Researchers at the University of California, San Diego, have developed a nanoparticle that mimics a human blood cell so that it can circulate through our bloodstream soaking up bacterial infections and toxins. These so-called ‘nanosponges’ are expected to be particularly effective in treating bacterial infections that have developed an immunity to antibiotic treatments—and also for treating venoms from snake bites.
The nanosponges are made up of a biocompatible polymer core and covered by an outer layer of red blood cell membrane. With a diameter of 85 nanometers, the nanosponges are 3000 times smaller than a human blood cell, so in a single infusion of nanosponges into the blood stream they would easily outnumber the red blood cells, and thus intercept most of the attacking toxins before they damaged the actual blood cells.
I’d summarize the case for the approach we’re proposing in terms borrowed from John Goodman, who has probably argued for this way of thinking longer than anyone. Simply put, people who are not on Medicare or Medicaid today purchase their insurance with money from a combination of three sources: their own pockets, employer funds (which come out of their pay), and a federal tax subsidy. The third of these today offers benefits in an arbitrary way (based on your tax bracket, employer decisions, state and local taxes, and other factors) that in practice helps the rich much more than the middle class, and the combination of the three has to be spent in a horribly distorted insurance system where costs are inflated by (among other things) the absence of transparency and consumer choice. Obamacare would make these problems worse. We propose to make the third source—the subsidy—the same for everyone, and therefore to make it available to people who don’t have it now and put at least catastrophic coverage within the reach of all. And we propose to enable the development of a competitive insurance market in which to purchase coverage. That would actually address the sources of the key problems with today’s system, rather than move even further in the direction of an inefficient and economically irrational health-care system that pulls off the extraordinary feat of being simultaneously open-ended and over-managed.
Government regulation is stifling America’s vibrant pharmaceutical industry. A recent report by the President’s Council of Advisors on Science and Technology estimates that it costs an average of $1.2 billion to win FDA approval and bring a new drug to market. Given that biopharmaceuticals account for roughly two percent of the economy, this is no small matter.
The chief problem is the complex process of clinical trials, in particular “Phase 3,” in which a drug is tested and retested to prove its its effectiveness in treating conditions across a broad population. These trials have a strong track record, but they are poorly suited to new biopharmaceuticals, which are often very effective in smaller, targeted groups despite a lower success rate in the public at large. Under the current system, many of these drugs may fail their trials despite their effectiveness when prescribed correctly.
Drug-resistant bacteria present a couple types of problems—they don’t die when attacked with typical antibiotics, and they form slimy, hard-to-remove colonies called biofilms, meaning they literally stick around after you’ve tried to wash them off. New treatments to prevent their spread have to take a different approach from other antimicrobial products. Researchers at IBM have a new idea, and they say it could work in hospitals, countertops and on your skin.
The new antimicrobial hydrogel, made of 90 percent water, gloops together spontaneously when warmed to body temperature. It can bust through biofilms and kill a whole host of bacterial types, from small bugs like E. coli to large bugs like methicillin-resistant Staphylococcus aureus. The hydrogel is comprised of specially designed polymers, which are biodegradable and positively charged. When mixed with water and warmed up, the polymers self-assemble into chains, and the result is a thick gel.
The research team, led by Yi-Yan Yang at the Singapore-based Institute of Bioengineering and Nanotechnology, says the gel can be incorporated into creams, thin-film coatings for medical instruments, wound treatments, and plenty of other uses.
Their key breakthrough is the way the material hunts down and kills its quarry. Rather than interfering with DNA or selectively binding to a bacterial cell wall, like antibiotics do, the polymers grab on to the cell wall and rip it open, letting the contents leak out. This is possible because of their positive charge—matching the negatively charged cell wall of a microbe—and their hydrophobicity, or avoidance of water. Bacteria stand no chance, and they can’t evolve resistance to this method of attack the way they could evolve resistance to the proteins found in drugs. It’s a physical attack.
Government regulation = inefficiency, bureaucratic labyrinths, inflated costs, rationing of care. This is the future of the United States, under the misnamed “Patient Protection and Affordable Care Act.”
More than 275 million people have moderate-to-profound hearing loss, and many of those cases are caused by a breach in the connection between the inner ear and the brain.
Researchers have now shown how to repair a key component of that connection — the auditory nerve — by using human embryonic stem cells to restore hearing in gerbils. “We have the proof of concept that we can use human embryonic stem cells to repair the damaged ear,” says lead author Marcelo Rivolta, a stem-cell biologist at the University of Sheffield, UK, whose research appears in Nature today. “More work needs to be done, but now we know it’s possible.”
Stem cells have been differentiated into auditory nerve cells before, but this is the first time that transplanted cells have successfully restored hearing in animals. Some in the field say that it is a pivotal step that will undoubtedly spur more research.
As scientists delved into the “junk” — parts of the DNA that are not actual genes containing instructions for proteins — they discovered it is not junk at all. At least 80 percent of it is active and needed. The result is an annotated road map of much of this DNA, noting what it is doing and how. It includes the system of switches that, acting like dimmer switches for lights, control which genes are used in a cell and when they are used, and determine, for instance, whether a cell becomes a liver cell or a neuron.
“It’s Google Maps,” said Eric Lander, president of the Broad Institute, a joint research endeavor of Harvard and the Massachusetts Institute of Technology. In contrast, the project’s predecessor, the Human Genome Project, which determined the entire sequence of human DNA, “was like getting a picture of Earth from space,” he said. “It doesn’t tell you where the roads are, it doesn’t tell you what traffic is like at what time of the day, it doesn’t tell you where the good restaurants are, or the hospitals or the cities or the rivers.”
The new result “is a stunning resource,” said Dr. Lander, who was not involved in the research that produced it but was a leader in the Human Genome Project. “My head explodes at the amount of data.” …
In one of the Nature papers, researchers link the gene switches to a range of human diseases — multiple sclerosis, lupus, rheumatoid arthritis, Crohn’s disease, celiac disease — and even to traits like height. In large studies over the past decade, scientists found that minor changes in human DNA sequences increase the risk that a person will get those diseases. But those changes were in the junk, now often referred to as the dark matter — they were not changes in genes — and their significance was not clear. The new analysis reveals that a great many of those changes alter gene switches and are highly significant.
The country can have a vibrant market for individual health insurance. Insurance proper is what pays for unplanned large expenses, not for regular, predictable expenses. Insurance policies should be “guaranteed renewable”: The policy should include a right to purchase insurance in the future, no matter if you get sick. And insurance should follow you from job to job, and if you move across state lines.
Why don’t we have such markets? Because the government has regulated them out of existence.
Most pathologies in the current system are creatures of previous laws and regulations. Solicitor General Donald Verrilli explained as much in his opening statement to the Supreme Court: “The individual market does not provide affordable health insurance,” he noted, “because the multibillion dollar subsidies that are available” for the “employer market are not available in the individual market.”
Start with the tax deduction employers can take for their contributions to group health-insurance policies—but which they cannot take for making contributions to employees for individual, portable insurance policies. This is why you have insurance only so long as you stay with one employer, and why you face pre-existing conditions exclusions if you change jobs….
The main argument for a mandate before the Supreme Court was that people of modest means can fail to buy insurance, and then rely on charity care in emergency rooms, shifting the cost to the rest of us. But the expenses of emergency room treatment for indigent uninsured people are not health-care’s central cost problem. Costs are rising because people who do have insurance, and their doctors, overuse health services and don’t shop on price, and because regulations have salted insurance with ever more coverage for them to overuse.
If we had a deregulated, competitive market in individual catastrophic insurance, that market would be so much cheaper than what’s offered today that we would likely not even need the mandate.
Meanwhile, staggeringly inefficient markets for health care itself need a thorough, competition-focused deregulation. Americans will know there’s a healthy market when hospitals post prices on their websites, and when new hospital and health-care businesses routinely enter to challenge the old ones. Here too regulations keep competition at bay….
Group health plans in today’s system may appear reasonable enough—they seem to resemble “buyers’ clubs,” where people pool together to get good deals from providers. But in a real buyer’s club, each buyer still pays his own bill—you don’t go into a Sam’s Club and haul off whatever you can with only a fixed $20 copayment. And real buyer’s clubs don’t depend on where you work. Real buyers’ clubs for health services could be a useful way to get competition going and revive the cash-and-carry market for individuals.
A deregulated health-care and health-insurance market can work. We can at least start by removing the obvious elephants in the room: all the legislation, regulation and interventions that needlessly keep prices up, keep competition and innovation out, shelter people from the economic consequences of their decisions, and prevent the emergence of real insurance that follows you from job to job and from health to illness and back.
This assumption—that understanding a system’s constituent parts means we also understand the causes within the system—is not limited to the pharmaceutical industry or even to biology. It defines modern science. In general, we believe that the so-called problem of causation can be cured by more information, by our ceaseless accumulation of facts. Scientists refer to this process as reductionism. By breaking down a process, we can see how everything fits together; the complex mystery is distilled into a list of ingredients. And so the question of cholesterol—what is its relationship to heart disease?—becomes a predictable loop of proteins tweaking proteins, acronyms altering one another. Modern medicine is particularly reliant on this approach. Every year, nearly $100 billion is invested in biomedical research in the US, all of it aimed at teasing apart the invisible bits of the body. We assume that these new details will finally reveal the causes of illness, pinning our maladies on small molecules and errant snippets of DNA. Once we find the cause, of course, we can begin working on a cure.
The problem with this assumption, however, is that causes are a strange kind of knowledge. This was first pointed out by David Hume, the 18th-century Scottish philosopher. Hume realized that, although people talk about causes as if they are real facts—tangible things that can be discovered—they’re actually not at all factual. Instead, Hume said, every cause is just a slippery story, a catchy conjecture, a “lively conception produced by habit.” When an apple falls from a tree, the cause is obvious: gravity. Hume’s skeptical insight was that we don’t see gravity—we see only an object tugged toward the earth. We look at X and then at Y, and invent a story about what happened in between. We can measure facts, but a cause is not a fact—it’s a fiction that helps us make sense of facts.
The truth is, our stories about causation are shadowed by all sorts of mental shortcuts. Most of the time, these shortcuts work well enough. They allow us to hit fastballs, discover the law of gravity, and design wondrous technologies. However, when it comes to reasoning about complex systems—say, the human body—these shortcuts go from being slickly efficient to outright misleading.
The reliance on correlations has entered an age of diminishing returns. At least two major factors contribute to this trend. First, all of the easy causes have been found, which means that scientists are now forced to search for ever-subtler correlations, mining that mountain of facts for the tiniest of associations. Is that a new cause? Or just a statistical mistake? The line is getting finer; science is getting harder. Second—and this is the biggy—searching for correlations is a terrible way of dealing with the primary subject of much modern research: those complex networks at the center of life. While correlations help us track the relationship between independent measurements, such as the link between smoking and cancer, they are much less effective at making sense of systems in which the variables cannot be isolated. Such situations require that we understand every interaction before we can reliably understand any of them. Given the byzantine nature of biology, this can often be a daunting hurdle, requiring that researchers map not only the complete cholesterol pathway but also the ways in which it is plugged into other pathways…. Unfortunately, we often shrug off this dizzying intricacy, searching instead for the simplest of correlations. It’s the cognitive equivalent of bringing a knife to a gunfight.
These troubling trends play out most vividly in the drug industry. Although modern pharmaceuticals are supposed to represent the practical payoff of basic research, the R&D to discover a promising new compound now costs about 100 times more (in inflation-adjusted dollars) than it did in 1950. (It also takes nearly three times as long.) This trend shows no sign of letting up: Industry forecasts suggest that once failures are taken into account, the average cost per approved molecule will top $3.8 billion by 2015. What’s worse, even these “successful” compounds don’t seem to be worth the investment…. We are witnessing Moore’s law in reverse.
On the costs and consequences of FDA regulation, the unmeasured costs of not bringing drugs to market, and why table salt would be banned if it were held to medical standards. The bit about Moore’s Law in reverse for new drugs is especially thought-provoking.
On Friday, India is set to reach a major milestone in the global battle against polio, recording a full year without a single new case of the disease in the country that was long its epicenter and its biggest exporter.
It is a massive global public health achievement that has defied the odds and confounded the skeptics, a victory — attained with U.S. financial support and expertise — that will see India removed from a list of four countries where the crippling disease remains endemic. The other three countries are Afghanistan, Pakistan and Nigeria.
The feat raises the very real possibility that polio, like smallpox, could one day be consigned to history, along with the heartbreaking image of the Indian beggar, crawling on twisted, thin legs, pleading for alms.
Until 1995, India recorded 50,000 to 150,000 cases of polio each year. In 2009, 14 years into India’s campaign to eradicate polio, 741 Indian children still contracted the incurable disease, more than anywhere else in the world, and morale was sagging.
In 2010, the number fell to 42. In 2011, only a single new case was recorded, that of a 2-year-old girl who fell ill Jan. 13.
Anuradha Gupta, a joint secretary in India’s Ministry of Health and Family Welfare, said the prevailing mood was one of hope, optimism and enthusiasm, but not smugness, given the risk that the disease could still find a way back from abroad.