What is the Merit of Originality?

‘I am not young enough to know everything,’ as Oscar Wilde once said, and maybe the rest of us aren’t either. It is often an unquestioned assumption that New trumps Old, that innovation usually leads to improvement, and that by standing on the shoulders of giants, the view is necessarily better. Clearer.

But there is wisdom in both the long as well as the panoramic views. Neither changing  your shoes nor altering your hat, really improves the safety of a voyage -nor does it address the original goal of a safe arrival of everybody on board. Appearing modern, seeming prepared, only helps if it helps –a leak is still a leak, especially if there are only lifeboats for a few…

Let me explain. I happened upon an article in the journal Nature that chronicled the introduction of a new, and highly accurate method of diagnosing TB through genetic analysis.  https://www.nature.com/news/improved-diagnostics-fail-to-halt-the-rise-of-tuberculosis-1.23000?WT ‘The World Health Organization (WHO), promptly endorsed the test, called GeneXpert, and promoted its roll-out around the globe to replace a microscope-based test that missed half of all cases.’ It sounded like a perfect technological fix for a disease that has so far avoided effective control. ‘Some 10.4 million people were infected with TB last year, according to a WHO report published on 30 October [2016?]. More than half of the cases occurred in China, India, Indonesia, Pakistan and the Philippines. The infection, which causes coughing, weight loss and chest pain, often goes undiagnosed for months or years, spurring transmission.’

Unfortunately, ‘[…] the high hopes have since crashed as rates of tuberculosis rates have not fallen dramatically, and nations are now looking to address the problems that cause so many TB cases to be missed and the difficulties in treating those who are diagnosed. […] The tale is a familiar one in global health care: a solution that seems extraordinarily promising in the lab or clinical trials falters when deployed in the struggling health-care systems of developing and middle-income countries. “What GeneXpert has taught us in TB is that inserting one new tool into a system that isn’t working overall is not going to by itself be a game changer. We need more investment in health systems,” says Erica Lessem, deputy executive director at the Treatment Action Group, an activist organization in New York City.’

But I mean, just think about it for a minute. ‘The machines cost $17,000 each and require constant electricity and air-conditioning — infrastructure that is not widely available in the TB clinics of countries with a high incidence of the disease, requiring the machines to be placed in central facilities.’ Sure, various groups agreed to subsidize the tests in 2012, but: ‘each cost $16.86 (the price fell to $9.98), compared with a few dollars for a microscope TB test.’ So which test would you choose if you were a government strapped for cash to provide for healthcare for a broad spectrum of other equally pressing needs?

‘Even countries that fully embraced GeneXpert are not seeing the returns they had hoped for. After a countrywide roll-out begun in 2011, the test is available for all suspected TB cases in South Africa. But a randomized clinical trial conducted in 2015 during the roll-out found that people diagnosed using GeneXpert were just as likely to die from TB as those diagnosed at labs still using the microscope test.’ That seems counterintuitive to say the least.

So what might be happening? ‘Churchyard [a physician specializing in TB at the Aurum Institute in Johannesburg, South Africa] suspects that doctors have been giving people with TB-like symptoms drugs, even if their microscope test was negative or missing, and that this helps to explain why his team found no benefit from implementing the GeneXpert test. Others have speculated that, by being involved in a clinical trial, patients in both arms of the trial received better care than they would otherwise have done, obfuscating any differences between the groups.’

‘Even with accurate tests, cases are still being missed. Results from the GeneXpert tests take just as long to deliver as microscope tests, and many people never return to the clinic to get their results and drugs; those who begin antibiotics often do not complete the regimen.’ Clearly, technology alone, without an adequate infrastructure to support it –without a properly funded and administered health care system- is not sufficient.

And it’s simply not enough to have even a well-funded health system that benefits just those who can afford it, leaving the rest of the population to fend for itself, and only seeking help when they can no longer cope –often when it is too late. Health care is a right, not a privilege –no matter what those in power would have us believe.

I’m certainly not arguing that improving technology is not part of the solution, but sometimes I wonder if it is merely putting new clothes on a beggar. Handing out flowers in a slum.

Let’s face it, real Health Care is more than a sign on a door, more than a few people in white coats. It is a kind of national empathy. A recognition that even the poorest among us, have something valuable to contribute; that even those who have strayed from society’s chosen path, are who any of us might be, but in different clothes.

The myth of Baucis and Philemon tugs at my memory: They were an old married couple living in a small village in Anatolia (part of Asian Turkey nowadays) who, unlike everyone else in the town, welcomed two peasants at their door who were seeking refuge for the night. The couple, of course, were unaware that they were actually welcoming two gods, Zeus and Hermes, disguised as humans. A common enough trope, perhaps, but an instructive one, I think -one that transcends virtually all cultures, and borders: the idea of helping others without any expectation of reward. It is not an exchange -a transaction- so much as an action. Agape, in fact.

Health care is like that. Or should be… It’s not about the glittering display in the shop window –there to impress the passersby- it’s about the people in the shop.















Once Upon a Time

Once upon a time, rumour had it that we were at the top of our game –nothing else came close. Well, maybe chimpanzees, but come on –they don’t even have a decent language, so how would we know? Anyway, we had no real competitors, and –just in case- we wrote the rules and we were the judges. Until now, that is.

It seems that the pigeon cartel has moved in on mammograms and apparently there is a push to read pathology slides as well: http://www.bbc.com/news/science-environment-34878151  Now I don’t want to come across as a Speciest, or suggest that I  wouldn’t welcome a family of them living down the street or anything, but it seems to me that we have draw the line somewhere. Jobs are going to be lost; an industry is in jeopardy. I mean, why would we train people for years and go to the expense of kitting them out in those long white coats that need constant laundering when it would be so much easier to head downtown and pull a couple of pigeons out the park? So what if they shed their feathers? Do we ever have enough pillows? And diseases they might carry? Show me a pathologist who is sterile and I’ll show you a hologram. And besides, you don’t have to put the pigeon on anybody’s breast, do you? They are experts once-removed –twice removed if you kept the cages in another room altogether. Mind you, the cooing sounds would help to allay the anxiety over the anticipated and legendary pain of pressing a perfectly good breast into an X-ray sandwich so compromises may evolve.

Now, I can foresee some difficulties in training the birds to use the standard-issue microscopes, though. Some thought will have to go into new designs for the eye-pieces, I suspect. Oh, and wing-activated focussing devices, too. For years we’ve been selfishly designing stuff for fingers and spectacle-wearing eyes straddling long and often itchy noses; it’s long since time to start thinking beaks and feathers.

But utilizing pigeons may just be the first tentative step in revolutionizing medicine –farming it out, as it were. The article also whispers about glimpses of giant African pouched rats detecting tuberculosis –something to do with stuff they keep in those pouches, I’ll bet. In breathless anticipation of a bespectacled, stethoscope-wielding animal with huge teeth and accompanied by the characteristic snaky tail, I was relieved that Google only displayed the nice ones you could feed peanuts to -the cute ones that nobody would mind crawling over her chest looking for little bits of TB. And maybe with a few modifications they could be induced to do mammography kinds of quests and check for cancer while they’re in the neighbourhood. Maybe, if they caught on as pets, we’d have a lot less disease to worry about. Oh sure, there’d be other stuff –fleas, for example, and maybe plague- but everything’s a trade-off isn’t it? We could train people in turn to learn to balance risks. Decide what’s really important to them or their families. I mean, don’t we already do this with sports and their attendant injuries? You have to admit that a lot more of us suffer from concussions than die from the Black Death nowadays. And then there’s the whole panoply of traffic –related issues. Uhmm, did I already mention war?

No, we have to look further afield than we have to date: new answers; new questions, even. I don’t know… I suppose it’s only a dream, but I’ve always felt we would all be better off using what’s around us, rather than destroying it. Joining the web of life, not tearing it down. We are Nature, for goodness sakes.

Who knows, this refreshing outlook might spawn new and exciting industries… I didn’t actually mean to use the word ‘spawn’. We haven’t yet enlisted salmon in our quest for laboratory help, although their legendary ability to see underwater might be a real boon to public health infrastructures –in waste treatment and the like. But don’t hold your breath; it’s coming. We’ve barely even splashed the surface!