Healthcare, medicine & pharmaceuticals

New ways to deliver drugs

Given some of the problems associated with taking medicine (eg, some people can’t swallow pills while others forget to take them or are terrified of needles), it’s surprising that more time and money isn’t spent on developing new delivery mechanisms. We’ve already seen needleless syringes and plasters (eg, nicotine patches) used to deliver drugs, so perhaps these two new ideas will stick. In Japan a contact lens maker (Menicon Co) has developed a lens that can slowly release medication into the eye. This is useful because traditional eye drops can be washed away by tears, reducing their effectiveness. The second idea is based around the humble drinking straw. Unistraw’s ‘Sipahh’ straw is primarily a way to deliver flavouring to milk (see food and drink section in this report - issue 9) but the technology can also be used to add other ingredients or pharmaceuticals, especially to younger and older patients. Meanwhile, a Swiss company called Vestergaard Frandsen has essentially inverted the same idea to create the Life Straw. This is a straw that can be used to filter 700 litres of water so it’s clean enough to drink. Seven types of filter – including active carbon and iodine – protect against diseases like typhoid. LifeStraw will be available from early 2006 and priced at around USD $3 each.

Clearly better

Turning pill packaging on its head, US retailer Target has introduced a range of upside-down pill bottles called Clear RX. The prescription packaging features clear plastic rather than the traditional brown or amber-coloured plastic so you can see what’s inside. The inverted and flattened design also makes reading the label easier. Critical information such as drug type and dosage appear on top while warnings are displayed on the reverse. There is also a pull-out card to display uses and side effects and coloured plastic rings around the neck to prevent confusion or family mix-ups.

Personalised drugs

Given that 90% of drugs don’t work for 30% of people, it’s perhaps not surprising that drug companies are starting to focus on precision drugs that are created by and targeted at an individual’s genetic make up and hereditary characteristics. The implications of individualised medicine are dramatic. First, it represents a shift away from the ‘blockbuster’ business model that is already at a something of a watershed, with fewer drugs getting launched and more getting withdrawn (in 2004 the there were just 113 submissions for approval in the US compared to 131 in 1996). Second, re-focusing R&D towards individuals – or, more accurately, sub-groups of individuals – means that pharmaceutical companies will be forced to address sub-populations in regions like Africa and India. According to a World Bank report published in the Lancet (UK), only 16% of drugs registered between 1975 and 1999 were for diseases more common in the developing world than in the West. Moreover, there has been an historical tendency to treat regions like Africa as cheap testing grounds rather than primary areas for clinical trials. If individualised treatments do take off – and they almost certainly will – genetic diversity will be an integral part of the testing process and regions like Africa will become much sought after for research and treatment.

New diseases

There are approximately 1,400 pathogens in the world that can kill people. According to researchers at Columbia University (US), new pathogens emerged (or re-emerged) 409 times during the past 50 years and the trend is accelerating significantly. Moreover, most of the new human pathogens are coming from animals. So what’s driving this increase? Nobody knows for sure, but somehow the way the world is changing is giving pathogens new opportunities to infect new species or get into new areas. The list of likely culprits includes rapid urbanisation (more people living closer together but also more people living close to animals – which are themselves squashed together), the intensification of agriculture and globalisation. However, it is probably the latter that is the most likely suspect. First, globalisation means that animals are moved from one place to another more frequently. Second people are moving more frequently and faster too. SARS (which was of animal origin) was spread by international travel, and as we become more connected through cheap air travel and the globalisation of jobs we are more susceptible to new and old diseases alike

Targeted healthcare

Supermarkets have used precision marketing using sophisticated social segmentation techniques for years to help them decide where to build stores to achieve maximum impact. Now heath planners are targeting those local communities most in need of testing or ‘intervention’ using the technique. The process has been pioneered in the UK by a healthcare information company called Dr Foster, market research firm Experian, and the Department of Health. The process can be used to target specific streets, schools and workplaces. For example, a campaign in Slough targeted individuals most in need of screening for type-2 diabetes.    Of the 2000 people identified using social categorisation, 106 were discovered to be undiagnosed type-2 sufferers. A similar campaign in Brent targeted teenage pregnancy. However, while such techniques are undoubtedly effective what is the cost in terms of privacy? For example, health services are already targeting people that aren’t yet ill but whose profile suggests that they will be in the future. This is spookily reminiscent of the Department of Future Crimes in the film ‘The Matrix’. Or another example: What if alcoholism or lung cancer was found to be a specific problem in one community. Should the government act to remove products like alcohol and tobacco from local shops in the area? (like they already do in some parts of Australia).