A comprehensive global strategy is necessarily to fight the ‘silent epidemic’ of hepatitis C, according to a new report from the Economist Intelligence Unit (EIU).

Social and personal barriers to diagnosis and treatment, combined with the extremely destructive nature of the disease, are contributing to high death rates.

The EIU calls for health systems to develop “innovative ways to reach out to patients”, drawing parallels with the early years of the HIV pandemic.

The Silent Pandemic: Tackling Hepatitis C with Policy Innovation was commissioned by Janssen, a leader in the hepatitis C drug market.

HCV, the virus that causes hepatitis C, is thought to affect 150 million people worldwide – most of whom will develop chronic liver disease. Hepatitis C caused 86,000 deaths in the EU in 2002.

The disease can be prevented and effectively treated, but as few as 10% of people with HCV are receiving treatment.

Causes of the high infection and death rates identified by the report include: transmission through medical equipment and transfusions; transmission through intravenous drug use; poor epidemiological data and a low diagnosis rate; and poor medical compliance by intravenous drug users.

“The report highlights that worldwide, despite the significant burden of HCV, governments have failed to get a grip on the scale and impact of the disease,” said Charles Gore, President of The World Hepatitis Alliance. “In both developed and developing countries, the true human and economic cost of HCV will continue to rise unless policy makers confront this urgent public health issue now.”

The EIU recommends a number of strategies: effective disease surveillance, better public awareness, and measures to reduce high-risk behaviour and transmission via healthcare systems.

It also recommends that health systems find “innovative ways to reach out to patients, rather than relying on traditional healthcare structures”.

Gaston Picchio, Global Hepatitis Disease Area Leader at Janssen, commented: “Janssen is committed to working with the HCV community and will continue to engage with healthcare professionals, government officials and patient advocates around the world to support their efforts to reduce the individual and societal burden of this devastating disease.”

Lack of access to specialists is a major factor in the UK’s high lung cancer mortality rates, according to the UK Lung Cancer Coalition.

The coalition, which includes doctors, pharmaceutical companies and patient groups, has produced an “aspirational” guide to delivering lung cancer care.

Late diagnosis, poorly structured care teams and a “nihilistic view” of the patient’s prognosis were also identified as reducing patient survival rates.

The coalition’s Dream MDT report makes 30 recommendations for delivering lung cancer diagnosis, treatment and care through multidisciplinary teams (MDTs).

The report says these recommendations “should challenge lung cancer practice to strive to exceed, rather than simply meet, NICE guidelines”.

The UK has 240 lung cancer MDTs but too few specialists and a culture of low expectation, the coalition argues. Its recommendations include:

• A Lung Cancer Nurse Specialist should play a key role in ensuring optimal care for each patient.

• Transfer of care from secondary to primary care needs to be improved, with the GP informed of the patient’s progress at all stages.

• Each patient should be assigned a specialist lung cancer physician to manage their treatment.

• The MDT should deliver a two-stage process: diagnosis and treatment.

• Patients should know at all times what the next step is in their care pathway.

According to the coalition, about a third of NHS lung cancer patients do not have access to lung cancer specialist nurses or physicians.

By following the recommendations, the NHS could save 10% of the lives currently being lost to lung cancer, the coalition argued.

While smoking cessation programmes have reduced the incidence of lung cancer, prognosis for those diagnosed with the condition is usually poor.

US researchers have defined and tested new criteria for ‘hypersexual disorder’ as a distinct type of mental illness.

The diagnostic criteria identify a pattern of compulsive sexual thoughts and behaviours that impact harmfully on the patient’s life.

Hypersexual disorder (HSD) or sex addiction often develops in adolescence and young adulthood, making early medical intervention possible.

A team of mental health specialists and other experts led by UCLA psychologist Rory Reid have proposed the criteria with a view to inclusion in the Diagnostic and Statistical Manual of Mental Disorders.

The recognition of HSD as a distinct mental health condition would open up a new field for medical interventions.

The proposed criteria were shown in a test of 207 patients to be 88% accurate in positive identification and 93% accurate in negative identification, taking negative life consequences as evidence.

Such a low (7%) rate of misdiagnosis compares favourably with other categories of mental disorder.

The diagnostic criteria include: a persistent pattern of sexual thoughts and urges; a pattern of sexual activity in response to stress or negative mood states; failure to reduce or stop problematic sexual behaviours; and personal distress caused by the impact of these behaviours on relationships.

The study reported that 54% of hypersexual patients traced the problems back before the age of 18 and another 30% to the age period 18–25. This pattern, Reid noted, “has ramifications for early intervention and prevention strategies”.

Characteristic problem behaviours included heavy reliance on pornography, cybersex, bought sex or high-risk sex.

Reid noted that such behaviours are common – “but for these patients, it’s a constant pattern that escalates until their desire for sex is controlling every aspect of their lives and they feel powerless in their efforts to change.”

Thomas Szasz, a leading advocate of ‘patient power’ in psychiatry and critic of forced treatment and psychoactive medication, has died aged 92.

The author of The Myth of Mental Illness (1961) had a significant influence on mental health treatment in the UK, where his championing of psychiatric patients’ right to determine their own treatment pathway had many supporters.

While most psychiatrists did not accept his view that mental illness had no physical basis, Szasz was instrumental in developing a more flexible attitude towards diagnosis and treatment.

In addition, his promotion of community-based psychiatric care helped to influence the mental health strategies of recent decades.

Born in Hungary in 1920, Szasz migrated to the US in 1938. From 1956, he lectured in psychiatry at Upstate Medical University in Syracuse, New York.

As a practising psychiatrist, academic lecturer and writer, Szasz showed a lifelong concern with the dignity and freedom of the individual.

Pointing to the use of psychiatry as punishment in totalitarian societies, he argued that using forced treatment to resolve “problems in living” was a violation of patients’ rights.

According to his colleague Mantosh Dewan, Szasz forced the psychiatric profession to confront “the arbitrariness of psychiatric diagnoses” and helped to bring about the “de-institutionalisation” of many patients.

In 2010, Szasz gave a keynote address to the Royal College of Psychiatrists in the UK – but the RCP’s American counterpart had not given him a platform in almost 50 years.

Maxine Vaccine examines the lessons of a preventable death for doctors and the healthcare industry, and asks whether the true barriers to integrated care are cultural rather than economic.

This week, many UK newspapers carried the story of Alina Sarag: a 15-year-old Birmingham girl who died of tuberculosis after being told by two doctors that her problems were purely ‘emotional’. The correct diagnosis was only made post mortem.

The patient suffered from breathing difficulties, severe weight loss and frequent vomiting. Her GP allegedly refused to refer her for a blood test, suggested she needed to see a psychiatrist, and asked her if she was missing a boyfriend.

Later, a doctor at Birmingham Children’s Hospital diagnosed her problem as “a psychological issue”. She died after a respiratory arrest, and a pathologist said she had “one of the most severe cases” of TB in his experience.

This terrible chain of events was a failure of the medical profession to approach a critical problem empirically, rather than applying the ‘patient psychology’ of a TV doctor.

Alina Sarag’s GP allegedly said: “We don’t need these tests, we are not going to get them done either.” Because he had already put the patient into a box: she was the type of patient he knew all about.

As the squeeze on NHS funding intensifies, it’s that kind of doctor – cynical, hasty, preferring cleverness to evidence – who will flourish. The new CCGs will be assessed in terms of their business performance. That means competing with other health organisations, not working with them.

Expert clinical opinion has pointed to a need for integrated care – for primary and secondary care providers to work more closely together, ensuring that each patient is supported by a combination of diagnostic and therapeutic services, so their treatment is evidence-based and meets their real needs.

Within that context, the pharmaceutical industry has the opportunity to work across the spectrum of care providers to bring the right medicines to the right patients, at the right time, at the right dosage. The outcome is both definable and achievable: optimal medication. That’s what patients deserve.

Whether CCGs and Foundation Trusts, as businesses, will be incentivised to achieve that, or whether putting patients into convenient boxes and making categorical diagnoses will prove a better fit with the new business culture of the NHS remains to be seen.

But when you put a person into a box, you may be nailing down the lid.

Maxine’s views are not necessarily those of Pharmaceutical Field.

Bristol-Myers Squibb (BMS) has entered into a broad framework agreement with Dako on the development of pharmacodiagnostic tests.

The agreement, which builds on a collaboration begun in 2008, aims to develop diagnostics to identify patients more likely to benefit from treatment with BMS investigational drug candidates.

Pharmacodiagnostics (or companion diagnostics) are an important feature of the growing personalised medicine approach, which can improve outcomes and reduce healthcare costs by identifying individuals who are more likely to benefit from specific therapies.

Dako, a global leader in tissue-based diagnostics, has a history of developing clinical diagnostics in collaboration with pharmaceutical companies that are used in conjunction with drugs.

“It is a great pleasure for me to announce Dako’s new collaboration with Bristol-Myers Squibb,” said Lars Holmkvist, CEO of Dako. “This alliance heralds the intentions of both companies to work closely together to develop new diagnostic tests linked to drugs for the higher purpose of identifying the patients most likely to respond to treatment.”

“It is part of Dako’s long-term strategy to collaborate with pharma companies on the development of companion diagnostic tests.”

Based in Denmark, Dako produces reagents, instruments and software used by hospitals and clinics in more than 80 countries worldwide in the diagnosis of cancer and the planning of its treatment.

A new technology for point of care diagnosis of carpal tunnel syndrome (CTS) is about to be become available to GPs through leading UK healthcare distributor Williams Medical Supplies.

Williams has an exclusive agreement with Finnish company Mediracer to make this groundbreaking diagnostic tool available to UK primary care.

CTS, often linked to typing or driving, is a pressure on the median nerve in the wrist that can lead to numbness, tingling, weakness or muscle damage in the hand.

The use of Mediracer’s NCS test is claimed to reduce the CTS screening cost per patient from £270 in secondary care to £67 in primary care.

The Mediracer NCS technology identifies nerve entrapments in the hand using disposable surface electrodes. The results can be used to diagnose CTS and grade its severity.

Steve Dunn, CEO of Williams Medical Supplies, said: “We have a strong presence in the primary care market, but we want to strengthen our position to help suppliers and manufacturers – like Mediracer – to win more business.

“By offering exclusivity on key products to Williams, these companies will benefit from our unparalleled market penetration and business support.”

“CTS is a high-incidence condition and our tool provides consultant interpretation within minutes, allowing GPs to do work which is normally confined to hospitals and which saves the NHS money,” commented Pasi Karsikas, Mediracer’s Sales Director.

“We chose to partner with Williams for a number of reasons – they are the UK’s leading GP supplier, with excellent customer support and unrivalled market penetration – so we are looking forward to a bright future in this marketplace.”

Based in Gwent, Williams Medical Supplies is the UK’s leading provider of medical supplies and services, used by around 9,000 of the 10,500 GP surgeries.

New funding for medical technology research by companies, clinicians and academics aims to promote innovative approaches to the prevention, diagnosis and treatment of diseases in the NHS.

The National Institute for Health Research (NIHR) Invention for Innovation (i4i) programme has allocated up to £13m for research projects, and has launched a call for proposals.

The NIHR i4i programme funds projects through prototype and commercial development until a technology is ready for clinical testing, bringing together academic or clinical researchers and technical experts from industry.

The programme has been updated in two ways:

• Research projects in Wales, as well as in England, are now eligible for i4i.
• Instead of being divided between early- and late-stage product development awards, applications will all be submitted through a single route.

As well as looking for technologies that will benefit NHS patients, the NIHR i4i programme supports collaboration between researchers in industry, the NHS and the academic field. Each approved proposal will bring together researchers from at least two of these sectors.

NIHR particularly welcomes proposals from SMEs and from teams that have previously succeeded in developing and commercialising new technologies.

Martin Hunt, NIHR i4i Programme Director, said: “In the present economic climate, it is becoming increasingly difficult for medtech companies to secure funding for new, innovative technologies. The NIHR i4i programme provides a valuable funding opportunity for the medtech sector.”

This year’s i4i funding covers a “much broader” range of projects than last year’s, he noted. “The amount of funding awarded is determined by the nature and scale of the proposed research activity and we are considering projects seeking larger funding amounts than before.”

Outline research proposals must be submitted by 5pm on Wednesday 7 December 2011. Further details are available at www.i4i.nihr.ac.uk.

University College Hospital (UCH), London has purchased the UK’s first Biograph mMR hybrid molecular MR system (pictured) from Siemens Healthcare.

In the same month, the hospital’s Institute of Nuclear Medicine brought together clinical scientists to celebrate its 50^th anniversary.

The Biograph mMR – one of the first to be installed in Europe – will be housed in the UCH Macmillan Cancer Centre and used for diagnosis and planning of patient treatment, as well as research.

The world’s first simultaneous whole-body PET-MRI scanner. the Biograph mMR has won the red dot design award 2011 and the Frost & Sullivan Best Practices Award 2011 for its integrated design and scanning capabilities.

At the Institute of Nuclear Medicine’s 50th anniversary, Bruce Rosen, Professor of Radiology, Health Sciences and Technology at Harvard Medical School, gave a lecture on the future of combined PET and MR.

UCH Chairman Richard Murley thanked the UCLH Charity for funding the purchase of the new scanner.

Professor Peter Ell, former Head of the Institute of Nuclear Medicine, summed up half a century of medical imaging, including the first European nuclear medicine brain scanner in the 1970s; the first dedicated mobile renal function apparatus in the 1980s; and the introduction of PET-CT in cancer management.

The FDA has approved Abbott Molecular’s genetic diagnostic, Vysis EGR1 FISH Probe Kit, to detect acute myeloid leukaemia (AML).

The new in vitro test is the third of Abbott’s FISH assays to be cleared for oncology applications in the US in the past two months.

Stafford O'Kelly, Head of Abbott's Molecular Diagnostics Business said that the medical technology “can identify which AML patients have the chromosomal abnormality upon diagnosis and provides physicians with another clinically validated tool to assess a patient's overall prognosis”.

The Kit’s technology detects chromosomal deletion in the bone marrow, and can be used in addition to cytogenetics, other biomarkers, morphology and other clinical information, at the time of AML diagnosis to determine prognosis.

Each year, more than 12,000 people are diagnosed with AML, which is a rapidly progressive disease. Current standard procedure involves aggressive chemotherapy drugs, while some patients may require a stem-cell transplant to replace unhealthy bone marrow with leukaemia-free stem cells.  

Part of Abbott, Abbott Molecular is a leader in molecular diagnostics, analysing DNA and RNA at the molecular level. Abbott Molecular's tests aim for earlier detection or diagnosis, to provide information of appropriate treatment, and improve monitoring of disease progression.

Abbott is a global healthcare company, which discovers, develops, manufactures and markets pharmaceuticals and medical products, including nutritionals, devices and diagnostics. The company employs nearly 90,000 people and commercialises its products in more than 130 countries worldwide.