Health equity

Governos dão passo decisivo rumo a vacinas mais acessíveis

Resolução passa na Assembleia Mundial da Saúde, pedindo por vacinas mais acessíveis e maior transparência nos preços

                                           Foto: Ikram N'gadi

Governos reunidos em Genebra para a Assembleia Mundial de Saúde anual soaram o alarme acerca do aumento exorbitante no preço para vacinar uma criança, e deram um passo decisivo no sentido de responder ao problema, por meio da aprovação de uma resolução que pedia por vacinas mais acessíveis e maior transparência nos preços das vacinas. A resolução foi adotada por todos os Estados-membros - mais de 60 países, incluindo Argélia, Austrália, Brasil, Colômbia, Líbano, Líbia, Equador, Egito, Indonésia, Níger, Nigéria, África do Sul, Tailândia, Paquistão, Filipinas, e a República da Coreia, entre outros –, que declararam explicitamente seu apoio à resolução e preocupações com os altos preços das vacinas.

A organização humanitária internacional Médicos Sem Fronteiras (MSF) recebeu com satisfação o forte sinal enviado pelos governos.

“Embora seja positivo ver os países defendendo a saúde de seu povo, isso também reflete a triste realidade de que as vacinas estão se tornando caras demais para uma grande parte da população mundial”, disse a dra. Manica Balasegaram, diretora executiva da Campanha de Acesso a Medicamentos de MSF. “Se os governos não tomarem medidas concretas em relação aos preços das vacinas, eles serão forçados cada vez mais a fazerem escolhas difíceis sobre quais doenças eles poderão ou não pagar para proteger suas crianças.”

Em janeiro, MSF lançou relatório sobre os preços das vacina, The Right Shot: Bringing Down Barriers to Affordable and Adapted Vaccines (“A Dose Certa: Eliminando os Obstáculos para Vacinas Acessíveis e Adaptadas”, em tradução livre), que mostrou que, nos países mais pobres, o preço para vacinar uma criança é atualmente 68 vezes superior ao que era em 2001, com diversas partes do mundo incapazes de arcar com os altos preços das vacinas, como a que combate a doença pneumocócica, que mata quase um milhão de crianças todos os anos.

Uma razão pela qual as vacinas são tão caras está ligada ao fato de que poucas informações sobre os preços estão disponíveis ao público, o que deixa diversos países em desenvolvimento e agências humanitárias às cegas para negociar com as companhias farmacêuticas. A Organização Mundial da Saúde recomendou maior transparência no preço das vacinas como passo fundamental para a melhoria da acessibilidade.

Muitos países expressaram uma necessidade urgente da resolução, dizendo que qualquer atraso em sua adoção levaria mais crianças a morrerem de doenças evitáveis por vacinação. MSF espera que os governos usem esse momento para garantir que os preços pagos sejam comunicados publicamente, e que esse pedido seja ouvido pelas companhias farmacêuticas e especialistas em saúde global em todo o mundo, levando a um esforço conjunto para reduzir os preços.

“Os países estão frustrados com o fato de que são incapazes de proteger suas crianças por causa dos altos preços das vacinas. O poder para aumentar a acessibilidade, melhorando coletivamente a transparência dos preços a nível nacional, está nas mãos dos governos. Com essa resolução, os países fizeram um apelo claro que é preciso mais ação. Temos de colocar a saúde pública antes do lucro: vacinas que salvam as vidas das crianças não devem ser um grande negócio nos países pobres”, disse a dra. Manica Balasegaram.

Science frauds

What’s Behind Big Science Frauds?

By ADAM MARCUS and IVAN ORANSKY

 

IN December, Science published a paper claiming that people could change their minds about same-sex marriage after talking for just 20 minutes with a gay person. It seemed too good to be true — and it was.

On Wednesday, the journal distanced itself from the study, after its accuracy was disputed, and one of the authors could not back up the findings. News organizations, which had reported on the study, scrambled to correct the record.

Retractions can be good things, since even scientists often fail to acknowledge their mistakes, preferring instead to allow erroneous findings simply to wither away in the back alleys of unreproducible literature. But they don’t surprise those of us who are familiar with how science works; we’re surprised only that retractions aren’t even more frequent.

Remember that study showing vaccines were linked to autism? The time scientists claimed to have cloned human embryonic stem cells? Or that simple, easy way that was supposed to revolutionize the creation of such stem cells?

Those were all frauds published in the world’s top scientific journals — The Lancet, Science and Nature. The vaccine scare has been associated with a surge in cases of measles, some of them deadly.

Every day, on average, a scientific paper is retracted because of misconduct. Two percent of scientists admit to tinkering with their data in some kind of improper way. That number might appear small, but remember: Researchers publish some 2 million articles a year, often with taxpayer funding. In each of the last few years, the Office of Research Integrity, part of the United States Department of Health and Human Services, has sanctioned a dozen or so scientists for misconduct ranging from plagiarism to fabrication of results.

Not surprisingly, the problem appears to get worse as the stakes get higher. The now-discredited paper on gay marriage — by Michael J. LaCour, a graduate student at U.C.L.A., and Donald P. Green, a political scientist at Columbia, who requested a retraction after his co-author failed to produce the raw data — had all the elements: headline-grabbing research, in a top journal, on a hot topic.

But dishonest scholars aren’t the only guilty ones. Science fetishizes the published paper as the ultimate marker of individual productivity. And it doubles down on that bias with a concept called “impact factor” — how likely the studies in a given journal are to be referenced by subsequent articles. The more “downstream” citations, the theory goes, the more impactful the original article.

Except for this: Journals with higher impact factors retract papers more often than those with lower impact factors. It’s not clear why. It could be that these prominent periodicals have more, and more careful, readers, who notice mistakes. But there’s another explanation: Scientists view high-profile journals as the pinnacle of success — and they’ll cut corners, or worse, for a shot at glory. 

 

And while those top journals like to say that their peer reviewers are the most authoritative experts around, they seem to keep missing critical flaws that readers pick up days or even hours after publication — perhaps because journals rush peer reviewers so that authors will want to publish their supposedly groundbreaking work with them.

Most science and health reporters rely on the top journals for news leads. They tend to move in a pack, descending on a small handful of news items each week. When the papers in those journals have the fillip of a hot topic, like sex or race, the frenzy is even greater. And yet many reporters fail to do the necessary due diligence before publishing their work. The drive for scoops is even greater in journalism than it is in science.

Economists like to say there are no bad people, just bad incentives. The incentives to publish today are corrupting the scientific literature and the media that covers it. Until those incentives change, we’ll all get fooled again.

* Adam Marcus, managing editor of Gastroenterology and Endoscopy News, and

* Ivan Oransky, global editorial director of MedPage Today, co-founded Retraction Watch, which tracks scientific errors.

Simulation

Robotic Butt Offers Prostate Exam Training For Medical Students: How ‘Patrick’ Teaches Empathy, Proper Technique

By Chris Weller

 

A robotic butt and virtual patient software allows medical students to receive feedback on the prostate exams they administer.

Medical students, meet Patrick.

The latest in training technology, Patrick is a simulated patient that talks to medical students while offering real-time feedback about the virtual prostate exam he’s receiving. While a perplexing site to behold — users actually check the mock prostate of a dummy’s rear end — doctors have praised the technology for allowing students to familiarize themselves with intimate exams before they ever encounter a live patient.

Patrick serves a dual purpose: personal and professional. Personally, he comes equipped with software that enables him to interact emotionally with the student and voice any concerns he has about the procedure. Dr. Benjamin Lok, one of the program’s designers, says the interpersonal relationship Patrick helps foster is invaluable from a practicing perspective. “This virtual human patient can talk to the learner, expresses fears and concerns about the prostate exam, and presents a realistic patient encounter,” Lok told Geekosystem.

The other purpose he serves is functional. Patrick is endowed with force sensors, which can alert the student when he or she is being too aggressive, and can report how thorough the student was in his or her examination.

“Consider this,” Lok said, “how would a medical student know if they are doing a good prostate exam? Currently it is impossible for the educator to gauge performance. This simulation provides performance, feedback, and an opportunity to learn and lower anxiety.”

Bedside manner — the geniality with which doctors approach their relationship with patients — has repeatedly been found to significantly impact a person’s perception of a medical procedure. Being able to distill technical jargon into easily digestible language for patients is necessary for doctors, but it’s not sufficient. They must also be able to communicate with patients on an emotional level, to empathize with them and provide comforting words, even if the prognosis is grim.

Prostate and breast exams rank among the most intimate, high-stake procedures doctors can administer. Unfortunately, they’re also two of the most crudely screened procedures, turning medicine into something of a coaching job as well. Worse, students hoping to break into these fields often do so without any communicative or technical training, Lok said. “Students receive minimal practice and interaction in intimate exams due to the high cost for training and high anxiety nature of the exams.”

“So our research group has spent the past 4 years exploring whether we can improve medical students preparation and performance in intimate exams using simulations,” he continued. Together with University of Wisconsin researcher, Dr. Carla Pugh, Lok and his research group developed what’s called a “mixed reality” simulator. Pugh’s development of the physical mannequin, combined with the computer program Lok’s group designed, makes for a realistic patient experience that students can interact with in real-time.

Patrick is in use at Drexel University and at the University of Florida, and the feedback he provides is currently setting the foundation for broader research into the use of virtual humans to prepare people for stressful interpersonal experiences.

Chris Weller

Chris is a Senior Reporter at Medical Daily, where he covers brain health and other fun stuff. read more

e-Learning

Systematic review of eLearning

eLearning as good as traditional training for health professionals

Electronic learning could enable millions more students to train as doctors and nurses worldwide, according to research

by Julian Fisher

        

Dr Al-Shorbaji speaking at the launch of the systematic review of eLearning in undergraduate health professionals edcuation at Council Room at  170 Queen’s Gate, Imperial College London.

Click here to Watch a video of the launch 

 

A review commissioned by the World Health Organisation (WHO) and carried out by Imperial College London researchers concludes that eLearning is likely to be as effective as traditional methods for training health professionals.

eLearning, the use of electronic media and devices in education, is already used by some universities to support traditional campus-based teaching or enable distance learning.

Wider use of eLearning might help to address the need to train more health workers across the globe. According to a recent WHO report, the world is short of 7.2 million healthcare professionals, and the figure is growing.

The Imperial team, led by Dr Josip Car, carried out a systematic review of the scientific literature to evaluate the effectiveness of eLearning for undergraduate health professional education.

 

Click here to download a copy of the report 

They conducted separate analyses looking at online learning, requiring an internet connection, and offline learning, delivered using CD-ROMs or USB sticks, for example.

The findings, drawn from a total of 108 studies, showed that students acquire knowledge and skills through online and offline eLearning as well as or better than they do through traditional teaching.

The authors suggest that combining eLearning with traditional teaching might be more suitable for healthcare training than courses that rely fully on eLearning because of the need to acquire practical skills.

Dr Josip Car, from the School of Public Health at Imperial College London said:  “eLearning programmes could potentially help address the shortage of healthcare workers by enabling greater access to education, especially in the developing world the need for more health professionals is greatest. 

“There are still barriers that need to be overcome, such as access to computers, internet connections, and learning resources, and this could be helped by facilitating investments in ICT. Universities should encourage the development of eLearning curricula and use online resources to reach out to students internationally.”

e-Health

MEDINFO 2015: eHealth-enabled Health

MEDINFO is the premier international health and biomedical informatics event. MEDINFO 2015 is hosted by SBIS (Brazilian Health Informatics Association) on behalf of the International Medical Informatics Association (IMIA) and will take place in the city of Sao Paulo from the 19^th to 23^rd August 2015.

Under the theme “eHealth-enabled Health”, the world leaders in this field will gather in Brazil to share knowledge and analyze how eHealth and Biomedical Informatics are contributing to address some of the most challenging problems in health care, public health, consumer health and biomedical research. Researchers, clinicians, technologists and managers are invited to contribute and share experiences on the use of information methods, systems and technologies to improve patient safety, enhance care outcomes, promote patient-centered care, facilitate translational research, enable precision medicine and improve education and skills in health informatics.

This will be an historical event as MEDINFO is hosted in South America for the first time. Inclusiveness will use of Spanish and Portuguese languages in tutorials and simultaneous translation in sessions held in the main auditorium.

MEDINFO 2015

Dates: August 19 – 23, 2015

Location: Frei Caneca Convention Center, São Paulo, Brazil.