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The New England Journal of Medicine this week labelled May's cyber attack on Britain's NHS “a wake-up call” for modern medicine, adding to demands for the sector to take security more seriously.
Few institutions are prepared for such attacks, as the NHS incident— which hit one in five English hospitals — demonstrated. Business also needs to play its part. As many as two in five makers of medical devices say they have not taken steps to prevent attacks. The US Food and Drug Administration has issued guidelines to manufacturers to beef up their defences while companies such as Johnson & Johnson and Philips are sending staff to cyber conferences to learn from "white hat" hackers.
This week we also reported FBI fears over “biological security” and concerns that the US was not doing enough to protect the genomic data used to create lucrative new medicines — data that could also be used to develop bioweapons.
Biomedical research relies on open cross-border networks: the US Genome Project, for example, would have taken much longer without help from Britain, Germany, France, Japan and China. The challenge for governments and industry alike is how to keep patients and medical data safe without damaging this crucial collaboration.
How important a breakthrough is your long-acting HIV therapy?
We have been working on this for a long time. It involves two principles: going from three drugs to two once HIV is undetectable, and then continuing with long-acting injectables. The slow-release technology comes from our work with antifungals and antipsychotics. Now we know that once every two months is do-able, we are experimenting with treatment every six months. This could be transformational for compliance, and for patients who can’t get pills every day.
Are you confident about success with your HIV vaccine?
It is one of the things I am most excited about. It represents 10 years of work. We were able to get very strong immunity in non-human primates. We have brought it into humans in 400 volunteers, and it has shown the same immunological response as in the primates. We think we have a vaccine we can bring to Phase 2B efficacy studies. It’s always high-risk but we have to continue to try.
How is your TB drug bedaquiline progressing?
We discovered the first new target after many decades; it was a lucky find. Now it gives us new pathways to look at, allowing us to go further than we ever thought. We have rolled it out to a large percentage of people with exceptionally positive results. So far 12,000 have been treated. It shows that adding a new drug with a new mechanism is a very valuable tool in multi-drug resistant TB. We are continuing research for a new triple therapy.
Breastfeeding No country is meeting international standards on breastfeeding according to research which says an investment of just $4.70 per newborn could generate $300bn in economic gains by 2025. In five of the largest emerging economies — China, India, Indonesia, Mexico and Nigeria — this lack of investment kills an estimated 236,000 children a year. (Devex, Unicef/WHO)
Leprosy leap Millions of leprosy cases are going unreported, experts say, 15 years after the disease was all but eliminated. Stigma, lack of knowledge and reduced funding are said to be the causes. (The Guardian)
China success Remarkable progress has been made on malaria in China over the last ten years, financed by the Global Fund and the Chinese government. Elimination programmes included indoor residual spraying, the distribution of insect nets and robust surveillance systems. (WHO monthly bulletin)
US aid goals The US Agency for International Development’s “Investing for Impact” report examines trends in global health financing and highlights how USAID is using private investment to implement its programmes. (USAID)
Filling the gap The “She Decides” initiative set up in the Netherlands to replace funding left by US withdrawal from overseas programmes that "provide or promote" abortion has raised $300m. HIV prevention efforts in Africa are at risk from the cuts. (NPR, FT Health, Guardian)
US opioid crisis The US commission on combating drug addiction and the opioid crisis called for the president to declare a national emergency, citing a death toll “equal to September 11 every three weeks”. Mississippi and other administrations have launched legal actions against pharma companies. (W Post, White House, FT)
UK drug deaths Record numbers are dying from drug poisoningin England and Wales with a big jump in fatalities from cocaine and the fentanyl painkiller — a key cause of US opioid deaths. Drug users in their 40s, the so-called “Trainspotting generation” — a reference to Danny Boyle's 1996 film about heroin addicts — are now the most affected. (BBC)
Antimicrobial resistance in Europe European agencies published more evidence on the link between antibiotic use and resistance in humans and animals. "To contain antibiotic resistance we need to fight on three fronts at the same time: human, animal, and the environment," said Vytenis Andriukaitis, European Commissioner for Health and Food Safety. (Cidrap)
Superbug scare US hospitals are taking evasive action to avoid the “catastrophic threat” of an outbreak of Candida auris, a member of the broader Candida fungal family that has hit institutions such as London's Royal Brompton. (Stat)
UK life sciences laggard A report for pharma giant Pfizer says Britain is falling behind in the prescription of new medicines, despite its prowess in science and a skilled workforce. Fixes suggested include new pricing models such as payment by results and multiyear NHS budgets. (FT)
Statins under scrutiny As the ubiquity of the cholesterol-lowering drugs grows, so does the controversy surrounding them. Do they deliver clinically meaningful benefits? (FT, British Journal of General Practice)
Tobacco industry smoulders The FDA's suggestions of stricter tobacco controls have left analysts pondering the industry's future. Cutting nicotine levels could lead to a sharp fall in cigarette smoking but might also encourage companies to encourage alternatives such as ecigarettes. (FDA, FT)
American health The more a developed country spends on healthcare, the longer its people live. The US is the exception with a life expectancy of 78.8 years, ranking 27th among OECD nations. The country spends more per capita on prescription medicines and over-the-counter products than all its peers. (Bloomberg)
Medicine's middle men How US pharmacy benefit managers affect medication costs and patients’ access to treatments. (Kaiser video)
Best from the journals
Genetic breakthrough Researchers using Crispr gene-editing technology have corrected a genetic defect in newly-created human embryos for the first time, raising hopes that some inherited diseases could be prevented. Discuss the issues and vote in our Twitter poll. (Nature, FT)
Blindness The global number of blind people increased 18 per cent between 1990 and 2015 to 36m and is forecast to rise to 115m by 2050. The number of those with moderate to severe visual impairment is set to rise from 217m to 588m. The increases are mainly due to growing and ageing populations. (The Lancet)
Dealing with Dengue Air travel is largely responsible for the spread of the Dengue virus, now affecting 390m people each year. Hubs such as Thailand and India help epidemics take hold, while China, Cambodia, Indonesia, and Singapore spread the virus to other Asian countries. (PLoS Neglected Tropical Diseases)
Research methods Examining alternatives to randomised control trials, long held up as the “gold standard” of clinical research. (NEJM)
Mediterranean diet The benefits of the Mediterranean diet with plenty of fresh fruit, vegetables and fish have been well documented but a new study shows the effects are largely confined to the better off, suggesting that richer families are able to buy better quality food higher in antioxidants and polyphenols and lower in pesticides. (International Journal of Epidemiology)
Sleep and obesity Adults suffering from a lack of sleep are more likely to be affected by obesity and other health problems. Globally, it is estimated that sleep duration on workdays has declined by 37 minutes in the last decade. (PLoS One)
Chronic fatigue syndrome A new study strengthens the view that myalgic encephalomyelitis (ME) — better known as chronic fatigue syndrome — is caused by inflammation. The disease has no known cure or effective treatments, is particularly prominent among women and can persist for decades. (PNAS, Stanford)
Fat switch Researchers say they have discovered a “switch” in the brain that co-ordinates energy expenditure with feeding and could have implications for the treatment of obesity. (Cell Metabolism)
Podcast of the week
Women’s health Alta Charo of the University of Wisconsin-Madison and a leading American authority on bioethics discusses recent Trump administration appointees and the implications of alternative science for women’s health. (NEJM, 11m)
In case you missed it
Last edition: Antibiotics under scrutiny
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Food for thought
The common craving for the sweet stuff — including our own weekly dash to the FT Cake Trolley — is generally thought to lift our mood. New research however shows increased sugar intake could be linked to the development of common mental health problems. (The Conversation)
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