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Access to medicines is no simple matter and is further complicated by the way they are priced. Drug companies sometimes charge more in poorer countries because they focus on middle-class patients who pay for their own care rather than the population at large. Coverage is patchy, as is payment by healthcare systems.
The same issues apply in the US where insurance cover for patients is incomplete — and complex — and Medicaid, the government programme that helps the poor, is unable to negotiate prices. That particularly applies to oral cancer drugs, as the FT reported last week.
As investigations in the UK have shown, complex rules governing generic drugs mean manufacturers can increase prices when there are few or no other competitors. We need greater scrutiny and transparency of the way suppliers price their drugs but also more sophisticated mechanisms to hold health systems accountable.
Agnes Binagwaho is Rwanda’s former health minister and current vice-chancellor of Partners in Health’s new University of Global Health Equity. The institution has launched a two-year MSc in global health delivery and opens a school of medicine next year.
What are the weaknesses of medical education you are trying to tackle?
Doctors need cultural sensitivity, inclusiveness and a focus on the poor. Most of the time, the cure is not linked to the doctor but to social determinants. The majority of the burden of disease can be solved near where people are living. Doctors are not currently educated in community health systems. We need an integrated approach with outreach, supported by technology.
How will you address these issues in your university?
We plan to offer the core elements of a Harvard MBA and Masters of Public Health, but with a greater focus on service delivery, implementation, equity and the social determinants of health. Most people in Rwanda live in rural areas, so our campus is not in Kigali but in northern Rwanda. The whole country is our classroom. We will bring students to refugee camps and get them to interact immediately with community health workers. It’s full immersion. We will embed students, and educate them through case studies in small classes.
Are you overwhelmed by foreign visitors seeking information on your health system?
We found we were taking a lot of time dealing with international delegations coming to Rwanda to meet our staff, and we were not getting much value from them. We’re trying to transform that. We are creating a two-week executive education programme, so visitors from ministries of health can get together with us to share innovation.
Cancer costs An FT investigation shows cancer drugs in the US do not get the same kind of discounting as other medicines. Doctors find themselves doubling up as financial planners to find affordable treatment for their patients. (FT)
Public health priorities The WHO's 10-year public health review called for fewer antibiotic prescriptions and curbs on their use by the food industry — a warning echoed by investors. It also demanded action on climate change and warned that more than 80 per cent of urban residents suffered air quality levels above WHO guidelines. (WHO, FT)
Sage advice The WHO's Strategic Advisory Group of Experts on Immunisation — or Sage — highlighted supply shortages for IPV vaccine to protect against polio. A separate report showed use of antibiotics varied widely across eastern Europe, from 3.12 doses per person a year in Azerbaijan to 14.75 in Turkey. Experts recommend limits of 8.54 to counter antimicrobial resistance. (WHO, Cidrap)
Fund management The Global Fund to Fight Aids, Tuberculosis and Malaria chose Aida Kurtovic from Bosnia and Herzegovina as its new chair. The world’s largest multilateral donor tackling infectious disease suffered embarrassment earlier this year when it had to restart the selection process for a new executive director. (Global Fund, FT)
Casualties of war Health workers were attacked in 23 countries last year. The "Impunity must end" report saidSyria was by far the worst case with 108 attacks on hospitals and other health facilities. Afghanistan, Iraq, South Sudan, and Yemen also experienced high levels of violence. (Safeguarding Health in Conflict)
Trumpcare past first hurdle Republicans finally got their health reform plan through the House of Representatives after a series of amendments, but it is not yet clear how the bill will fare in the Senate. Congress separately rebuffed White House plans for cuts to The National Institutes of Health and instead proposed a $2bn increase. (FT, NYT, Forbes, The Hill)
Burden of Zika A Zika epidemic in the US could cost anything between $183m and $1.2bn including medical costs and lost productivity. Alabama, Florida, Georgia, Louisiana, Mississippi, and Texas are the states most at risk. (PLoS)
African-Americans Death rates for African-Americans dropped 25 per cent between 1999 and 2015. They are still however more likely to die younger, are 50 per cent more likely to have high blood pressure and are much more likely to die from heart disease than white Americans. (CDC)
Big Tobacco beaten The ban on tobacco logos in Australia looks to have been backed by the World Trade Organisation, paving the way for other countries to introduce tougher plain packaging rules. (Bloomberg)
Virtual treatment Pain relief through virtual reality is being used on opioid addicts in the US. Playing VR games is not just distraction — it can reduce activity in parts of the brain associated with feeling pain, tricking your senses into believing the computer-generated environments are real. Meanwhile fears are growing of a new opioid danger: “grey death”. (Mosaic Science, Stat)
Legionnaires' leap Cooling towers are suspected of being one of the main sources of the quadrupling of cases of Legionnaires' Disease in the US between 2000 and 2014. Other possible reasons range from improved testing for the disease to ageing infrastructure. (WSJ)
Sniffing out disease Even in the ancient world it was recognised that human odour could be suggestive of illness: diabetics' breath sometimes smells of rotten apples for example. Portable devices to analyse these human odours are now within reach. Another ancient health indicator — the state of our teeth — is examined in a new book. (New York Times, Nature)
Mental health warning UK MPs said financial pressures were restricting mental health services in schools and colleges. Half of all mental illness starts before the age of 15 and three quarters by age 18, their report said. (Commons Health Committee)
Bingeing Brits Of the 29m who drink alcohol in the UK, almost 8m "binge" on their heaviest drinking day — especially higher earners. But the overall proportion of adults who drink — 57 per cent — is at its lowest level since 2005. (Office for National Statistics)
Best from the journals
HIV hopes Scientists using the Crispr gene-editing technique have been successful in removing the HIV virus from mice, bringing human clinical trials a step closer. Encouraging medical breakthroughs however need to be matched by stronger government action and strategies such as promoting condom use. (Molecular Therapy, The Lancet)
Africa warning Lifestyle changes among rural Africans, including the wider availability of electricity, transport and mobile phones, are making dramatic changes to the way diseases spread, particularly those that transfer from animals to humans. Even simple scenarios like villagers gathering around a TV can heighten risk. (American Journal of Tropical Medicine and Hygiene)
Privatisation and health The post-Soviet economic upheavals of the 1990s had a significant effect on male mortality in Russia. Workers in towns that experienced rapid privatisation — and subsequent high unemployment and levels of stress — suffered a 13 per cent higher death rate than in other areas. (The Lancet)
Sharing Swedes By 2020, all Swedes over 16 will have access to their medical records after a 20-year programme of legal and technical advance. All the country's hospitals, primary care centres, and psychiatric facilities already use electronic records, compared with 65 per cent for Europe overall and 81 per cent for hospitals. (BMJ)
Support for statins New research argues that the benefits of statins outweigh concerns about their side effects. Muscle-related problems for example are largely the product of the “nocebo” effect — patients reported problems when they were aware that statins were being used but not when their use was blinded. (The Lancet)
Aspirin and breast cancer Low-dose aspirin is linked with lower risk of breast cancer. The disease is the most common cancer in women worldwide and the second most common cancer overall. (Breast Cancer Research)
Seeing hands UK scientists have developed a prosthetic hand that “sees” and learns how to grip. A camera is added to a basic myoelectric hand which can be taught how to recognise certain shapes and grasp them appropriately. (Journal of Neuroengineering)
Podcast of the week
Guy Thwaites, Director of Oxford University Clinical Research, discusses infectious disease and the fight against anti-microbial resistance in Southeast Asia. (ABC Radio, 20m)
In case you missed it
FT Health previous issue: Moving beyond malaria
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Fads and the food industry Researchers warned this week that gluten-free diets were only appropriate for those with coeliac disease. Otherwise, cutting back on whole grain foods may increase the risk of heart disease. This is unwelcome news for the food industry: global sales of gluten-free food jumped 12.6 per cent last year to $3.5bn, compared with overall packaged foods growth of just 4 per cent. (BMJ, FT)