Many of the medical advances of the past half century have involved expensive, high-tech diagnostic tests and treatments. A trend in this direction has worried health economists and politicians as it could send already high health care costs into the stratosphere.
But in both medicine and dentistry, creative, low-tech, and inexpensive approaches to improving health and extending life play an important role.
A few years ago, the FDA approved Zolgensma, which costs just over $2 million per dose, to treat spinal muscular atrophy, a rare childhood genetic disorder.a disease caused by a genetic defect called SMN1, which affects approximately 400 babies each year in the United States, and is the most common disease and dies in the first few years of life. This treatment uses a non-pathogenic, genetically engineered virus to SMN1 Genes are introduced into the patient’s cells so that they can synthesize proteins needed for normal muscle neuron development.
Gene therapy treats an increasing number of genetic diseases, but its cost is prohibitive. Last year, the FDA approved a product called Hemgenix to treat hemophilia B caused by mutations in hemoglobin. At $3.5 million for a single injection, it is the most expensive drug in the world. Another application of gene therapy was recently reported in a phase 3 trial of a biologic called aloctocogenve roxaparvovec. This significantly reduced bleeding rates in patients with severe hemophilia A despite standard factor VIII prophylaxis. Pharmacokinetic modeling suggested that factor VIII activity levels would remain in the range of mild hemophilia for at least 5 years after gene transfer.
Another remarkable genetic engineering feat reported in the journal Nature 2017. He had epidermolysis bullosa conjunctiva, a genetic disease that had caused large portions of his skin to blister and be destroyed by an experimental gene therapy procedure used to distort and grow sheets of healthy skin. His 7-year-old boy’s life was saved. He was dying, but two years after being treated with genetically modified cells by a multinational team, his skin was healthy and he was leading a normal life.
While these kinds of high-tech interventions are eye-opening, there are many simpler, cheaper, yet very important innovations for diagnosing and preventing disease. A checklist for office and ICU personnel. According to a Norwegian research group, “safety checklists are effective in a variety of clinical settings by enhancing guideline adherence, improving human factors, reducing the incidence of adverse events, and reducing mortality and morbidity.” It appears to be an effective tool for improving patient safety in
In some cases, simple tools or devices are important for clinical diagnosis. One example is a handheld direct ophthalmoscope. This allows the practitioner to look inside the eye to determine the health of the retina, optic nerve, vascular system, and vitreous humor (fluid inside the eye). Invented in 1851, it costs less than $200.
Another example is how a single blood test can confirm that a patient in the emergency room has not had a heart attack, avoiding the inconvenience and expense of additional invasive tests and unnecessary hospitalizations. A sensitive blood test measures levels of cardiac troponin, a protein involved in muscle contraction. If the levels are undetectable, that is, below the detection limit of the test, the patient has a greater than 99% chance of her. no Have had a heart attack and have a very low risk of other adverse cardiac events for at least 30 days.
This innovative approach benefits patients, reduces the frequency of hospital stays, and helps reduce healthcare costs.
Falls are both a cause and a consequence of poor health in older adults. They are the leading cause of injury-related emergency room visits and the leading cause of accidental death in Americans age 65 and older. To gauge the potential benefits of low-tech approaches to prevent these injuries, a New Zealand study group compared mortality rates. Percentage of falls and fall injuries on low-impact flooring (LIF) compared to standard vinyl flooring in a ‘elderly health ward’. Falls were prospectively monitored with written reports of all incidents, noting the location and outcome of each fall. and injury frequency.
Investigators found that there were 278 falls (out of 178 falls) over the 31 months of the study. Although the fall rates he found were indistinguishable between the two groups, “the frequency of fall-related injuries was significantly lower when occurring in LIF (34% of falls on the control floor compared to 34% of falls on the control floor). was 22% of the total)”. Also, many of the injuries avoided were serious. “Fracture occurred in 0.7% of falls in the LIF cohort compared to 2.3% of him in the control cohort.”
As such, the New Zealand study provides a compelling rationale for adding low-impact flooring (among other changes) to housing for older people.
Dentistry also benefits from expensive high-tech innovations such as dental implants, but low-tech preventive methods can provide much-needed dental health benefits. It is one of the major public health concerns for both the nation and the developed world.It is one of the most common chronic diseases in the United States, and most adults will have at least one cavity in their lifetime. will be Tooth decay causes inflammation of the surrounding gum tissue, abscesses, and ultimately tooth loss. In addition to severely impairing quality of life, dental caries and periodontitis are associated with increased risk of cardiovascular events, systemic infections such as endocarditis, and complications during pregnancy.
Perhaps the ultimate low-cost, low-tech intervention is dental floss, which offers tremendous health benefits. Removes dirt and plaque between teeth and deep in the gums that cannot be reached by brushing alone. By regularly removing plaque from these areas, flossing can help prevent gum disease, tooth decay, and bad breath. This is especially important given the link between periodontal disease and serious cardiovascular events. .
The Centers for Disease Control estimates that about 100 million Americans still do not have access to fluoridated water. Wider adoption of this low-tech and highly effective procedure will greatly reduce the need for many dental procedures.
High-tech miracles continue to garner attention, but simpler, relatively inexpensive innovations are also essential to improving public health. This has political implications. We need to put research funding into potential big-ticket high-tech blockbusters and original, low-tech innovations.
Henry I. Miller is a physician, molecular biologist, and Glenn Swogger Distinguished Fellow of the American Council on Science and Health. He was the founder of his FDA’s Office of Biotechnology. Shiv Sharma is a dentist and owner of Palo Alto Oral Health.