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H E A LT H & S C I E N C E
In pursuit of next-generation
Ebola stockpile vaccines
Vaccines could be ready for future outbreaks
OREGON: In this Wednesday, Dec 3, 2014 photo, a nurse prepares liver cancer patient
Crispin Lopez Serrano for an endoscopy at a Clackamas, Ore hospital. — AP
Culturally sensitive palliative
care represents new approach
WEST LINN: When doctors diagnosed Pilar
Alcantara with advanced breast cancer, she
felt lost and intimidated. Growing up in
Mexico, she learned to deal with illnesses
using home remedies and prayer. She was
taught that doctors weren’t to be questioned, and she preferred not to know the
details of her illnesses or treatment plans.
She felt hopeless, but that was before she
connected with a Portland, Oregon-based
nonprofit that takes cultural habits and
beliefs into account while focusing on comfort and quality of life for patients with serious or terminal illnesses. She said the
approach saved her.
“A few years ago, because of the pain
and uncertainty, I wanted to bail on life,”
Alcantara said. “Palliative care gave me
more control over my cancer.” Palliative
care, which focuses on the well-being of
patients with serious illnesses by improving
doctor-patient communication and treating pain and side effects, has gained traction across the nation, but the culturally
sensitive model embraced by Familias en
Accion, the treatment center that has
helped Alcantara, represents a new
Medical crises
The method has taken root in Portland
and Seattle, and it’s being taught to nursing students in California for its potential to
improve care and reduce costs. Dr Woody
English, former medical director of palliative care at Providence Health and Services
in Portland, said the multi-faceted
approach “has the ability to transform the
usual health care system.” Studies show palliative care decreases emotional and medical crises and cuts down on unnecessary
emergency room trips and hospitalizations,
leading to cost savings sought under the
Affordable Care Act. “A patient who is not
having a crisis does not call 911,” Dr Diane
Meier, director of the Center to Advance
Palliative Care, said.
By adding a cultural emphasis, health
care professionals aim to address patient
needs that would otherwise be overlooked.
“Until we understand a patient’s drivers
and concerns - the social, emotional, religious and historical contexts - we can’t
begin to help the person,” and help them,
Meier said.
Familias started its program in 2011 with
a $260,000 grant from the Portland-based
Cambia Health Foundation. The system
involves patient navigators who help
chronically ill Latinos access doctors, fill out
insurance forms and find financial assistance. Familias also offers support groups
and health literacy sessions to help ease
stress, stabilize emotions and address cultural factors that might hinder care.
At the outset, the group tracked 90 seri-
ously ill patients for two years and showed
a 62 percent reduction in inpatient, outpatient and ER costs.
Among those who received help from
Familias was Crispin Lopez Serrano, a liver
cancer patient who had resigned himself to
fate and faith. The 58-year-old suburban
Portland resident had lost his private
health insurance when his illness made him
unable to work construction. “I was just
going to get by with the grace of God, eating aloe and drinking herbal teas,” Lopez
Serrano said.
A Familias navigator, however, helped
him sign up for Medicaid and retain his
same doctors. The support groups restored
his hope and let him know he wasn’t alone.
Getting to know other Latinos who were
fighting serious illnesses “motivated me to
live,” he said. Advocates want such programs expanded to help the increasing
population of aging minorities, and the
approach has popped up in spots around
the US
At Harborview Medical Center in Seattle,
where the foreign-born population has
increased 40 percent over the past decade,
culturally specific palliative care programs
have been created for immigrants from
Mexico, Somalia, Vietnam and elsewhere.
And, citing a need for growth, California
State University’s Institute for Palliative
Care has begun offering an online course
that hones in on the needs of Latino
Radically changed
The programs help break down barriers
that traditional care models miss, gaps that
can lead to improper diagnoses and poor
treatment. “Being culturally competent
means you know where people come from,
their values, and you take an extra step to
go toward where they are,” Olga Gerberg,
director of patient navigators at Familias,
said. “You need to address the mentality of
the person’s approach to illness.” In
Alcantara’s case, the organization radically
changed her approach by encouraging her
to educate herself about different types of
treatments and teaching her how to discuss them with her doctor.
With the help of her patient navigator,
the 45-year-old found a new oncologist
and decided against chemotherapy,
instead choosing a less taxing treatment
that allows more time with her two children. She now volunteers as a patient navigator, helping other Latinos. She says
there’s a need, since others likely face treatment barriers similar to her own. Growing
up, “health was just not so important,” she
said, explaining an obstacle that she once
faced. “It wasn’t something you discussed
openly. If there were problems, you fixed it
yourself.” — AP
LONDON: As West Africa’s devastating Ebola
outbreak begins to dwindle, scientists are looking beyond the endgame at the kind of nextgeneration vaccines needed for a vital stockpile
to hit another epidemic hard and fast.
Determined not to lose scientific momentum
that could make the world’s first effective Ebola
interventions a reality, researchers say the shots,
as well as being proven to work, must be cheap,
easy to handle in Africa and able to hit multiple
virus strains.
That may mean shifting focus from the
stripped-down, fast-tracked vaccine development ideas that have dominated the past six
months, but it mustn’t mean the field gets
bogged down in complexities. “We need a stockpile because there will be other outbreaks,” said
Seth Berkley, chief executive of the GAVI global
immunization alliance, which helps bulk-buy
vaccines for poor countries.
The experimental vaccines now moving into
large clinical trials in West Africa target the current Ebola Zaire virus strain, but the next outbreak may be different. “We need to work with
the pharmaceutical industry to create secondgeneration vaccines that would cover not just
Ebola Zaire but also Ebola Sudan and perhaps
Marburg, perhaps Lassa. The idea is to have vaccines that will work across different places,”
Berkley said.
Right now, scientists are grappling with several tricky issues-partly due to success in cutting
new infections in the vast Ebola outbreak. With
relatively few new cases, big trials in Liberia and
Sierra Leone to test the first generation singledose one strain vaccines may not have the statistical power needed to show whether the
shots work. And already, early data from safety
trials in humans suggest a single-dose vaccination with the most advanced vaccine, from
GlaxoSmithKline, may not provoke an immune
response strong enough to protect people
exposed to the virus.
“We now know you get around 10 times fewer antibodies in humans (than in monkeys) and
probably five times fewer T-cells,” said Adrian Hill
of Oxford’s Jenner Institute, referring to two key
elements of the immune system. This strongly
suggests that a two-dose regime, or a so-called
“prime-boost” approach, is the one likely to
prove effective, Hill said.
Sizeable challenge
These and other issues add up to a sizeable
to do list for scientists focusing on vaccines for
future stockpiles. Producing multi-strain, or multivalent, vaccines that could protect against different types of Ebola and other haemorrhagic
fevers will be more time consuming than making today’s monovalent shots, but it is by no
means impossible. In fact, several of the candidate Ebola vaccines being fast-tracked through
testing started out as multivalents before being
stripped back to deal with the current outbreak.
Another challenge is ensuring vaccines have
a long shelf-life and can be easily transported in
the tropics. At the moment, test shots are kept
at -70 or -80 degrees Celsius, although Johnson
& Johnson says its Ebola vaccine can be stored
at normal fridge temperature for many weeks.
Producing adequate volumes, however, looks
manageable. Hopefully, the next time Ebola
emerges from Africa’s forests it will be spotted
earlier and immunization will be needed for perhaps tens of thousands of people-nothing like
the tens of millions who would need vaccines in
a worldwide flu pandemic. Finally companies
still need a regulatory green light, which gets
tricky if large-scale trials fail to produce clear
proof that the shots are both safe and effective
in people.
Researchers and drugmakers say, however,
that regulators have made clear stockpile Ebola
vaccines could be approved on efficacy data
from tests in monkeys or other non-human primates plus proof of safety and immune
response in humans, reflecting contingency
plans for vaccines designed for bioterror attacks.
Pursuing tomorrow’s vaccines is not to say
one of today’s monovalent shots from GSK,
Merck or J&J might not yet have a role in ringfencing lingering pockets of infection in the current epidemic, and perhaps finally stamping it
out. “I’m pretty optimistic there’s still a role for
vaccination in ending this outbreak,” said Hill.
“And I’m certainly optimistic that we’ll learn for
the next outbreak which of these vaccine
approaches is the most likely to work, and be
ready to tackle it early on.” — Reuters
Scientist considered father
of birth control pill dies
SAN FRANCISCO: Carl Djerassi, the chemist
widely considered the father of the birth control pill, has died. Djerrasi died of complications of cancer Friday in his San Francisco
home, Stanford University spokesman Dan
Stober said. He was 91. Djerassi, a professor
emeritus of chemistry at Stanford, was most
famous for leading a research team in Mexico
City that in 1951 developed norethindrone, a
synthetic molecule that became a key component of the first birth control pill.
“The pill” as it came to be known radically
transformed sexual practices and women’s
lives. The pill gave women more control over
their fertility than they had ever had before
and permanently put doctors - who previously didn’t see contraceptives as part of their job
- in the birth control picture. In his book, “This
Man’s Pill,” Djerassi said the invention also
changed his life, making him more interested
in how science affects society.
In 1969, he submitted a public policy article about the global implications of US contraceptive research, according to the Stanford
News Service. In 1970, he published another
article about the feasibility of a birth control
pill for men. “The thoughts behind these two
public policy articles had convinced me that
politics, rather than science, would play the
dominant role in shaping the future of human
birth control,” he wrote.
Later in life, Djerassi, a native of Austria
who came to the US in 1939 with his mother,
wrote poems, short stories and plays. He used
stock earnings from the company that made
the pill to help collect Paul Klee art work,
which he donated to the San Francisco
Museum of Modern Art, the San Francisco
Chronicle reported.
AUSTRIA: In this Oct 20, 2009 file photo, Carl Djerassi talks to Austrian Chancellor Werner
Faymann, not seen, at the federal chancellery in Vienna. — AP
“Carl Djerassi is probably the greatest
chemist our department ever had,” Richard N
Zare, the Marguerite Blake Wilbur Professor in
Natural Science at Stanford, said in an obituary released by the university. “I know of no
person in the world who combined the mastery of science with literary talent as Carl
“He also is the only person, to my knowledge, to receive from President Nixon the
National Medal of Science and to be named
on Nixon’s blacklist in the same year,” Zare
added. Djerassi told the Chronicle last year he
was tired of talking about the pill. “Carl did
many things in his life - he was a true
Renaissance man and scholar,” Philip Darney, a
contraceptive scientist and director of the
University of California, San Francisco’s Bixby
Center for Global Reproductive Health, told
the Chronicle. He is survived by a son, Dale
Djerassi; a stepdaughter, Leah Middlebrook;
and a grandson, Alexander M Djerassi. — AP