Healthcare, medicine & pharmaceuticals

Undoing the past

The science of memory recovery and preservation is set to be a growth industry given the increasing number of people aged sixty-plus who are losing their capacity for recollection. Conversely, the removal of long-term memories for younger people is receiving an increasing amount of interest to assist with post-traumatic stress disorder (PTSD). For example, 49% of rape victims suffer from some kind of PTSD as do 17% of people involved in serious car accidents and 14% of people who suddenly lose a member of their immediate family. Add to this an increase in war and terrorism related PTSD (in both soldiers and civilians) and you can perhaps understand why venture capital is flowing into this area. So how does memory work and how can it be removed? From a purely biological (evolutionary) point of view, memory is used for future survival. In other words, our brains are programmed to remember good and bad experiences so that we can repeat or avoid the same experience. Moreover, if an experience is repeated often enough it passes from short to long-term storage. One way of removing unwanted memories is to administer drugs immediately after a dramatic event (which is perhaps something some people do already by drinking to forget). Another way is to turn on or off certain genes that are involved with the consolidation of memories or even to administer an electric shock just after a person has been forced to recall a traumatic incident.

New drugs

Developments in genomic medicine and molecular biology are driving the creation of numerous new compounds, some of which are likely to make it onto pharmacist’s shelves in the near future.  For diabetics, daily injections of insulin could soon be a thing of the past following US and EU approval for a new inhaled form of insulin called Exubera from Pfizer. Other new drugs just approved or in the pipeline include Acomplia from Sanofi-Aventis to manipulate hunger (for obesity treatment), Gardasil from Merck to treat cervical cancer and Zostavaz (also from Merck) to treat shingles. Gardasil is being talked about as part of a roster of shots that children receive in the US, which should spark some interesting ethical debates. There is also a drug called Indiplon aimed at America’s 70 million insomniacs that allows people to fall asleep within 15 minutes and stay asleep longer without many of the traditional side effects like grogginess.

The architecture of sleep

There is a quiet revolution going on in the science of sleep. In the US, 70 million have trouble getting a proper night’s sleep and US $50 billion is lost every year due to sleeplessness. Add to this 100,000 automobile accidents caused by tiredness and you can see why getting a good night’s sleep is keeping lots of people awake. Conversely, the demands of our 24-hour societies mean that people are also looking for ways to keep people awake. One of the most successful drugs aimed at the latter is Modafinil, which was launched in 1998 and now has sales of US $575 million per year. This is intended to treat serious medical conditions like sleep apnoea but it is increasingly being used as a stimulant much in the same way as coffee, alcohol, cigarettes or even cocaine. Not surprisingly the US military is interested in Modafinil (and newer drugs like CX717) because it can keep combat troops awake for 48-hours while other drugs can provide sleep on demand. What about the other side of the sleep equation? The term ‘sleep architecture’ refers to the fact that humans have several sleep states each with its own brain state. Understanding each of these will be key to advances in the control of sleep and awakeness in the future. For example, it is highly likely that drugs will be developed that will give people condensed doses of ‘super-sleep’. There could even be pills to provide the equivalent 2, 4, 6 or 8-hour doses of quality sleep that would free us from the need for genuine sleep. But what are the longer-term consequences of a society where sleep is available 24/7? or where people work or play for 22-hours and sleep for just two? Or how about a technology that could remove the need for sleep completely? On a related note, the Economist magazine recently reported on similarities between animal hibernation and dementia in humans. In short, if we can fully understand hibernation, we may be able to turn off diseases like Alzheimer’s with the flick of a switch.

Health haves and have nots

Here are some interesting statistics. In the US last year, deaths caused by smoking tobacco have fallen for the first time since records began seventy-five years ago. In 1965 41.9% of Americans smoked but today that figure has fallen to 20.9%. However, globally tobacco use is rising with increasing numbers of people, particularly women, taking up smoking in countries like China, Bangladesh, Malaysia and Cambodia. In other words the world is becoming polarised between non-smoking countries in the West and smoking countries in East Asia (with most of the big tobacco companies being based in the former). So what’s likely to happen next? First, healthy and wealthy regions like the Europe and the US will probably have to support the health infrastructure in the East. Secondly, there will be a continued battle between treasury ministers and health ministers over how the tobacco industry should be regulated and how information about smoking should be paid for. Lastly, it is quite conceivable that healthcare will be openly rationed and laws will be passed to limit access to health services based on lifestyle factors.

e-therapy

Telemedicine has been around for a while but it has largely been confined to hospitals monitoring patients at home in terms of vital signs or drug delivery. However, an emerging area of care is e-therapy where psychologists and psychiatrists are treating patents remotely – either to jump long waiting queues or because the patents live in remote areas. The technologies that are being used are varied and include everything from e-mail and mobile phones to websites and streaming video and they are being used to treat conditions like post-traumatic stress disorder, anxiety and addiction. Early studies indicate that long-distance therapy is widely accepted and liked by patients but there are problems around identity verification and confidentiality. In the US licences to practice medicine are also limited to state boundaries but access to the Internet access is not.Time for the law to catch up with technology perhaps?