Scientists ‘Clear’ Alzheimer’s Plaque From Mice Using Only Light And Sound


Clumps of harmful proteins that interfere with brain functions have been partially cleared in mice using nothing but light and sound.

Research led by MIT has found strobe lights and a low pitched buzz can be used to recreate brain waves lost in the disease, which in turn remove plaque and improve cognitive function in mice engineered to display Alzheimer’s-like behaviour.

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It’s a little like using light and sound to trigger their own brain waves to help fight the disease.

This technique hasn’t been clinically trialled in humans as yet, so it’s too soon to get excited – brain waves are known to work differently in humans and mice.

But, if replicated, these early results hint at a possible cheap and drug-free way to treat the common form of dementia.

So how does it work?

Advancing a previous study that showed flashing light 40 times a second into the eyes of engineered mice treated their version of Alzheimer’s disease, researchers added sound of a similar frequency and found it dramatically improved their results.

“When we combine visual and auditory stimulation for a week, we see the engagement of the prefrontal cortex and a very dramatic reduction of amyloid,” says Li-Huei Tsai, one of the researchers from MIT’s Picower Institute for Learning and Memory.

It’s not the first study to investigate the role sound can play in clearing the brain of the tangles and clumps of tau and amyloid proteins at least partially responsible for the disease.

Previous studies showed bursts of ultrasound make blood vessels leaky enough to allow powerful treatments to slip into the brain, while also encouraging the nervous system’s waste-removal experts, microglia, to pick up the pace.

Several years ago, Tsai discovered light flickering at a frequency of about 40 flashes a second had similar benefits in mice engineered to build up amyloid in their brain’s nerve cells.

“The result was so mind-boggling and so robust, it took a while for the idea to sink in, but we knew we needed to work out a way of trying out the same thing in humans,” Tsai told Helen Thomson at Nature at the time.

The only problem was this effect was confined to visual parts of the brain, missing key areas that contribute to the formation and retrieval of memory.

While the method’s practical applications looked a little limited, the results pointed to a way oscillations could help the brain recover from the grip of Alzheimer’s disease.

As our brain’s neurons transmit signals they also generate electromagnetic waves that help keep remote regions in sync – so-called ‘brain waves’.

One such set of oscillations are defined as gamma-frequencies, rippling across the brain at around 30 to 90 waves per second. These brain waves are most active when we’re paying close attention, searching our memories in order to make sense of what’s going on.

Tsai’s previous study had suggested these gamma waves are impeded in individuals with Alzheimer’s, and might play a pivotal role in the pathology itself.

Light was just one way to trick the parts of the brain into humming in the key of gamma. Sounds can also manage this in other areas.

Instead of the high pitched scream of ultrasound, Tsui used a much lower droning noise of just 40 Hertz, a sound only just high enough for humans to hear.

Exposing their mouse subjects to just one hour of this monotonous buzz every day for a week led to a significant drop in the amount of amyloid build up in the auditory regions, while also stimulating those microglial cells and blood vessels.

“What we have demonstrated here is that we can use a totally different sensory modality to induce gamma oscillations in the brain,” says Tsai.

As an added bonus, it also helped clear the nearby hippocampus – an important section associated with memory.

The effects weren’t just evident in the test subjects’ brain chemistry. Functionally, mice exposed to the treatment performed better in a range of cognitive tasks.

Adding the light therapy from the previous study saw an even more dramatic effect, clearing plaques in a number of areas across the brain, including in the prefrontal cortex. Those trash-clearing microglia also went to town.

“These microglia just pile on top of one another around the plaques,” says Tsai.

Discovering new mechanisms in the way nervous systems clear waste and synchronise activity is a huge step forward in the development of treatments for all kinds of neurological disorders.

Translating discoveries like this to human brains will take more work, especially when there are potential contrasts in how gamma waves appear in mice and human Alzheimer’s brains.

So far early testing for safety has shown the process seems to have no clear side effects.

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Are Young Adults Given to More Mental Distress?


Study suggests generational shift in mood disorders, suicide-related outcomes; digital media may play role

Mood disorders increased in young adults across the past decade, with smaller and less consistent trends observed in older adults, according to national survey data.

Of more than 500,000 survey participants, the percentage of adolescents ages 12 to 17 (“iGen,” “Generation Z”) experiencing a major depressive episode in the last year increased by 52% from 2005 to 2017, while the percentage of young adults ages 18 to 25 (“Millennials”) experiencing serious psychological distress in the last month was up 71% from 2008 to 2017, reported Jean Twenge, PhD, of San Diego State University, and colleagues.

The same trends were not observed in respondents ages >25, including “Generation X,” and “Boomers,” with a slight decline in psychological distress observed among adults ≥65. The incidence of major depressive episodes was unchanged, or slightly decreased, in respondents ages ≥26, they wrote in the Journal of Abnormal Psychology.

These trends could be explained by the introduction of smartphones in the developmental stages of more recent generations, Twenge, who is also the author of “iGen,” told MedPage Today.

“When you think of how lives have changes from 2010 to 2017, a clear answer is that over time, people started spending more time on phones and on social media, less time face-to-face with their friends, and less time sleeping,” Twenge said. “As we know from other studies, spending more time with screens, less time sleeping, and less time face-to-face with friends is not a good formula for mental health.”

Depression has increased in the U.S. over recent years, with the fastest rise in youth and young adults, according to health insurance data. Certain aspects of digital media, such as the introduction of smartphones and social media, have also been linked to a higher likelihood of major depressive disorder, specifically among Millennials.

Twenge said youth might be more susceptible to some of the effects of digital media because it was such an integral part of their development early on. She also noted that the findings here contrast with other theories that the increase could be attributed to today’s teens being more open about their mental health, or more willing to seek help, she said, as the current study asked about symptoms and behaviors, instead of inpatient or clinical data regarding specific disorders.

“I think it’s possible the change in social lives of young people has been more pronounced in the age of the smartphone,” Twenge said. “Older people may already have an established social network and the change in how they use their social time may not be as extensive as it has been for teens and young adults.”

“Getting your first smartphone at 12 is fundamentally different than getting your first smartphone at 30,” she added.

Twenge and colleagues used responses from the National Survey on Drug Use and Health of individuals ≥12 years. Rates of serious psychological distress were determined through responses to the Kessler-6 Distress Scale, and rates of major depressive episodes and suicide ideation were determined through NCS-Replication interviews. Deaths by suicide were measured through CDC Fatal Injury Reports (1999-2017).

In total, 212,913 adolescents (ages 12-17) responded from 2005 to 2017 and 398,967 adults (≥18) responded from 2008 to 2017. These groups were similar in terms of sex (51% vs 52% female), race, and ethnicity, with over 50% of both samples being non-Hispanic white, close to 15% being non-Hispanic black, and 15% Hispanic in both groups. A slightly higher percentage of the older group had family incomes <$49,999 compared with the adolescent group (55% vs 46%).

Women had greater increases in mood disorders versus men across the number of reported major depressive episodes, suicide-related outcomes, and serious psychological distress, Twenge and colleagues reported.

The percentage of white Americans experiencing major depressive episodes and suicide-related outcomes increased more than it did for other races or ethnicities, although Hispanic respondents had the greatest increase in psychological stress, they added.

Finally, the biggest increases in psychological distress and suicidal ideation were observed in respondents with the highest family incomes, while increases of adult major depressive disorder and suicide attempts were greater in lower income families.

The authors cautioned against overinterpreting the suicide ideation result, as few respondents reported their thoughts about suicide or attempted suicides. However, they noted that since each later generation had increased thoughts of suicide, it appears this increase was due to cohort as well.

Study limitations included its cross-sectional design and the fact that it included only single-item assessments of suicide ideation or attempts. Suicide-related outcomes also weren’t assessed in adolescents, researchers reported, and irritability was not included in the assessment for this group’s major depressive episodes.

The results suggest a need for more research to understand the role of factors such as technology and digital media use and sleep disturbance may play in mood disorder and suicide-related outcomes, and to develop specialized interventions for younger cohorts, the authors concluded. “This work is necessary given the high cost of mood disorders and suicide.”

NICE 2018 Guideline on management of stable COPD


https://speciality.medicaldialogues.in/nice-2018-guideline-on-management-of-stable-copd/

New Drug to Control High Cholesterol for Statin intolerant patients: NEJM Study


https://speciality.medicaldialogues.in/new-drug-to-control-high-cholesterol-for-statin-intolerant-patients-nejm-study/

Yes, You Are Lovable With Depression and Anxiety


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If you worry that your anxiety or depression will limit your chances for relationships, you’re not alone. Many people are concerned that having a psychological condition—especially a chronic one—might make them unattractive to other people. How am I going to find friends or a partner when I’m dealing with depression or anxiety? Who’s going to want to sign up for this?The fear of rejection can make you think that your only option is to hide your condition – that if you tell the truth, people will leave. But, most people aren’t looking for perfection from you—they want honesty. Honesty is the foundation of relationships and true intimacy. And rather than your struggles being a deal breaker, the person likely will recognize them as a single aspect of who you are.

I’ve heard many of my patients describe their relief to find that dating partners were not put off when they acknowledged their condition. Partners who are familiar with anxiety and depression may understand the strength it takes to keep going. They might even live with these conditions themselves, given how common they are.

But what if they’re not accepting of you – what if, for them, it is a deal breaker? It’s true that not everyone will have a positive response to mental health conditions. But if this happens, or has happened to you already, remember that other people’s choices do not define you. If someone can’t see past your struggles, that says a lot more about who they are than it says about you. And just because that one particular person was not comfortable with your condition doesn’t mean that everyone will have the same response.

Still, when someone reacts negatively to you, it hurts. For many people, this kind of rejection can trigger automatic thoughts, like I’ll always be alone, that may feel true in the moment but are not based in reality. Watch out for related thoughts that might pop up in this area, such as:

  • Being anxious and depressed means I’m unlovable.
  • I don’t deserve to be happy.
  • Love is for other people; it won’t ever happen for me.
  • I’m too broken to ever be loved.
  • Nobody wants me around.
And perhaps the most disturbing thought of all: No one would miss me if I died. This belief is common among those thinking about ending their own lives, and is patently false. Don’t believe it—more people than you realize love and appreciate you, and would be devasted if you ended your life. The people who care about you need you, just as you are. (If you do have suicidal thoughts, please reach out for help: call the National Suicide Prevention Lifeline at 800-273-TALK or text 741741 to connect with a counselor at Crisis Text Line)As with any problematic thoughts, start by recognizing them as thoughts that may or may not be true. Then share them with someone who cares about you and knows you well. They’ll be able to point out where you’re being too hard on yourself. If you haven’t already, also seek out the support of a qualified professional—someone who can work with you not only on the symptoms you’re having but on any harsh self-judgments.

Going through anxiety or depression or any other psychological condition doesn’t make you unlovable—it makes you human. And we love the person who trusts us enough to show us their humanity. Chances are there are people right now who are more willing to love you than you even know. Why not let them?

Major Study Finds Pregnancy Issue Actually Linked to Autism, And It’s Not Vaccines


It’s a common but erroneous belief among anti-vaxxers that if a pregnant woman gets jabbed, she puts her unborn child at risk of autism.

This couldn’t be further from the truth. Instead, a growing body of research suggests that when a mother goes unvaccinated, that is when she truly leaves her child vulnerable.

A new study of nearly 1.8 million children in Sweden has found that the risks for autism and depression are significantly higher if your mother was hospitalised with an infection during pregnancy.

The results build on a nascent but burgeoning idea that specific infections, when contracted during pregnancy, can harm a developing brain, boosting the risk of psychiatric disorders coming on later in life, including conditions such as bipolar disorder, schizophreniadepression, and autism.

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This new study, however, paints a much broader stroke. Instead of revealing one or two bad infections, the authors found that the results remained the same whether or not the hospitalisation was due to severe infections – like influenza, meningitis and pneumonia – or much more mild UTIs.

In other words, it isn’t necessarily a specific virus, but infection in general that appears to be causing these problems, and it seems to be the case even when the affliction can’t reach the fetal brain.

“The results indicate that safeguarding against and preventing infection during pregnancy as far as possible by, for instance, following flu vaccination recommendations, may be called for,” says Verena Sengpiel, an expert in obstetrics and gynaecology at the University of Gothenburg.

Drawing on data from the Medical Birth Register for almost 1.8 million children, born in Sweden between 1973 and 2014, the authors tallied how many of their mothers had been hospitalised with an infection during their respective pregnancies.

The researchers then tracked these children and their mental health through the inpatient register until 2014, when the oldest ones were turning 41.

Statistical analysis of the data revealed a worrying link between a child’s mental health and their mother’s immune system.

While the study did not find an increased risk of schizophrenia or bipolar disorder, the authors did find that when a pregnant woman goes to the hospital for an infection, her child is more likely to seek hospital treatment for depression and autism later on in life.

In fact, among these children, the increased risk was 79 percent for autism and 24 percent for depression.

“Overall, we found evidence that exposure to maternal infection during fetal life increased the risk of autism and possibly of depression in the child,” the authors write.

“Although the individual risk appears to be small, the population effects are potentially large.”

As fascinating as it is, the study is only observational, so it can’t tell us exactly how a maternal infection would impact a child’s developing brain.

Nevertheless, recent studies on animal models have suggested that these infections might be causing an inflammatory reaction in the nervous system, altering gene expression in the brain and changing its architecture.

The thing is, many of these studies also note there are a multitude of genetic factors at play, so the answer to this puzzle could be highly complex.

“Our results cannot exclude the possibility of increased risk for psychopathologic conditions as a result of a dual “hit”: an inflammatory fetal brain injury on a background of genetic susceptibility,” the authors of the new study write.

More research will be needed before we can say for sure what is going on. In the meantime, however, the best thing a pregnant mother can do is stay healthy and adhere to the best medical advice out there. Getting all your vaccinations is a good start.

Source: JAMA Psychiatry.

Americans now more likely to die from opioids than car crashes


​It marks a first for the U.S., where some 49,000 people died from opioids in 2018.

  • Each American has about a 1 in 7,569 chance of dying from an opioid overdose, according to a National Safety Council report. The probability of dying in a motor vehicle accident is 1 in 8,096.
  • The death rate for opioids is now six times higher than it was in 1999, with about 130 Americans dying every day from the drugs.
  • Narcan is a life-saving drug that can stop opioid overdoses in their tracks, however factors like stigma and cost are preventing this antidote from becoming more accessible.

For the first time in U.S. history, Americans are more likely to die from opioid overdoses than car accidents, according to a new report from the nonprofit National Safety Council.

Americans have a 1 in 7,569 chance of dying from an opioid overdose, while the probability of dying in a motor vehicle accident is 1 in 8,096. Those odds were calculated by dividing the total U.S. population by the total number of deaths for each cause in 2017, using data on preventable deaths from the National Center for Health Statistics.

“We’ve made significant strides in overall longevity in the United States, but we are dying from things typically called accidents at rates we haven’t seen in half a century,” Ken Kolosh, manager of statistics at the National Safety Council, said in a press release. “We cannot be complacent about 466 lives lost every day. This new analysis reinforces that we must consistently prioritize safety at work, at home and on the road to prevent these dire outcomes.”

The figures on opioid deaths are even more startling when presented in terms of lifetime odds, which are approximated by dividing the one-year odds of dying from a particular cause by the life expectancy of a person born in 2017 (78.6 years). Measured this way, Americans have a 1 in 96 probability of dying from an opioid overdose.

The lifetime odds of dying in a plane crash? 1 in 188,364.

“As human beings, we’re terrible at assessing our own risk,” Kolosh told National Public Radio. “We typically focus on the unusual or scary events … and assume that those are the riskiest.”

Opioids abuse and overdoses have been on the rise for years. In 2017, more than 49,000 people died of opioid overdoses, according to the National Institute on Drug Abuse. That’s about six times higher than the rate for 1999. Now, an average of 130 Americans die every day from an opioid overdose.

The increased availability of fentanyl, a powerful synthetic opioid, is partly responsible for the recent spike in opioid overdoses, the council said in the press release.

“The nation’s opioid crisis is fueling the Council’s grim probabilities, and that crisis is worsening with an influx of illicit fentanyl.”

​Can Narcan curb the opioid crisis?

There’s one life-saving drug that, if administered quickly and properly, can stop nearly all opioid overdoses in their tracks: naloxone, commonly known as Narcan. Patented in 1961, the drug works by preventing the brain’s receptors from bonding with opioids, eliminating their effects on the body. Narcan can’t stop the addiction, but it can stop an overdose.

In 2018, U.S. Surgeon General Jerome Adams issued an advisory calling for more people to carry and learn how to administer Narcan, which is already carried by many EMTs and police officers.

“The call to action is to recognize if you’re at risk,” Adams told NPR. “And if you or a loved one are at risk, keep within reach, know how to use naloxone … We should think of naloxone like an EpiPen or CPR. Unfortunately, over half of the overdoses that are occurring are occurring in homes, so we want everyone to be armed to respond.”

Some believe making Narcan more accessible is the key to curbing the opioid crisis. That’s why most U.S. states have recently implemented a so-called standing order that allows people to get Narcan from a pharmacist without having to visit a doctor. Still, several factors seem to be preventing Narcan from being as ubiquitous as advocates like Adams might hope.

One problem is stigma. A 2017 study published in the Journal of the American Pharmacists’ Association showed how both pharmacists and addicts report being uncomfortable engaging in face-to-face discussions about the need for Narcan. The researchers argued that this stigma might be reduced through policies that call for pharmacies to universally offer Narcan to patients obtaining opioid prescriptions.

Another component of the stigma surrounding Narcan is an argument that says increasing the drug’s accessibility actually enables addicts. The idea is that addicts are more willing to take risks, and take increasingly dangerous drugs like fentanyl, when they know they have a life-saving drug in their pocket. Proponents of this idea might argue that Narcan “subsidizes recklessness,” but others say denying medical patients a lifesaving drug isn’t the answer.

“I understand the frustration,” Police Chief Thomas Synan Jr. of Newtown, Ohio, told The Associated Press. “I understand the feeling that someone is doing something to themselves, so why do the rest of us have to pay? But our job is to save lives, period.”

But perhaps the biggest obstacle to increasing the accessibility of Narcan is the price. As STAT points out, a life-saving dose of Narcan cost just $1 a decade ago, but now “costs $150 for the nasal spray, a 150-fold increase,” while a “naloxone auto-injector, approved in 2016, costs $4,500.”

As Stephen Wood wrote for Harvard Law School’s Bill of Health, these price increases came “when the opioid epidemic was at its peak, and they came without any explanation.” If the prices don’t drop, it’s unlikely that efforts like standing orders and community distribution programs will be effective.

Ultimately, Wood argued, it’s all about the money for pharmaceutical companies.

“Naloxone has gone from a $21 million dollar a year industry prior to 2014, to a booming $274 million dollar take per year since 2015. There is no doubt: pharmaceutical companies are making money off the opioid epidemic. Additionally, those who need this drug the most, often don’t have access to it. They are the under- or uninsured, so waving a co-pay is moot.

There are plenty of opportunities to reduce costs. Several authorities have asked for induction of federal law 28 U.S.C. section 1498, which would allow the United States to contract with a manufacturer to act on their behalf to create a less costly product. However, this still puts the onus of the cost on the tax payer. The pharmaceutical industry brought us the opioids that sparked this epidemic, heavily marketing oxycontin and oxycodone, which retail at around $1.25 a pill. What could possibly justify the antidote costing upwards of 3,600 percent more? There is no justification for this and policy makers need to draw their attention to this scamming of the general public in a time of crisis.”

Cannabis Could Increase Men’s Sperm Count


Cannabis Could Increase Men's Sperm Count

 

Men who have smoked marijuana at some point in their life had significantly higher concentrations of sperm when compared with men who have never smoked marijuana, according to new research led by Harvard T.H. Chan School of Public Health. The study, conducted in the Fertility Clinic at Massachusetts General Hospital, also found that there was no significant difference in sperm concentrations between current and former marijuana smokers.

“These unexpected findings highlight how little we know about the reproductive health effects of marijuana, and in fact of the health effects of marijuana in general,” said Jorge Chavarro, associate professor of nutrition and epidemiology at Harvard Chan School. “Our results need to be interpreted with caution and they highlight the need to further study the health effects of marijuana use.”

The study will be published on February 5, 2019 in Human Reproduction.

It is estimated that 16.5 percent of adults in the US use marijuana, and support for legal recreational use of marijuana has increased dramatically in recent years. Understanding the health effects associated with marijuana use is important given the growing perception that it poses few health hazards.

The researchers hypothesized that marijuana smoking would be associated with worse semen quality. Previous studies on marijuana have suggested that it is associated with negative effects on male reproductive health, but most of those studies had focused on animal models or on men with histories of drug abuse.

For this study, researchers collected 1,143 semen samples from 662 men between 2000 and 2017. On average, the men were 36 years old, and most were white and college educated. Additionally, 317 of the participants provided blood samples that were analyzed for reproductive hormones. To gather information on marijuana use among study participants, researchers used a self-reported questionnaire that asked the men a number of questions about their usage, including if they had ever smoked more than two joints or the equivalent amount of marijuana in their life and if they were current marijuana smokers.

Among the participants, 365, or 55 percent, reported having smoked marijuana at some point. Of those, 44 percent said they were past marijuana smokers and 11 percent classified themselves as current smokers.

Analysis of the semen samples showed that men who had smoked marijuana had average sperm concentrations of 62.7 million sperm per milliliter of ejaculate while men who had never smoked marijuana had average concentrations of 45.4 million sperm per milliliter of ejaculate. Only 5 percent of marijuana smokers had sperm concentrations below 15 million/mL (the World Health Organization’s threshold for “normal” levels) compared with 12 percent of men who had never smoked marijuana.

The study also found that among marijuana smokers, greater use was associated with higher serum testosterone levels.

The researchers cautioned that there are several potential limitations to the findings, including that participants may have underreported marijuana use given its status as an illegal drug for most of the study period. The researchers emphasized that they do not know to what extent these findings may apply to men in the general population as the study population consisted of subfertile men in couples seeking treatment at a fertility center. Additionally, they noted that there are few similar studies to compare their results against.

“Our findings were contrary to what we initially hypothesized. However, they are consistent with two different interpretations, the first being that low levels of marijuana use could benefit sperm production because of its effect on the endocannabinoid system, which is known to play a role in fertility, but those benefits are lost with higher levels of marijuana consumption,” said Feiby Nassan, lead author of the study and a postdoctoral research fellow at Harvard Chan School. “An equally plausible interpretation is that our findings could reflect the fact that men with higher testosterone levels are more likely to engage in risk-seeking behaviors, including smoking marijuana.”

Italy bans unvaccinated children from school


  A generic photograph of a vaccine being drawn from a vial into a needle
The new law demands 10 compulsory vaccinations – and has proved controversial

Italian children have been told not to turn up to school unless they can prove they have been properly vaccinated.

The deadline follows months of national debate over compulsory vaccination.

Parents risk being fined up to €500 (£425; $560) if they send their unvaccinated children to school. Children under six can be turned away.

The new law came amid a surge in measles cases – but Italian officials say vaccination rates have improved since it was introduced.

Under Italy’s so-called Lorenzin law – named after the former health minister who introduced it – children must receive a range of mandatory immunisations before attending school. They include vaccinations for chickenpox, polio, measles, mumps, and rubella.

Children up to the age of six years will be excluded from nursery and kindergarten without proof of vaccination under the new rules.

Those aged between six and 16 cannot be banned from attending school, but their parents face fines if they do not complete the mandatory course of immunisations.

The deadline for certification was due to be 10 March after a previous delay – but as it fell on a weekend, it was extended to Monday.

“Now everyone has had time to catch up,” Health Minister Giulia Grillo told La Repubblica newspaper.

She had reportedly resisted political pressure from deputy prime minister Matteo Salvini to extend the deadline even further.

Ms Grillo said the rules were now simple: “No vaccine, no school”.

Italian media report that regional authorities are handling the situation in a number of different ways.

In Bologna, the local authority has sent letters of suspension to the parents of some 300 children, and a total of 5,000 children do not have their vaccine documentation up to date.

In other areas there have been no reported cases, while still others have been given a grace period of a few days beyond the deadline.

Is the law having an effect?

The new law was passed to raise Italy’s plummeting vaccination rates from below 80% to the World Health Organisation’s 95% target.

On Monday – the last day for parents to provide documentation proving their children had been properly vaccinated – the Italian health authority released figures claiming a national immunisation rate at or very close to 95% for children born in 2015, depending on which vaccine was being discussed.

The 95% threshold is the point at which “herd immunity” kicks in – when enough of the population is vaccinated for the spread of the disease to become unlikely, thereby protecting those who cannot be vaccinated.

That includes babies too young to be vaccinated themselves, or those with medical conditions such as a compromised immune system.

Last month, an eight-year-old recovering from cancer was unable to attend school in Rome due to his weak immune system.

The child had spent months receiving treatment for leukaemia, but was at risk of infection because a proportion of pupils in the school had not been vaccinated – including several in the same class.

Image copyright Getty Images
Image caption Demonstrations against compulsory vaccination were held in Rome, 2017

The Lorenzin law, drafted by the previous government, had a tumultuous birth. When the current coalition came to power, it said it would drop mandatory immunisations although it later reversed its position.

The two populist parties in power had faced accusations that they were pursuing anti-vaccination policies.

Writing in a Facebook post on Monday, Ms Grillo admitted it “is a law that, at the time of approval, we criticised for several reasons” – and said that the law would be changed to include only those vaccinations that were necessary based on scientific data.

Why do parents not immunise their children?

The anti-vaccination movement has been growing globally in recent years, sparking alarm from the World Health Organization.

A long-discredited paper by Andrew Wakefield was behind much of the scare, but rumours around immunisation have continued to spread, leading to public health risks as not enough people are immune to such diseases.

Mr Wakefield was struck off the UK medical register after fraudulently claiming there was a link between the measles, mumps and rubella vaccine (MMR) and autism and bowel disease in children.

He made the claim based on the experiences of just 12 children, and no other study since has been able to replicate his results.

Digital Technology Is Transforming Care Delivery


Jim was an elderly patient suffering from emphysema. He lived some distance from the nearest hospital and couldn’t easily see a doctor, and he was rushed to the hospital once or twice a month when symptoms of his chronic lung condition flared up, putting a heavy strain on him and his family. Then Jim’s life was transformed: He became the beneficiary of a revolutionary approach to healthcare, and he could be tested and his condition monitored without ever having to go to a hospital.

American health provider Mercy Health put Jim on a new “virtual care” program, and care was brought directly to his bedside at home. Mercy used remote technology to carry out tests, monitor Jim and make sure any worrying signs were responded to before they became an emergency.

This example shows how care delivery is being transformed by modern digital technology. Jim’s care was managed by the Mercy Virtual Care Center, a “hospital without beds” that uses digital technology to enable remote care of patients at home.

Randy Moore, former president of Mercy Virtual, speaking at the Siemens Healthineers Executive Summit in Frankfurt, Germany in October 2018, recalled how Jim’s wife summed up the benefits of remote care. “She told us, ‘Our family had two years where I could leave the house, go shopping and not be afraid. Jim got to be at home. You gave us the best gift we could have,’” Moore said. Hospitals can be stressful for the families of patients as they are an unusual and often inconvenient setting. Relatives may prefer home-based care.

The Value-Based Approach

Modern healthcare is about more than simply caring for the sick, he added. “We have to be excellent if Jim shows up, but we also have to be in the business of health optimization. We can unleash that power and give 10 times the value we have in the past,” said Moore.

Finding more effective ways of caring for patients is essential to overcome the challenges facing modern healthcare. Aging populations have created a spike in chronic illnesses even as healthcare budgets are spiraling downward and costs spiral upward, and new treatments are ever more expensive.

Many healthcare systems were put in place a hundred years ago primarily to treat acute medical problems, at a time when most people didn’t live long enough to develop chronic conditions. Today’s health systems are often ill-equipped to cope with the rise in long-term care. Hospitals are paid for the number of operations they perform—the “fee for service” model—not for the long-term well-being of patients. Yet hospitals are an expensive way of caring for patients. This disparity is forcing the transformation of healthcare systems to achieve the most patient value for money spent by keeping hospitalizations to a minimum.

The new value-based healthcare approach is turning the care model on its head. It rewards health providers for prevention and long-term results, rather than one-off operations, often providing a fixed fee or “capitation fee” for each patient every year. This incentivizes care providers to prevent illnesses by educating as well as diagnosing and intervening early.

Value-based healthcare is also leading a sea change in the way care is provided.

Improving Access to Care

Expanding access to care is an important step to reduce the incidence and severity of illness and to treat conditions before they lead to hospitalization. This means greater use of ambulatory services to diagnose, observe and treat patients outside hospitals. Many chronic conditions such as diabetes and lung disease, including emphysema, lend themselves to this approach.

Oak Street Health is one U.S. organization that has pioneered ways of improving access to healthcare for ordinary Americans, primarily working with older Medicare patients and focusing on prevention and treatment in the community. Chief Medical Officer Dr. Griffin Myers, told the Executive summit that 80 percent of illnesses are related to social and environmental factors, such as poor access to healthy food and clean water, a lack of stable housing and neighborhood violence. Doctors tend to think such factors are not part of their job, but Myers disagrees.

“It is time for us as leaders in this space to take responsibility for those social factors because those are the things that determine how well our patients do,” he said.

Oak Street charges insurers a set fee for patients, and pays all their medical bills as well as costs related to social and other factors, such as transportation. “The value-based model is not theoretical. Our goal is to keep people happy, healthy and out of hospitals,” said Myers.

Oak Street has achieved a 40 percent reduction in hospitalizations largely by addressing social determinants. However, a drawback in today’s reimbursement systems for hospitals is that this approach may lead to a decline in hospitals’ income as they treat fewer patients.

Increasing Workforce Productivity

While demand for care is rising, the medical professionals needed to provide this care are in limited supply. To address this imbalance, health providers are looking for ways to improve workforce productivity.

In a value-based healthcare system, productivity is increased by organizing care around a patient’s medical condition with integrated teams collaborating to help the patient through all stages of care.

A good example of this is the Martini-Klinik in Hamburg, Germany which was established in 2005 to focus on delivering care for a single condition – prostate cancer. The clinic handles over 2,200 prostate cancer cases a year and claims better outcomes than any other organization. But the clinic doesn’t simply “cure” patients and send them on their way. The Martini-Klinik uses research and patient surveys to measure the long-term outcomes of its care and find ways of improving them.

The clinic has focused on boosting productivity through training and supporting staff. This has led to greater job satisfaction and staff loyalty with a low employee turnover.

The clinic uses a system where all physicians involved in treating prostate cancer are given joint incentives. This encourages them to work together, reducing difficulties with handing over information and losing data.

As Dr. Ghada Trotabas, Senior Vice President of Marketing and Sales at Siemens Healthineers, told the summit: “The complexities of medicine have by far exceeded the ability of the single individual. Today’s medicine needs to be practiced in teams.” She compared these teams to “pit crews,” the integrated group of mechanics who service race cars.

Today’s value-based  care teams help the patient before, during and after treatment, and deal with side effects, complications and care throughout the process.

Like Oak Street Health, provider Kaiser Permanente, based in California, also uses a capitation model with a set fee per patient which creates incentive to improve the health of each patient and prevent illness. Kaiser promotes benchmarking of staff across the organization so everyone can see who the top, middle and lowest performers are in every area of care. Dr. John Mattison, Kaiser’s Chief Health Information Officer, told the summit that a workflow specialist regularly analyzes the company’s benchmarking data and helps recommend how clinics can achieve the best results. “We replicate that across the program, which requires integrated care and an ethos and culture, so you can transfer those processes and the system configurations from site to site very easily,” he said.

Mattison noted that too much emphasis has been placed on giving health providers incentives based on procedures, rather than outcomes. “The only way to change that is to change the cultural model—changing leadership, inspiration and motivation—as well as aligning the kinds of outcomes you want with pay.”

Managing Population Health

Value-based healthcare is also about managing health across entire populations. This includes public health information campaigns that promoted disease prevention and screening, as well as programs to identify chronic patients who will benefit from intensive programs and treatments.

Globally, managing population health will require a massive expansion of healthcare systems in developing countries. India has launched one of the biggest projects globally to put healthcare within reach of hundreds of millions of underserved people: Ayushman Bharat – also known as “Modicare,” launched in early 2018 by Prime Minister Narendra Modi, will bring health insurance and medical care to 500 million Indian citizens, cover healthcare costs of up to $7,800 for 100 million impoverished families and spend $188 million to create “health and wellness” centers.

“Healthcare was not on the political agenda of India like it has been in the USA,” Dr. Girdhar Gyani, Director General of India’s Association of Health Providers, told the summit. “Half of the money has been driven by the state government directly. But in the new scheme, we are pushing the insurance companies to drive it; the insurers will learn to make sure they put emphasis on preventive healthcare, and that is where technology will play a leading role.”

Modern advances in healthcare are designed to keep hospitalization to a minimum. As Kaiser Permanente’s John Mattison said, “An unplanned hospitalization for someone with a chronic disease is a system failure.”

Patients and their families are welcoming the transformation in care delivery, as illnesses are prevented, hospitalizations are reduced and the care workflow is improved. Hospitals may find that traditional income streams decline as a result of more efficient and remote care, but the clear aim is to keep patients out of expensive hospital beds and improve their quality of life.

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