Sunday roundup 1
A collection of interesting healthcare-related news I found interesting this week
Healthcare advances at its own pace, but some stories tend to stand out. This is my list of interesting stories that jumped out at me over the past week.
The race to develop a Marburg virus vaccine
The Marburg virus is a highly pathogenic filovirus, which makes it a relative of the ebolavirus. Similar to the ebolavirus and, more famously, covid-19, the Marburg virus is naturally found in fruit bats. Humans usually get infected by coming in contact with an infected animal (bat, non-human primate, etc.), or coming in direct contact with the body fluids of infected individuals.
While there have been multiple outbreaks of the Marburg virus over the years, the current Rwandan outbreak comes as its public health system already struggles with an mpox epidemic. This is Rwanda's first ever Marburg virus outbreak and there have already been 36 confirmed cases and 11 recorded deaths. While this pales compared to historical cases like Angola's (374 cases and 329 deaths between 2004-05, an 88% fatality rate), the speed with which the outbreak has gained momentum has alarmed scientists around the world. Furthermore, the outbreak has occurred in districts bordering the DRC, Uganda, and Tanzania, which may require a multi-country response.
At least three vaccines are already under development. The most promising one seems to be a candidate led by the Sabine Vaccine Institute in Washington which has been tested in 40 healthy adults in the US and found to safely generate an immune response against the virus. The vaccine is currently being tested in a larger field trial in Uganda and Kenya with a view to being deployed as soon as possible. Another candidate being led by the University of Oxford is currently undergoing trials in the United Kingdom, though it is not yet as far along as the American vaccine. A third vaccine, similar to an approved ebolavirus vaccine, being developed by the International AIDS Vaccine Initiative in New York City is expected to begin production soon.
It is hoped that these vaccines will be used for containing the outbreak in Rwanda. The vaccines are expected to be tested out in the field using a strategy known as ring immunisation, where suspected and expected contacts of the infected individuals are vaccinated. The Rwandan health authority has greater resources than its neighbours, so it is hoped that the outbreak remains contains within Rwandan borders.
Gambling as a public health problem
The realm of public health encompasses practically all individual behaviours. Nearly every behaviour has some health consequence or another. However, gambling is a unique phenomenon which has pernicious effects on individual behaviour which is not fully understood from a public health perspective. A recently published Lancet Public Health Commission makes the case for regulating gambling as a public health policy measure given its similarity to other forms of addiction and its effects not just on the individual but on the family.
Gambling can inflict substantial harm on individuals, families, and communities. Beyond the obvious danger of financial losses and financial ruin, these harms can include loss of employment, broken relationships, health effects, and crime-related impacts. Gambling can heighten the risk of suicidality and domestic violence. Research evidence and first-hand accounts from individuals affected by gambling corroborate the association between gambling and these many and various detrimental effects.
A substantial proportion of harm is suffered by those individuals who fall below the threshold for gambling disorders outlined in the International Classification of Diseases-11 or the American Psychiatric Association's Diagnostic and Statistics Manual-5. Therefore, examining the effect of gambling across the entire spectrum of consumption is crucial. As with other harmful commodities, adverse effects are often felt not just by the person gambling, but also by significant others, families, and friends, and can result in both tangible and intangible costs to communities and societies. Although some harms might be short-lived, others are long lasting and can affect subsequent generations.
The commission conducted a thorough review of published literature and various policy objectives, concluding that around 80 million people around the world may be experiencing some sort of gambling addiction.
Now that number is substantive and difficult to argue against. If that estimate is conservative, we may be looking at the problem too lightly. Given the legality of gambling across countries and the easy availability of online gambling, it may not be long before the problem spirals out of control.
The Lancet recommends restrictions and prohibitions on gambling around the world. The phrasing of the recommendations hearkens back to when bans on smoking were being considered: while smoking has not been banned in most places, restrictions have been growing heavier. A similar approach may lead to generational change when it comes to gambling.
An optimistic view on changing mental health levels
As we gain dominance over diseases that have long been regarded as the scourge of mankind, increasing amounts of ink are being spilled about "diseases of modernity". As Stephen Bush writes in the FT, the human race is suffering from success. We have burned the candle at both ends to take care of diseases once seen as completely intractable and have been remarkably successful at dealing with new problems (COVID-19 being the most prominent example). The result? We're slowly starting to realise that humans aren't exactly built to last. If we don't fall to one illness or another, we tend to more esoteric issues such as diabetes, osteoporosis, or more worryingly, depression.
Bush does not mean to say that mental health issues are any better or worse than other issues, but he does unequivocally make the point that having these problems is better than not having them. Sure, there were fewer cases of depression in the 1800s than there are today, for instance. But fewer people (as a proportion of the population) have known the grief of losing a child, or the acute pain of untreated gangrene. As Bush says,
Just as important, there are significantly fewer causes of what Burton described as melancholia of “disposition”. [...] If, as I think is reasonable, we stick to Burton’s definition that what marks out depression is that it is a characteristic of your resting condition, the average 17th-century person spent an awful lot more time in grief or in pain, and therefore had a lot less time to realise or identify that they were also experiencing Burton’s grievous and common disease.
This does not give us any reason to glorify mental health issues, of course. However, past the darkness of mental health issues lies the distant glimmer of the promised land. Just as diabetes went from something you lived with to something which was solved using insulin and metformin to something being actively prevented by GLP-1 agonists, mental health issues may go from being treated using therapy and prozac to being targeted at the source.