Global Health Ideas

Finding global health solutions through innovation and technology

Archive for the ‘Pharmaceuticals’ Category

“Innovating for the Health of All” open for registration (Havana, November 2009)

Forum 2009
Innovating for the health of all
Innovando para la salud de todos
Havana, Cuba, 16-20 November 2009

Registration here

The letter:

Dear colleague,

Forum 2009: Innovating for the Health of All is this year’s milestone event in research and innovation for health. Organized by the Global Forum for Health Research, it will take place from 16-20 November in Havana, Cuba, at the invitation of the Ministry of Public Health.

What exactly is “innovation”?* How can decision-makers and practitioners work together to foster innovation for health and health equity? What can we learn from innovation policies and initiatives around the world? These questions will be answered in Forum 2009‘s interwoven discussions of social innovation and technological innovation.

This event will bring together some 800 leaders and experts from around the world to share ideas and forge new partnerships. It will include a unique mix of stakeholders from health and science ministries, research agencies and institutions, development agencies, foundations, nongovernmental organizations, civil society, the private sector and media.

As you expand your networks, you will also be able to learn from discussions on social entrepreneurship for health, public-private product development for neglected diseases, eHealth, knowledge-translation platforms, national health innovation systems, donor-country harmonization and coherence, and innovative financing strategies.

With the theme “innovation,” we are challenged to be innovative in the programme itself including new session formats that are more interactive, new ways to network and share information, and new opportunities for inclusion.

So please join us. Registration is now open on http://www.globalforumhealth.org. We very much look forward to seeing you in Cuba.

Yours sincerely,
Professor Stephen Matlin
Executive Director
Global Forum for Health Research

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Microbicides – Where are they Now? How much have we spent?

I was just sent this information (thanks to Becky!) about a new round of funding for microbicides, which comes on the heels of promising results from a trial of the PRO2000 microbicide candidate. We covered this a couple of years ago and at the time I said – the potential of this drug is revolutionary. With microbicides there was great excitement and hope, then there was failure and now there is some maturity. Okay, maybe I am overstating the case, the take home point is that we still don’t have a product and this is not cheap, easy, or quick. Developing a drug is complicated, involves huge risk, can take decades and is highly uncertain. Let’s review the drug development time line again for those of you not familiar – the graph below gives the most simplistic picture:

rx_development_timeline_crude

The early microbicide discussions took place almost 15 years ago (International Working Group on Vaginal Microbicides, source). Over half that amount of time, from 2000-2007, $1.1 Billion has already been invested in microbicide R&D! It takes anywhere from $200M to $1 Billion to bring a single novel drug to market. Let’s hope one of these compounds works and makes it through phase III. But how much will we have spent? $2 Billion, $3 billion? If it works, it will have been worth the money, however, we must ask if we took the most efficient financial route to get to the end point and if there were better financial models – that is a valid question.

Pharmaceutical Waste Dumped at Record Levels

We are generally focused on solutions and here, but I couldn’t help but post this news story on pharmaceutical “waste” being dumped into the water supply in India and what the subsequent impact might be (drug resistance, unknown clinical damage to those who consume the water, environmental destruction):

rx_waste
World’s highest drug levels entering India stream
AP News, Jan 25 (see full story here or here)

PATANCHERU, India –When researchers analyzed vials of treated wastewater taken from a plant where about 90 Indian drug factories dump their residues, they were shocked. Enough of a single, powerful antibiotic was being spewed into one stream each day to treat every person in a city of 90,000.

And it wasn’t just ciprofloxacin being detected. The supposedly cleaned water was a floating medicine cabinet — a soup of 21 different active pharmaceutical ingredients, used in generics for treatment of hypertension, heart disease, chronic liver ailments, depression, gonorrhea, ulcers and other ailments.

Those Indian factories produce drugs for much of the world, including many Americans. The result: Some of India’s poor are unwittingly consuming an array of chemicals that may be harmful, and could lead to the proliferation of drug-resistant bacteria.

In India, villagers near this treatment plant have a long history of fighting pollution from various industries and allege their air, water and crops have been poisoned for decades by factories making everything from tires to paints and textiles. Some lakes brim with filmy, acrid water that burns the nostrils when inhaled and causes the eyes to tear… “I’m frustrated. We have told them so many times about this problem, but nobody does anything,” said Syed Bashir Ahmed, 80, casting a makeshift fishing pole while crouched in tall grass along the river bank near the bulk drug factories. “The poor are helpless. What can we do?”

Written by Aman

January 25, 2009 at 9:43 pm

Donation Mapping Tool

The Partnership for Quality Medical Donations (PQMD) Mapping Tool, provides unprecedented access to information about the medical product donations being made…to the world’s most vulnerable populations. [Anyone] can easily determine where PQMD member donations are sent, find information on how the donations are being used by the communities who receive them and access a library of medical donation resources…” Source: Google Map Technology Enhances First Global Medical Donations Map

—-

I was alerted to the newly launched donation mapping tool by Jessica over at GHP (Global Health Progress). Thanks to her I got to sit in on a presentation of the tool which I found fascinating (but not sure anyone else did based on the lack of questions in the audience). The tool is a mashup of Google maps and donation metrics globally (location, type of donation, organizations involved, what type of supplies, volume, staffing on the ground to name some). The goal is to help collaboration, answer questions and facilitate the process of identifying who is working where and what are they doing? Second they wanted to bring to life the impact of donations (places, faces and outcomes). Other things I took away from the presentation:

  • Massive unmet need for medical supplies. Poor infrastructure & distribution are key challenges
  • Donations are meeting up to 40% of health needs in some areas
  • PQMD has 27 members total (non cash EX US dollar volume was $4 Billion dollars, including non PQMD members)
  • Private sector + NGO + Academia combo mix: The tool was incubated at Loma Linda School of Public health and is a joint effort with PQMD and industry.

They have put a lot of work into this and I think they have lots of neat information. The data comes from primary and secondary data sources. For example they use actual donor member shipping records and augment that with onsite data collection, interviews and site visits on ground with facility staff (location, staffing, needs). The public view is different from the private view so as not to compromise security of the facilities. There is a lot more I could write about this, but I’ll stop here and let you play around with the tool yourself:
mapping_pic

A few other things to note – the PQMD site has various interesting resources. Here are some more notes, and things to check out:

Have comments about the tool, leave them here:

Global Health Council 2009: New Technologies + Proven Strategies = Healthy Communities

The Global Health Council has released the theme for their 2009 conference to be held in Washington, DC: “New Technologies + Proven Strategies = Healthy Communities”.  I’ve been helping them with development of their CFP over the summer months – the focus is largely on ICT, but there is consideration given to other technologies also.  This is an applied conference with significant international representation.  In terms of a broad global health meeting, this is the best I’ve attended.

Written by Jaspal

September 2, 2008 at 2:30 pm

“Design Thinking” in Harvard Business Review (Tim Brown)

Cross-post from Design Research for Health: Mongolia:
 
Saw this over at Jocelyn Wyatt’s blog:

IDEO’s CEO, Tim Brown, wrote an article for June’s Harvard Business Review. This is a great introduction to design thinking.

If this link doesn’t work, go to the HBR website and look for the “Design Thinking” link.  Currently it is accessible as free content.

Brown does a great job of showing how thinking in design terms has value beyond products.  Services, processes, systems, experience, strategy can all benefit from design thinking.  And even with products, it’s not just about defining requirements in the late stages of the game, it’s about innovation:
 

Although many others became involved in the [Shimano “Coasting”] project when it reached the implementation phase, the application of design thinking in the earliest stages of innovation is what led to this complete solution. Indeed, the single thing one would have expected the design team to be responsible for—the look of the bikes—was intentionally deferred to later in the development process, when the team created a reference design to inspire the bike companies’ own design teams.

 

A couple extensions to Brown’s statements about the Aravind Eye Care System:    

 

Much of its innovative energy has focused on bringing both preventive care and diagnostic screening to the countryside. Since 1990 Aravind has held “eye camps” in India’s rural areas, in an effort to register patients, administer eye exams, teach eye care, and identify people who may require surgery or advanced diagnostic services or who have conditions that warrant monitoring.

 

In developing its system of care, Aravind has consistently exhibited many characteristics of design thinking. It has used as a creative springboard two constraints: the poverty and remoteness of its clientele and its own lack of access to expensive solutions. For example, a pair of intraocular lenses made in the West costs $200, which severely limited the number of patients Aravind could help. Rather than try to persuade suppliers to change the way they did things, Aravind built its own solution: a manufacturing plant in the basement of one of its hospitals. It eventually discovered that it could use relatively inexpensive technology to produce lenses for $4 a pair.

First, Aravind did try to persuade suppliers to change the way they did things.  The promise of a huge latent market was not convincing enough for existing suppliers to drop the price of their intraocular lenses (IOL).  It was then that Aravind built its own capacity to produce lenses, in what came to be known as Aurolab.  I would argue that both their attempts at negotiation with IOL manufacturers and their decision to produce their own lenses were reflective of design thinking.

Second, what Aravind did with outreach was based on the prior activities of the Dr. V and the other Aravind founders.  As far back as the 1960s, they were conducting eye camps while in government service.  The key innovation was a management one: changing from in-the-field surgery to screening patients and transporting them to hospitals for surgery.  This greatly reduced the burden on technical resources (surgeons and technology) and made patient followup easier.

Written by Jaspal

June 6, 2008 at 10:41 am

Global Health Council 5: We ♥ Margaret Chan

Friday ended with an impressive lineup of global health leaders discussing the disconnect between horizontal and vertical funding in the plenary session titled Meeting Along the Diagonal: Where the First and Last Mile Connect.  A webcast of this session, and 2-3 others from the Global Health Council Conference, will be available on kaisernetwork.org starting Tues-3-Jun-2008.  It’s nearly 2 hours long, but brings together ideas from the Gates Foundation, WHO, the Global Health Council, and USAID.  As much as it was about these organizations and the types of organizations (foundation, multilateral, advocacy, bilateral), it was about the individuals who spoke their minds:

  • Jaime Sepulveda, Director, Integrated Health Solutions Development, Bill & Melinda Gates Foundation
  • Margaret Chan, Director-General, World Health Organization
  • Nils Daulaire, President and CEO, Global Health Council
  • Henrietta H. Fore, Administrator, U.S. Agency for International Development, Director, U.S. United States Foreign Assistance
Victor Kamanga of the Malawi Network of People Living With HIV/AIDS was supposed to speak at this panel representing the community perspective, but was denied a visa by the United States.  Nils was brave enough to say that it may have been due to Kamanga being HIV-positive.
The session was moderated by Susan Dentzer, Editor-in-Chief of Health Affairs, and her performance – one that was witty, but neither overbearing or spectatorish – made more sense after I learned about her NewsHour and NPR roots.
Administrator Fore spoke of USAID’s accomplishments and left immediately for the White House.  The session was awash in metaphors related to the theme: diagonal (Sepulveda), fractal (Daulaire), circular (Gordon Perkin, in the audience).  Dentzer synthesized the overall position of each of the speakers in a few words (in order that they spoke):
  • Fore: “horizontal aspects to vertical programs”
  • Sepulveda: “integration”
  • Chan: “connect”
  • Nils: “fractal”
The collective message for me from the session was this: health systems are complex, we need to look at integrated solutions, and it will take time.
Sepulveda’s framework for looking at health systems requirements was his effort to “make that black box {of health systems] transparent”.  His four requirements of health systems are:
  1. Stewardship
  2. Financing
  3. Delivery (personal and non-personal services)
  4. Resource Generation (people, information, vaccines, technology)
He referred in his comments to 2 articles:
  1. Walsh J A & Warren K S. Selective primary health care: an interim strategy for disease control in developing countries. N. Engl. J. Med. 301.967-74, 1979.
  2. An “forgotten” article that Sepulveda wrote in the 1980s in the Bulletin of the WHO on the topic of “diagonalism”, but perhaps not in those words.  (I wasn’t able to find it, but if you know of the article, please post a link as a comment.)
Both Sepulveda and Daulaire had some interesting things to say, but I want to focus on Margaret Chan.  About 2/3 of the way through the sesssion, I was so taken by Margaret Chan’s honesty and perspective that I wrote “I ♥ Margaret Chan” in my notebook.  I passed my notebook to an NIGH colleague sitting next to me, who then showed me his notebook which had “I [heart] Margaret Chan” written atop his penultimate page of notes.  He didn’t want to draw a heart, he later told me, because he was afraid somebody might see it.  If that wasn’t weird enough, I told the story to another NIGH colleague, who responded that she too had written “I ♥ Margaret Chan” in her notebook.
Some Margaret Chan highlights (keep in mind her emphases in her tenure at the WHO have been Africa, primary healthcare, and women)
  • Dentzer told her she was “the James Brown of global health”, a reference to her work ethic
  • “What works for Hong Kong doesn’t work for Zambia.”  This sounds obvious, but there was quite a lot of talk at this conference about exporting successful models from one country to another.  I’m not saying you can’t learn from successes, but there is at least some better work we need to do in adapting those models to different situations.
  • “Primary healthcare faded from the vocabulary of global health.”  She cited Periago’s “crushed” comment from earlier in the day.  In fact, she brought in a lot of examples of what other people were saying throughout the day, so it’s clear that she was listening.
  • One of the other examples she brought up was a Johns Hopkins professor who in a morning comment advocated for “health impact assessments” like “environmental impact assessments” prior to doing something new.  (Sorry, don’t know the name of the JHU professor.)
  • “Famous soft drink”.  She didn’t name it because she didn’t want to advertise for it, but asked “why can’t we get to the same areas of the world?” (a reference to technologies like vaccines and medicines).  If we can’t do that, “we fail our people”.
  • “It’s easy to blame people when you fail.”
  • In referring to her 30+ years of experience: “I look young, but I’m not”.
  • “Primary healthcare was alive” in places like Brazil, India, and Argentina, even though it wasn’t in the “official vocabulary”.
  • “I’m not going to repeat the WHO definition of health.  To me health is a social objective.”
  • In indicating that we need to train more mid-level professionals: “For the clinicians in the audience, don’t worry, there’s plenty of work.”
  • “We have not listened enough.”  “We underestimate the ingenuity of the community.” “If you say ‘talk is one thing, walk is another’, I rest my case.”
  • “We are insular. We only look at the health sector.”  We need to look at safe water and sanitation, education, etc.
  • “Ministry of Health [alone] cannot handle the complexity of the situation.”
  • “Let’s be realistic. Even NGOs are making profits.”
  • “Why is it that working with industry is seen as dirty?” “Industry is part of the solution.”  We need to work with food and pharmaceutical industries.
  • Peer review is “another elephant in the room”- Chan identified most of the elephants.  It is a process by which “your friends condone your work”.

And my favorite, because it directly addresses the work I do and that we need to advocate for in the development of new technologies and services:

  • “I didn’t realize that the color of bednets makes a difference.”
  • “It wasn’t until we brought in the anthropologists that we found out that the color red represented death.”
  • They changed the color to yellow and people started to use them.
I encourage you to watch the session if you can spare the time.  Posted from the Wi-Fi bus between DC and New York.