I’m ready to confess that I’ve been basking in a particular drug-induced fantasy for a number of years. It’s a different type than we usual read about, and I suspect it’s shared by a fair number of other folks who work in biopharma. We dream of the day when a medicine we created begins to help patients. All those years of training and hard work (both yours and your colleagues), coupled with a little bit of luck and backed by a whole lot of money, have finally paid off. Maybe a family member has their life saved. Perhaps it helps your favorite athlete or musician, and they send you a nice note expressing their gratitude. Maybe no one you know personally takes the new drug, but sales figures tell you its helping thousands, if not millions, of people. Kudos rain down on you like an Oklahoma summer downpour, and one day it all culminates in an early morning phone call from Sweden.
That’s the dream, anyway. Reality, however, has a way of forcing itself into your reverie whenever you start to feel like you have a good understanding of how it all works. I love the awesome technical capabilities that the latest breakthroughs in biotechnology confer upon us. We can identify a whole genome’s worth of individual cancer mutations at the molecular level in just a few days. It’s possible to visualize the growth of a bacterial infection in living animals using bioluminescent imaging. The capability now exists to create entirely new organisms using pre-assembled genetic building blocks in a synthetic biology approach. A list of recent biomedical advances would easily fill a number of pages.
Living in this futuristic world is highly seductive, but what I’ve been reflecting on lately is how science has yet to catch up with either society or medicine in being able to actually solve a number of healthcare problems. A recent article revealed how doctors identified previously unknown gene mutations that were the underlying cause affecting sick newborns in a neonatal intensive care unit. The analysis took only two days, and it eliminated the need to run a large number of other tests. This knowledge, however, wasn’t actionable. It didn’t enable the doctors to treat the children, and they died.
While the technology is dazzling, it’s pretty humbling to recognize just how much more important low-tech solutions can be in the real world. Equally impressive is how well these solutions acquit themselves on an expense: benefit calculation. Many healthcare solutions cost virtually nothing, but contribute immensely to patient outcomes. While we toil to discover new, life saving medications, it’s become clear that a number of simple, inexpensive solutions can be more effective in helping a much wider spectrum of patients than any drug we can come up with.
Let me share a few examples:
Hand Washing By Hospital Staff Prevents Infections
Doctors, not surprisingly, hang out in an environment that is rife with viruses and bacteria. Touching and being coughed and sneezed on by countless patients every day makes them ideal disease transmitters. Virtually every hospital insists that their doctors (and nurses) wash their hands in between seeing patients, but, unfortunately, not every medical professional heeds this advice. Hand washing is an incredibly effective, low-tech method for preventing the spread of infections, but getting our health care professionals to consistently practice this technique has been challenging. We’ve read about the rise of dangerous drug-resistant bacteria (e.g. MRSA), yet studies have shown that only about 30 percent of the interactions between patients and hospital workers are preceded by hand washing. Every year some 48,000 Americans die from hospital acquired infections, and many others have their stays prolonged. Ironically, numerous high-tech approaches have been rolled out in an effort to combat the rise of hospital-acquired infections. One group has installed video cameras that send images of doctors seeing intensive care patients to India, where workers have been trained to check that hand washing gets done in every case. Another approach uses smart wristbands that use lights and vibrations to remind doctors to wash their hands when meeting new patients. Positive and negative reward programs have also been tried in an attempt to increase the practice of washing hands. It’s gotten to be so bad that at least one hospital has resorted to the same system your third grade teacher used when she wanted to motivate you: they pass out gold stars that workers can wear on their lapels.
Prescriptions Go Unfilled
I started off this article by reflecting on the dream of creating a very useful new drug. A bigger problem may be that people are not taking the existing medicines that were prescribed for them. A recent article estimates that 130,000 people die each year in the U.S. because of this. Exactly why
