It may be the ultimate free lunch - how to reap all the advantages of a calorically restricted diet, including freedom from disease and an extended healthy lifespan,without eating one fewer calorie. Just take a drug that tricks the body into thinking it's on a diet.
It sounds too good to be true, and maybe it is.Yet, such drugs are now in clinical trials. Even if they should fail, as most candidate drugs do,their development represents a new optimism among research biologists that ageing is not immutable, that the body has resources that can be mobilised into resisting disease and averting the adversities of old age.
This optimism, however, is not fully shared.Evolutionary biologists, the experts on the theory of ageing, have strong reasons to suppose that the human lifespan cannot be altered in any quick and easy way. But they have been confounded by experiments with small laboratory animals, including roundworms, fruit flies and mice. In all these species, the change of single genes has brought noticeable increases in lifespan.
With theorists' and their gloomy predictions cast in the shade, at least for the time being,experimental biologists are pushing confidently into the tangle of linkages that evolution has woven among food intake, fertility and lifespan.
"My rule of thumb is to ignore the evolutionary biologists - they're constantly telling you what you can't think," Gary Ruvkun of the Massachusetts General Hospital remarked in June after making an unusual discovery about longevity.
Excitement among researchers on ageing has picked up in the last few years with the apparent convergence of two lines of inquiry: single gene changes and the diet known as caloric restriction.
In caloric restriction, mice are kept on a diet that is healthy but has 30 percent fewer calories than a normal diet. The mice live 30 to 40 percent longer than usual with the only evident penalty being that they are less fertile.
People find it almost impossible to maintain such a diet, so this recipe for longevity remained a scientific curiosity for many decades. Then came the discovery of the single gene changes,many of which are involved in the body's regulation of growth, energy metabolism and reproduction. The single gene changes thus, seem to be pointing to the same biochemical pathways through which caloric restriction extends lifespan.
If biologists could only identify these pathways,it might be possible to develop drugs that would trigger them. Such drugs could in principle have far-reaching effects. Mice on caloric restriction seem protected from degenerative disease, which may be why they live longer. A single drug that protected against some or all the degenerative diseases of ageing would enable people to enjoy more healthy years, a great benefit in itself, even if it did not extend lifespan.
The leading candidates for such a role are drugs called sirtuin activators, which may well be mimicking caloric restriction, in whole or in part. The chief drug is resveratrol, a minor ingredient of grapes and red wine. Sirtris Pharmaceuticals of Cambridge, Massachusetts, is now conducting clinical trials of resveratrol, in a special formulation, and of small-molecule drugs that also activate sirtuin but can be given in much lower doses. The resveratrol formulation and one of the small chemicals have passed safety tests and are now being tested against diabetes and other diseases. The Food and Drug Administration (FDA) does not approve drugs to delay ageing, because ageing in its view is not a disease.
The resveratrol tests are still under way, but last month the results with another substance,the anti-fungal drug rapamycin, were published.Rapamycin was found to extend mice's lives significantly even though by accident the mice were already the equivalent of 60 years old when the experiment started.
Rapamycin has nothing to do with caloric restriction, so far as is known, but the study provided striking proof that a chemical can extend human lifespan.
Another result, directly related to the caloric restriction approach, emerged last month from a long-awaited study of rhesus monkeys kept on such a diet.
The research was led by Richard Weindruch of the University of Wisconsin. As fellow primates,the monkeys are the best possible guide to whether the mouse results will apply in people. And the answer they gave was ambiguous.
The monkeys who had spent 20 years on caloric restriction were in better health than their normally fed counterparts, and suffered less diabetes, cancer and heart disease, apparently confirming that caloric restriction holds off the degenerative diseases of ageing in primates as well as rodents.
But as for lifespan, the diet extended life significantly only if the researchers excluded deaths that were apparently unrelated to ageing,such as under the anaesthesia necessary to take blood samples. When all deaths were counted,lifespan was not significantly extended.
Some researchers think it is perfectly valid to ignore such deaths. Others note that in mouse studies one just counts the numbers of dead mice without asking what they died of, and the same procedure should be followed with monkeys,since one cannot be sure if a death under anaesthesia might have been age related.
With the rapamycin and rhesus monkey results,David Sinclair said,"we have more weight on the side of people who think it's going to be possible". He emphasised the ability of both caloric restriction and sirtuin-activating drugs to postpone the many diseases of ageing, at least in mice. To have one drug that postponed many degenerative diseases in people would be a significant advance, he said, even without any increase in longevity.
People may live so long already that no drug could make much of a difference. Probably because of reductions in infant mortality and other types of disease, human life expectancy in developed countries has been on a remarkable,unbroken upward trend for the last 160 years.Female life expectancy at birth rose from 45 years in 1840 to 85 years in 2000.
An important difference among experts on ageing is whether there is an intrinsic rate of ageing. Supposing there were cures for all diseases,what would one die of, if one died at all? Vijg and Campisi believe there is a steady build-up of damage to DNA and to proteins such as collagen and elastin fibres that knit the body together.Damage to DNA means that the regulation of genes becomes less precise, and this regulatory drift disrupts the stem cells that repair each tissue. Even if all diseases could be treated, it is not clear that anything could overcome intrinsic ageing.
Miller, on the other hand, said he believes that no clear distinction can be made between disease and other frailties of ageing."Anything a doctor can charge for we call disease, but wrinkled skin, white hair or not feeling good in the morning, these we don't call disease," he said.
He said he thinks that the idea of intrinsic ageing is not well defined and that contrary to the theories of the evolutionary biologists, there may be simple ways to intervene in the ageing process.
In the view of evolutionary biologists, the lifespan of each species is adapted to the nature of its environment. Mice live at most a year in the wild because owls, cats and freezing to death are such frequent hazards. Mice with genes that allow longer life can rarely be favoured by natural selection. Rather, the mice that leave the most progeny are those that devote resources to breeding at as early an age as possible.
According to this theory, if mice had wings and could escape their usual predators, natural selection ought to favour longer life. And indeed the maximum lifespan of bats is three-and-ahalf times greater than flightless mammals of the same size, according to research by Gerald S.Wilkinson of the University of Maryland.
In this view, cells are so robust that they do not limit lifespan. Instead the problem, especially for longer-lived species, is to keep them under control lest they cause cancer. Cells have not blocked the evolution of extremely long lifespans,for example, that of the bristlecone pine, which lives 5,000 years, or certain deep sea corals, whose age has been found to exceed 4,000 years.
Some species seem to be imperishable. A tiny freshwater animal known as a hydra can regenerate itself from almost any part of its body,apparently because it makes no distinction between its germ cells and its ordinary body cells. In people the germ cells, the egg and sperm,do not age; babies are born equally young, whatever the age of their parents. The genesis of ageing was the division of labour in the first multicellular animals between the germ cells and the body cells.
That division put the role of maintaining the species on the germ cells and left the body cells free to become specialised, similarly in neurons or skin cells. But in doing so the body cells made themselves disposable. The reason we die, in the view of Thomas Kirkwood, an expert on the theory of ageing, is that constant effort is required to keep the body cells going."This, in the long run, is unwarranted - in terms of natural selection, there are more important things to do," he writes.
All that seems clear about lifespan is that it is not fixed. And if it is not fixed, there may indeed be ways to extend it.
Monday, August 31, 2009
HOUSE PASSES BUDGET BILL AMID JIBES
The House of Representatives yesterday morning passed the 2010 budget bill by 244 to 10 votes, ending 42 hours of deliberation.
Prime Minister Abhisit Vejjajiva promised after the vote that the government would ensure the money was well spent.
Initially debate on the 2010 budget bill was expected to end about 2am yesterday.
However, in the end it ended much later, about 10am yesterday.
Of the MPs in the House,244 voted to pass the bill. Ten others voted against the bill, and 69 MPs abstained.
The government will spend 1.7 trillion baht during the next fiscal year. The 2010 Budget Act comprises 34 articles.
Yesterday morning's deliberation focused on education and public health issues.
Some members of the opposition Puea Thai Party attacked the budget during the debate as inefficient, saying the money earmarked for boosting the economy would not be enough.
Public Health Minister Witthaya Kaewparadai said the money allocated to the Public Health Ministry under the 2010 budget was very small. It meant that over the next seven years, the ministry could not afford to renovate any hospital buildings or construct new buildings.
However, the "Thailand: Investing from Strength to Strength" programme,which is the government's economic stimulus programme, would offer money for construction work at all provincial hospitals and 60 district hospitals, said Mr Witthaya.
LET ME GO HOME: Prime Minister Abhisit Vejjajiva, captured in different moods during the lengthy and at times feisty budget bill debates in the House, which lasted from Friday until yesterday morning.
Prime Minister Abhisit Vejjajiva promised after the vote that the government would ensure the money was well spent.
Initially debate on the 2010 budget bill was expected to end about 2am yesterday.
However, in the end it ended much later, about 10am yesterday.
Of the MPs in the House,244 voted to pass the bill. Ten others voted against the bill, and 69 MPs abstained.
The government will spend 1.7 trillion baht during the next fiscal year. The 2010 Budget Act comprises 34 articles.
Yesterday morning's deliberation focused on education and public health issues.
Some members of the opposition Puea Thai Party attacked the budget during the debate as inefficient, saying the money earmarked for boosting the economy would not be enough.
Public Health Minister Witthaya Kaewparadai said the money allocated to the Public Health Ministry under the 2010 budget was very small. It meant that over the next seven years, the ministry could not afford to renovate any hospital buildings or construct new buildings.
However, the "Thailand: Investing from Strength to Strength" programme,which is the government's economic stimulus programme, would offer money for construction work at all provincial hospitals and 60 district hospitals, said Mr Witthaya.
LET ME GO HOME: Prime Minister Abhisit Vejjajiva, captured in different moods during the lengthy and at times feisty budget bill debates in the House, which lasted from Friday until yesterday morning.
Friday, August 28, 2009
A MILLION INFECTED BY SWINE-FLU VIRUS IN FOUR MONTHS, SAYS MINISTRY
More than a million Thais have been infected by the typeA (H1N1) virus in the past four months, the Public Health Ministry revealed yesterday
Public Health Minister Witthaya Kaewparadai said yesterday that some 60 million of the Thai population are now at risk of being infected by the new flu virus.
"Surveillance remains an important mechanism to fight the pandemic," he added.
Earlier, Disease Control Department spokesperson Dr Suppamit Chunsutiwat estimated that more than 6 million to 30 million people would be infected by the new flu virus and about 600 to 1,200 people would die from the pandemic as most people do not have immunity against the type A (H1N1) virus.
He added that the pandemic was likely to continue for two to three years and then become the annual flu.
Former Public Health Minister Dr Mongkol Na Songkla, who chairs the Thai Health Promotion Foundation's subcommittee to fight the typeA (H1N1) influenza, said the pandemic in Bangkok and nearby provinces was slowing down. However, the disease had spread to upcountry provinces, especially among farmers.
Witthaya urged farmers who develop flulike symptoms to stay at home and avoid close contact with poultry as the disease could be transmitted from human to animals.
"The Department of Livestock is closely monitoring the birdflu virus H5N1 and H1N1," he said. "So far, we have not seen any mutation of the new flu virus and drug resistant virus strain."
Meanwhile, Government Pharmaceutical Organisation (GPO) board chairperson Dr Wichai Chokwiwat said the GPO has decided to produce the live attenuated vaccine against the typeA (H1N1) virus after the World Health Organisation, laboratories in the Netherlands and Russia confirmed that the virus seed vaccine - imported from Russia - proved to be safe on animals and its genotype and gene expression did not change.
The GPO's scientists had last week injected the virus vaccine into the second lot of 1,500 of specific free pathogen eggs. The eggs were then incubated for two to three days during which time the virus multiplied. The eggs will he harvested once it contains millions of virus vaccine.
Wichai said the GPO will harvest the second lot of the virus vaccine from the eggs on August 31. If the eggs produce the virus vaccine with a higher yield than the first lot of eggs, GPO will have to delay the human trial for two weeks.
However, if the second lot of eggs produce vaccine virus with lower yield than the first lot of eggs, GPO could use the vaccine virus harvested from the first lot of eggs.
Even the first lot of eggs produced a low yield of the virus vaccine but the World Health Organisation's expert said the amount from the first lot would be enough to produce vaccine and could be tested on 12 volunteers by September 4. However, GPO will make its decision whether to delay or continue the human trial followed the deadline.
Public Health Minister Witthaya Kaewparadai said yesterday that some 60 million of the Thai population are now at risk of being infected by the new flu virus.
"Surveillance remains an important mechanism to fight the pandemic," he added.
Earlier, Disease Control Department spokesperson Dr Suppamit Chunsutiwat estimated that more than 6 million to 30 million people would be infected by the new flu virus and about 600 to 1,200 people would die from the pandemic as most people do not have immunity against the type A (H1N1) virus.
He added that the pandemic was likely to continue for two to three years and then become the annual flu.
Former Public Health Minister Dr Mongkol Na Songkla, who chairs the Thai Health Promotion Foundation's subcommittee to fight the typeA (H1N1) influenza, said the pandemic in Bangkok and nearby provinces was slowing down. However, the disease had spread to upcountry provinces, especially among farmers.
Witthaya urged farmers who develop flulike symptoms to stay at home and avoid close contact with poultry as the disease could be transmitted from human to animals.
"The Department of Livestock is closely monitoring the birdflu virus H5N1 and H1N1," he said. "So far, we have not seen any mutation of the new flu virus and drug resistant virus strain."
Meanwhile, Government Pharmaceutical Organisation (GPO) board chairperson Dr Wichai Chokwiwat said the GPO has decided to produce the live attenuated vaccine against the typeA (H1N1) virus after the World Health Organisation, laboratories in the Netherlands and Russia confirmed that the virus seed vaccine - imported from Russia - proved to be safe on animals and its genotype and gene expression did not change.
The GPO's scientists had last week injected the virus vaccine into the second lot of 1,500 of specific free pathogen eggs. The eggs were then incubated for two to three days during which time the virus multiplied. The eggs will he harvested once it contains millions of virus vaccine.
Wichai said the GPO will harvest the second lot of the virus vaccine from the eggs on August 31. If the eggs produce the virus vaccine with a higher yield than the first lot of eggs, GPO will have to delay the human trial for two weeks.
However, if the second lot of eggs produce vaccine virus with lower yield than the first lot of eggs, GPO could use the vaccine virus harvested from the first lot of eggs.
Even the first lot of eggs produced a low yield of the virus vaccine but the World Health Organisation's expert said the amount from the first lot would be enough to produce vaccine and could be tested on 12 volunteers by September 4. However, GPO will make its decision whether to delay or continue the human trial followed the deadline.
Thursday, August 27, 2009
Preventing blood clots
The risk of life-threatening blood clots related to air travel spurred a marketing boom for flight socks and airlines recommending passengers to do seat exercises, especially on long-haul journeys. Cramped seating, long periods of inactivity and dehydration are major factors contributing to so-called economy-class syndrome or deep vein thrombosis (DVT).
Besides frequent flyers, those on a long drive may also have increased risk of DVT, said Assoc Professor Thanainit Chotanaphuti, MD of Phramongkutklao College of Medicine."If you're on a coach for nine hours from Chiang Mai to Bangkok and develop pain and swelling in one leg then you may have DVT," he said.
In clinical practice, the orthopaedic surgeon has to deal with DVT as a complication of total knee and total hip replacement, especially among ageing Thais.Fifteen years ago, he was more busy fixing broken arms and legs of younger people from accidents whereas today Phramongkutklao Hospital's Orthopaedic Department is receiving more older patients for major operations.
Venous blood clots, also known as venous thromboembolism (VTE), include DVT and pulmonary embolism (PE).
DVT, a blood clot in a deep vein usually in the leg,can be caused by slowing or stopping blood flow.Blood in the leg veins travel to the heart and then to the lungs. A blood clot that breaks loose and blocks a vessel in the lung can lead to PE, damaging the lung and other vital organs and in some cases resulting in death.
How does surgery put patients at a higher blood clot risk? Blood vessel damage during an operation can trigger a blood clot formation as the body naturally responds to the injury byproducing blood clots to act as a plug to prevent bleeding. Afterwards, restricted mobility during hospitalisation doubles the trouble.Moreover, the risk of developing venous blood clots continues for at least two months after surgery, and most symptomatic cases develop after discharge from the hospital.
"Blood clot prevention for patients undergoing major orthopaedic surgery includes using anticoagulants. After the operation, instead of bed rest for two or three days, we advise patients to get moving and walk as soon as they can to reduce the risk," said Dr Thanainit."Not many people recognise that it can cause sudden death. Out of four cases, it is likely that two are due to heart disease, one from stroke, and the fourth from a venous blood clot."
Killing around 300,000 people in the US and 500,000 in Europe each year, venous blood clots are estimated to be the third most common cardiovascular disease after heart disease and stroke. What was once thought to be a rare phenomenon among Asian populations has become a worrying trend and studies have shown that Asians do get clots. According to the Assessment of the Incidence of DVT in Asia study conducted among 407 patients who had undergone major orthopaedic surgery,41 percent of Asian patients were at risk of the disease.
Despite the well-recognised risks, there remains a low rate of appropriate preventative treatment for blood clotting. The recent multinational ENDORSE study in 32 countries revealed that fewer than 60 percent of surgical patients at risk received standard venous blood clot prophylaxis.
Anticoagulants in current use for the prevention of blood clots have several disadvantages. Low molecular weight heparin injections make long-term and home use inconvenient and impractical for the patient. Vitamin K antagonists, while taken orally,may require frequent monitoring.
"The need for drugs that are convenient for both the patient and the physician has led to the development of Factor Xa inhibitors, which target specific points in the blood coagulation cascade, as a new treatment option," said Dr Frank Misselwitz, head of Bayer Schering Pharma's Cardiovascular Therapeutic Area in Wuppertal, Germany. Last September,the German pharmaceutical giant introduced a Factor Xa inhibitor taken as a once-daily tablet, to provide uncomplicated blood clot prevention.
The new drug has been extensively studied in the RECORD clinical program, the largest of its kind ever conducted on an oral anticoagulant in the prevention of venous blood clots after total knee or hip surgery. Comprising four trials, it involved more than 12,500 participants, of which 1,300 were from the Asia Pacific region.
"With its favourable benefit-risk profile, rivaroxaban could transform treatment approaches for the prevention of potentially life-threatening blood clots following hip or knee replacement surgery," said Dr Misselwitz.
Besides frequent flyers, those on a long drive may also have increased risk of DVT, said Assoc Professor Thanainit Chotanaphuti, MD of Phramongkutklao College of Medicine."If you're on a coach for nine hours from Chiang Mai to Bangkok and develop pain and swelling in one leg then you may have DVT," he said.
In clinical practice, the orthopaedic surgeon has to deal with DVT as a complication of total knee and total hip replacement, especially among ageing Thais.Fifteen years ago, he was more busy fixing broken arms and legs of younger people from accidents whereas today Phramongkutklao Hospital's Orthopaedic Department is receiving more older patients for major operations.
Venous blood clots, also known as venous thromboembolism (VTE), include DVT and pulmonary embolism (PE).
DVT, a blood clot in a deep vein usually in the leg,can be caused by slowing or stopping blood flow.Blood in the leg veins travel to the heart and then to the lungs. A blood clot that breaks loose and blocks a vessel in the lung can lead to PE, damaging the lung and other vital organs and in some cases resulting in death.
How does surgery put patients at a higher blood clot risk? Blood vessel damage during an operation can trigger a blood clot formation as the body naturally responds to the injury byproducing blood clots to act as a plug to prevent bleeding. Afterwards, restricted mobility during hospitalisation doubles the trouble.Moreover, the risk of developing venous blood clots continues for at least two months after surgery, and most symptomatic cases develop after discharge from the hospital.
"Blood clot prevention for patients undergoing major orthopaedic surgery includes using anticoagulants. After the operation, instead of bed rest for two or three days, we advise patients to get moving and walk as soon as they can to reduce the risk," said Dr Thanainit."Not many people recognise that it can cause sudden death. Out of four cases, it is likely that two are due to heart disease, one from stroke, and the fourth from a venous blood clot."
Killing around 300,000 people in the US and 500,000 in Europe each year, venous blood clots are estimated to be the third most common cardiovascular disease after heart disease and stroke. What was once thought to be a rare phenomenon among Asian populations has become a worrying trend and studies have shown that Asians do get clots. According to the Assessment of the Incidence of DVT in Asia study conducted among 407 patients who had undergone major orthopaedic surgery,41 percent of Asian patients were at risk of the disease.
Despite the well-recognised risks, there remains a low rate of appropriate preventative treatment for blood clotting. The recent multinational ENDORSE study in 32 countries revealed that fewer than 60 percent of surgical patients at risk received standard venous blood clot prophylaxis.
Anticoagulants in current use for the prevention of blood clots have several disadvantages. Low molecular weight heparin injections make long-term and home use inconvenient and impractical for the patient. Vitamin K antagonists, while taken orally,may require frequent monitoring.
"The need for drugs that are convenient for both the patient and the physician has led to the development of Factor Xa inhibitors, which target specific points in the blood coagulation cascade, as a new treatment option," said Dr Frank Misselwitz, head of Bayer Schering Pharma's Cardiovascular Therapeutic Area in Wuppertal, Germany. Last September,the German pharmaceutical giant introduced a Factor Xa inhibitor taken as a once-daily tablet, to provide uncomplicated blood clot prevention.
The new drug has been extensively studied in the RECORD clinical program, the largest of its kind ever conducted on an oral anticoagulant in the prevention of venous blood clots after total knee or hip surgery. Comprising four trials, it involved more than 12,500 participants, of which 1,300 were from the Asia Pacific region.
"With its favourable benefit-risk profile, rivaroxaban could transform treatment approaches for the prevention of potentially life-threatening blood clots following hip or knee replacement surgery," said Dr Misselwitz.
Medical bills give govt fever
The Democrat-led coalition has taken a courageous step in pursuing long-delayed plans to overhaul the medical benefits scheme for civil servants. The decision will certainly prove unpopular. It most likely will be met with strong opposition frommembers of the government's workforce, whose resistance to the initiative derailed the project two years ago.
The reason that has forced Deputy Prime Minister Korbsak Sabhasavu, who is in charge of national economic affairs, to pick up this potentially hot political potato for consideration again, is more than obvious.The government's financial health is in a precarious condition at present. The long-standing medical cost overrun has, therefore, again become a major and logical target for slashing, in the government's attempt to maintain the state's balance sheet. The past several governments have noted the alarming trend in the state's expenses with regard to the ballooning cost of civil servants' medical welfare. But none dared seriously tackle the problem out of fear that this would stir discontent among the 2.3-million-strong civil workforce - the main work horse which implements state policies.
It was not until 2007, when the Surayud Chulanont government assumed office, that the problem was raised for serious consideration. This occurred after the 37-billion-baht budget earmarked for civil servants was quickly used up within the first nine months of that fiscal year, forcing the military-installed government to turn to the Treasury's reserves to cover the shortfall.The Comptroller General's Department was then instructed to study guidelines to curb medical expenses incurred by state employees. A ceiling on medical expenses for certain diseases and lists of essential and non-essential medicines were then drawn up, along with tighter control over the reimbursement process for medical expenses for civil servants nationwide.However, that effort to overhaul the welfare collapsed even before the new systemwas put in force the following year. This happened after the Council of State ruled in favour of civil servants' complaints that the Comptroller General had no power to control doctors' dispensing of expensive medicine under the medical welfare system.
Deputy PM Korbsak has pointed out that uncontrolled expenses plus the unethical exploitation of the medical welfare scheme by some civil servants has caused the state's medical bills to jump from 30 billion baht to 80 billion baht in just four years. This almost equals the state's annual budget for the universal health scheme covering more than 40 million people nationwide.
In comparison, it is understandable that civil servants earn substantially less than employees at the same job level in private firms. Many people found state employment attractive only because it offered job security and generous welfare which extended to their families.However, civil servants must realise that the government is in no position to carry on footing these astronomical medical bills. Without proper control, the expenditure on civil servants' medical bills could climb beyond 200 billion baht a year within the next decade. This is outrageous and unacceptable.
Minister Korbsak has suggested that instead of relying on the national budget alone, civil servants should join the government in helping to contribute to a fund to cover their medical welfare. The idea is worth exploring if it will ease the state's financial burden. But first the government will need to get civil servants to accept that they must stop freeloading on the state budget for their medical expenses. Getting civil servants to acquiesce will be a difficult job indeed.
The reason that has forced Deputy Prime Minister Korbsak Sabhasavu, who is in charge of national economic affairs, to pick up this potentially hot political potato for consideration again, is more than obvious.The government's financial health is in a precarious condition at present. The long-standing medical cost overrun has, therefore, again become a major and logical target for slashing, in the government's attempt to maintain the state's balance sheet. The past several governments have noted the alarming trend in the state's expenses with regard to the ballooning cost of civil servants' medical welfare. But none dared seriously tackle the problem out of fear that this would stir discontent among the 2.3-million-strong civil workforce - the main work horse which implements state policies.
It was not until 2007, when the Surayud Chulanont government assumed office, that the problem was raised for serious consideration. This occurred after the 37-billion-baht budget earmarked for civil servants was quickly used up within the first nine months of that fiscal year, forcing the military-installed government to turn to the Treasury's reserves to cover the shortfall.The Comptroller General's Department was then instructed to study guidelines to curb medical expenses incurred by state employees. A ceiling on medical expenses for certain diseases and lists of essential and non-essential medicines were then drawn up, along with tighter control over the reimbursement process for medical expenses for civil servants nationwide.However, that effort to overhaul the welfare collapsed even before the new systemwas put in force the following year. This happened after the Council of State ruled in favour of civil servants' complaints that the Comptroller General had no power to control doctors' dispensing of expensive medicine under the medical welfare system.
Deputy PM Korbsak has pointed out that uncontrolled expenses plus the unethical exploitation of the medical welfare scheme by some civil servants has caused the state's medical bills to jump from 30 billion baht to 80 billion baht in just four years. This almost equals the state's annual budget for the universal health scheme covering more than 40 million people nationwide.
In comparison, it is understandable that civil servants earn substantially less than employees at the same job level in private firms. Many people found state employment attractive only because it offered job security and generous welfare which extended to their families.However, civil servants must realise that the government is in no position to carry on footing these astronomical medical bills. Without proper control, the expenditure on civil servants' medical bills could climb beyond 200 billion baht a year within the next decade. This is outrageous and unacceptable.
Minister Korbsak has suggested that instead of relying on the national budget alone, civil servants should join the government in helping to contribute to a fund to cover their medical welfare. The idea is worth exploring if it will ease the state's financial burden. But first the government will need to get civil servants to accept that they must stop freeloading on the state budget for their medical expenses. Getting civil servants to acquiesce will be a difficult job indeed.
"Bad, cruel" nurses come under fire
Britain's National Health Service (NHS) delivers sometimes "appalling" standards of basic care carried out by "bad, cruel nurses" who should be banned from the profession, a patients lobby group said yesterday.
A report by the Patients Association told of people left lying in their own excrement and urine, having to go without food or drink and having call bells taken away from them.
The group, a charity set up 40 years ago to represent views of patients,demanded an urgent review of basic care standards. The association's president, Claire Rayner, a former nurse and television personality, said she was sickened by the report.
"For far too long now, the Patients Association has been receiving calls from people wanting to talk about the dreadful,neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses," she said in a foreword to the report.
"I am sickened by what has happened to some parts of my profession of which I was so proud. These bad, cruel nurses may be - probably are - a tiny proportion of the nursing work force, but even if they are only 1% or 2% of the whole they should be identified and struck off the nursing register."
The Patients Association published a dossier of the experiences of 16 patients,whose stories were outlined by them and their relatives.
Adrian Goddard described how his mother Pamela, suffering from cancer,was "often found in her own faeces and urine" when family members arrived to visit her. Relatives would "need to prompt staff to come and wash and change her".
Janet Brooks said her father, Thomas,was left without incontinence pads.
"He was bleeding rectally and he ended up laying in urine and blood. He also wet the floor and my elderly mother wiped this up while the nurse and the assistant nurse looked on and did nothing to help," Ms Brooks said in the dossier.
Patients Association director Katherine Murphy said the accounts showed some patients were "denied basic dignity".
The Royal College of Nursing, which speaks for thousands of nurses, said poor care was "completely unacceptable" but added this should not overshadow what it said was the "vast majority of good quality care given to millions of patients every day".
A report by the Patients Association told of people left lying in their own excrement and urine, having to go without food or drink and having call bells taken away from them.
The group, a charity set up 40 years ago to represent views of patients,demanded an urgent review of basic care standards. The association's president, Claire Rayner, a former nurse and television personality, said she was sickened by the report.
"For far too long now, the Patients Association has been receiving calls from people wanting to talk about the dreadful,neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses," she said in a foreword to the report.
"I am sickened by what has happened to some parts of my profession of which I was so proud. These bad, cruel nurses may be - probably are - a tiny proportion of the nursing work force, but even if they are only 1% or 2% of the whole they should be identified and struck off the nursing register."
The Patients Association published a dossier of the experiences of 16 patients,whose stories were outlined by them and their relatives.
Adrian Goddard described how his mother Pamela, suffering from cancer,was "often found in her own faeces and urine" when family members arrived to visit her. Relatives would "need to prompt staff to come and wash and change her".
Janet Brooks said her father, Thomas,was left without incontinence pads.
"He was bleeding rectally and he ended up laying in urine and blood. He also wet the floor and my elderly mother wiped this up while the nurse and the assistant nurse looked on and did nothing to help," Ms Brooks said in the dossier.
Patients Association director Katherine Murphy said the accounts showed some patients were "denied basic dignity".
The Royal College of Nursing, which speaks for thousands of nurses, said poor care was "completely unacceptable" but added this should not overshadow what it said was the "vast majority of good quality care given to millions of patients every day".
SSO kidney cover denied
The Social Security Office is denying medical treatment to social security members suffering kidney diseases who share the same surname as their employer, activists say.
Subin Noksakul, president of the Thai Kidney Club, yesterday said it was unacceptable that the SSO would reject claims based on the relationship between employees and employers.
Social security members had been accused of collaborating with employers to defraud the SSO, he said.
"What the SSO should do is to examine the employees' status to find out if they get paid and pay taxes," he said.
Mr Subin also called on the SSO to speed up its decision on the right to medical treatment of SSF members who contracted kidney disease before they joined the social security scheme. The SSO was reluctant to extend medical coverage to people who developed kidney diseases before they became social security members.
He said it was not right to deny these people treatment because they had paid into the Social Security Fund.
"The SSO must not forget that people with kidney problems are capable of working," he said.
Thanaporn Methawikool, head of the SSO's medical standardisation unit, said yesterday it had been agreed that social security members' right to kidney treatment would have to be examined.
She said she would ask SSO officers to speed up their deliberation so those eligible could receive quick treatment for their illnesses.
Subin Noksakul, president of the Thai Kidney Club, yesterday said it was unacceptable that the SSO would reject claims based on the relationship between employees and employers.
Social security members had been accused of collaborating with employers to defraud the SSO, he said.
"What the SSO should do is to examine the employees' status to find out if they get paid and pay taxes," he said.
Mr Subin also called on the SSO to speed up its decision on the right to medical treatment of SSF members who contracted kidney disease before they joined the social security scheme. The SSO was reluctant to extend medical coverage to people who developed kidney diseases before they became social security members.
He said it was not right to deny these people treatment because they had paid into the Social Security Fund.
"The SSO must not forget that people with kidney problems are capable of working," he said.
Thanaporn Methawikool, head of the SSO's medical standardisation unit, said yesterday it had been agreed that social security members' right to kidney treatment would have to be examined.
She said she would ask SSO officers to speed up their deliberation so those eligible could receive quick treatment for their illnesses.
HIGHER OUTPUT SOUGHT BY KINGSGATE
Kingsgate Consolidated, Australian owner of Thailand's biggest gold mine, is seeking to double output at the operation from 2011 and forecast the price of bullion to rise as high as US$1,500 (Bt51,200) per ounce within two years.
The company expects government approvals next month to expand capacity of the plant at its Chatree Mine to 5 million tonnes of ore a year, Gavin Thomas CEO of the Sydney-based company, siad yesterday.
"We've obviously got a cashflow machine here. If we can keep the head-grade high, we make a lot of money," Thomas said.
"I see gold moving well over its price. I see it moving sideways in the short term and moving upwards $1.1200 to $1,500 in the next 12-24 months."
The company posted a net profit after tax fell 10 per cent to 32.5 million Australian dollars(Bt921 million) for the fiscal year ending June 30 on production of 76,028 ounces.
Output is forecast to increase to 120,000-140,000 ounces this year, Kingsgate said in a statement.
The company expects government approvals next month to expand capacity of the plant at its Chatree Mine to 5 million tonnes of ore a year, Gavin Thomas CEO of the Sydney-based company, siad yesterday.
"We've obviously got a cashflow machine here. If we can keep the head-grade high, we make a lot of money," Thomas said.
"I see gold moving well over its price. I see it moving sideways in the short term and moving upwards $1.1200 to $1,500 in the next 12-24 months."
The company posted a net profit after tax fell 10 per cent to 32.5 million Australian dollars(Bt921 million) for the fiscal year ending June 30 on production of 76,028 ounces.
Output is forecast to increase to 120,000-140,000 ounces this year, Kingsgate said in a statement.
VACCINES SHOULD BE AT FOREFRONT IN CHILD HEALTH
Paediatricians and health experts at an international conference have called for pneumococcal conjugate vaccine to be added to the country's routine immunisation program, as the World Health Organisation has reported pneumonia kills two million children under five annually - one death every 15 seconds. The three-day event, titled "Asian Vaccine Conference 2009", last ended Saturday with the signing of the "Siem Reap Declaration".
It called for policy-makers, academics, the pharmaceutical industry and others to put vaccination at the forefront of child protection - and to put under-utilised vaccines such as those of pneumococcal, haemophilus influenzae type-b (Hib), and rotavirus into a national immunisation program (NIP).
Dr Lulu C Bravo, chairwoman of the Asian Strategic Alliance for Pneumococcal Disease Prevention, said half the under-five deaths from pneumonia came from an infection with bacteria called streptococcus pneumoniae, leading to invasive pneumococcal diseases (IPDs) such as blood infection and meningitis. Most kids with severe IPDs become disabled and often die.
Citing the 2004 WHO death rate figures among under-five children, she said pneumonia was the number one killer at 19 per cent followed by diarrhoea at 17 per cent and IPDs at 10 per cent. Bravo said the first and second killers were vaccine-preventable.
"Every child needs to be protected and it's their right (to be vaccinated)," she said adding this would be in line with the Millennium Development Goals' two-thirds reduction in child mortality by 2015.
"Vaccines cannot be considered as 'costs' but 'investments' to create quality children for a country's future," Bravo said.
The pneumococcal conjugate vaccine was included in the US immunisation programme for under-five children in 2000. The infection ratio of 80 to every 100,000 toddlers declined to 4.6 in 2003, a 94-per-cent drop.
Out of 92 countries with the vaccine available for sale, 39 have included it in their NIPs. Hong Kong will be the first in the Asia-Pacific region to introduce the vaccine as part of its programme, from September 1.
Thailand currently has this vaccine as an alternative for parents to buy for infants at Bt3,000-Bt3,500 per shot. The four-shot schedule begins at two months, followed by more shots at four, six and 12-15 months.
Royal College of Paediatricians president Somsak Lolekha said the vaccine also benefited unvaccinated people, especially the pneumonia-prone group over 65. It also reduced the number of pneumococcal patients with penicillin resistance (by 98 per cent among under-two children and 79 per cent of over-65 persons).
Besides vaccination, parents can protect their children by teaching them good hygiene (especially frequent hand washing and covering nose and mouth when sneezing), by breast-feeding infants and by consulting doctors about immunity boosting.
New pneumococcal conjugate vaccines - PCV-10 and PVC-13 - are coming soon. PCV-10, which boosts immunity against haemophilus influenzae and could immunise 80 per cent of Thais, is being registered with the Thai Food and Drug Administration. PVC-13 could immunise 90-95 per cent of Thais and its registration with the US FDA is underway, he added.
If the government included vaccines in its immunisation programme, pharmaceutical companies would stampede to offer products and the price would drop, Somsak said. He suggested countries in the region come together for better bargaining to buy the vaccine in large lots at the lowest price.
Bangkok Metropolitan Administration (BMA) deputy governor Dr Malinee Sukvejchaworakij attended the conference. The BMA launched a pilot project supplying PCV-7 to some 100 children born on December 5 last year and reportedly has in the pipeline a similar project to provide the vaccine to "risky children" (such as those born underweight or with heart disease).
It called for policy-makers, academics, the pharmaceutical industry and others to put vaccination at the forefront of child protection - and to put under-utilised vaccines such as those of pneumococcal, haemophilus influenzae type-b (Hib), and rotavirus into a national immunisation program (NIP).
Dr Lulu C Bravo, chairwoman of the Asian Strategic Alliance for Pneumococcal Disease Prevention, said half the under-five deaths from pneumonia came from an infection with bacteria called streptococcus pneumoniae, leading to invasive pneumococcal diseases (IPDs) such as blood infection and meningitis. Most kids with severe IPDs become disabled and often die.
Citing the 2004 WHO death rate figures among under-five children, she said pneumonia was the number one killer at 19 per cent followed by diarrhoea at 17 per cent and IPDs at 10 per cent. Bravo said the first and second killers were vaccine-preventable.
"Every child needs to be protected and it's their right (to be vaccinated)," she said adding this would be in line with the Millennium Development Goals' two-thirds reduction in child mortality by 2015.
"Vaccines cannot be considered as 'costs' but 'investments' to create quality children for a country's future," Bravo said.
The pneumococcal conjugate vaccine was included in the US immunisation programme for under-five children in 2000. The infection ratio of 80 to every 100,000 toddlers declined to 4.6 in 2003, a 94-per-cent drop.
Out of 92 countries with the vaccine available for sale, 39 have included it in their NIPs. Hong Kong will be the first in the Asia-Pacific region to introduce the vaccine as part of its programme, from September 1.
Thailand currently has this vaccine as an alternative for parents to buy for infants at Bt3,000-Bt3,500 per shot. The four-shot schedule begins at two months, followed by more shots at four, six and 12-15 months.
Royal College of Paediatricians president Somsak Lolekha said the vaccine also benefited unvaccinated people, especially the pneumonia-prone group over 65. It also reduced the number of pneumococcal patients with penicillin resistance (by 98 per cent among under-two children and 79 per cent of over-65 persons).
Besides vaccination, parents can protect their children by teaching them good hygiene (especially frequent hand washing and covering nose and mouth when sneezing), by breast-feeding infants and by consulting doctors about immunity boosting.
New pneumococcal conjugate vaccines - PCV-10 and PVC-13 - are coming soon. PCV-10, which boosts immunity against haemophilus influenzae and could immunise 80 per cent of Thais, is being registered with the Thai Food and Drug Administration. PVC-13 could immunise 90-95 per cent of Thais and its registration with the US FDA is underway, he added.
If the government included vaccines in its immunisation programme, pharmaceutical companies would stampede to offer products and the price would drop, Somsak said. He suggested countries in the region come together for better bargaining to buy the vaccine in large lots at the lowest price.
Bangkok Metropolitan Administration (BMA) deputy governor Dr Malinee Sukvejchaworakij attended the conference. The BMA launched a pilot project supplying PCV-7 to some 100 children born on December 5 last year and reportedly has in the pipeline a similar project to provide the vaccine to "risky children" (such as those born underweight or with heart disease).
Wednesday, August 26, 2009
Stimulus, global rebound to revive medical trade
Medical care and equipment businesses are betting on global recovery and the government stimulus package to advance their industries' outlook.
Thirty percent of the government's Strong Thailand investment programme is devoted to medical care upgrading,said Paijit Warachit, deputy permanent secretary for Public Health Ministry.
The ministry over three years will receive 86 billion baht -30% for replacing equipment and the rest for constructing hospitals and provincial health-care centres as well as training health personnel.
"This allocation will improve the life of the public and indirectly improve the economic performance of related industries," said Dr Paijit.
The ministry will adjust its regulations to give private hospitals flexibility in supporting Thailand as a hub for medical tourism, he added.
The industry expects more exhibitors and visitors at the upcoming Fourth International Exhibition on Hospital, Diagnostic, Pharmaceutical, Medical and Rehabilitation Equipment and Supplies to be held at Queen Sirikit Convention Center from Sept 16-18.
"Compared with its third exhibition held two years ago, the number of local and international exhibitors signed to join the event has increased 5% to 250 participants. We hope the number of visitors will increase by 25% to about 5,000," said Gernot Ringling, managing director of Messe Dusseldorf Asia Pte Ltd, the event organiser.
Some industry insiders are barely affected by the global slump, he said. Only small operators have been hit - and they expect strong improvement in the near future from global recovery and the government's planned revamp of national health care.
The medical industry is still a sunshine industry and the increase in exhibitors signing up to the event shows demand is still high, he said.
The government projects medical tourism revenue nearly tripling from $1.3 billion in 2005 to $4.4 billion by 2012, said Mr Ringling.
The improving outlook is shored up by treatment and hospitality for foreign patients continuing to meet international standards.
The trading value of about $50 million generated by the 2007 exhibition is also expected to increase this year. But forecasting is difficult because the figure includes post-event sales, he said.
Thirty percent of the government's Strong Thailand investment programme is devoted to medical care upgrading,said Paijit Warachit, deputy permanent secretary for Public Health Ministry.
The ministry over three years will receive 86 billion baht -30% for replacing equipment and the rest for constructing hospitals and provincial health-care centres as well as training health personnel.
"This allocation will improve the life of the public and indirectly improve the economic performance of related industries," said Dr Paijit.
The ministry will adjust its regulations to give private hospitals flexibility in supporting Thailand as a hub for medical tourism, he added.
The industry expects more exhibitors and visitors at the upcoming Fourth International Exhibition on Hospital, Diagnostic, Pharmaceutical, Medical and Rehabilitation Equipment and Supplies to be held at Queen Sirikit Convention Center from Sept 16-18.
"Compared with its third exhibition held two years ago, the number of local and international exhibitors signed to join the event has increased 5% to 250 participants. We hope the number of visitors will increase by 25% to about 5,000," said Gernot Ringling, managing director of Messe Dusseldorf Asia Pte Ltd, the event organiser.
Some industry insiders are barely affected by the global slump, he said. Only small operators have been hit - and they expect strong improvement in the near future from global recovery and the government's planned revamp of national health care.
The medical industry is still a sunshine industry and the increase in exhibitors signing up to the event shows demand is still high, he said.
The government projects medical tourism revenue nearly tripling from $1.3 billion in 2005 to $4.4 billion by 2012, said Mr Ringling.
The improving outlook is shored up by treatment and hospitality for foreign patients continuing to meet international standards.
The trading value of about $50 million generated by the 2007 exhibition is also expected to increase this year. But forecasting is difficult because the figure includes post-event sales, he said.
Most transplant organs "from death row"
The majority of transplanted organs in China come from executed prisoners, state media reported yesterday in a rare disclosure about an industry often criticised for being opaque and unethical.
The country's Health Ministry and the Red Cross Society of China this week launched a national organ donation system to reduce reliance on death row inmates and encourage donations from the public, the China Daily newspaper reported.
Condemned prisoners are "definitely not a proper source for organ transplants", the report quoted Vice-Health Minister Huang Jiefu as saying. He has publicly acknowledged that most transplant organs are taken from executed prisoners, but only with prior consent.
Foreign medical and human rights groups have long criticised China's organ transplant trade as being opaque, profitdriven and unethical. Critics say death row prisoners may feel compelled to become donors.
Voluntary donations in China remain far below demand, partly because of cultural bias against organ removal before burial. About 1.5 million people in China need transplants, but only about 10,000 operations are performed annually,Chinese health officials say.
China has acknowledged that kidneys,livers, corneas and other organs are routinely removed from executed prisoners, but gave no details. Chinese transplant specialists estimate at least 90% of transplanted organs come from executed prisoners, human rights groups say.
The China Daily said more than 65%of organ donations come from death row, citing unnamed "experts".
China puts to death more people than any other country. Earlier this year,Amnesty International said China executed at least 1,718 people in 2008. The exact number is not known.
The new donor system, launched on Tuesday, will link possible donors with recipients and make public a waiting list of patients to increase transparency in allocating organs. The Red Cross will also encourage post-public donations.
The new system is China's latest step to regulate organ transplants. In 2007,officials agreed not to transplant organs from prisoners or others in custody, except into members of their families.
Also, regulations introduced in 2007 bar donations from living people who are not related to or emotionally connected to the transplant patient.
The Health Ministry said it could not provide more information on the new donor system as staffers were busy.
The country's Health Ministry and the Red Cross Society of China this week launched a national organ donation system to reduce reliance on death row inmates and encourage donations from the public, the China Daily newspaper reported.
Condemned prisoners are "definitely not a proper source for organ transplants", the report quoted Vice-Health Minister Huang Jiefu as saying. He has publicly acknowledged that most transplant organs are taken from executed prisoners, but only with prior consent.
Foreign medical and human rights groups have long criticised China's organ transplant trade as being opaque, profitdriven and unethical. Critics say death row prisoners may feel compelled to become donors.
Voluntary donations in China remain far below demand, partly because of cultural bias against organ removal before burial. About 1.5 million people in China need transplants, but only about 10,000 operations are performed annually,Chinese health officials say.
China has acknowledged that kidneys,livers, corneas and other organs are routinely removed from executed prisoners, but gave no details. Chinese transplant specialists estimate at least 90% of transplanted organs come from executed prisoners, human rights groups say.
The China Daily said more than 65%of organ donations come from death row, citing unnamed "experts".
China puts to death more people than any other country. Earlier this year,Amnesty International said China executed at least 1,718 people in 2008. The exact number is not known.
The new donor system, launched on Tuesday, will link possible donors with recipients and make public a waiting list of patients to increase transparency in allocating organs. The Red Cross will also encourage post-public donations.
The new system is China's latest step to regulate organ transplants. In 2007,officials agreed not to transplant organs from prisoners or others in custody, except into members of their families.
Also, regulations introduced in 2007 bar donations from living people who are not related to or emotionally connected to the transplant patient.
The Health Ministry said it could not provide more information on the new donor system as staffers were busy.
GPO cooks up first batch of flu vaccine
Researchers have produced the first local batch of vaccines for use against influenza type-A (H1N1).
The Government Pharmaceutical Organisation, which is making the vaccine, is now looking for a new academic partner to step up production ahead of the second wave of infections expected in December.
GPO managing director Witit Artavatkun yesterday said 1,270 vials, each containing 0.7ml of the vaccine, were labelled and stored in a temperaturecontrolled room awaiting sterilisation tests. The process would take two weeks.
Mahidol University's faculty of veterinary science is preparing for further tests on animals before moving on to a clinical trial, in line with a recommendation by the subcommittee overseeing health strategies against the flu pandemic, Dr Witit said.
Virologist Prasert Thongcharoen, the subcommittee chairman, raised concerns over the safety of fast-tracked vaccine research and said careful development was needed as Thailand had adopted the live-attenuated vaccine technology, as opposed to unactivated virus technology.
Live-attenuated vaccine technology allows a large amount of vaccine to be produced in a short period of time.
Dr Witit said the GPO had followed development steps recommended by the World Health Organisation.
The agency was considering using facilities at King Mongkut's University of Technology (KMUT) Thon Buri to boost production of the vaccine to accommodate the second wave of the influenza.
He said the agency hoped to use facilities at KMUT's Bang Khunthian campus as its second plant for making the vaccine.
Dr Witit admitted the maximum production capacity of the plant at Silpakorn University's faculty of pharmaceutical sciences in Nakhon Pathom province was just 540,000 doses per month.
The agency hopes to produce 10 million doses of the vaccine by December.
A five-year rental plan for using university laboratories to develop vaccines is being negotiated with KMUT. The GPO said it could invest 150 million baht into the project. Additional funds have been sought from the World Health Organisation, he said.
Meanwhile, the Public Health Ministry yesterday confirmed eight new deaths from H1N1, raising the country's death toll to 119.
Paichit Varachit, deputy permanent secretary for public health, said the deaths between Aug 16 and 22 were four women and four men. Half were aged from 31 to 40 years, which is categorised as a risk group.
The rise in the number of deaths in the past week was the smallest since weekly tallies were begun on July 15. It was nearly half the 14 deaths reported the week before.
Dr Paichit said the H1N1 outbreak in Bangkok and surrounding areas was diminishing, but it was spreading in northern provinces."The ministry has instructed every province to strictly follow two reduction measures: Reduce both the number of viral infections and the overall death toll as much as they can," he said. Dr Paichit said the government committee in charge of containing the H1N1 outbreak, chaired by Deputy Prime Minister Sanan Kachornprasart, met on Tuesday and agreed to continue anti-flu measures.
H1N1 WATCH Deaths: As of Aug 22,compared to Aug 15 111 119 Aug 15 Aug 22 Contact numbers: * Public Health Ministry hotline: 02-590-1994 (24 hours) or 1422 * Health Emergency Response Unit: 02-590-3333 * BMA disease control division: 02-245-8106 POST graphics
The Government Pharmaceutical Organisation, which is making the vaccine, is now looking for a new academic partner to step up production ahead of the second wave of infections expected in December.
GPO managing director Witit Artavatkun yesterday said 1,270 vials, each containing 0.7ml of the vaccine, were labelled and stored in a temperaturecontrolled room awaiting sterilisation tests. The process would take two weeks.
Mahidol University's faculty of veterinary science is preparing for further tests on animals before moving on to a clinical trial, in line with a recommendation by the subcommittee overseeing health strategies against the flu pandemic, Dr Witit said.
Virologist Prasert Thongcharoen, the subcommittee chairman, raised concerns over the safety of fast-tracked vaccine research and said careful development was needed as Thailand had adopted the live-attenuated vaccine technology, as opposed to unactivated virus technology.
Live-attenuated vaccine technology allows a large amount of vaccine to be produced in a short period of time.
Dr Witit said the GPO had followed development steps recommended by the World Health Organisation.
The agency was considering using facilities at King Mongkut's University of Technology (KMUT) Thon Buri to boost production of the vaccine to accommodate the second wave of the influenza.
He said the agency hoped to use facilities at KMUT's Bang Khunthian campus as its second plant for making the vaccine.
Dr Witit admitted the maximum production capacity of the plant at Silpakorn University's faculty of pharmaceutical sciences in Nakhon Pathom province was just 540,000 doses per month.
The agency hopes to produce 10 million doses of the vaccine by December.
A five-year rental plan for using university laboratories to develop vaccines is being negotiated with KMUT. The GPO said it could invest 150 million baht into the project. Additional funds have been sought from the World Health Organisation, he said.
Meanwhile, the Public Health Ministry yesterday confirmed eight new deaths from H1N1, raising the country's death toll to 119.
Paichit Varachit, deputy permanent secretary for public health, said the deaths between Aug 16 and 22 were four women and four men. Half were aged from 31 to 40 years, which is categorised as a risk group.
The rise in the number of deaths in the past week was the smallest since weekly tallies were begun on July 15. It was nearly half the 14 deaths reported the week before.
Dr Paichit said the H1N1 outbreak in Bangkok and surrounding areas was diminishing, but it was spreading in northern provinces."The ministry has instructed every province to strictly follow two reduction measures: Reduce both the number of viral infections and the overall death toll as much as they can," he said. Dr Paichit said the government committee in charge of containing the H1N1 outbreak, chaired by Deputy Prime Minister Sanan Kachornprasart, met on Tuesday and agreed to continue anti-flu measures.
H1N1 WATCH Deaths: As of Aug 22,compared to Aug 15 111 119 Aug 15 Aug 22 Contact numbers: * Public Health Ministry hotline: 02-590-1994 (24 hours) or 1422 * Health Emergency Response Unit: 02-590-3333 * BMA disease control division: 02-245-8106 POST graphics
Walking tall with Vojta
Breakthrough treatment arrives in Thailand to give hope to disabled kids
Sirindhorn National Medical Rehabilitation Centre (SNMRC) yesterday teamed up with the University of Heidelberg's Orthopaedic Hospital to give children born with limb deficiency a better chance of walking and growing up to lead active lives.
Over the past 15 years, Thailand has recorded 114,381 cases of children with disabilities, many of them with multiple physical impairments.
200 medics to be trained
SNMRC's director, Dr Daranee Suvapan, said that under the collaboration about 200 healthcare practitioners will be sent on a threeday seminar given by German experts to learn a new multidisciplinary approach to treatment for mobilityimpaired children.
The new treatment is dubbed the Vojta Therapy after its originator Dr Vaclav Vojta, a Czech neurologist concerned with problems of motor rehabilitation.
Initially used to treat children with cerebral palsy, Vojta Therapy is well regarded across Europe and Japan. Rather than training the body directly, Vojta Therapy stimulates the brain to create coordinated movements that aid functions such as balance, gait, grasping and speech.
Daranee said the therapy would provide an alternative treatment for complex problems that are better tackled with a multidisciplinary approach. Cases of stroke, spinal cord injury, cerebral palsy and amputation would also benefit from the longterm followup care offered by Vojta Therapy, she added.
Thailand currently has 300 medics specialising in physical rehabilitation, but many of them lack the skills to diagnose disease, evaluate function, set goals and monitor a child's development.
"We need to develop our medical worker's skills to a level where they can diagnose disease and provide appropriate care to patients," said Daranee.
Sirindhorn National Medical Rehabilitation Centre (SNMRC) yesterday teamed up with the University of Heidelberg's Orthopaedic Hospital to give children born with limb deficiency a better chance of walking and growing up to lead active lives.
Over the past 15 years, Thailand has recorded 114,381 cases of children with disabilities, many of them with multiple physical impairments.
200 medics to be trained
SNMRC's director, Dr Daranee Suvapan, said that under the collaboration about 200 healthcare practitioners will be sent on a threeday seminar given by German experts to learn a new multidisciplinary approach to treatment for mobilityimpaired children.
The new treatment is dubbed the Vojta Therapy after its originator Dr Vaclav Vojta, a Czech neurologist concerned with problems of motor rehabilitation.
Initially used to treat children with cerebral palsy, Vojta Therapy is well regarded across Europe and Japan. Rather than training the body directly, Vojta Therapy stimulates the brain to create coordinated movements that aid functions such as balance, gait, grasping and speech.
Daranee said the therapy would provide an alternative treatment for complex problems that are better tackled with a multidisciplinary approach. Cases of stroke, spinal cord injury, cerebral palsy and amputation would also benefit from the longterm followup care offered by Vojta Therapy, she added.
Thailand currently has 300 medics specialising in physical rehabilitation, but many of them lack the skills to diagnose disease, evaluate function, set goals and monitor a child's development.
"We need to develop our medical worker's skills to a level where they can diagnose disease and provide appropriate care to patients," said Daranee.
TESTS START ON VACCINE FOR 2009 INFLUENZA
The first 1,270 doses of a clinical nasalspray vaccine against the typeA(H1N1) flu is now being tested on animals to study sterilisation and toxicity, Government Pharmaceutical Organisation (GPO) director Dr Vitthit Attavejchakul said yesterday.
The trial would be carried out by Mahidol University's Faculty of Veterinary Science and the results released in about two weeks, he said.
Meanwhile, the second lot of 1,500 specific pathogenfree eggs was inoculated with a virus seed vaccine on Tuesday. They are expected to provide a new yield of flu vaccine by tomorrow.
The GPO had planned to test the first lot of clinical vaccine against new flu virus in 24 human volunteers by September 4.
But because the German eggs produce a low yield of the new flu vaccine, the GPO has decided to test the vaccine on only half (12) of the volunteers.
The rest of the volunteers will have to wait till the second lot of clinical vaccine is ready at the end of September.
GPO plans to produce 20 million doses of the vaccine initially, and Silpakorn University's Faculty of Pharmacy is contracted to produce 10 million doses of the new flu vaccine.
However, the plant at Silpakorn University can only produce 540,000 doses of the vaccine a month, so the GPO is negotiating with King Mongkut University of Technology's Thon Buri campus to supply further amounts of vaccine.
GPO will allocate Bt150 million for a new vaccine plant and will spend four months installing machines and devices for vaccine production.
If construction of the plant at King Mongkut University of Technology's Thon Buri campus is finished, GPO will use this plant to produce live attenuated vaccine while the plant at Silpakorn will shift to produce inactive vaccine.
A leading scientist at Chulalongkorn University, Dr Thirawat Hemajutha, has suggested the GPO should renovate its animal vaccine plant, run by the Department of Livestock, at Pak Chong district in Nakhon Ratchasima, for use as a plant to temporarily produce human vaccine promptly.
Vitthit said he had already asked the Department of Livestock but was told this was not possible, as the department plans to produce three animal vaccines and could not stop that work.
Vitthit said the virus seed vaccine imported from Russia had not changed significantly or mutated into virulent form.
"We did not see any significant changes in the virus' genes, particularly in the position to control its virulence," he said.
"Every process that we have done to produce vaccine is cerฌtified by the World Health Organisation."
The Public Health Ministry confirmed yesterday that eight more people had died from the new strain of typeA (H1N1) flu last week, bringing the total number of fatality to 119.
Deputy permanent secretary for Health Dr Paijit Warachit said the new fatalities were four men and four women. Half were people aged between 31 to 40 years of age and categorised as a risk group for the new flu.
Paijit said the ministry remained on its guard against the H1N1 flu pandemic. It was urging provincial authorities to monitor people who have flulike illness as the disease has already spread among farmers and workers.
The ministry has distributed about 6.7 million tablets of the antiviral drug oseltamivir to hospitals upcountry to treat patients with flulike illnesses. It had also "reserved" about six million tablets at the GPO and Department of Disease Control. So far, about 1.8 million pills had been given out in a bid to save patients' lives.
The trial would be carried out by Mahidol University's Faculty of Veterinary Science and the results released in about two weeks, he said.
Meanwhile, the second lot of 1,500 specific pathogenfree eggs was inoculated with a virus seed vaccine on Tuesday. They are expected to provide a new yield of flu vaccine by tomorrow.
The GPO had planned to test the first lot of clinical vaccine against new flu virus in 24 human volunteers by September 4.
But because the German eggs produce a low yield of the new flu vaccine, the GPO has decided to test the vaccine on only half (12) of the volunteers.
The rest of the volunteers will have to wait till the second lot of clinical vaccine is ready at the end of September.
GPO plans to produce 20 million doses of the vaccine initially, and Silpakorn University's Faculty of Pharmacy is contracted to produce 10 million doses of the new flu vaccine.
However, the plant at Silpakorn University can only produce 540,000 doses of the vaccine a month, so the GPO is negotiating with King Mongkut University of Technology's Thon Buri campus to supply further amounts of vaccine.
GPO will allocate Bt150 million for a new vaccine plant and will spend four months installing machines and devices for vaccine production.
If construction of the plant at King Mongkut University of Technology's Thon Buri campus is finished, GPO will use this plant to produce live attenuated vaccine while the plant at Silpakorn will shift to produce inactive vaccine.
A leading scientist at Chulalongkorn University, Dr Thirawat Hemajutha, has suggested the GPO should renovate its animal vaccine plant, run by the Department of Livestock, at Pak Chong district in Nakhon Ratchasima, for use as a plant to temporarily produce human vaccine promptly.
Vitthit said he had already asked the Department of Livestock but was told this was not possible, as the department plans to produce three animal vaccines and could not stop that work.
Vitthit said the virus seed vaccine imported from Russia had not changed significantly or mutated into virulent form.
"We did not see any significant changes in the virus' genes, particularly in the position to control its virulence," he said.
"Every process that we have done to produce vaccine is cerฌtified by the World Health Organisation."
The Public Health Ministry confirmed yesterday that eight more people had died from the new strain of typeA (H1N1) flu last week, bringing the total number of fatality to 119.
Deputy permanent secretary for Health Dr Paijit Warachit said the new fatalities were four men and four women. Half were people aged between 31 to 40 years of age and categorised as a risk group for the new flu.
Paijit said the ministry remained on its guard against the H1N1 flu pandemic. It was urging provincial authorities to monitor people who have flulike illness as the disease has already spread among farmers and workers.
The ministry has distributed about 6.7 million tablets of the antiviral drug oseltamivir to hospitals upcountry to treat patients with flulike illnesses. It had also "reserved" about six million tablets at the GPO and Department of Disease Control. So far, about 1.8 million pills had been given out in a bid to save patients' lives.
Tuesday, August 25, 2009
H1N1 could cause 90,000 US deaths
Swine flu could infect as much as half of the US population this year and cause up to 90,000 deaths,President Barack Obama's science advisers warned on Monday.
Laying out a "plausible scenario" for the epidemic's impact in the United States, the report painted a grim picture of stress on the US health-care system as it struggles to cope with a flood of flu patients.
The epidemic's resurgence could "produce infection of 30-50% of the US population this fall and winter, with symptoms in approximately 20-40% of the population [60-120 million people],more than half of whom would seek medical attention", the report said.
As many as 1.8 million people could be admitted to hospitals with up to 300,000 of them requiring treatment in intensive care units (ICU).
"Importantly, these very ill patients could occupy 50-100% of all ICU beds in affected regions of the country at the peak of the epidemic and could place huge stress on ICU units, which normally operate close to capacity," it said.
The epidemic, it said,"could cause between 30,000 and 90,000 deaths in the United States, concentrated among children and young adults", it said.
That compares with 30,000 to 40,000 deaths from seasonal flu each year,mainly among people over age 65.
The report said the epidemic poses "especially high risks" for people with pre-existing conditions such as pregnant women and patients with neurological disorders, respiratory impairment,diabetes or severe obesity.
It also mentioned Native Americans as being at risk from the swine flu.
The flu's resurgence could occur as early as September when the school term begins, and peak in mid-October.
But a vaccine against the A(H1N1)virus is only projected to be available in mid-October, and it will take vaccinated individuals several more weeks to develop protective immunity, the report said.
"This potential mismatch in timing could significantly diminish the usefulness of vaccination for mitigating the epidemic and could place many at risk of serious infection," it said.
The report by the President's Council of Advisors on Science and Technology said that while the virus is "unlikely to resemble the deadly flu pandemic of 1918-19", the current strain still "poses a serious health threat".
According to the latest official US figures, the 2009 swine flu strain has already killed 522 people in the US and hospitalised almost 8,000 people since it emerged in Mexico at the end of April.
The group recommended accelerating preparation of flu vaccines for distribution to high-risk individuals and clarifying guidelines for the use of anti-viral medicines. Advisers also called on the public to stay informed on A(H1N1)'s expected spread as the northern hemisphere's regular flu returns with the colder months.
These efforts involve using social networking sites on the Internet to propagate health messages and an "intensive public education" campaign to promote awareness to the threat.
The White House also needs to create a post that has "primary authority to coordinate key decisions" for fighting the pandemic, the report said.
Among other recommendations are for workplaces to "liberalise rules for absenteeism" so employees are not pressured to come to work when they feel sick.
Laying out a "plausible scenario" for the epidemic's impact in the United States, the report painted a grim picture of stress on the US health-care system as it struggles to cope with a flood of flu patients.
The epidemic's resurgence could "produce infection of 30-50% of the US population this fall and winter, with symptoms in approximately 20-40% of the population [60-120 million people],more than half of whom would seek medical attention", the report said.
As many as 1.8 million people could be admitted to hospitals with up to 300,000 of them requiring treatment in intensive care units (ICU).
"Importantly, these very ill patients could occupy 50-100% of all ICU beds in affected regions of the country at the peak of the epidemic and could place huge stress on ICU units, which normally operate close to capacity," it said.
The epidemic, it said,"could cause between 30,000 and 90,000 deaths in the United States, concentrated among children and young adults", it said.
That compares with 30,000 to 40,000 deaths from seasonal flu each year,mainly among people over age 65.
The report said the epidemic poses "especially high risks" for people with pre-existing conditions such as pregnant women and patients with neurological disorders, respiratory impairment,diabetes or severe obesity.
It also mentioned Native Americans as being at risk from the swine flu.
The flu's resurgence could occur as early as September when the school term begins, and peak in mid-October.
But a vaccine against the A(H1N1)virus is only projected to be available in mid-October, and it will take vaccinated individuals several more weeks to develop protective immunity, the report said.
"This potential mismatch in timing could significantly diminish the usefulness of vaccination for mitigating the epidemic and could place many at risk of serious infection," it said.
The report by the President's Council of Advisors on Science and Technology said that while the virus is "unlikely to resemble the deadly flu pandemic of 1918-19", the current strain still "poses a serious health threat".
According to the latest official US figures, the 2009 swine flu strain has already killed 522 people in the US and hospitalised almost 8,000 people since it emerged in Mexico at the end of April.
The group recommended accelerating preparation of flu vaccines for distribution to high-risk individuals and clarifying guidelines for the use of anti-viral medicines. Advisers also called on the public to stay informed on A(H1N1)'s expected spread as the northern hemisphere's regular flu returns with the colder months.
These efforts involve using social networking sites on the Internet to propagate health messages and an "intensive public education" campaign to promote awareness to the threat.
The White House also needs to create a post that has "primary authority to coordinate key decisions" for fighting the pandemic, the report said.
Among other recommendations are for workplaces to "liberalise rules for absenteeism" so employees are not pressured to come to work when they feel sick.
Organiser upbeat over 4th Medical Fair Thailand
Messe Dusseldorf Asia expects the 4th Medical Fair Thailand, a biennial event, will generate more business than the US$50 million (Bt1.7 billion) in the previous edition, due mainly to rising global demand for health care despite the world economic crisis.
"I can't estimate the exact figure of trading value during the fair this year, but I hope the number will be higher than last time," said Gernot Ringling, managing director of Messe Dusseldorf Asia.
Messe Dusseldorf Asia is a regional branch of Messe Dusselorf, one of the world's leading trade fair organisers.
"I've talked with many people in the medical industry in Southeast Asia, including in medical hubs like Thailand, and know that there is demand to develop and upgrade the facilities and medical technology of hospitals. This is because the medical sector is still a sunshine industry, which has had less of an impact from the global crisis," he said.
The 4th Medical Fair Thailand, an international exhibition covering hospitals, diagnostics, pharmaceuticals, medical and rehabilitation equipment and supplies, will be held on September 16-18 at the Queen Sirikit National Convention Centre.
Ringling said Messe Dusseldorf was confident about organising the fair in Thailand because it believes in the country's potential as a regional medical hub. "Thailand's medical industry has grown very fast in the last 10 years not only in the region, but also in the world market.
Thailand in 2004 generated revenue of $2 billion from foreign patients. I expect the value to increase to $4.4 billion by 2012," he said.
He added that it was very interesting that Singapore - Thailand's competitor in becoming the main medical regional hub - had started to promote itself as a world medical destination before the Kingdom, but that Thailand had gained more recognition as a hub and attracted more foreign patients.
Singapore can attract patients from neighbouring countries such as Indonesia, while Thailand is the medical destination for Middle Eastern countries.
Messe Dusseldorf Asia has a regional office in Singapore and also organises medical fairs in the country.
"I believe that the advantages of Thailand's medical industry are pricing, which is more reasonable, and good service in medical treatment," said Ringling.
Some 250 exhibitors will be participating in the 4th Medical Fair Thailand, slightly higher than in 2007. However, the number of visitors is expected to be 5,000 per day, a sharp rise from 4,000 daily two years ago.
Among the many highlights of the latest medical technology on show will be a wireless wheelchair controller using Bluetooth, as well as advanced respiratory equipment.
"I can't estimate the exact figure of trading value during the fair this year, but I hope the number will be higher than last time," said Gernot Ringling, managing director of Messe Dusseldorf Asia.
Messe Dusseldorf Asia is a regional branch of Messe Dusselorf, one of the world's leading trade fair organisers.
"I've talked with many people in the medical industry in Southeast Asia, including in medical hubs like Thailand, and know that there is demand to develop and upgrade the facilities and medical technology of hospitals. This is because the medical sector is still a sunshine industry, which has had less of an impact from the global crisis," he said.
The 4th Medical Fair Thailand, an international exhibition covering hospitals, diagnostics, pharmaceuticals, medical and rehabilitation equipment and supplies, will be held on September 16-18 at the Queen Sirikit National Convention Centre.
Ringling said Messe Dusseldorf was confident about organising the fair in Thailand because it believes in the country's potential as a regional medical hub. "Thailand's medical industry has grown very fast in the last 10 years not only in the region, but also in the world market.
Thailand in 2004 generated revenue of $2 billion from foreign patients. I expect the value to increase to $4.4 billion by 2012," he said.
He added that it was very interesting that Singapore - Thailand's competitor in becoming the main medical regional hub - had started to promote itself as a world medical destination before the Kingdom, but that Thailand had gained more recognition as a hub and attracted more foreign patients.
Singapore can attract patients from neighbouring countries such as Indonesia, while Thailand is the medical destination for Middle Eastern countries.
Messe Dusseldorf Asia has a regional office in Singapore and also organises medical fairs in the country.
"I believe that the advantages of Thailand's medical industry are pricing, which is more reasonable, and good service in medical treatment," said Ringling.
Some 250 exhibitors will be participating in the 4th Medical Fair Thailand, slightly higher than in 2007. However, the number of visitors is expected to be 5,000 per day, a sharp rise from 4,000 daily two years ago.
Among the many highlights of the latest medical technology on show will be a wireless wheelchair controller using Bluetooth, as well as advanced respiratory equipment.
P&G's drug business sale fits strategy
The Procter & Gamble Co's $3.1 billion sale of its prescription drug business is in line with its recent strategy of shedding products to focus on areas with the best growth and profitmargin prospects.
The deal announced on Monday with Warner Chilcott PLC will take away $2.3 billion in annual revenues, including the billion-dollar brand Actonel, an osteoporosis treatment. Last year, P&G sold another billion-dollar brand, Folgers coffee, to J.M. Smucker Co for some $3 billion.
"We know that our shareholders don't reward us ... for absolute size; they reward us for growth," Bob McDonald, who became P&G's CEO on July 1, told analysts in a conference call.
"And we are going to do what we have to do to get the right portfolio of businesses together."
P&G, the world's largest consumer products maker, reported on Aug 5 that its fourth-quarter profit fell 18% and sales 11%. Its revenue for the fiscal year that ended June 30 was $79 billion.
McDonald said Monday's deal would allow P&G to concentrate more resources on consumer health care, including overthe-counter medicines such as Vicks and Prilosec OTC, feminine care products such as Always, and oral care led by the Crest toothpaste brand.
He said P&G had plenty of room to increase sales in the consumer health care market, which has grown 5 to 6%per year and has good margins and solid potential.
P&G, also targeting beauty and grooming, has recently acquired the upscale men's skin care line Zirh and men's grooming business The Art of Shaving.
Analysts think P&G eventually could sell such major brands as Braun appliances, Duracell batteries and Pringles snacks.
Among satisfied buyers of P&G businesses has been Smucker, which earlier bought Jif peanut butter and Crisco shortening from P&G.
The Orrville, Ohio-based company reported last Friday its fiscal first-quarter profit more than doubled and beat expectations, mainly because of increased sales from Folgers.
The deal announced on Monday with Warner Chilcott PLC will take away $2.3 billion in annual revenues, including the billion-dollar brand Actonel, an osteoporosis treatment. Last year, P&G sold another billion-dollar brand, Folgers coffee, to J.M. Smucker Co for some $3 billion.
"We know that our shareholders don't reward us ... for absolute size; they reward us for growth," Bob McDonald, who became P&G's CEO on July 1, told analysts in a conference call.
"And we are going to do what we have to do to get the right portfolio of businesses together."
P&G, the world's largest consumer products maker, reported on Aug 5 that its fourth-quarter profit fell 18% and sales 11%. Its revenue for the fiscal year that ended June 30 was $79 billion.
McDonald said Monday's deal would allow P&G to concentrate more resources on consumer health care, including overthe-counter medicines such as Vicks and Prilosec OTC, feminine care products such as Always, and oral care led by the Crest toothpaste brand.
He said P&G had plenty of room to increase sales in the consumer health care market, which has grown 5 to 6%per year and has good margins and solid potential.
P&G, also targeting beauty and grooming, has recently acquired the upscale men's skin care line Zirh and men's grooming business The Art of Shaving.
Analysts think P&G eventually could sell such major brands as Braun appliances, Duracell batteries and Pringles snacks.
Among satisfied buyers of P&G businesses has been Smucker, which earlier bought Jif peanut butter and Crisco shortening from P&G.
The Orrville, Ohio-based company reported last Friday its fiscal first-quarter profit more than doubled and beat expectations, mainly because of increased sales from Folgers.
Province leads the way in mapping out the future
Suphan Burihas won an award for its effective implementation of GIS, writes Sasiwimon Boonruang
Many public organisations have adopted the geographical information system (GIS)as a tool for city planning and administration, with Suphan Buri being particularly successful.
This is due to its complete database system and network integration through every agency, according to Somsak Pureesrisak, the governor of Suphan Buri, Thailand's most successful province in terms of utilising GIS and MIS (management information system).
The principle is that the data must be updated by the data owners, said Somsak, adding that GIS has been implemented in every agency in the province.
Somsak suggested public agencies adopt the data carried out by the Public Health Ministry because village health volunteers have to collect both household and personal data. With a population of some 800,000, Suphan Buri has 174 health stations, where some 15,000 village health volunteers work.
"The village health volunteers' primary job is to visit the people, and they are close to the public. The data research carried out by these staff is extremely relevant because they really work in the field," he said.
Prior to 2005, Suphan Buri used the Health Centre Information System (HCIS) as the population database survey. Ten hospitals in the province have used five different hospital systems: Hos XP, Hospital OS, Khon Kaen , Mit Net and Stat Dispence. The big problem is the database systems cannot interoperate between hospitals and the health centres.
The system then changed to E-Care in 2006, with the focus on developing the database system of the health centres and covering information on patients and medicine. The GIS database of people and households has now been added to E-Care and the system has been used in the provincial health centres and district health centres.
"In the rural area, all data can be collected and the treatment and village visiting schedule can be checked over the web service," Somsak said, noting that the administrator can also view medicines are available, in what quantities, at each health centre.
However, another problem is that each health centre uses a different code for the same medicines. The computer programs of hospitals and health centres also are not integrated, which presents problems in data sharing between them.E-Care, which was used until 2008, has now been replaced by E-Health.
The governor, who has a background in engineering, has ordered the government agencies to consolidate all databases to solve the problem of data integration. The Hos XP has been chosen,allowing data integration among the agencies to become workable, whereby the health centres are the primary care units.
Besides checking the data via the web service, E-Health also allows the government to verify personal records through the data centre. Provincial health centres take care of he data of public health service reports, while the provincial hospitals collect medical records of patients.
Over the next year, the province plans to implement a patient fingerprint system. This will be useful for many bureaux such as the police as it can double up as a source to aid criminal investigations.
The governor pointed out that Thai people hold several multi-purpose cards:ID card, driving license, tax card, ATM card, social security card, and so on.
"Wouldn't it be smarter to have one person with one record, rather than one person with too many records," he suggested, noting that in the future,the data integration of those organisations - Provincial Administration department, Revenue department, Transport department, Social Security Office,Public Health Ministry, and so on will enable officials to work more efficiently, through the approach of "one person, one record".
The governor pointed out that the Land department has the data of landowners and deeds, and the province has further developed the data by applying GIS. The system enables officials to view details of houses, the data of family members and their occupations,because the residents in that home some case may be not the land owners.
MIS has been working with GIS through the matching-up of databases and pictures of household locations and the members of the families. Here, they apply GIS to link with the farmer database.
"We can connect further between the data of locations and the MIS and make use of them in many aspects,"said the governor.
However, he admitted that the GIS here is not yet perfect. There is the farming land data of the entire province and all the farming land locations, but it is not yet thoroughly understood what kinds of crops are grown at each.
Making use of the technology in Suphan Buri can answer many problems that the government today is dealing with. One example is to keep records of foreign workers; who they are and where they live. The global positioning system (GPS), aerial photographs,3D technology, and photos of the land location have been used to help verify alien workers, both legal and illegal.
The Labour Ministry needs measures to manage alien labour, by registering them and their family members. Somsak pointed out that Suphan Buri has some 8,000 registered alien workers. Including their family members, this means a total of around 20,000 foreigners legally living in the province. The health centres have records of these people and their data is stored on web application, which the immigration office has access to. Police can check alien records via mobile phone or computer, and the system can report to them via SMS, MMS or web service.
Suphan Buri is now working with Samut Sakhon province to implement the alien labourers' examination system with smart cards and fingerprint technology. The system is expected to be in place by next year."We are now studying if both technologies can be combined,"said Somsak.
To prove the persons' right to the land, Suphan Buri has applied aerial photography and then set the GPS. The system can therefore match house locations with owners, and how many households are in each location.
The province has already covered more than 500,000 plots of land.
This will help Suphan Buri to prove whether or not government policies such as rice pricing insurance and crop insurance are working.
Suphan Buri is now working with the Natural Resources and Environment Ministry to add to the database of public land of different types, such as national parks, mangrove forests and wildlife sanctuaries.
So far, the province's GIS system and aerial photographs have served the ministry in coping with the problem of water shade areas, forest areas and national reservation areas.
These will be used to prove the right of land occupation and examine incidences of public land invasion.
The governor pointed out the government's policy of land and property tax and community title deeds can be performed with less effort and greater accuracy once the public agencies have a good database to refer to and have use of GIS and MIS.
Suphan Buri province was recently honoured with the Special Achievement Award in GIS (SAG)2009, at the ESRI International User Conference, as it has made extraordinary contributions to the global society and set new precedents throughout the GIS community.
Several organisations have implemented GIS, but not as effectively as Suphan Buri, where the system has been integrated into day-to-day operations.
The GIS utilisation here leads to benefits for the public and the overall local administration, said ESRI (Thailand)general manager Krairop Luanguthai.
Many public organisations have adopted the geographical information system (GIS)as a tool for city planning and administration, with Suphan Buri being particularly successful.
This is due to its complete database system and network integration through every agency, according to Somsak Pureesrisak, the governor of Suphan Buri, Thailand's most successful province in terms of utilising GIS and MIS (management information system).
The principle is that the data must be updated by the data owners, said Somsak, adding that GIS has been implemented in every agency in the province.
Somsak suggested public agencies adopt the data carried out by the Public Health Ministry because village health volunteers have to collect both household and personal data. With a population of some 800,000, Suphan Buri has 174 health stations, where some 15,000 village health volunteers work.
"The village health volunteers' primary job is to visit the people, and they are close to the public. The data research carried out by these staff is extremely relevant because they really work in the field," he said.
Prior to 2005, Suphan Buri used the Health Centre Information System (HCIS) as the population database survey. Ten hospitals in the province have used five different hospital systems: Hos XP, Hospital OS, Khon Kaen , Mit Net and Stat Dispence. The big problem is the database systems cannot interoperate between hospitals and the health centres.
The system then changed to E-Care in 2006, with the focus on developing the database system of the health centres and covering information on patients and medicine. The GIS database of people and households has now been added to E-Care and the system has been used in the provincial health centres and district health centres.
"In the rural area, all data can be collected and the treatment and village visiting schedule can be checked over the web service," Somsak said, noting that the administrator can also view medicines are available, in what quantities, at each health centre.
However, another problem is that each health centre uses a different code for the same medicines. The computer programs of hospitals and health centres also are not integrated, which presents problems in data sharing between them.E-Care, which was used until 2008, has now been replaced by E-Health.
The governor, who has a background in engineering, has ordered the government agencies to consolidate all databases to solve the problem of data integration. The Hos XP has been chosen,allowing data integration among the agencies to become workable, whereby the health centres are the primary care units.
Besides checking the data via the web service, E-Health also allows the government to verify personal records through the data centre. Provincial health centres take care of he data of public health service reports, while the provincial hospitals collect medical records of patients.
Over the next year, the province plans to implement a patient fingerprint system. This will be useful for many bureaux such as the police as it can double up as a source to aid criminal investigations.
The governor pointed out that Thai people hold several multi-purpose cards:ID card, driving license, tax card, ATM card, social security card, and so on.
"Wouldn't it be smarter to have one person with one record, rather than one person with too many records," he suggested, noting that in the future,the data integration of those organisations - Provincial Administration department, Revenue department, Transport department, Social Security Office,Public Health Ministry, and so on will enable officials to work more efficiently, through the approach of "one person, one record".
The governor pointed out that the Land department has the data of landowners and deeds, and the province has further developed the data by applying GIS. The system enables officials to view details of houses, the data of family members and their occupations,because the residents in that home some case may be not the land owners.
MIS has been working with GIS through the matching-up of databases and pictures of household locations and the members of the families. Here, they apply GIS to link with the farmer database.
"We can connect further between the data of locations and the MIS and make use of them in many aspects,"said the governor.
However, he admitted that the GIS here is not yet perfect. There is the farming land data of the entire province and all the farming land locations, but it is not yet thoroughly understood what kinds of crops are grown at each.
Making use of the technology in Suphan Buri can answer many problems that the government today is dealing with. One example is to keep records of foreign workers; who they are and where they live. The global positioning system (GPS), aerial photographs,3D technology, and photos of the land location have been used to help verify alien workers, both legal and illegal.
The Labour Ministry needs measures to manage alien labour, by registering them and their family members. Somsak pointed out that Suphan Buri has some 8,000 registered alien workers. Including their family members, this means a total of around 20,000 foreigners legally living in the province. The health centres have records of these people and their data is stored on web application, which the immigration office has access to. Police can check alien records via mobile phone or computer, and the system can report to them via SMS, MMS or web service.
Suphan Buri is now working with Samut Sakhon province to implement the alien labourers' examination system with smart cards and fingerprint technology. The system is expected to be in place by next year."We are now studying if both technologies can be combined,"said Somsak.
To prove the persons' right to the land, Suphan Buri has applied aerial photography and then set the GPS. The system can therefore match house locations with owners, and how many households are in each location.
The province has already covered more than 500,000 plots of land.
This will help Suphan Buri to prove whether or not government policies such as rice pricing insurance and crop insurance are working.
Suphan Buri is now working with the Natural Resources and Environment Ministry to add to the database of public land of different types, such as national parks, mangrove forests and wildlife sanctuaries.
So far, the province's GIS system and aerial photographs have served the ministry in coping with the problem of water shade areas, forest areas and national reservation areas.
These will be used to prove the right of land occupation and examine incidences of public land invasion.
The governor pointed out the government's policy of land and property tax and community title deeds can be performed with less effort and greater accuracy once the public agencies have a good database to refer to and have use of GIS and MIS.
Suphan Buri province was recently honoured with the Special Achievement Award in GIS (SAG)2009, at the ESRI International User Conference, as it has made extraordinary contributions to the global society and set new precedents throughout the GIS community.
Several organisations have implemented GIS, but not as effectively as Suphan Buri, where the system has been integrated into day-to-day operations.
The GIS utilisation here leads to benefits for the public and the overall local administration, said ESRI (Thailand)general manager Krairop Luanguthai.
Woman held for illegal dentistry
Police have arrested a teenage woman for illegal dentistry which is thought to have caused the death of a 17-year old student in Khon Kaen.
Police said Porntip Wannasri,19, was arrested following a raid on a townhouse on Kasikorn Thung Sang Road in Khon Kaen's Muang district.
She was questioned about the death of Jutamas Chaisong,17, a Matayom 5 (Grade 11) student who is thought to have died from a thyroid infection and heart complications on Sunday, police said.
Police say they found dental tools and dental braces at the townhouse.
It is alleged that on Aug 10 Ms Porntip fitted Ms Jutamas with cosmetic dental braces at the townhouse which doubled as a dental clinic.
Ms Jutamas developed a serious toothache a few days later. The condition deteriorated leading her to seek medical attention at Khon Kaen Hospital on the evening of Aug 20, when a doctor told her she had a heart problem and an infected thyroid gland.
She was prescribed a month's medication.
Around midnight the same day, Ms Jutamas's symptoms worsened and she suffered a sore throat and breathing difficulties. She was admitted to intensive care and died on the night of Aug 23.
Police said Ms Porntip had admitted she had provided scores of teenagers with cosmetic dental treatment without a licence and moved from place to place to avoid being caught.
She said Ms Jutamas was the first customer to have died.
The cause of Ms Jutamas's death has yet to be established by autopsy.
Public Health Ministry spokesman Suphan Srithamma yesterday warned that fake dentists face up to three years in prison and a maximum fine of 30,000 baht.
The Health Service Support Department and provincial health offices have been ordered to remain on guard for bogus dental clinics.
Cosmetic dental braces were a fad which carried a severe health risk due to possible heavy metal contamination from phoney braces, Sutha Jienmaneechotchai, director of the Department of Health's Dental Health Division, said.
Police said Porntip Wannasri,19, was arrested following a raid on a townhouse on Kasikorn Thung Sang Road in Khon Kaen's Muang district.
She was questioned about the death of Jutamas Chaisong,17, a Matayom 5 (Grade 11) student who is thought to have died from a thyroid infection and heart complications on Sunday, police said.
Police say they found dental tools and dental braces at the townhouse.
It is alleged that on Aug 10 Ms Porntip fitted Ms Jutamas with cosmetic dental braces at the townhouse which doubled as a dental clinic.
Ms Jutamas developed a serious toothache a few days later. The condition deteriorated leading her to seek medical attention at Khon Kaen Hospital on the evening of Aug 20, when a doctor told her she had a heart problem and an infected thyroid gland.
She was prescribed a month's medication.
Around midnight the same day, Ms Jutamas's symptoms worsened and she suffered a sore throat and breathing difficulties. She was admitted to intensive care and died on the night of Aug 23.
Police said Ms Porntip had admitted she had provided scores of teenagers with cosmetic dental treatment without a licence and moved from place to place to avoid being caught.
She said Ms Jutamas was the first customer to have died.
The cause of Ms Jutamas's death has yet to be established by autopsy.
Public Health Ministry spokesman Suphan Srithamma yesterday warned that fake dentists face up to three years in prison and a maximum fine of 30,000 baht.
The Health Service Support Department and provincial health offices have been ordered to remain on guard for bogus dental clinics.
Cosmetic dental braces were a fad which carried a severe health risk due to possible heavy metal contamination from phoney braces, Sutha Jienmaneechotchai, director of the Department of Health's Dental Health Division, said.
VACCINE TESTED TO GET READY FOR NEW PANDEMIC
The Government Pharmaceutical Organisation (GPO) has its first samples of typeA (H1N1) influenza nasal spray vaccine and has begun tests with animals to study its safety and toxicity, GPO director Dr Vitthit Attavejchakul said yesterday.
" We have made the decision to step forward and produce the new vaccine. Nothing has changed the of vaccine's production procedure," he insisted.
The move comes after GPO scientists succeeded in culturing the virus in specific pathogen free eggs imported from Germany.
The German eggs have produced low yields of the vaccine but,Vitthit said,World Health Organisation experts had suggested GPO continue testing the vaccine in animals for 10 days to check safety and toxicity before trying it out on volunteers.
The GPO has already inoculated the virus seed vaccine into 1,500 specific pathogen free eggs and the results will be released soon. "I hope we'll have good news on this Friday," he said.
Because the German eggs had produced a low yield of the new flu vaccine, GPO decided to turn to other countries and placed orders for the same type of eggs from the Charles River company, a US supplier in Massachusetts.
But the first batch of these US eggs was damaged during transportation, resulting in a further delay to the vaccine testing process in Thailand. The next shipment of US eggs will arrive here on September 15, Vitthit said.
The eggs will be cultured for seven days, then another seven days are needed to test the vaccines in animals before being given to humans.
Based on the GPO's schedule, the first 20 million vaccine doses should be available in December when a second wave of the flu pandemic is likely in Thailand.
To date, only Silpakorn University's Faculty of Pharmacy is contracted to produce 10 million doses of the newflu vaccine, so the GPO is negotiating with other parties to supply the remaining volume.
Dr Thirawat Hemajutha of Chulalongkorn University cited a report from Mahidol University's Faculty of Science which has decoded the virus gene and found that the virus seed vaccine GPO imported from Russia has changed slightly and might have mutated.
" I was surprised when I read this report. The virus might be stronger than its current strain," he said. "If GPO still uses this virus seed to produce vaccine it might cause errors," he added.
He said he did not intend to panic the public over his warning but he wanted people to be aware of a likely second pandemic wave.
He said pregnant women should be the first group to receive the new flu virus vaccine as their risk of mortality is fourtimes higher than of other people. Medical workers will be the second group, followed by those people who are in the high risk categories.
To meet a second pandemic, he suggested pregnant women stay at home, while educational agencies should tell students to send addresses and contact numbers to their institutions in case they fall ill.
Meanwhile, the Office of the Higher Education Commission's secretarygeneral Sumeth Yamnun has urged schools upcountry to prepare measures to fight the pandemic expected in two or three months.
" We have made the decision to step forward and produce the new vaccine. Nothing has changed the of vaccine's production procedure," he insisted.
The move comes after GPO scientists succeeded in culturing the virus in specific pathogen free eggs imported from Germany.
The German eggs have produced low yields of the vaccine but,Vitthit said,World Health Organisation experts had suggested GPO continue testing the vaccine in animals for 10 days to check safety and toxicity before trying it out on volunteers.
The GPO has already inoculated the virus seed vaccine into 1,500 specific pathogen free eggs and the results will be released soon. "I hope we'll have good news on this Friday," he said.
Because the German eggs had produced a low yield of the new flu vaccine, GPO decided to turn to other countries and placed orders for the same type of eggs from the Charles River company, a US supplier in Massachusetts.
But the first batch of these US eggs was damaged during transportation, resulting in a further delay to the vaccine testing process in Thailand. The next shipment of US eggs will arrive here on September 15, Vitthit said.
The eggs will be cultured for seven days, then another seven days are needed to test the vaccines in animals before being given to humans.
Based on the GPO's schedule, the first 20 million vaccine doses should be available in December when a second wave of the flu pandemic is likely in Thailand.
To date, only Silpakorn University's Faculty of Pharmacy is contracted to produce 10 million doses of the newflu vaccine, so the GPO is negotiating with other parties to supply the remaining volume.
Dr Thirawat Hemajutha of Chulalongkorn University cited a report from Mahidol University's Faculty of Science which has decoded the virus gene and found that the virus seed vaccine GPO imported from Russia has changed slightly and might have mutated.
" I was surprised when I read this report. The virus might be stronger than its current strain," he said. "If GPO still uses this virus seed to produce vaccine it might cause errors," he added.
He said he did not intend to panic the public over his warning but he wanted people to be aware of a likely second pandemic wave.
He said pregnant women should be the first group to receive the new flu virus vaccine as their risk of mortality is fourtimes higher than of other people. Medical workers will be the second group, followed by those people who are in the high risk categories.
To meet a second pandemic, he suggested pregnant women stay at home, while educational agencies should tell students to send addresses and contact numbers to their institutions in case they fall ill.
Meanwhile, the Office of the Higher Education Commission's secretarygeneral Sumeth Yamnun has urged schools upcountry to prepare measures to fight the pandemic expected in two or three months.
Monday, August 24, 2009
Considering longer chemotherapy
The newest prognosis for cancer may be longer chemotherapy.Doctors and pharmaceutical companies are moving towards treating cancer patients with drugs continuously, even when they may not urgently need them. That would be a departure from the common practice of stopping treatment when the cancer is under control and resuming it only if the cancer worsens.
The strategy is called maintenance therapy - akin to periodic tune-ups aimed at preventing a car from breaking down. Doctors say it could prolong the time that tumours are under control,helping to turn cancer into a chronic disease that is kept in check even if it is not cured.
While maintenance therapy is not entirely new, its use is growing, in part because some of the newer cancer drugs are more tolerable than the toxic ones of old and can be taken for longer periods.
At the recent annual meeting of the American Society of Clinical Oncology,for instance, doctors filled a huge auditorium for a debate on whether it is time to adopt maintenance therapy for lung cancer, the nation's leading cause of cancer death. Other cancers for which maintenance therapy is being used or tried include ovarian cancer, multiple myeloma and non-Hodgkin's lymphoma.
But some experts say that in many cases, the longer-term use of drugs has not been proved to prolong life.
Instead, it may just subject cancer patients to more side effects and tens of thousands of dollars in extra costs. There is also concern that tumours might become resistant to a drug used for a long time.
"Generally more is better, in both dose and potentially duration," said Dr Susan L. Kelley, chief medical officer of the Multiple Myeloma Research Foundation, which sponsors research on treatments for that disease. However, she said,"there are numerous kinds of cost to the patient, to the health system, to give these drugs over the longer term."
Dr Lawrence H. Einhorn, a professor at Indiana University, said much of the push for maintenance therapy was coming from pharmaceutical companies,which want their drugs "to be used as early as possible and as long as possible".
And executives of these companies acknowledge that the therapy would mean bigger sales."This is clearly a game-changing opportunity," Brian P.Gill, vice-president for corporate communications at Celgene, which is testing its drug Revlimid for maintenance treatment of multiple myeloma, told investors at a conference in March.
But the executives, and many doctors,say there is a good rationale for maintenance therapy.
Although treatment varies with the type of cancer, many patients now receive several initial cycles of chemotherapy.Then, if the cancer goes into remission,or even if the tumour simply stops growing, the therapy is stopped. It is resumed,usually with different drugs, only when the cancer starts worsening again.
That strategy evolved in part because the older chemotherapy drugs were so toxic that patients often needed to take a holiday from treatment.
"But if you think about it practically,you don't really want to give the tumour a holiday," said Colin Goddard, the chief executive of OSI Pharmaceuticals, which is trying to position its lung cancer drug Tarceva for use in maintenance therapy.
Some cancer patients welcome, or even demand, maintenance therapy,wanting to keep up the fight against their disease.
"I was one of those people who was frightened to stop chemo," said Barbara Platzer,71, of St Louis, who has ovarian cancer.
So when her initial six cycles of chemotherapy ended with her cancer in remission, she enrolled in a clinical trial that provided her with 12 monthly maintenance treatments of an experimental drug called Xyotax. The results of the trial are not yet known, but Platzer's cancer has remained in remission.
But Caryl Castleberry of Glen Ellen,California, who also has ovarian cancer,turned down maintenance therapy.
"I could hardly wait to be free from treatment, so the extra year they suggested was just not acceptable," said Castleberry,61, whose cancer has nonetheless remained in remission for six years.
Dr Robert L. Coleman, an expert on ovarian cancer at the M.D. Anderson Cancer Centre in Houston, said that because relapses tend to be fatal, there has been an urgent effort to prevent or delay them. But over the years, eight maintenance therapies failed in clinical trials.
Finally, a study published in 2003 showed that 12 monthly maintenance treatments of paclitaxel, a generic drug whose brand name is Taxol, delayed tumour progression by about seven months as compared with three monthly treatments with the same drug. But the difference in survival was not statistically significant, Dr Coleman said, so there is still some debate about the merits of maintenance therapy for ovarian cancer.
For lung cancer, the move to maintenance therapy is being spurred by the results of a clinical trial of the drug Alimta that were presented at the oncology meeting in Orlando, Florida, in late May.Based on that trial, both the Food and Drug Administration and European regulators approved the use of Alimta for maintenance therapy earlier this month.
The trial, sponsored by Eli Lilly, which makes Alimta, involved 663 patients with advanced cancer whose tumours had shrunk or remained stable after the customary four cycles of initial chemotherapy. In typical practice, those patients would not be treated again unless their tumours resumed growing.
But in the trial, some patients got Alimta immediately after completing the initial, or first-line, chemotherapy. They lived a median of 13.4 months, significantly longer than the 10.6 months for those who got a placebo. And patients with the type of tumour for which Alimta works best lived a median of 15.5 months with maintenance therapy.
"This will change the treatment paradigm," said Dr Chandra P. Belani, deputy director of the Penn State Hershey Cancer Institute and the lead investigator in the trial.
But sceptics said the trial did not directly compare giving Alimta immediately with waiting until the tumour worsened. So it is not clear whether it was just the drug that provided the benefit, rather than the maintenance therapy.Two-thirds of the patients in the placebo group did get second-line therapy when their tumours worsened, but usually not with Alimta.
Alimta, also known as pemetrexed,costs about $4,000(136,000 baht) per infusion given once every three weeks.Based on data from Lilly's trials, patients getting the drug as maintenance therapy would receive an average of three more infusions than those getting the drug as second-line therapy.
Also, about 30 to 50 percent of lung cancer patients never get second-line chemotherapy, often because their condition worsens too much. So if Alimta were used as maintenance therapy, many more patients would get it.
For non-Hodgkin's lymphoma, the drug used for maintenance is usually Rituxan, or rituximab, which is sold by Genentech and Biogen Idec.
A clinical trial showed that maintenance therapy with Rituxan did not help patients with an aggressive form of the disease. But a separate study, published recently in The Journal of Clinical Oncology , showed that it helped those with less aggressive forms of the disease.
After three years, cancer had not worsened for 68 percent of those who received the maintenance therapy. That was true for only 33 percent of those who did not receive the therapy. The survival difference was smaller, with 92 percent of those who got the maintenance therapy alive after three years compared with 86 percent of those who did not.
"We need more follow-up to see if it will improve overall survival," said Dr Thomas M. Habermann of the Mayo Clinic, an author of the study. Nevertheless, many doctors are giving patients maintenance treatment, usually four weekly infusions of Rituxan every six months for two years. That would cost about $30,000(1 million baht) a year.
For multiple myeloma, the drug being tried most often for maintenance therapy - Revlimid, or lenalidomide - is already being used for patients with relapses. It costs more than $6,000(204,000 baht) a month and is taken as a once-a-day pill,making it particularly convenient for long-term use.
Right now it is used for an average of 10 months in the United States; with maintenance therapy that could grow to years, since remissions for multiple myeloma can last that long.
Trials are under way, but some doctors are not waiting."We really need some randomised data to support it, but in the meantime it seems like a good idea,"said Dr Brian G.M. Durie, chairman of the International Myeloma Foundation,an advocacy and research group that gets some financing from pharmaceutical companies.
Kevin, a graduate student with multiple myeloma, says he hoped a stem cell transplant would mark the end of his treatment. So he was taken aback when his doctor suggested taking Revlimid for two years as maintenance therapy as part of a clinical trial. He has been taking it a year so far, with some mild side effects like fatigue.
"I'm not enthusiastic about being on a drug like this indefinitely," he said."But on the other hand, it's a lot better than relapse."
The strategy is called maintenance therapy - akin to periodic tune-ups aimed at preventing a car from breaking down. Doctors say it could prolong the time that tumours are under control,helping to turn cancer into a chronic disease that is kept in check even if it is not cured.
While maintenance therapy is not entirely new, its use is growing, in part because some of the newer cancer drugs are more tolerable than the toxic ones of old and can be taken for longer periods.
At the recent annual meeting of the American Society of Clinical Oncology,for instance, doctors filled a huge auditorium for a debate on whether it is time to adopt maintenance therapy for lung cancer, the nation's leading cause of cancer death. Other cancers for which maintenance therapy is being used or tried include ovarian cancer, multiple myeloma and non-Hodgkin's lymphoma.
But some experts say that in many cases, the longer-term use of drugs has not been proved to prolong life.
Instead, it may just subject cancer patients to more side effects and tens of thousands of dollars in extra costs. There is also concern that tumours might become resistant to a drug used for a long time.
"Generally more is better, in both dose and potentially duration," said Dr Susan L. Kelley, chief medical officer of the Multiple Myeloma Research Foundation, which sponsors research on treatments for that disease. However, she said,"there are numerous kinds of cost to the patient, to the health system, to give these drugs over the longer term."
Dr Lawrence H. Einhorn, a professor at Indiana University, said much of the push for maintenance therapy was coming from pharmaceutical companies,which want their drugs "to be used as early as possible and as long as possible".
And executives of these companies acknowledge that the therapy would mean bigger sales."This is clearly a game-changing opportunity," Brian P.Gill, vice-president for corporate communications at Celgene, which is testing its drug Revlimid for maintenance treatment of multiple myeloma, told investors at a conference in March.
But the executives, and many doctors,say there is a good rationale for maintenance therapy.
Although treatment varies with the type of cancer, many patients now receive several initial cycles of chemotherapy.Then, if the cancer goes into remission,or even if the tumour simply stops growing, the therapy is stopped. It is resumed,usually with different drugs, only when the cancer starts worsening again.
That strategy evolved in part because the older chemotherapy drugs were so toxic that patients often needed to take a holiday from treatment.
"But if you think about it practically,you don't really want to give the tumour a holiday," said Colin Goddard, the chief executive of OSI Pharmaceuticals, which is trying to position its lung cancer drug Tarceva for use in maintenance therapy.
Some cancer patients welcome, or even demand, maintenance therapy,wanting to keep up the fight against their disease.
"I was one of those people who was frightened to stop chemo," said Barbara Platzer,71, of St Louis, who has ovarian cancer.
So when her initial six cycles of chemotherapy ended with her cancer in remission, she enrolled in a clinical trial that provided her with 12 monthly maintenance treatments of an experimental drug called Xyotax. The results of the trial are not yet known, but Platzer's cancer has remained in remission.
But Caryl Castleberry of Glen Ellen,California, who also has ovarian cancer,turned down maintenance therapy.
"I could hardly wait to be free from treatment, so the extra year they suggested was just not acceptable," said Castleberry,61, whose cancer has nonetheless remained in remission for six years.
Dr Robert L. Coleman, an expert on ovarian cancer at the M.D. Anderson Cancer Centre in Houston, said that because relapses tend to be fatal, there has been an urgent effort to prevent or delay them. But over the years, eight maintenance therapies failed in clinical trials.
Finally, a study published in 2003 showed that 12 monthly maintenance treatments of paclitaxel, a generic drug whose brand name is Taxol, delayed tumour progression by about seven months as compared with three monthly treatments with the same drug. But the difference in survival was not statistically significant, Dr Coleman said, so there is still some debate about the merits of maintenance therapy for ovarian cancer.
For lung cancer, the move to maintenance therapy is being spurred by the results of a clinical trial of the drug Alimta that were presented at the oncology meeting in Orlando, Florida, in late May.Based on that trial, both the Food and Drug Administration and European regulators approved the use of Alimta for maintenance therapy earlier this month.
The trial, sponsored by Eli Lilly, which makes Alimta, involved 663 patients with advanced cancer whose tumours had shrunk or remained stable after the customary four cycles of initial chemotherapy. In typical practice, those patients would not be treated again unless their tumours resumed growing.
But in the trial, some patients got Alimta immediately after completing the initial, or first-line, chemotherapy. They lived a median of 13.4 months, significantly longer than the 10.6 months for those who got a placebo. And patients with the type of tumour for which Alimta works best lived a median of 15.5 months with maintenance therapy.
"This will change the treatment paradigm," said Dr Chandra P. Belani, deputy director of the Penn State Hershey Cancer Institute and the lead investigator in the trial.
But sceptics said the trial did not directly compare giving Alimta immediately with waiting until the tumour worsened. So it is not clear whether it was just the drug that provided the benefit, rather than the maintenance therapy.Two-thirds of the patients in the placebo group did get second-line therapy when their tumours worsened, but usually not with Alimta.
Alimta, also known as pemetrexed,costs about $4,000(136,000 baht) per infusion given once every three weeks.Based on data from Lilly's trials, patients getting the drug as maintenance therapy would receive an average of three more infusions than those getting the drug as second-line therapy.
Also, about 30 to 50 percent of lung cancer patients never get second-line chemotherapy, often because their condition worsens too much. So if Alimta were used as maintenance therapy, many more patients would get it.
For non-Hodgkin's lymphoma, the drug used for maintenance is usually Rituxan, or rituximab, which is sold by Genentech and Biogen Idec.
A clinical trial showed that maintenance therapy with Rituxan did not help patients with an aggressive form of the disease. But a separate study, published recently in The Journal of Clinical Oncology , showed that it helped those with less aggressive forms of the disease.
After three years, cancer had not worsened for 68 percent of those who received the maintenance therapy. That was true for only 33 percent of those who did not receive the therapy. The survival difference was smaller, with 92 percent of those who got the maintenance therapy alive after three years compared with 86 percent of those who did not.
"We need more follow-up to see if it will improve overall survival," said Dr Thomas M. Habermann of the Mayo Clinic, an author of the study. Nevertheless, many doctors are giving patients maintenance treatment, usually four weekly infusions of Rituxan every six months for two years. That would cost about $30,000(1 million baht) a year.
For multiple myeloma, the drug being tried most often for maintenance therapy - Revlimid, or lenalidomide - is already being used for patients with relapses. It costs more than $6,000(204,000 baht) a month and is taken as a once-a-day pill,making it particularly convenient for long-term use.
Right now it is used for an average of 10 months in the United States; with maintenance therapy that could grow to years, since remissions for multiple myeloma can last that long.
Trials are under way, but some doctors are not waiting."We really need some randomised data to support it, but in the meantime it seems like a good idea,"said Dr Brian G.M. Durie, chairman of the International Myeloma Foundation,an advocacy and research group that gets some financing from pharmaceutical companies.
Kevin, a graduate student with multiple myeloma, says he hoped a stem cell transplant would mark the end of his treatment. So he was taken aback when his doctor suggested taking Revlimid for two years as maintenance therapy as part of a clinical trial. He has been taking it a year so far, with some mild side effects like fatigue.
"I'm not enthusiastic about being on a drug like this indefinitely," he said."But on the other hand, it's a lot better than relapse."
Warner Chilcott reported in $3bn deal for P&G unit
Drugmaker Warner Chilcott PLC could announce a $3 billion takeover of Procter & Gamble Co's prescription drug business as early as yesterday, the Wall Street Journal has reported, citing unidentified people familiar with the deal.
Asked to comment on the report on Sunday, P&G spokesman Tom Millikin told the Associated Press that the consumer products company did not respond to rumour or speculation. A mess-age left at Warner Chilcott's offices was not immediately returned.
Cincinnati-based P&G, known for brands like Tide detergent, Gillette razors and Pampers diapers, said late last year it was interested in exiting the prescription drug business. That segment's products include women's osteoporosis treatment Actonel, which generates more than $1 billion in annual revenue.
Private-equity firm Cerberus Capital Management and drug maker Forest Laboratories were also purportedly interested in the P&G division, according to the paper.
If completed, the deal would more than double Ireland-based Warner Chilcott's annual revenue and expand its share of the women's health market.The company, which makes birth control,female hormone therapies and dermatology products, has forecast annual sales of just over $1 billion for this fiscal year.
P&G has said it sees better potential with over-the-counter products such as Vicks cough medicines and other personal care brands, like Always and Tampax feminine care. Last year the company sold off its Folgers coffee business to J.M. Smucker Inc, and added beauty and grooming businesses to its portfolio.
The paper said six banks were expected to put up $4 billion in financing, with $3 billion going toward the sale and the rest to refinance $1 billion in existing Warner Chilcott debt.
Asked to comment on the report on Sunday, P&G spokesman Tom Millikin told the Associated Press that the consumer products company did not respond to rumour or speculation. A mess-age left at Warner Chilcott's offices was not immediately returned.
Cincinnati-based P&G, known for brands like Tide detergent, Gillette razors and Pampers diapers, said late last year it was interested in exiting the prescription drug business. That segment's products include women's osteoporosis treatment Actonel, which generates more than $1 billion in annual revenue.
Private-equity firm Cerberus Capital Management and drug maker Forest Laboratories were also purportedly interested in the P&G division, according to the paper.
If completed, the deal would more than double Ireland-based Warner Chilcott's annual revenue and expand its share of the women's health market.The company, which makes birth control,female hormone therapies and dermatology products, has forecast annual sales of just over $1 billion for this fiscal year.
P&G has said it sees better potential with over-the-counter products such as Vicks cough medicines and other personal care brands, like Always and Tampax feminine care. Last year the company sold off its Folgers coffee business to J.M. Smucker Inc, and added beauty and grooming businesses to its portfolio.
The paper said six banks were expected to put up $4 billion in financing, with $3 billion going toward the sale and the rest to refinance $1 billion in existing Warner Chilcott debt.
Lawson makes medicine foray
Japan's No.2 convenience store chain Lawson Inc said it would jointly open stores with drugstore operator Matsumotokiyoshi to take advantage of deregulation and seek growth in a mature market.
The alliance comes less than three months after Japan loosened regulations on the sale of most over-the-counter drugs, paving the way for cold medicines and aspirin to be sold at convenience stores around the country.
"We have been wanting to sell medicines, and there have been strong requests by our customers," Lawson chief executive Takeshi Niinami said at a news conference yesterday.
Lawson has been looking for new store formats in a saturated market of more than 42,000 convenience stores nationwide. It has been emphasising a need to lure the older generation and also open grocery-style stores.
It and Matsumotokiyoshi, Japan's largest drug store chain, said they planned to open stores from next year that will stock over-the-counter drugs and cosmetics in addition to convenience store mainstays such as boxed lunches and bottled drinks.
Niinami said that he would like to have 1,000 such stores in five years,and added that Lawson also plans to sell medicines at 500 of its stores within the next two years with the help of Matsumotokiyoshi.
But some analysts said they did not expect the drug store alliance to give an immediate boost to Lawson's earnings.
"I don't see either merits or drawbacks for Lawson in one or two years' time," said Junichi Kanamori, a retail analyst at Mitsubishi UFJ Securities.
Kanamori said given the scale of Lawson, which has about 9,500 stores, the new stores with Matsumotokiyoshi "are unlikely to have a significant impact soon."
Matsumotokiyoshi shares ended almost flat at 2,305 yen after jumping as much as 7.6% after the market open,while Lawson rose 2% to 4,110 yen,underperforming a 3.4% rise in the benchmark Nikkei average.
Matsumotokiyoshi had been in talks with several major convenience store chains for a business partner as it braces for greater competition in the $12 billion market after deregulation of over-thecounter medicine sales earlier this year.
"Competition with non-drug store players is likely to intensify," Matsumotokiyoshi CEO Namio Matsumoto told the news conference.
The government has introduced less rigorous qualifications for selling most over-the-counter drugs, which only licensed pharmacists had been previously allowed to sell, enabling supermarkets and other retailers to offer medicines without the expense of hiring pharmacists.
Seven & I, which runs supermarkets,and rival Aeon Co Ltd are trying to expand their drug sales by taking advantage of the new deregulation.
In the convenience store sector, topranked Seven-Eleven, a unit of Seven &I, and No.3 FamilyMart Co Ltd have also started selling drugs at some stores.
Analysts said, however, that not many convenience stores would be likely to sell drugs given their limited store space and the sales volume needed to justify the labour costs of qualified sales staff,who are paid more than regular parttime workers.
The alliance comes less than three months after Japan loosened regulations on the sale of most over-the-counter drugs, paving the way for cold medicines and aspirin to be sold at convenience stores around the country.
"We have been wanting to sell medicines, and there have been strong requests by our customers," Lawson chief executive Takeshi Niinami said at a news conference yesterday.
Lawson has been looking for new store formats in a saturated market of more than 42,000 convenience stores nationwide. It has been emphasising a need to lure the older generation and also open grocery-style stores.
It and Matsumotokiyoshi, Japan's largest drug store chain, said they planned to open stores from next year that will stock over-the-counter drugs and cosmetics in addition to convenience store mainstays such as boxed lunches and bottled drinks.
Niinami said that he would like to have 1,000 such stores in five years,and added that Lawson also plans to sell medicines at 500 of its stores within the next two years with the help of Matsumotokiyoshi.
But some analysts said they did not expect the drug store alliance to give an immediate boost to Lawson's earnings.
"I don't see either merits or drawbacks for Lawson in one or two years' time," said Junichi Kanamori, a retail analyst at Mitsubishi UFJ Securities.
Kanamori said given the scale of Lawson, which has about 9,500 stores, the new stores with Matsumotokiyoshi "are unlikely to have a significant impact soon."
Matsumotokiyoshi shares ended almost flat at 2,305 yen after jumping as much as 7.6% after the market open,while Lawson rose 2% to 4,110 yen,underperforming a 3.4% rise in the benchmark Nikkei average.
Matsumotokiyoshi had been in talks with several major convenience store chains for a business partner as it braces for greater competition in the $12 billion market after deregulation of over-thecounter medicine sales earlier this year.
"Competition with non-drug store players is likely to intensify," Matsumotokiyoshi CEO Namio Matsumoto told the news conference.
The government has introduced less rigorous qualifications for selling most over-the-counter drugs, which only licensed pharmacists had been previously allowed to sell, enabling supermarkets and other retailers to offer medicines without the expense of hiring pharmacists.
Seven & I, which runs supermarkets,and rival Aeon Co Ltd are trying to expand their drug sales by taking advantage of the new deregulation.
In the convenience store sector, topranked Seven-Eleven, a unit of Seven &I, and No.3 FamilyMart Co Ltd have also started selling drugs at some stores.
Analysts said, however, that not many convenience stores would be likely to sell drugs given their limited store space and the sales volume needed to justify the labour costs of qualified sales staff,who are paid more than regular parttime workers.
Govt targets civil service health bills
The government plans to overhaul the medical benefits scheme for civil servants in a bid to curb huge medical bills run up by civil servants and their families.
Deputy Prime Minister Korbsak Sabhavasu revealed the plan to the Bangkok Post yesterday.Many civil servants and their families have been criticised for seeking reimbursement for unnecessary medical expenses.
Mr Korbsak said some civil servants had even sought refunds for nonmedical service bills, like spa treatment.
To slash their medical bills, civil servants would be required to contribute to a proposed medical savings account which would pay up to 20%of their expenses.
Mr Korbsak said he had told the Budget Bureau to look for ways to cut the mounting medical bills.
Medical expenses run up by civil servants have grown by at least 15 billion baht a year.
He said the national medical welfare budget for civil servants had skyrocketed from 30 billion baht a year to 80 billion a year over the past four years.
Civil servants are entitled to free medical care provided by the govern-ment. Their medical expenses are also reimbursed by the ComptrollerGeneral's Department under the Finance Ministry.
Mr Korbsak has proposed that the medical welfare scheme change from a "free-for-all" system providing coverage for civil servants and their families to one whereby civil servants would have to make contributions to pay 10% to 20% of their bills.
The contributions would be drawn from the medical welfare budget for civil servants and would be set aside as a net savings account for civil servants.
From 10% to Korbsak: Claims 20% of the budget,must be reduced or between 8 billion and 16 billion baht would be earmarked as funds to go towards net saving accounts made available to all civil servants.
The money would accumulate each year if it was not spent.
Mr Korbsak expected the measure to help cut unnecessary medical claims or reimbursements by civil servants.
"There are 2 million civil servants.With their family members, that comes to about 4 million to 5 million and they run up medical bills of almost 100 billion baht," Mr Korbsak said.
"This is comparable to the 100 billion baht budget for the universal healthcare scheme for more than 40 million people nationwide."
He said many civil servants had sought reimbursement for non-medical bills such as spa services.
Many also seek refunds for bills for medical cosmetic products instead of medications to treat health problems.
"A skin care clinic recently reported that 400 of its 500 customers who came in for a skin rejuvenation injection worth 10,000 baht were civil servants," Mr Korbsak said.
He said the national list of essential medicines for medical reimbursements was also in need of a major overhaul to adjust to the economic downturn.
Asource at the ComptrollerGeneral's Department said the department had come up with a tentative solution to cutting civil servants' medical bills.
Under the proposal, medical expenses for a civil servant would be divided into three funds.
They are a net savings account which would account for 20% of the total medical expenses of a civil servant, a general healthcare fund (50%), and a fund for treatment of illnesses with high treatment expenses (50%), the source said.
"In the event the funds are not spent,they would be paid as a special pension when a civil servant retires."
Deputy Prime Minister Korbsak Sabhavasu revealed the plan to the Bangkok Post yesterday.Many civil servants and their families have been criticised for seeking reimbursement for unnecessary medical expenses.
Mr Korbsak said some civil servants had even sought refunds for nonmedical service bills, like spa treatment.
To slash their medical bills, civil servants would be required to contribute to a proposed medical savings account which would pay up to 20%of their expenses.
Mr Korbsak said he had told the Budget Bureau to look for ways to cut the mounting medical bills.
Medical expenses run up by civil servants have grown by at least 15 billion baht a year.
He said the national medical welfare budget for civil servants had skyrocketed from 30 billion baht a year to 80 billion a year over the past four years.
Civil servants are entitled to free medical care provided by the govern-ment. Their medical expenses are also reimbursed by the ComptrollerGeneral's Department under the Finance Ministry.
Mr Korbsak has proposed that the medical welfare scheme change from a "free-for-all" system providing coverage for civil servants and their families to one whereby civil servants would have to make contributions to pay 10% to 20% of their bills.
The contributions would be drawn from the medical welfare budget for civil servants and would be set aside as a net savings account for civil servants.
From 10% to Korbsak: Claims 20% of the budget,must be reduced or between 8 billion and 16 billion baht would be earmarked as funds to go towards net saving accounts made available to all civil servants.
The money would accumulate each year if it was not spent.
Mr Korbsak expected the measure to help cut unnecessary medical claims or reimbursements by civil servants.
"There are 2 million civil servants.With their family members, that comes to about 4 million to 5 million and they run up medical bills of almost 100 billion baht," Mr Korbsak said.
"This is comparable to the 100 billion baht budget for the universal healthcare scheme for more than 40 million people nationwide."
He said many civil servants had sought reimbursement for non-medical bills such as spa services.
Many also seek refunds for bills for medical cosmetic products instead of medications to treat health problems.
"A skin care clinic recently reported that 400 of its 500 customers who came in for a skin rejuvenation injection worth 10,000 baht were civil servants," Mr Korbsak said.
He said the national list of essential medicines for medical reimbursements was also in need of a major overhaul to adjust to the economic downturn.
Asource at the ComptrollerGeneral's Department said the department had come up with a tentative solution to cutting civil servants' medical bills.
Under the proposal, medical expenses for a civil servant would be divided into three funds.
They are a net savings account which would account for 20% of the total medical expenses of a civil servant, a general healthcare fund (50%), and a fund for treatment of illnesses with high treatment expenses (50%), the source said.
"In the event the funds are not spent,they would be paid as a special pension when a civil servant retires."
FIRMS RACE TO GET SWINE-FLU VACCINES TO THE MARKET
More than two dozen pharmaceutical companies are racing against the clock to test, produce and ship more than a billion doses of swine-flue vaccines to anxious populations worldwide bracing for a second wave of infection.
But even if things proceed smotthly, delivery will not keep up with demand as the northern hemisphere enters the autumn and winter flu season, the World Health Organisation (WHO) has warned.
Initial estimates that the pharmaceutical industry could crank out 94 million doses a week beginning in October have been slashed due to poorer than expected yields from the so-called "seed virus" strains developed by WHO - approved laboratories.
According to the global health authority, 25 drug companies have announced their intention to make the vaccines.
Five of those firms will account for more than 80 per cent of production: Sanofi -Pasteur in France, AstraZeneca and GlaxoSmithKline in Britain, Baxter in the United States, and the Swiss group Novartis.
Significant numbers of vaccines should start to arrive within five to six weeks, they say.
Never in history has there been an attempt to vaccinate so many people in so short a period of time.
Immune-boosting drugs did not even exist in 1918, when a far more virulent progenitor of the type - A (H1N1) virus claimed upward of 40 million lives.
But even if things proceed smotthly, delivery will not keep up with demand as the northern hemisphere enters the autumn and winter flu season, the World Health Organisation (WHO) has warned.
Initial estimates that the pharmaceutical industry could crank out 94 million doses a week beginning in October have been slashed due to poorer than expected yields from the so-called "seed virus" strains developed by WHO - approved laboratories.
According to the global health authority, 25 drug companies have announced their intention to make the vaccines.
Five of those firms will account for more than 80 per cent of production: Sanofi -Pasteur in France, AstraZeneca and GlaxoSmithKline in Britain, Baxter in the United States, and the Swiss group Novartis.
Significant numbers of vaccines should start to arrive within five to six weeks, they say.
Never in history has there been an attempt to vaccinate so many people in so short a period of time.
Immune-boosting drugs did not even exist in 1918, when a far more virulent progenitor of the type - A (H1N1) virus claimed upward of 40 million lives.
Sunday, August 23, 2009
Pregnant pause for surrogate mums
Taiwan has warned a Thai surrogate company against seeking infertileparent clients in Taiwan, where the law bans using surrogate mothers to produce babies.
Wu Hsiu-ying, an official from the Council of Agriculture, told the Taiwanese edition of Apple Daily doctors who introduce infertile parents to a foreign surrogate mother company face losing their licence and fines of up to NT$250,000(260,000 baht).)
"Taiwan has not passed the surrogate mother bill," she told the Apple Daily ."So if a doctor arranges a surrogate mother for infertile parents here, he or she could lose their doctor's licence."
AnApple Daily reporter, posing as a client, contacted the headquarters of a Bangkok firm, Baby 101, about the service. The reporter said he was told it would charge US$50,000(1.7 million baht) for the service.
The surrogate mothers, who were re-portedly Vietnamese, live in a dormitory 20 minutes' drive from Bangkok.
Baby 101 has been advertising to potential Taiwan clients through a Chineselanguage ad on the internet.
The ad lists Baby 101's headquarters'telephone number in Bangkok, and its branch company's telephone number in Phnom Penh.
An estimated one of every seven Taiwan couples is incapable of bearing children, the Apple Daily reported.
Wu Hsiu-ying, an official from the Council of Agriculture, told the Taiwanese edition of Apple Daily doctors who introduce infertile parents to a foreign surrogate mother company face losing their licence and fines of up to NT$250,000(260,000 baht).)
"Taiwan has not passed the surrogate mother bill," she told the Apple Daily ."So if a doctor arranges a surrogate mother for infertile parents here, he or she could lose their doctor's licence."
AnApple Daily reporter, posing as a client, contacted the headquarters of a Bangkok firm, Baby 101, about the service. The reporter said he was told it would charge US$50,000(1.7 million baht) for the service.
The surrogate mothers, who were re-portedly Vietnamese, live in a dormitory 20 minutes' drive from Bangkok.
Baby 101 has been advertising to potential Taiwan clients through a Chineselanguage ad on the internet.
The ad lists Baby 101's headquarters'telephone number in Bangkok, and its branch company's telephone number in Phnom Penh.
An estimated one of every seven Taiwan couples is incapable of bearing children, the Apple Daily reported.
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