25 de gener 2016

Maximizing health and welfare

Maximizing Healthy Life Years: Investments that Pay Off
Future of Healthy How to Realize Returns on Health

Key relationships (click to enlarge)
 

Summary
 

Key tipping points (not exhaustive)
 

Nothing specially new. Good infographics. This report relates to the health determinants literature. Anyway, for your files.

22 de gener 2016

Rethinking drug regulation and health risk mitigation

FDA in the Twenty-First Century. The Challenges of Regulating Drugs and New Technologies

A new book on FDA addresses the  "perennial and new problems and the improvements the agency can make to better serve the public good.". The book would deserve a detailed critique, however, let me skip directly to chapter 25: Device-ive Maneuvers FDA’s Risk Assessment of Bifurcated Direct-to-Consumer Genetic Testing.
In this blog I've written about the same topic. My position is clear: stop direct-to consumer testing. I have explained the rationale here. And what the book says, it is exactly the same:
Three steps are necessary to ensure the safety and effectiveness of DTC
genomic information. First, the underlying data must be analytically  valid—that is, the genomic data sequence must be accurate and precise. Second, the information must be clinically valid—the findings must be causally associated with clinical outcomes. And third, the risks of disclosing the genomic information must be minimized. FDA’s ability to effectively regulate genomic information hinges upon the approach taken to each of these challenges
Meanwhile, in Europe, nobody cares about it. It's a great shame.











 

La Lídia Pujol canta l'imne d'Occitània, "Se canta" (apelat tanben "Aqueres montanhes" en la Val d'Aran), dins lo programa de TV3 (Television de Catalonha) 


Comunicat del 20 de genièr de 2016 del President de l’IEO sul tractament de las lengas regionalas per l’estat francés.
ASSASSINAR SEI LENGAS, ANSIN VÒU LA FRANÇA ? ASSASSINAR SEI LENGAS, ANSIN VÒU LA FRANÇA ?
L’Institut d’Estudis Occitans (IEO) denóncia aut e fòrt que l’Assemblada Nacionala ague fach rebuta a la proposicion de lèi de Paul Molac, relativa a l’Ensenhament immersiu dei lengas regionalas e a sa promocion dins l’espaci public e audiovisuau.
Per memòria, aquesta denegada vèn après : la promessa vana dau candidat Hollande sus la ratificacion de la Carta europenca dei Lengas Regionalas ò Minoritàrias (ambé lo debat mancat a l’Assemblada Nacionala), lo rapòrt Filippetti de julhet 2013 e sei 42 prepausicions passadas per malhas, tornat mai en octòbre de 2015 l’engatjament dau president de la Republica per la Carta, rebutat per la drecha senatoriala e que dire de l’ensenhament dei lengas regionalas assecat…
Convendretz que i a de qué se pausar la question.
Sorda que mai se pòt pas a la demanda populària, la França, es que vòu pas finalament assassinar sei lengas regionalas per de bòn ?
A la veritat, aquesta decision fa chifrar, notadament per son escart d’ambé la demanda sociala, e discredita lo foncionament democratic.
D’escondons, vesèm s’organizar l’eliminacion metodica de nòstrei lengas de l’espaci public republican.
Amb aqueste refús, la França demòra un còp de mai dins lo rodolet dei país reborsiers que donan ges d’estatut a sei lengas. Lo pluralisme linguïstic, pasmens, es una aisina de coësion indispensabla per la Nacion e un element de sa credibilitat internacionala.
Acceptar la postura dau Govèrn actuau de la França que mespresa de lengas que parlan sei ciutadans a milierats se pòt pas mai !
L’IEO demanda per aquò au Govèrn d’iniciativas nòvas que laissan oblidar lei còps que s’es mancat.
Coma lo digueriam encara en octòbre 2015 a Montpelhier, volèm una lèi !
Volèm una lèi que done un estatut vertadier ai lengas regionalas e garantisse sei locutors de tota exclusion e discriminacion.


Pèire Brechet
President de l’IEO
 

15 de gener 2016

Inducing methylation

Nutrition, Exercise and Epigenetics: Ageing Interventions
Epigenetics refers to an inheritable but reversible phenomenon that changes gene expression without altering the underlying DNA sequence. Thus, it is a change in phenotype without a change in genotype. The field of epigenetics is quickly growing especially because environmental and lifestyle factors can epigenetically interact with genes and determine an individual’s susceptibility to disease. Interestingly, aging is associated with substantial changes in epigenetic phenomena. Aging induces global DNA hypomethylation and gene-specific DNA hypermethylation due to the altered expression of DNA methyltransferases (DNMTs).
The evidence of the impact of epigenetics on aging is growing. And nutrition plays a key role on epigenetics through the life course. Thus, there are crucial reasons to focus on nutrition early in life.
It is clear that epigenetic alterations caused by aging may provide a milieu that can develop age-associated diseases such as cancer, cardiovascular diseases, neurocognitive diseases and metabolic diseases. Nutrition is one of the most important environmental factors that can modify epigenetic phenomena. Therefore, one might speculate that nutrition may delay the age-associated epigenetic change and possibly reverse the aberrant epigenetic phenomena that can cause age-associated diseases. Indeed, many nutrients and bioactive food components, which can affect one-carbon metabolism that can regulate methylation of DNA and histone or directly inhibit epigenetic modifying enzymes, are showing promising results in delaying the aging process and preventing age-associated diseases through epigenetic mechanisms.
And beyond nutrition, there is exercise. This is what this book explains and it shows the foundations for better health. If it's "only" an issue of regulating methylation...where are the incentives?



11 de gener 2016

Economic perspectives on public health

Promoting Health, Preventing Disease:The Economic Case

The rethoric behind disease prevention and Health promotion is well known. However, in practice, more needs to be done. A new book by WHO Euro reflects the economic case for such policies
Health promotion and disease prevention have a major role to play in Health policy worldwide, yet they are underused, partly because evidence to suport a strong case for action is difficult to gather. Aimed at a broad audience of policymakers, practitioners and academics, this book is designed to provide an economic perspective on the challenges to better health promotion and chronic disease prevention.
Four diferent considerations:
  • The costs of inaction: What are the economic consequences of not taking action to promote and protect the health of the population?
  • The costs of action: What would it cost to intervene by providing a promotion or preventive measure?
  • The cost-effectiveness of action: What is the balance between what it costs to intervene and what would be achieved in terms of better outcomes – e.g. emotional well-being, physical health, improved quality of life, educational performance?
  • The levers for change: What economic incentives can encourage more use of those interventions that are thought to be cost-effective and less use of those interventions which are not?
This book will be a key reference for public health policies, the background and state of the art, pros and cons of each policy, are clearly detailed. Highly recommended.



07 de gener 2016

The quid pro quo at the heart of the international health regulations

Disease Diplomacy. International Norms and Global Health Security

The implementation of international health regulations has its pluses and minuses. Some countries show reluctance to accept a new landscape of global health security. All these issues are reflected in an interesting recent book.
We have seen dramatic changes in the past decade. The engagement of high-level political and security communities with an area that had previously been primarily treated as a technical concern has been a major cause of that change, but it has also meant that the new system is taking time to settle. Prior to 2005, the IHR had not been substantially revised since 1969.

International norms are by their very nature collective ideas, and they rely on that collectivity—the notion of states as forming a cohesive international society—in order to function effectively. When a number of states cannot meet the IHR core capacity requirements and cannot attract the help they need to do so, the entire ethos of the global health security regime is undermined. This, for us, is the challenge facing norm leaders: how to maintain the regime’s political purchase when the security discourse used to establish it is increasingly met with antipathy post-H1N1 and with a lack of financial support to institutionalize the necessary capacities in the domestic structures of the poorest states. Thus, one of the key lessons we draw from the norm-building process examined in this book is that recognizing appropriate behavioral standards and “wanting to do the right thing” are not the same as having the ability to conform to those standards.






06 de gener 2016

A disease-producing organism

Disease Selection. The Way Disease Changed the World


Understanding human life is a great undertaking. After all these years the origins of our cells are not so clear. But let me quote a recent book and its suggested approach:

Evolutionary biologists have looked for some time for a suitable prokaryotic cell that when engulfed by another would form the nucleus of the nascent eukaryotic cell, but none has been identified that matches all the required criteria. However, Luis Villarreal, working with viruses, has come to the astounding conclusion that the primitive cell nucleus could have originated from a complex virus. The vaccinia virus, for example, seems to have all the same mechanisms that are required by a eukaryotic cell nucleus. The virus that formed the nucleus brought with it all the basic genes – thought to number about 324 – that are necessary to form the cell.
It requires a little time, and perhaps rereading of what has just been said, to realize that every cell in our bodies has a nucleus that was derived from a virus. We are the result of a very early disease process!

So not only is the nucleus of our cells derived from a virus but the mitochondria are from a parasitic bacterium. There can be no closer link between us and disease-producing organisms.


05 de gener 2016

Technology, organization and the health system

The digital revolution: eight technologies that will change health and care

A short article by the King's Fund describes key technologies for the future. Really, the future is now:
1. The smartphone
2. At-home or portable diagnostics
3. Smart or implantable drug delivery mechanisms
4. Digital therapeutics
5. Genome sequencing
6. Machine learning
7. Blockchain
8. The connected community
As usual, we need to split technologies according to its value and social willingness to pay. Easier said than done. That's why I would suggest a close look at the report on Better value in NHS. Technology innovation without organizational change to take advantage of its value is extremely costly.
This is the agenda for NHS transformation: