (e.g., OLPC--> Netbooks, Mobile phone 3G--> Pervasive Mobile Computing)

In contrast, the New York Times Science section recently ran a story on the rising costs of IVF back home.
A large portion of the expense comes from carrying multiple babies and the risks they carry as all too frequent premature births. It looks as if the CDC is talking to their African counterparts. The Times reports they hired an economist to look at the numbers.

In Atlanta, the Centers for Disease Control and Prevention hired an economist to predict what would happen if single embryo transfer were used in a large number of IVF cases.

Dr. Macaluso, the C.D.C. reproductive health official, estimates the patients, businesses and insurance providers would save more than $500 million annually, even taking into consideration the cost of extra in-vitro rounds, by lowering neonatal intensive care, special education and other costs of premature babies.

Expanded applications for Mobile phones in developing countries

The Economist has a special report on the transformative impact of cell phones in the developing world - a technology that we view as an enabler and multiplier of global health devices.

Tapping into a library of answers using cell-phones

I saw this article in today's New York Times about "Question Box" an answering service that people in the Uganda call into with their cell-phones and citizen-librarians scour the web for answers and call them right back. A simple solution that empowers and catalyzes development!
I was struck by the fact that these citizen-librarians are paid in cell-phone minutes ...similar to our approach to TB Therapeutic Compliance - XoutTB!

Microchipped BP Pills Remind Patients to Take Their Meds

Someone at a conference recently alerted me to this approach to compliance. Those are some tiny chips!

Microchipped BP Pills Remind Patients to Take Their Meds

Shared via AddThis

Simple Breath Counter to Combat Pneumonia

From our friends at Global Health Ideas, a new find for a live saving device---a breath counter.

healthcare + design award: fighting pneumonia in remote areas: "

I just discovered an interesting blog: healthcare + design and they had this post up on design excellence awards. Not sure how much this Breath Counter costs, but worth investigating further:

“Fighting Pneumonia: Breath Counter The Breath Counter is a simple, effective testing device to help detect pneumonia in children under five, living in remote areas in developing countries. Pneumonia is the number one cause of death in the under five worldwide, killing an average of two million each year. ”

Philanthropy by Design

“The Breath Counter was created within Philips Design’s Philanthropy by Design program, established in 2005 in which, together with partners such as Non-Governmental Organizations (NGOs), public bodies and social players with complementary expertise and values, Philips Design donates its creative expertise and socio-cultural knowledge to create solutions to improve the health and environment of the more fragile categories of the world’s developing societies.”

"

Medical Innovation in Nicaragua

The IADB is supporting our project in Nicaragua for an appropriate biomedical innovation cluster. We are deploying a number of learning kits so that local inventors, physicians, engineers, and public health personnel can develop their next little devices that could. I'll try to cross post as much as I can, but otherwise, please visit the team blog at http://iihnicaragua.wordpress.com

$10 Medical Simulation

No, it’s not OPERATION, but it take a few cues from it. We simple breadboard circuit to create a basic platform for a medical probe simulator. You can use any time of instrument but we started with a syringe (we’re trying to get a biopsy needle). Some tin for conductive leads placed in our tissue simulator and some emdedded anatomical structures provide signals to a circuit tied to a webcam that sounds an alarm if a wrong path in the “intervention” has taken place.

Our idea is to let the doctors and healthcare workers decide what type of instrument and procedure they want to simulate. We’re providing the electronic and mechanical tools for it.

Economist Magazine monitors XoutTB

The latest issue of the Economist magazine's Technology Monitor has a profile of our smart therapeutic compliance system - XoutTB.

THD Blog is now Global Health Ideas

Aman, Jaspal, Ben and company have outdone themselves. The venerable global health blog, THD (Technology, Heath, and Development) is now Global Health Ideas, featuring a fresh, clean look and feel with more of the same content that we have been used to seeing over the years. This has to be my favorite global health blog and I bet it will rank among your top 10, if it isn’t already. Take note of their new address http://globalhealthideas.org/ as well as their new RSS feed to keep your reader nourished.

http://globalhealthideas.org/feed/

Right now, they are live blogging the Global Health Council conference in Washington, D.C.

Check out some of the recent action

Global Health Council (GHC36): Trust & social desirability in m-health

Global Health Council (GHC36): No such thing as “HIV in Africa”

GHC36: Discovering New Strategies Using Proven [mHealth] Technologies

and a recent MIT spinoff!! Global Health Startup: SHE Innovates for Reproductive Health

Dr. Kris Olson featured in Scientific American

Dr. Kris Olson, who leads CIMIT's Global Health Initiative, just got featured in Scientific American 10: Guiding Science for Humanity. SciAm does a pleasant, if brief overview, of a physician who's at the forefront of changing the way we develop technologies for patients in developing countries.

From Scientific American:

One colleague told the Boston Globe that Olson is “The Man” when the topic turns to lifesaving technologies for the developing world. Last year Olson and the Center for Integration of Medicine and Innovative Technology (CIMIT)—a nonprofit consortium of Boston teaching hospitals and engineering schools—moved ahead with a program to demonstrate the effectiveness of $7 resuscitators, tubes through which a medical worker exhales into a newborn’s mouth. The program started after the 2004 South Asian tsunami. Since then, about 500 midwives in Aceh, Indonesia, have been trained to use the technology.

If want to learn more, go to CIMIT GHI. They even have a Facebook group.

D-Lab Health Update: May 9th at the MIT Museum

Where: MIT Museum
When: May 9, 2009
What: D-Lab Project Presentations including D-Lab Health

Our students have decided to address a group of multidisciplinary challenges they encountered in Nicaragua. Despite the awesome weather in Boston this weekend, they are furiously designing and prototyping in the lab to meet their deadlines.

What we expecting: We have devices that address issues in pulmonary drug delivery for the rural situations, post-operative infection control solutions, glucose monitoring, and novel centrifuge designs to enable accessible diagnostic procedures in developing world laboratories.

We'll keep you up to date!

Unite for Sight conference @ Yale

> I am at the Unite for Sight conference. A last minute registration +
> road trip with fellow D-Labbers led us to New Haven for the weekend.
>
> Some highlights
>
> - Appropriate surgical devices from BD (next post)
> - no wifi so it's difficult to blog
> - lots and lots of people!!!
> - Yale is prettier than MIT (but they don't let you bring drinks
> inside the buildings)
> - Blogging on the iPhone leaves much to be desired
>