Salud Pública (Continuación)

Cuando se trata de la atención de la salud, todas las partes involucradas –los pacientes y prestadores de servicios, las empresas farmacéuticas y los gobiernos– saben que algo tiene que cambiar. Durante décadas, el gasto en salud ha aumentado en promedio dos puntos porcentuales más rápidamente que el crecimiento económico en los países de la OCDE. Y, a medida que la población envejece y aumenta la incidencia de enfermedades crónicas, el problema solo puede empeorar si no se toman medidas al respecto. Necesitamos nuevos y mejores modelos, y estrategias eficaces para adoptarlos.

Esto es particularmente cierto en los sistemas de salud de los países en vías de desarrollo, que a menudo cuentan con menos recursos que en los países desarrollados.…  Seguir leyendo »

Hace cincuenta y un años, James Watson, Maurice Wilkins y Francis Crick fueron galardonados con el Premio Nobel de Medicina por su descubrimiento de la estructura del ADN –un avance que inauguró la era de los genes. Desde entonces, el campo de la genética ha avanzado significativamente, en particular por los resultados del Proyecto del Genoma Humano que, en 2003, identificó la totalidad de los aproximadamente 23,000 genes y 3 billones de pares de bases químicas en el ADN humano a fin de examinar numerosas enfermedades raras.

Sin embargo, a pesar de la evidencia de que gran parte de las enfermedades tienen un claro componente genético, solo se ha encontrado una fracción de los genes que las explican.…  Seguir leyendo »

La especie humana tiene un rendimiento reproductivo pobre y la tasa mensual de fecundidad natural no supera el 20% y es la más baja del reino animal. En otras palabras, una pareja supuestamente fértil puede necesitar un mínimo de 5-6 meses para conseguir un embarazo espontáneamente. Este bajo potencial de fertilidad que debería ser protegido y potenciado está amenazado por riesgos de orden médico pero principalmente de tipo social. No hay más que analizar los datos sociodemográficos españoles y compararlos con la situación que se da en Europa. En las últimas décadas se ha observado un incremento de la edad a la que las mujeres tienen su primer hijo, siendo en el 2010 la media de edad de 29,7 años en la Unión Europea mientras que en España es 31 años.…  Seguir leyendo »

Cuando era niño y vivía en Kano, en el norte de Nigeria, mi maestro de Corán estaba paralizado por completo de la cintura para abajo. Un muchacho con quien crecí no podía usar sus piernas. Fui testigo de esto hace 50 años, y en aquel entonces no sabía que ellos estaban paralizados debido a la poliomielitis. Este tipo de cosas eran sencillamente algo natural en la vida de Nigeria. En ese momento, nunca me imaginé que todo ese daño se hubiese evitado con una vacuna de fácil administración – es decir, si estas personas hubiesen sido inmunizadas, se hubiese evitado la parálisis.…  Seguir leyendo »

LA Humanidad se ha preocupado, desde siempre, de alargar la vida y conseguir la inmortalidad. Avances recientes prometen averiguar las bases genéticas del envejecimiento. Hasta hace poco no había evidencia fidedigna de edades muy avanzadas. Ahora la hay; por ejemplo, la Sra. Jeanne Calmmet, que era la estrella de 800 centenarios, que estudió Jean Dausset, tenía 122 años cuando falleció, con sus facultades físicas y mentales en muy buenas condiciones. Un año antes de su muerte le preguntaron cómo veía el futuro. Ella dijo: «Muy corto». Mi centenaria favorita es la premio Nobel Rita Levy Montalcini, que con 103 años va al laboratorio todos los días.…  Seguir leyendo »

I hope you never have this experience: a loved one is hospitalized. Her doctors tell you her infection is resistant to antibiotics. She dies. More than 60,000 American families go through that experience each year — and the number is almost certain to rise.

Multidrug-resistant organisms are showing up in top-flight hospitals — like the klebsiella found in the National Institutes of Health’s Clinical Center this year, which may have led to the deaths of seven patients. Even infections that used to be a breeze to treat, like gonorrhea, are becoming incurable.

In much of the world, of course, bacterial disease is a routine cause of tragedy.…  Seguir leyendo »

Los efectos perjudiciales de los medicamentos suelen aparecen en los titulares noticiosos en todo el mundo. Después de todo, es fácil vender historias de horror sobre "fármacos que matan". Sin embargo, y aunque sus efectos nocivos sean una causa legítima de inquietud, no necesariamente representan un problema grave de sanidad pública si son mayores sus beneficios.

Puesto que ayudan más de lo que dañan, se recurre a fármacos con perfiles de seguridad altamente adversos para tratar enfermedades que pueden acabar por causar la muerte, como es el caso de varias formas de cáncer, la artritis inflamatoria y el VIH. En lugar de evaluar aisladamente la seguridad de un medicamento, es necesario considerar sus efectos adversos en relación con su eficacia.…  Seguir leyendo »

Not long ago, the very notion of an AIDS-free world was one many of us working in the field did not dare dream of.

Now there is a new sense of optimism, driven in large part by scientific advances that have elevated the potential of anti-retroviral treatment as prevention to official health policy. They have been complemented by the development of an international scientific strategy and alliance working towards an H.I.V. cure — an idea that until recently many believed was redundant.

“Getting to Zero” has been the slogan for World AIDS Day (Dec. 1) since 2011 and will remain so through until 2015, coinciding with the Millennium Development Goal target of halting and beginning to reverse the spread of H.I.V./AIDS.…  Seguir leyendo »

Ridding the world of polio is proving to be an elusive goal. And a key problem may well be that organizers of the global anti-polio initiative, and of other global health programs, are not listening to the people they want to help — or to each other.

As a result, in many communities targeted by the programs, people perceive a gulf between global programs like polio eradication and more immediate local health needs.

As one man in Northern Nigeria asked me, “Why polio, polio, polio, when we cannot get a health clinic near our village?”

In fact, in the parts of Nigeria, Pakistan and Afghanistan where polio survives, the disease is not a major health issue.…  Seguir leyendo »

Every year, some 30 million children in Africa survive the first few perilous weeks of life, but within five years 2.5 million of them die. More than a half million of these deaths are a result of an easily curable disease: malaria.

In recent years, some progress has been made against malaria, which is caused by a parasite, Plasmodium falciparum, that is transmitted to humans by mosquitoes. The world spends roughly a billion dollars a year trying to contain the disease — mostly through insecticide-treated bed nets — and treating it at government-run clinics.

But just as nets are vulnerable to holes and wily mosquitoes, so, too, have our efforts to treat malaria been plagued by gaps, failures and the extraordinary cleverness of the pathogen itself.…  Seguir leyendo »

El brote de la enfermedad de la vaca loca en el Reino Unido, que obligó a sacrificar 3,7 millones de vacas y dañó seriamente la industria ganadera de ese país, comenzó de forma insidiosa. En 1986, una vaca en el RU desarrolló una enfermedad cerebral desconocida. El año siguiente, al someter el cerebro a pruebas de laboratorio, se descubrió que estaba carcomido por infinidad de pequeñas vacuolas, que le daban una apariencia similar a la de una esponja. Por este motivo, a la enfermedad se la bautizó con el nombre científico “encefalopatía espongiforme bovina”. En pocos meses comenzaron a aparecer casos nuevos en todo el país.…  Seguir leyendo »

Mucho se ha hablado de las diferencias entre el hombre y la mujer, son dos estilos distintos y a la vez complementarios. Pero hay un hecho que ha cambiado el panorama y ha sido la incorporación de la mujer a la universidad, que comienza en Europa hacia 1960, aunque lo hace antes en Estados Unidos. Se trata de una frontera imprecisa, desdibujada, borrosa, de contornos zigzagueantes, aunque habría que analizar muchos matices, sobre todo en los países del Este, bajo el régimen comunista.

La incidencia de la depresión en la mujer es de dos a tres veces mayor que en el hombre en el mundo occidental.…  Seguir leyendo »

It wasn’t funny, really, but everybody laughed at the scene in the 1979 film “Starting Over” when Burt Reynolds’s character had a panic attack in the furniture department of Bloomingdale’s (something to do with terror at the prospect of buying a couch). “Does anyone have a Valium?” his brother called out as Burt hyperventilated. The punch line: Every woman in the store reached into her purse and pulled out a little vial of pills.

Nor was it surprising that all those Bloomie’s shoppers could be so helpful, since by that time Valium, which had been introduced in 1963, was the best-selling prescription drug in America, with billions of blue or yellow or white pills, each stamped with a trademark V, sold every year.…  Seguir leyendo »

In the summer of 2007, mobile health (mHealth) was a field in its infancy. Monsoon season in Bangladesh, however, was in full swing, and with it came an enormous spike in cholera cases. I was working at a diarrheal disease hospital in the capital, Dhaka, at the time. More than 1,000 patients were rushed to the hospital on stretchers every day, most admitted to the makeshift wards of canvas tents that sprawled over parking lots and spilled into the streets.

It was there that I saw my first patient die. He was a 53-year-old male, a husband and a father, emaciated and severely dehydrated.…  Seguir leyendo »

Bad news is always interesting, especially when it starts small and threatens to grow large, like the little cloud on the distant horizon, no bigger than “a man’s hand”, that is destined to rise as a thunderhead (1 Kings 18:44). That’s why we read so avidly about the recent outbreaks of Ebola virus disease among villages in Uganda and the Democratic Republic of Congo, and about West Nile fever in the area around Dallas (where 15 have died of it since July). And that’s why, early this month, heads turned toward Yosemite National Park after the announcement of a third death from hantavirus pulmonary syndrome among recent visitors there.…  Seguir leyendo »

Consider an all-too-common scenario: You're burning up from a high fever after a routine surgical procedure, and an infection specialist is called to help treat your problem. You assume that a short course of antibiotics will quickly turn things around. But the specialist candidly admits: "I'm sorry, I can't treat your infection. You've got a resistant bacteria, a super bug."

Any of us might hear those frightening words sooner than we think.

Antibiotics once seemed like a miracle weapon in our fight against microbes that have plagued mankind for millenniums, killing untold numbers of people with wounds and serious infections. But we're in danger of losing that weapon.…  Seguir leyendo »

The beginning of the end of AIDS? The article with that title jumped out at me last week, as I did my weekly table-of-contents scan of The New England Journal of Medicine. I wasn’t prepared for the flood of emotion that overcame me. The beginning of the end? Could it really be?

For those of us who did our medical training in the late ’80s and early ’90s, AIDS saturated our lives. The whole era had a medieval feel, with visceral suffering and human decimation all around. Death was vivid, brutal and omnipresent.

Bellevue Hospital, where I trained, was one of those city hospitals that felt like ground zero for the plague.…  Seguir leyendo »

This week, tens of thousands of delegates are meeting in Washington for the biennial International AIDS Conference, striving to advance an agenda for an AIDS-free generation. Achieving such an ambitious goal will require multiple strategies, but virtually all agree that male circumcision — which provides powerful protection against HIV infection as well as other health benefits for men and women — must be a core element. Yet although some prevention efforts in Africa have been successful, others have floundered.

One of the lessons learned from these experiences is that when powerful Western donors set out to help people in poorer parts of the world, they sometimes end up creating more problems.…  Seguir leyendo »

Getting to zero – zero new HIV infections, zero discrimination and zero AIDS-related deaths – was unimaginable just a decade ago. Today, it has moved from commitment to action – from President Obama to Ebube Sylvia Taylor, born free of HIV despite her mother being infected with AIDS – to make AIDS part of history. The challenge before us is not how, but how quickly. We owe it to the more than 34 million people living with HIV.

The rate of new HIV infections has fallen in most parts of the world – more than 56 countries have stabilized or reduced HIV infections by more than 25 percent.…  Seguir leyendo »

Some drugs that the World Health Organization (WHO) has approved for distribution to the world’s poor are of inferior quality — shoddy products that hurt people who urgently need medicine — and some of the manufacturers, predominantly Chinese and Indian firms, may be knowingly producing them. This is the conclusion of my research teams’ studies, published this week in the journal Research and Reports in Tropical Medicine.

We purchased, off the shelf from local pharmacies, about 2,600 drugs to treat malaria, tuberculosis and bacterial infections in low- and middle-income countries, including Ghana, Nigeria, Turkey, India and China. We then tested these drugs to see how much active pharmaceutical ingredient — the chemical that performs the drug’s lifesaving function — they contained.…  Seguir leyendo »