I commend to your attention the work of Dr. Denise L Faustman and the TNF alpha working group.
What cannot be done in the US can easily be done overseas.
I would also like to discuss my experiences with BCG with you.
You might also be interested in our project to study the application of metformin and aspirin on cancer patients.
For personal correspondence:
Jeremy N. Smith
1131 Jackson Street
Missoula, MT 59802
1.406.721.1664
jeremynsmith@jeremynsmith.comJeremy N. Smith
www.jeremynsmith.com/
The Upshot
What’s worse: Ebola or AIDS? Measles or malnutrition? Lung cancer or low back pain? As individuals, as a nation, and as a global community, where should we focus our time and money to improve lives the most?
The
way we usually answer these questions is to count the number of deaths:
The more people killed, the more important the problem. Counting deaths
is so familiar that few have thought to question it. But death toll
alone says nothing about how long people live, and good health is much
more than not being dead.
Every year, for example, more than six million people worldwide die of stroke. Only about 300,000 people die worldwide of meningitis. So is stroke 20 times worse for humanity than meningitis?
Not necessarily — because most people who die of stroke are age 75 or
older, while those most likely to die of meningitis are infants. Death
is an inevitability, but a death in very early childhood is a tragedy.
All else being equal, saving the lives of infants should still be one of
our global health systems’ top priorities.
Now consider everything that doesn’t
kill people. If you are blind or deaf, anxious or depressed, disabled,
disfigured or simply sick, your pain does not show up in death records
or life expectancy statistics. Yet nonfatal conditions are responsible
for a majority of health spending — and of human suffering. Every time
we see a doctor and don’t die afterward, we demonstrate the inadequacy of counting deaths to track health.
Faced
with these issues, health economists have in recent years developed new
summary measures of personal, public and global health, perhaps chief
among them a unit they call disability-adjusted life years, or DALYs.
DALYs (rhymes with tallies) are akin to one of the advanced statistics —
like Wins Above Replacement — that have revolutionized professional sports. Except, in this case, the wins and losses are years of healthy life.
DALYs
are calculated first by measuring how many potential years of life are
lost when a person dies. DALYs then incorporate the total years lived
with disability — a measure based on international estimates of how much
each nonfatal condition detracts from perfect health. Being paralyzed,
for example, is considered close to half as healthy as perfect health,
so every year you live with paralysis, you have lost the equivalent of half a year of healthy life.
Focusing
on disability-adjusted life years may sound convoluted compared with
simple lives lost. But it more closely aligns with most people’s
intuitive sense of how health really works. Say, for example, that I’m
in a paralyzing car crash at age 35, but survive until age 65, when I
die (alas) from a heart attack. Then, assuming an ideal life span of 85
years, I lost 20 years of potential life to the heart attack. But,
because I lived 30 years with paralysis
after the car crash, the crash cost me the equivalent of 15 years of
healthy life. My total health loss is 35 DALYs, a figure that accounts
both for the health loss from the fatal heart attack and the health loss
from the nonfatal car crash.
Just
as baseball and other sports have been transformed by our understanding
of new numbers, public and global health can be, too.
In
late 2012, the British medical journal The Lancet published a new
ranking of the world’s leading health problems comparing deaths and
DALYs by cause. In terms of death, scientists reported, lung cancer
kills about 200,000 more people than road injuries annually. But
measured by DALYs, road injuries are almost two and a half times worse
for humanity. That’s because most fatal victims of lung cancer
are in their 60s, 70s and 80s, while those most likely to die of road
injury are in their 20s and 30s — and road injuries cause almost 40
times more disabilities. If you are an international policy maker or aid
agency choosing how much to invest in road safety relative to
antismoking campaigns, that’s vital information.
The
same kind of analysis works even better at a national level, where most
health spending takes place, because current health care gaps usually
correlate much more with the leading causes of DALYs than the leading
causes of deaths. As Mexico moved to a universal health care system in
the last decade, it used this type of analysis to prioritize those
treatments — like medications for childhood cancers, and emergency care
after a car accident — that reduce DALYs the most.
Australia
has used its own DALY calculations to direct close to $900 million in
public health program spending since 2009, focusing successfully on
curbing tobacco use, childhood obesity and diabetes.
Now
people everywhere can bring “Moneyball” to medicine. A few months after
releasing their global numbers in The Lancet, the same scientists
supplied the underlying figures for 187 nations. These statistics will
be updated again later this year. At last report, in the United States,
measured by DALYs, the third-largest health problem was low back pain. Fifth is major depressive disorders. Eleventh is neck pain.
Thirteenth is anxiety disorders. None of these maladies kill anyone
directly, so they don’t even show up on a list of leading killers. But
they still cause huge amounts of pain and suffering, and cost our
economy billions of dollars in lost productivity.
When
will low back pain get the research funds and attention given to lung
cancer, just below it in a DALY ranking? The toll from major depressive disorder,
No. 5, is estimated to be 20 percent worse than that from stroke. Why
don’t we promote early detection in the same way, on public billboards
and ad campaigns? Health loss from anxiety disorders is estimated to be
80 percent higher than that from breast cancer. Do advocates for anxiety treatment even have their own colored ribbon?
These
are provocative questions, and new statistics in any field are
inherently threatening to the status quo. But just because we have
always looked at things one way is no reason not to consider
alternatives, especially when it comes to something as fundamental as
improving how we all live and die. We don’t have to take new measures
like the DALY as the final word, but they highlight areas for health
gain we might otherwise miss. Advanced stats are too important to leave
to professional sports teams. We can all try to choose the prevention,
detection and treatment strategies that best add years to life and life to years.
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Watch Dr. Faustman's interview about the Phase I trial
Your donation will directly support our Phase II research.
Raised to date: $18.4 million
Our total need: $25.2 million.
Raised to date: $18.4 million
Our total need: $25.2 million.
------------
Interested in the Phase II Trial?
The Faustman Lab at Massachusetts General Hospital
Denise Faustman, MD, PhD, is Director of the Immunobiology
Laboratory at the Massachusetts General Hospital (MGH) and an Associate
Professor of Medicine at Harvard Medical School. Her current research
focuses on discovering and developing new treatments for type 1 diabetes
and other autoimmune diseases, including Crohn's disease, lupus,
scleroderma, rheumatoid arthritis, Sjögren's syndrome, and multiple
sclerosis. She is currently leading a human clinical trial program
testing the efficacy of the BCG vaccine for reversal of long-term type 1
diabetes. Positive results from the Phase I study were reported in 2012.Dr. Faustman's type 1 diabetes research has earned her notable awards such as the Oprah Achievement Award for “Top Health Breakthrough by a Female Scientist” (2005), the "Women in Science Award" from the American Medical Women’s Association and Wyeth Pharmaceutical Company for her contributions to autoimmune disease research (2006), and the Goldman Philanthropic Partnerships/Partnership for Cures “George and Judith Goldman Angel Award” for research to find an effective treatment for type 1 diabetes (2011). Her previous research accomplishments include the first scientific description of modifying donor tissue antigens to change their foreignness. This achievement earned her the prestigious National Institutes of Health and National Library of Medicine “Changing the Face of Medicine” Award (2003) as one of 300 American physicians (one of 35 in research) honored for seminal scientific achievements in the United States.
Dr. Faustman earned her MD and PhD from Washington University School of Medicine in St. Louis, Missouri, and completed her internship, residency, and fellowships in Internal Medicine and Endocrinology at the Massachusetts General Hospital in Boston, Massachusetts.
© 2014 Massachusetts General Hospital
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