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It's all about the money when it comes to disease
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Drug resistance
The antibiotic apocalypse At the last UK general election, the threat of antibiotic resistance was barely a blip in the public consciousness, let alone occupying the thoughts of politicians. That changed in 2013, when Sally Davies, the chief medical officer for England, publicly warned of the apocalyptic scenario – on a par with global warming, she said – of running out of drugs. It is happening because bacteria evolve to survive antibiotics, even when they are used properly, and new drugs aren’t being developed fast enough to replace ones that are becoming less effective. Infections resistant to antibiotics kill at least 25,000 people in Europe annually. Moreover, antibiotics to prevent incidental infection are essential for many medical procedures, from operations to cancer treatment. These will become difficult, or impossible, to carry out as resistance rises. An independent panel appointed by the government last year has estimated that if new treatments do not become available, global deaths could soar to 10 million a year by 2050 at a cost to the economy of $100 trillion. Even in the near future, the UK’s share of that cost could cripple the already cash-strapped NHS. Patients with drug-resistant infections need to stay in hospital for longer and even if newer drugs exist, they are often more expensive and have more side effects. Then there are the costs of hospital-wide emergency measures to stop the spread of “superbugs” like MRSA. To tackle the problem, the panel called for five measures. One is a pot of government and philanthropic money to develop new anti-microbial drugs and bring them to market. It also called for efforts to make existing
inequality in the UK is set to grow. drugs go further by reviewing The last two governments have the recommended doses or recognised the need to reduce combining drugs to more inequalities in health. Since effectively kill resistant bacteria. 2004, the NHS budget has been The panel also wants to take distributed so that deprived areas the guesswork out of diagnosing and poverty-related health issues infections. It can be almost such as smoking and obesity impossible to tell if some receive more money. The system infections are viral or bacterial is being redesigned to give even from symptoms alone. more weighting to deprivation. Technology such as IRIDICA, a diagnostic platform approved for use in Europe in December, could “Tackling health inequality means tackling wealth help match the drug to the bug. It inequality but politicians can distinguish a thousand types lack the courage to do this” of pathogen in a matter of hours. Such new technology won’t “Everyone should have the be enough to solve the problem, says Richard Smith of the London opportunity to live a healthy life no matter what their background School of Hygiene and Tropical is,” said a Department of Health Medicine. Doctors must learn spokesperson. to conserve antibiotics, old However, it is less clear that and new, and the effort must be politicians fully appreciate the global. However careful a doctor impact that income and wealth is with antibiotics, uncontrolled inequalities have on these health use elsewhere spawns resistant disparities. When it comes to bacteria that spread everywhere. Debora MacKenzie redressing the income imbalance, the focus on individuals rather than on making a wider change Inequality to society is frustrating, says Kate Pickett of the University of York. Reducing wealth inequality could be achieved by taxes that go up more as income increases, for If the low rates of cancer seen in example. The importance of such the richer portion of UK society measures was highlighted by the were replicated across the nation, independent Marmot Review on 19,200 fewer people would die health inequalities in 2010, but every year. It is a shocking Pickett believes all political parties statistic, and one that isn’t lack the courage to tackle such restricted to cancer: across almost issues head on, despite the known every measure of health, those costs of inequality. Michael Bond with less money get more disease. It is tempting to frame this as a LONGEVITY problem of poverty: if everyone could afford to eat wholesome food and join a gym, disparities in health would diminish. But this is only partly true. Economic Sixty may be the new 40, but will inequality can also cause anxiety 80 ever be the new 60? It will need about social status for those to be, if the NHS is to support a with less, which can lead to changing population. chronic stress that weakens the When the NHS was founded in cardiovascular and immune 1948, nearly half the population systems, says Richard Wilkinson died before the age of 65. Now of the University of Nottingham. This is bad news for the NHS given only 14 per cent do. By 2035, the over-65s will make up 23 per cent > recent forecasts that predict
It’s all about the money
Ageing society’s greater burden
Worldly advice Similar challenges face healthcare systems around the globe. Some countries have come up with clever solutions that could benefit others.
india Treating a hospital like a factory might not sound a promising approach, but it is one way to make complex heart operations more efficient without increasing risks. The Narayana Hrudayalaya health system in Bangalore has improved its cardiac surgeries by copying Japan’s approach to car-making. By allocating the various preparatory and surgical stages to teams with relevant skills and training, the region’s main hospital now conducts more surgeries than some top US sites, with equal or better results. sweden Communication is everything. After an elderly woman with breathing difficulties had to talk to 36 healthcare workers before receiving treatment, the County Jönköping Council in Sweden decided to reform how it deals with elderly patients. By getting different parts of the health system to talk to each other, they were able to coordinate and simplify the path to treatment. Admissions were cut by almost 22 per cent over five years, and many waiting times for referrals have dropped from 48 days or more to just two weeks. Cuba Cuba does more with less. Despite having been under US sanctions for decades, people in the country have similar life expectancies to US citizens. The island has one of the highest concentrations of doctors in the world, with a family physician living every four blocks, seeing patients from their house, serving about 300 local families. Regular visits mean health problems tend to be diagnosed early and vaccination rates are among the highest in the world.
Penny Sarchet
21 March 2015 | NewScientist | 23
Drug resistance
The antibiotic apocalypse At the last UK general election, the threat of antibiotic resistance was barely a blip in the public consciousness, let alone occupying the thoughts of politicians. That changed in 2013, when Sally Davies, the chief medical officer for England, publicly warned of the apocalyptic scenario – on a par with global warming, she said – of running out of drugs. It is happening because bacteria evolve to survive antibiotics, even when they are used properly, and new drugs aren’t being developed fast enough to replace ones that are becoming less effective. Infections resistant to antibiotics kill at least 25,000 people in Europe annually. Moreover, antibiotics to prevent incidental infection are essential for many medical procedures, from operations to cancer treatment. These will become difficult, or impossible, to carry out as resistance rises. An independent panel appointed by the government last year has estimated that if new treatments do not become available, global deaths could soar to 10 million a year by 2050 at a cost to the economy of $100 trillion. Even in the near future, the UK’s share of that cost could cripple the already cash-strapped NHS. Patients with drug-resistant infections need to stay in hospital for longer and even if newer drugs exist, they are often more expensive and have more side effects. Then there are the costs of hospital-wide emergency measures to stop the spread of “superbugs” like MRSA. To tackle the problem, the panel called for five measures. One is a pot of government and philanthropic money to develop new anti-microbial drugs and bring them to market. It also called for efforts to make existing
inequality in the UK is set to grow. drugs go further by reviewing The last two governments have the recommended doses or recognised the need to reduce combining drugs to more inequalities in health. Since effectively kill resistant bacteria. 2004, the NHS budget has been The panel also wants to take distributed so that deprived areas the guesswork out of diagnosing and poverty-related health issues infections. It can be almost such as smoking and obesity impossible to tell if some receive more money. The system infections are viral or bacterial is being redesigned to give even from symptoms alone. more weighting to deprivation. Technology such as IRIDICA, a diagnostic platform approved for use in Europe in December, could “Tackling health inequality means tackling wealth help match the drug to the bug. It inequality but politicians can distinguish a thousand types lack the courage to do this” of pathogen in a matter of hours. Such new technology won’t “Everyone should have the be enough to solve the problem, says Richard Smith of the London opportunity to live a healthy life no matter what their background School of Hygiene and Tropical is,” said a Department of Health Medicine. Doctors must learn spokesperson. to conserve antibiotics, old However, it is less clear that and new, and the effort must be politicians fully appreciate the global. However careful a doctor impact that income and wealth is with antibiotics, uncontrolled inequalities have on these health use elsewhere spawns resistant disparities. When it comes to bacteria that spread everywhere. Debora MacKenzie redressing the income imbalance, the focus on individuals rather than on making a wider change Inequality to society is frustrating, says Kate Pickett of the University of York. Reducing wealth inequality could be achieved by taxes that go up more as income increases, for If the low rates of cancer seen in example. The importance of such the richer portion of UK society measures was highlighted by the were replicated across the nation, independent Marmot Review on 19,200 fewer people would die health inequalities in 2010, but every year. It is a shocking Pickett believes all political parties statistic, and one that isn’t lack the courage to tackle such restricted to cancer: across almost issues head on, despite the known every measure of health, those costs of inequality. Michael Bond with less money get more disease. It is tempting to frame this as a LONGEVITY problem of poverty: if everyone could afford to eat wholesome food and join a gym, disparities in health would diminish. But this is only partly true. Economic Sixty may be the new 40, but will inequality can also cause anxiety 80 ever be the new 60? It will need about social status for those to be, if the NHS is to support a with less, which can lead to changing population. chronic stress that weakens the When the NHS was founded in cardiovascular and immune 1948, nearly half the population systems, says Richard Wilkinson died before the age of 65. Now of the University of Nottingham. This is bad news for the NHS given only 14 per cent do. By 2035, the over-65s will make up 23 per cent > recent forecasts that predict
It’s all about the money
Ageing society’s greater burden
Worldly advice Similar challenges face healthcare systems around the globe. Some countries have come up with clever solutions that could benefit others.
india Treating a hospital like a factory might not sound a promising approach, but it is one way to make complex heart operations more efficient without increasing risks. The Narayana Hrudayalaya health system in Bangalore has improved its cardiac surgeries by copying Japan’s approach to car-making. By allocating the various preparatory and surgical stages to teams with relevant skills and training, the region’s main hospital now conducts more surgeries than some top US sites, with equal or better results. sweden Communication is everything. After an elderly woman with breathing difficulties had to talk to 36 healthcare workers before receiving treatment, the County Jönköping Council in Sweden decided to reform how it deals with elderly patients. By getting different parts of the health system to talk to each other, they were able to coordinate and simplify the path to treatment. Admissions were cut by almost 22 per cent over five years, and many waiting times for referrals have dropped from 48 days or more to just two weeks. Cuba Cuba does more with less. Despite having been under US sanctions for decades, people in the country have similar life expectancies to US citizens. The island has one of the highest concentrations of doctors in the world, with a family physician living every four blocks, seeing patients from their house, serving about 300 local families. Regular visits mean health problems tend to be diagnosed early and vaccination rates are among the highest in the world.
Penny Sarchet
21 March 2015 | NewScientist | 23