CRISPR and the future of medicine

 130th Annual Shattuck Lecture (2020) - CRISPR: Rewriting DNA and the Future of Medicine

Great! A must watch!

Video with Jennifer A. Doudna, Ph.D., and Eric J. Rubin, M.D., Ph.D.

How does a pandemic end?

 The end of epidemics

How do we choose to do the right thing?

The Power of Ethics. How to Make Good Choices in a Complicated World

The message

Ethical decision-making tethers us to our humanity. I see ethical decision-making as perhaps the greatest human connector. It binds us in a common optimistic project of benefiting and protecting society and humanity. Of crafting great stories for ourselves and others. Of continuing to probe what it means to be human in a technology-infused world.

But ethics on the edge require using our power and voices, seizing responsibility, taking action, and committing to truth. We all can actively choose ethics, rather than passively let ethics happen (or not). We all can prioritize humans over machines. We all can make decisions reflecting to future generations what we will tolerate for ourselves and demand of our legacy—rather than submitting to whatever trajectory that morally questionable leaders, innovators, and rogue actors define. We all can seek solutions and not just point out where others have fallen short.

The summary,

Four easily recallable steps, and the questions derived from these four words, will keep us focused: principles, information, stakeholders, and consequences.

Question #1: What are my guiding principles?

Who are you, as an individual or an organization? What do you stand for?

Question #2: Do I have the information I need to make this decision?

And what important information lies in the gap between the information you should know and the information you can know?

Question #3: Who or what stakeholders matter to my decision?

Who or what could influence, or be affected by, your decision?

Question #4: What are the potential consequences of my decision in the short, medium, and long term?

Have you considered the immediate and future impact of your decision at the time of the decision?

The book

and a video,

 

A better public health after COVID-19

 ¿ Será mejor la salud pública tras la COVID-19?

A must read op-ed.

La COVID-19 nos ha cuestionado sobre múltiples aspectos relacionados con la toma de decisiones en salud pública, desde la comunicación en salud hasta las bases jurídicas de las medidas de prevención, pasando por la monitorización de las conductas relacionadas con la infección o la aplicación de los modelos epidemiológicos.

 

 

Covid and social perspectives

 THE COVID-19 CRISIS. Social Perspectives

In Chapter 13

13 Post-pandemic Routes in the Context of Latin Countries: The Impact of COVID-19 in Italy and Spain by Anna Sendra, Jordi Farré, Alessandro Lovari and Linda Lombi

In terms of health and risk communication, the COVID crisis has emphasised the lack of specific training in crisis and emergency communication of many public sector organisations, including health institutions. This first social media pandemic has been a major challenge for health communicators; individuals often failed in effectively communicating data and numbers to counteract the infodemic and thus reduce the impact of false narratives. With the increasing diversification of social media platforms, ‘individuals’ health […] will be shaped by a multitude of social forces, each of which can mediate different kinds of health contagion processes’ (Zhang and Centola, 2019). Mitigating the spread of fake news seems to involve coordinated efforts between authorities, mass media and digital companies, but it also appears crucial to invest in education and digital literacy for developing a critical awareness of the use of digital technologies that could be useful for facing future health crises. In other words, the strengthening of comprehensive population-centred responses lies on finding answers concerning how the mechanisms of public concern will operate to engage in coherent protection rules or in what ways the forms of interaction will change

Outline of the book:

PART I: INTRODUCTION

1 COVID Society: Introduction to the Book

Deborah Lupton and Karen Willis

2. Contextualising COVID-19: Sociocultural Perspectives on Contagion

Deborah Lupton

PART II: SPACE, THE BODY AND MOBILITIES

3. Moving Target, Moving Parts: The Multiple Mobilities of the COVID-19 Pandemic

Nicola Burns, Luca Follis, Karolina Follis and Janine Morley

4. Physical Activity and Bodily Boundaries in Times of Pandemic

Holly Thorpe, Julie Brice and Marianne Clark

5. City Flows During Pandemics: Zooming in on Windows

Oimpia Mosteanu

6. The Politics of Touch-Based Help for Visually Impaired Persons During the COVID-19 Pandemic: An Autoethnographic Account

Hidi Lourens

PART III: INTIMACIES, SOCIALITIES AND CONNECTIONS

7. #DatingWhileDistancing: Dating Apps as Digital Health Technologies During the COVID-19 Pandemic

David Myles, Stefanie Duguay and Christopher Dietzel

8. ‘Unhome’ Sweet Home: The Construction of New Normalities in Italy During COVID-19

Veronica Moretti and Antonio Maturo

9. Queer and Crip Temporalities During COVID-19: Sexual Practices, Risk and Responsibility

Ryan Thorneycroft and Lucy Nicholas

10. Isol-AID, Art and Wellbeing: Posthuman Community Amid COVID-19

Marissa Willcox, Anna Hickey-Moody and Anne M. Harris

PART IV: HEALTHCARE PRACTICES AND SYSTEMS

11. Strange Times in Ireland: Death and the Meaning of Loss Under COVID-19

Jo Murphy-Lawless

12. Between an Ethics of Care and Scientific Uncertainty: Dilemmas of General Practitioners in Marseille

Romain Lutaud, Jeremy K. Ward, Gaëtan Gentile and Pierre Verger

13 Post-pandemic Routes in the Context of Latin Countries: The Impact of COVID-19 in Italy and Spain

Anna Sendra, Jordi Farré, Alessandro Lovari and Linda Lombi

14. Risky Work: Providing Healthcare in the Age of COVID-19

Karen Willis and Natasha Smallwood

PART V: MARGINALISATION AND DISCRIMINATION

15. The Plight of the Parent-Citizen? Examples of Resisting (Self-)Responsibilisation and Stigmatisation by Dutch Muslim Parents and Organisations During the COVID-19 Crisis

Alex Schenkels, Sakina Loukili and Paul Mutsaers

16. Anti-Asian Racism, Xenophobia and Asian American Health During COVID-19

Aggie J. Yellow Horse

17. Ageism and Risk During the Coronavirus Pandemic

Peta S. Cook, Cassie Curryer, Susan Banks, Barbara Barbosa Neves, Maho Omori, Annetta H. Mallon and Jack Lam

The world (dis)order after COVID-19

 COVID-19 AND WORLD ORDER. THE FUTURE OF CONFLICT, COMPETITION, AND COOPERATION

A free book of interest:

Part I. Applied History and Future Scenarios

Chapter 1. Ends of Epidemics

Jeremy A. Greene and Dora Vargha

Chapter 2. The World after COVID: A Perspective from History

Margaret MacMillan

Chapter 3. Future Scenarios: "We are all failed states, now"

Philip Bobbitt

Part II. Global Public Health and Mitigation Strategies

Chapter 4. Make Pandemics Lose Their Power

Tom Inglesby

Chapter 5. Origins of the COVID-19 Pandemic and the Path Forward: A Global Public Health Policy Perspective

Lainie Rutkow

Chapter 6. Bioethics in a Post-COVID World: Time for Future-Facing Global Health Ethics

Jeffrey P. Kahn, Anna C. Mastroianni, and Sridhar Venkatapuram

Part III. Transnational Issues: Technology, Climate, and Food

Chapter 7. Global Climate and Energy Policy after the COVID-19 Pandemic: The Tug-of-War between Markets and Politics

Johannes Urpelainen

Chapter 8. No Food Security, No World Order

Jessica Fanzo

Chapter 9. Flat No Longer: Technology in the Post-COVID World

Christine Fox and Thayer Scott

Part IV. The Future of the Global Economy

Chapter 10. Models for a Post-COVID US Foreign Economic Policy

Benn Steil

Chapter 11. Prospects for the United States' Post-COVID-19 Policies: Strengthening the G20 Leaders Process

John Lipsky

Part V. Global Politics and Governance

Chapter 12. When the World Stumbled: COVID-19 and the Failure of the International System

Anne Applebaum

Chapter 13. Public Governance and Global Politics after COVID-19

Henry Farrell and Hahrie Han

Chapter 14. Take It Off-Site: World Order and International Institutions after COVID-19

Janice Gross Stein

Chapter 15. A "Good Enough" World Order: A Gardener's Manual

James B. Steinberg

Part VI. Grand Strategy and American Statecraft

Chapter 16. Maybe It Won't Be So Bad: A Modestly Optimistic Take on COVID and World Order

Hal Brands, Peter Feaver, and William Inboden

Chapter 17. COVID-19's Impact on Great-Power Competition

Thomas Wright

Chapter 18. Building a More Globalized Order

Kori Schake

Chapter 19. Could the Pandemic Reshape World Order, American Security, and National Defense?

Kathleen H. Hicks

Part VII. Sino-American Rivalry

Chapter 20. The United States, China, and the Great Values Game

Elizabeth Economy

Chapter 21. The US-China Relationship after Coronavirus: Clues from History

Graham Allison

Chapter 22. Building a New Technological Relationship and Rivalry: US-China Relations in the Aftermath of COVID

Eric Schmidt

Chapter 23. From COVID War to Cold War: The New Three-Body Problem

Niall Ferguson

Vaccine diplomacy

 PREVENTING THE NEXT PANDEMIC. Vaccine Diplomacy in a Time of Anti-science

Throughout modern history, vaccines have surpassed all other biotechnologies in terms of their impact on global public health. Because of vaccines, smallpox was eradicated, and polio has been driven to near global elimination, while measles deaths have declined more than 90%, and Haemophilus influenzae type b meningitis is now a disease of the past in the United States and elsewhere.

I define one part of vaccine diplomacy as a subset or specific aspect of global health diplomacy in which large-scale vaccine delivery is employed as a humanitarian intervention, often led by one or more of the UN agencies, most notably Gavi, UNICEF, and WHO, or potentially a nongovernmental development organization

 Do vaccines really deserve their own designation for a special type of diplomacy? Yes, I believe so, especially when we consider that between the past century and this one vaccines have saved hundreds of millions of lives [2]. In this sense, the technology of vaccines and their widespread delivery represent our most potent counterforce to war and political instability in modern times. Vaccines represent not only life-saving technologies and unparalleled instruments for reducing human suffering, but they also serve as potent vehicles for promoting international peace and prosperity. They are humankind’s single greatest invention.

The greater issue is that in each of these four cases—smallpox, polio, Ebola, and COVID-19—the global health community had to respond to a crisis and scramble to rapidly develop, test, license, and distribute these vaccines. Could we also implement an anticipatory system in which nations prioritize vaccine diplomacy and routinely employ it to improve international relations? The Global Health Security Agenda does not currently emphasize vaccine development, although new organizations like CEPI and start-up innovation funds from the Japanese and South Korean governments represent promising steps toward global vaccine diplomacy. I am an enthusiastic champion of their efforts. However, I also believe that an opportunity exists for a more comprehensive effort to tackle the world’s most prevalent poverty-related neglected diseases while simultaneously expanding international scientific cooperation as a core element.

The answer might be found somewhere in the G20...

 

Regulating AI in healthcare

 Approval of artificial intelligence and machine learning-based medical devices in the USA and Europe (2015–20): a comparative analysis

Timely article. A must read to understand current situation.

A helpful document with the current approved technologies. 

Radiology leads the ranking:

Comparison of the situation between USA and EUROPE.

Pandonomics

Pandemic Economics

Key take-aways from the final chapter:

• Pandemic preparedness starts at home.

• Firms cannot rely on bailouts and need to adjust their business

strategies to pandemic risk.

• Financial pandemic preparedness can help with other disasters

and vice versa.

• Cost-efficient adjustment and investments in preparedness

require a sustained long-term approach.

• City planning and (re)construction should be focussed on

resilience and based on citizen and community engagement.

• The organization of the access to health care facilities during

pandemics is a local task; national governments need to set

uniform standards and rules that govern access to health care.

• Governments should use the adjustment potential of the economy

and focus support on sectors that need to and can grow.

• Outbreak management teams and scientific councils that advise

governments on pandemic response need a stronger basis in all

relevant sciences.

• The nation state is only the optimal health care area in very

special cases.

• International organizations should make the assessment of

pandemic preparedness a standard element of country studies,

monitoring and surveillance.

• Pandemics have not yet received the explicit attention they need

in the Sustainable Development Goals (SDGs).

• Strengthening global governance is an elementary step in proactive

pandemic preparedness.

Allocating vaccines

 Public Perspectives on COVID-19 Vaccine Prioritization

US adults broadly agreed with the National Academies of Science, Engineering, and Medicine’s prioritization framework. Respondents endorsed prioritizing racial/ethnic communities that are disproportionately affected by COVID-19, and older respondents were significantly less likely than younger respondents to endorse prioritizing healthy people older than 65 years. This provides reason for caution about COVID-19 vaccine distribution plans that prioritize healthy adults older than a cutoff age without including those younger than that age with preexisting conditions, that aim solely to prevent the most deaths, or that give no priority to frontline workers or disproportionately affected communities.

Beware.

 

Parov Stelar

Conflicting views on human heritable genome editing

 Heritable Human Genome Editing: The Public Engagement Imperative

Now limited to preclinical research by a prohibitive federal statute, the conduct of HHGE in the United States may well be at the mercy of the mutable arc of public opinion, the trajectory of which is unknowable.44 Eventual public acceptance of HHGE may well follow if it can be shown to have a unique and favorable impact on the global burden of incurable genetic disease. Such a trajectory would be further buttressed by the plight of parents and their children, which is universally resonant and hard to ignore. Medical science has, after all, been down this road before. Standing in opposition to the prospect of HHGE are deep-rooted misgivings over runaway technological progress that is liable to shatter millennia-old societal norms. Additional concerns draw on the prospect of liberal eugenics, access inequities, imponderable impairment, and progeny-related harm. Reconciling the conflicting views of the current steady state will require time, perhaps generational time, before the dust settles. In the interim, it is nothing short of imperative that HHGE be subjected to the rigors of public deliberation along the lines applied to MRT and related reproductive technologies.45 What is called for is informed public judgment that has accounted for both the relevant concerns and the potential to advance human welfare.

 

Why Basque country spends in health 24% more than Catalonia?

Estadística de Gasto Sanitario Público

And why they spend 5,5% of GDP and Catalonia 4,9%?

On value (once again)

 From value for money to value-based health services: a twenty-first century shift

VBHS cannot be achieved without reorienting existing fragmented models of care towards one that rests on a strong primary health care foundation (19) with an integrated community care component and underpinned by the principle of people coproducing health. This may encompass a shift from inpatient to outpatient and ambulatory care, where appropriate. It requires investment in holistic and comprehensive care, including health promotion and prevention strategies that support people’s health and well-being (20). It further requires effective referral systems, flexible and multidisciplinary provider networks, and participatory monitoring and evaluation strategies.

Nothing new. 

Joaquim Mir

Economic evaluation of vaccination

 Evaluating Vaccination Programs That Prevent Diseases With Potentially Catastrophic Health Outcomes: How Can We Capture the Value of Risk Reduction?

Why QALYs doesn't fit for CEA of vaccination?

In the last 5 years, guidelines have been developed for performing cost-effectiveness analyses (CEAs) for the economic evaluation of vaccination programs against infectious diseases. However, these cost-effectiveness guidelines do not provide specific guidance for including the value of reducing the risk of rare but potentially catastrophic health outcomes, such as mortality or long-term sequelae. Alternative economic evaluation methods, including extended CEA, the impact inventory, cost-benefit analyses, willingness to pay or the value of a statistical life, to capture the value of this risk reduction could provide more complete estimates of the value of vaccination programs for diseases with potentially catastrophic health and nonhealth outcomes. In this commentary, using invasive meningococcal disease as an example, we describe these alternative approaches along with examples to illustrate how the benefits of vaccination in reducing risk of catastrophic health outcomes can be valued. These benefits are not usually captured in CEAs that only include population benefits estimated as the quality adjusted life-years gained and reduced costs from avoided cases.