Monday, September 27, 2010

Misc Safety Warnings

“My doctor gave me six months to live, but when I couldn't pay the bill he gave me six months more.”
- Walter Matthau

Today I present two medical items.

The New England Journal of Medicine published an easy-to-read article about Retinal Injuries from a Handheld Laser Pointer. A 15-yr-old boy bought a laser pointer online "for popping balloons from a distance and burning holes into paper cards and his sister's sneakers." He was playing with the laser in front of a mirror to create a “laser show” when the laser reflected back and hit him in the eyes several times. One eye was damaged to 20/50; after four four months this eye healed to 20/32 vision.

What struck me about this story was this statement, "In the past, laser pointers sold to the public had a maximal output of 5 mW, which is regarded as harmless .... The measured output of the laser in this case was 150 mW ... normally restricted to occupational and military environments". Lasers upto 700 mW can be bought on the Internet as "fun toys". Frighteningly a parent can not readily identify a harmless laser pointer from a hazardous one; the beams look much the same.

An even more terrifying story is Are you ready for a world without antibiotics? Before the 20th century, surgeons were feared and avoided by most people. Doctors had mastered surgical skills with centuries of practice but the majority of patients still died afterwards from infections and disease. This changed with the discovery of antibiotics - it was a medical miracle and made hospitals trusted rather than feared. But this is changing as germs become resistant. The newest miracle drug is "carbapenems" but strains of bacteria in India have been found that are resistant to this too. As one doctor puts it, "This is potentially the end. There are no antibiotics in the pipeline that have activity against [the bacteria strain from India]. We have a bleak window of maybe 10 years, where we are going to have to use the antibiotics we have very wisely, but also grapple with the reality that we have nothing to treat these infections with. ... Frankly, pharmaceutical companies as well as governments and the European Commission need to really get their act together.""

The author of the article thinks 10 years is optimistic. Pharmaceutical companies pours tons of money into "life drugs" like heart medicine, stomach acids blockers, mental health (Valium), etc where, once prescribed, you take the medicine the rest of your life regardless of the cost. Antibiotics you take for a few weeks and then stop so there's less money made by the Pharmaceutical company. They go where the money is.

Bottom Line

How would life change in a world without Antibiotics? Mortality rates of abdominal surgery will skyrocket. Burst appendixes are fatal again. Transplant surgery becomes high risk; the patient will be killed by infection while on immune-suppressing drugs. Pneumonia returns as a mass-killer and TB becomes incurable.

Update warns that Rich-world diseases could hijack poor world's biotech. There are 70+ small biotech firms around the globle working on affordable cures to diseases that affect the world's poor. Shantha Biotechnics of Hyderabad, India, found a way to slash the cost of Hepatitis B vaccination by 60-fold (that's 1/60 the cost!)

The big companies have little interest in making drugs cheaper (why make less money?) or in spending massive research dollars for a drug the poor won't be able to afford. Instead they focus on drugs for wealthy Westerners.

The article warns of two dangers that may derail the quest for cheap drugs:
1. The small firms partner with the big guys to manufacture and distribute the new drugs for the poor and find themselves pushed to work on drugs for the wealthy instead.
2. Successful small firms are bought out by the big guys who may or might not distribute the new drugs cheaply.

Update 2

Since I'm on the topic of pharmaceuticals, 2,000-Year Old Greek Shipwreck Reveals Medical Secrets of the Ancient World
Intact pills have been found sealed in jars on an ancient Greek shipwreck. DNA analysis reveals carrot, radish, celery, wild onion, oak, cabbage, alfalfa, yarrow and hibiscus extract. It also found sunflower extract which has botanists scratching their heads since sunflowers were thought to have first come to Europe from the Americas with Columbus in the 1490's.

Update 3
Drug Resistant Super Bug Found in Three States - individuals who went to India for low cost surgery brought the super-germ back with them.

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