Month: June 2024

New Cervical Cancer Test Catches Significantly More Cases

Female reproductive system. Credit: Scientific Animations CC4.0 BY-SA

Researchers have developed a simpler and more effective screening method for cervical cancer than the method used today. A comprehensive study published in Nature Medicine shows that the test detects significantly more cancers and precancerous stages.

Most countries have a very extensive cervical cancer screening program that starts with testing for different variants of the human papillomavirus (HPV) that causes cervical cancer. In the case of an HPV-positive test, this is followed by cytological analysis, the examination of gynaecological cell samples by microscopy, which is dependent on human interpretation.

The new molecular test WID-qCIN, which could replace the cytological analysis, can automatically analyse epigenetic changes in cells. These changes, where genes are switched on or off, are influenced by factors such as environment, lifestyle, and aging, and can increase the risk of cancer and other diseases.

Fewer invasive procedures

The current study by researchers at Karolinska Institutet and the University of Innsbruck included more than 28 000 women over the age of 30 who underwent screening in Stockholm between January and March 2017. The researchers analysed a total of 2377 HPV-positive samples with the WID-qCIN test combined with a test for two high-risk HPV types (HPV 16 and 18). In this way, they were able to detect 100% of all invasive cervical cancer and 93% of all serious precancerous lesions that occurred within a year of sampling.

In addition, the new test, in combination with the HPV 16/18 test, was able to predict 69% of all cancers and precancerous lesions up to six years after the sample was taken. This can be compared with only 18% with today’s screening method.

“By integrating the WID-qCIN test into our screening programs, we would be able to identify more cancer cases while reducing the need for invasive procedures,” says Joakim Dillner, Professor of Infectious Disease Epidemiology at Karolinska Institutet and co-author of the study.

A significant improvement 

When cell changes are detected in today’s screening program, the woman undergoes a vaginal examination, a so-called colposcopy, where the gynaecologist looks at the cervix with the help of a microscope and, if necessary, takes a biopsy. The biopsy involves a surgical procedure that, among other things, can lead to negative pregnancy outcomes like premature delivery. The results of the current study suggest that implementation of the WID-qCIN test could reduce the number of colposcopy examinations by 40%.

“This would mean a significant improvement compared to today’s screening methods, which were introduced in the 1960s,” says the study’s last author Martin Widschwendter, Professor at the University of Innsbruck (Austria) and visiting Professor at Karolinska Institutet. “With its simplicity and objective assessment, the WID-qCIN test can improve the effectiveness of these programs and support the global strategy to eliminate cervical cancer.” 

Source: Karolinska Institutet

New Pulsatility Metric in Brain Blood Vessels for Studying Dementia

Photo by Anna Shvets on Pexels

Researchers from the Mātai Institute and the Auckland Bioengineering Institute have developed a new metric from measured blood circulation in the brain. The new metric opens up new research avenues for brain conditions, including Alzheimer’s disease and other forms of dementia. The research has been published in the leading research journal Scientific Reports Nature.

Each time the heart beats, it pumps blood through the brain vessels, causing them to expand slightly and then relax. This pulsation in the brain helps distribute blood evenly across different areas of the brain, ensuring that all parts receive the oxygen and nutrients they need to function properly.

In healthy vessels, the pulse wave is dampened before it reaches the smallest vessels, where high pulsatility could be harmful. The new metric provides a comprehensive measure of the small vessel pulsatility risk.

The new metric is based on 4D flow MRI technology, and is particularly crucial because increased vascular pulsatility is linked to several brain conditions, including Alzheimer’s disease and other forms of dementia.

By accurately measuring how pulsatility is transmitted in the brain, researchers can better understand the underlying mechanisms of these diseases and potentially guide the development of new treatments.

Current MRI methods face limitations due to anatomical variations and measurement constraints. The new technique removes this issue by integrating thousands of measurements across all brain vessels, rather than the traditional method of looking at one spot. This provides a richer metric representative of the entire brain.

“The ability to measure how pulsatility is transmitted through the brain’s arteries could revolutionise our approach to neurological diseases, and support research in vascular damage hypotheses,” says first author Sergio Dempsey.

“Our method allows for a detailed assessment of the brain’s vascular health, which is often compromised in neurodegenerative disorders.”

The study also highlighted the potential to enhance clinical assessments and research on brain health. By integrating this new metric into routine diagnostic procedures, healthcare providers can offer more precise and personalised care plans for individuals at risk of or suffering from cognitive impairments.

To make the most of the new metric’s implications for patient care, the researchers have made their tools publicly available, integrating them into pre-existing open-source software. This enables scientists and clinicians worldwide to adopt the advanced methodology, fostering further research and collaboration in the field of neurology.

Results from the initial study of the metric also identified important sex differences in vascular dynamics which has initiated a new study focusing on sex-related dynamics.

The research team is planning further studies to explore the applications of this technique in larger and more diverse populations.

Source: University of Auckland

Sonic ‘Tweezers’ can Manipulate Objects inside the Body

Photo by Pawel Czerwinski on Unsplash

In 2018, Arthur Ashkin won the Nobel Prize in Physics for inventing optical tweezers: laser beams that can be used to manipulate microscopic particles. While useful for many biological applications, optical tweezers require extremely controlled, static conditions to work properly.

“Optical tweezers work by creating a light ‘hotspot’ to trap particles, like a ball falling into a hole. But if there are other objects in the vicinity, this hole is difficult to create and move around,” says Romain Fleury, head of the Laboratory of Wave Engineering in EPFL’s School of Engineering.

Fleury and postdoctoral researchers Bakhtiyar Orazbayev and Matthieu Malléjac have spent the last four years trying to move objects in uncontrolled, dynamic environments using soundwaves. In fact, the team’s method – wave momentum shaping – is entirely indifferent to an object’s environment or even its physical properties. All the information that’s required is the object’s position, and the soundwaves do the rest.

“In our experiments, instead of trapping objects, we gently pushed them around, as you might guide a puck with a hockey stick,” Fleury explains.

The unconventional method, funded by the Swiss National Science Foundation (SNSF) Spark program, has been published in Nature Physics in collaboration with researchers from the University of Bordeaux in France, Nazarbayev University in Kazakhstan, and the Vienna University of Technology in Austria.

Very simple, very promising

If soundwaves are the hockey stick in Fleury’s analogy, then a floating object like a ping-pong ball is the puck. In the lab’s experiments, the ball was floating on the surface of a large tank of water, and its position was captured by an overhead camera. Audible soundwaves emitted from a speaker array at either end of the tank directed the ball along a pre-determined path, while a second array of microphones ‘listened’ to the feedback, called a scattering matrix, as it bounced off of the moving ball. This scattering matrix, combined with the camera’s positional data, allowed the researchers to calculate in real time the optimal momentum of the soundwaves as they nudged the ball along its path.

“The method is rooted in momentum conservation, which makes it extremely simple and general, and that’s why it’s so promising,” Fleury says.

He adds that wave momentum shaping is inspired by the optical technique of wavefront shaping, which is used to focus scattered light, but this is the first application of the concept to moving an object. What’s more, the team’s method is not limited to moving spherical objects along a path: they also used it to control rotations, and to move more complex floaters like an origami lotus.

Mimicking conditions inside the body

Once the scientists succeeded in guiding a ping-pong ball, they performed additional experiments with both stationary and moving obstacles designed to add inhomogeneity to the system. Successfully navigating the ball around these scattering objects demonstrated that wave momentum shaping could perform well even in dynamic, uncontrolled environments like a human body. Fleury adds that sound is a particularly promising tool for biomedical applications, as it is harmless and noninvasive.

“Some drug delivery methods already use soundwaves to release encapsulated drugs, so this technique is especially attractive for pushing a drug directly toward tumour cells, for example.”

Source: Ecole Polytechnique Fédérale de Lausanne

Time to Debunk Four Persistent Myths about Intermittent Fasting

Photo by Malvestida on Unsplash

In a new article published in Nature Reviews Endocrinology, researchers at the University of Illinois Chicago debunk four common myths about the safety of intermittent fasting. 

Intermittent fasting as a weight loss method has grown increasingly popular, with a large body of research demonstrating its safety. Despite this, several myths about fasting have spread among clinicians, journalists and the general public: that fasting can lead to a poor diet or loss of lean muscle mass, cause eating disorders, or decrease sex hormones. 

In a new commentary, UIC researchers debunk each of these. They base their conclusions on clinical studies, some of which they conducted and some done by others. 

“I’ve been studying intermittent fasting for 20 years, and I’m constantly asked if the diets are safe,” said lead author Krista Varady, professor of kinesiology and nutrition at UIC. “There is a lot of misinformation out there. However, those ideas are not based on science; they’re just based on personal opinion.”  

There are two main types of intermittent fasting. With alternate-day eating, people alternate between days of eating a very small number of calories and days of eating what they want. With time-restricted eating, people eat what they want during a four- to 10-hour window each day, then don’t eat during the rest of the day. The researchers conclude both types are safe despite the popular myths.

Their conclusions: 

Intermittent fasting does not lead to a poor diet: The researchers point to studies showing the intake of sugar, saturated fat, cholesterol, fibre, sodium and caffeine do not change during fasting compared with before a fast. And the percentage of energy consumed in carbohydrates, protein and fat doesn’t change, either.  

Intermittent fasting does not cause eating disorders: None of the studies show that fasting caused participants to develop an eating disorder. However, all the studies screened out participants who had a history of eating disorders, and the researchers say that those with a history of eating disorders should not try intermittent fasting. They also urge paediatricians to be cautious when monitoring obese adolescents if they start fasting, because this group has a high risk of developing eating disorders. 

Intermittent fasting does not cause excessive loss of lean muscle mass: The studies show that people lose the same amount of lean muscle mass whether they’re losing weight by fasting or with a different diet. In both cases, resistance training and increased protein intake can counteract the loss of lean muscle. 

Intermittent fasting does not affect sex hormones: Despite concerns about fertility and libido, neither oestrogen, testosterone nor other related hormones are affected by fasting, the researchers said. 

Source: University of Illinois Chicago

A Ketamine Depression Treatment in a Safer Oral Tablet Form

Photo by Danilo Alvesd on Unsplash

A University of Otago-led clinical trial has tested an oral form of ketamine therapy for treatment-resistant depression that has fewer side effects whilst also reducing the risk of abusing the powerful, tightly-regulated anaesthetic.

Working in collaboration with New Zealand’s Douglas Pharmaceuticals, researchers have conducted a trial of ketamine in an extended-release tablet form. The study, published in Nature Medicine, involved 168 adults for whom regular anti-depressant therapy repeatedly failed. They either took a range of oral doses of ketamine or a placebo for 12 weeks.

Professor Paul Glue, Otago’s Hazel Buckland Chair in Psychological Medicine, says the highest dose of ketamine – 180mg – showed significant improvement in depressive symptoms, compared with patients who received placebo.

“Ketamine can be given by injection or nasal spray, but these methods can leave people feeling spaced out, sedated, and increases their blood pressure. This study shows the extended-release ketamine tablets are safe and effective, and overall, tolerability was good, with participants reporting minimal side effects,” he says.

Douglas Pharmaceuticals is now seeking the interest of partners to complete registrational clinical trials and prepare for commercialisation of the tablets.

“We have found there are many people, here in New Zealand and around the world, who have treatment-resistant depression, and who have no or very little chance of accessing ketamine. Because most doses of this tablet formulation can be taken at home, this is potentially a much cheaper and convenient option for these patients compared with weekly clinic visits for ketamine injections or nasal sprays.”

Ketamine has been used legally by doctors in New Zealand since the 1970s for sedation and pain relief, but it has been classified as an illegal drug for recreational use since the 1980s.

Professor Glue says having the drug in a tablet form reduces the risk of abuse as the manufacturing process makes them difficult to manipulate.

Source: University of Otago

Private Clinic Offers Affordable Healthcare for its Community

Photo by Derek Finch

Only 16% of South Africans can afford private healthcare, and many low-income earners cannot afford healthcare and must rely on community clinics. These facilities are under intense pressure as they often cannot cope with the demand. For many workers, getting medical attention at these facilities means waiting for hours and being unable to work for a day and therefore losing wages. However, things could change if the pioneering efforts of a dedicated nurse with the financial backing of Standard Bank reach their full national potential.

“We assist this sector by working longer hours than do local government clinics that only open five days a week. Our services are available seven days a week at R300 per visit. Those able to pay for primary healthcare often must travel long distances to get to pharmacy-based primary healthcare clinics, mostly in the suburbs. The Rapha Clinic has been strategically placed between the city and the townships so that it can be easily reached by people commuting from their homes to the city,” says Ntombi Skosane, founder of Rapha Healthcare Services.

For Skosane, the clinic, which is located in the Montana area of Pretoria, realised her dream of being able to fill a vital gap in providing primary and basic healthcare to her community.

“As a nurse with 30 years in both the public and the private sector, I believed that I could open a clinic where I could establish a community service offering quality healthcare at affordable rates. The growing success of our operation shows that I was correct,” she adds.

Using her experience of clinics as a guide, Skosane has opted to have Rapha offer nine core services ranging from antenatal care and family planning to assisting with immunisations and wound care, as well as helping those with chronic illnesses and HIV testing and counselling.

“The Rapha Clinic met the stringent guidelines for being considered for a grant. These included an assessment of the viability of the business by the Standard Bank Enterprise Development Funding Committee, the commitment and required personal investment of the owner, and the sector in which the business operates. Although the business was operating successfully, it needed financial assistance to reach its full potential. In this case, the company needed additional stock and equipment to deliver a full service. After considering the application, Standard Bank purchased the required equipment for Rapha,” says Naledzani Mosomane, Head of Enterprise and Supplier Development at Standard Bank.

Skosane says that acquiring additional medical and surgical stock, emergency trollies, a vaccine fridge, wheelchairs, and air-conditioning through Standard Bank meant that the clinic would be able to attend to more patients more efficiently.

Rapha may be just a single clinic, but new outlets are being planned for Gauteng and the North West Province. Ten new clinics are being considered, as are health assessment centres in partnership with gyms and medical aids.

“We believe that Rapha Healthcare Services has a bright future. We look forward to playing a central role in growing the nation’s small business sector and developing relationships with a new generation of entrepreneurs,” says Mosomane.

Pre-menopausal Ovary Removal Linked to Reduced White Matter Integrity

Photo by Anna Shvets

Women who have their ovaries removed before menopause, particularly before the age of 40, have reduced white matter integrity in multiple regions of the brain later in life. The findings appear online in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

“We know that having both ovaries removed before natural menopause causes abrupt endocrine dysfunction, which increases the risk of cognitive impairment and dementia,” said Michelle Mielke, PhD, professor at Wake Forest University School of Medicine. “But few neuroimaging studies have been conducted to better understand the underlying mechanisms.”

For the study, the research team examined data from the Mayo Clinic Study of Aging to identify women over the age of 50 with available diffusion tensor imaging, a magnetic resonance imaging (MRI) technique that measures white matter in the brain. The cohort was comprised of:

  • 22 participants who had premenopausal bilateral oophorectomy (PBO) before age 40 
  • 43 participants who had PBO between the ages of 40 and 45
  • 39 participants who had PBO between the ages of 46 and 49
  • 907 participants who did not have PBO before the age of 50

“Females who had premenopausal bilateral oophorectomy before the age of 40 had significantly reduced white matter integrity in multiple regions of the brain,” said Mielke, the study’s corresponding author. “There were also trends in some brain regions such that women who had PBO between the ages of 40–44 or 45–49 years also had reduced white matter integrity, but many of these results were not statistically significant.”

Mielke said that 80% of participants who had their ovaries removed also had a history of oestrogen replacement therapy. Therefore, the study was not able to determine whether the use of oestrogen replacement therapy after PBO mitigated the effects of PBO on white matter integrity. She noted that the ovaries secrete hormones both before (primarily oestrogen, progesterone and testosterone) and after menopause (primarily testosterone and androstenedione). 

“Having both ovaries removed results in an abrupt decrease in both oestrogen and testosterone in women,” Mielke said. “Therefore, one possible explanation for our results is the loss of both oestrogen and testosterone.”

Mielke said additional research is needed to further understand how white matter changes are associated with cognitive impairment.

“While these findings are important for women to consider before having premenopausal bilateral oophorectomy for non-cancerous conditions, we need a larger and more diverse cohort of women to validate these results.”

Source: Wake Forest University School of Medicine

Chemotherapy Before Surgery Extends Survival in Pancreatic Cancer

Pancreatic cancer. Credit: Scientific Animations CC BY-SA 4.0

Patients with pancreatic cancer who received chemotherapy both before and after surgery experienced longer survival rates than would be expected from surgery followed by chemotherapy, according to a new study from researchers at Yale School of Medicine.

The study, published June 20 in JAMA Oncology, included patients with pancreatic ductal adenocarcinoma (PDAC), an aggressive cancer with a high mortality rate which accounts for 90% of pancreatic cancers. The researchers say these findings are encouraging for the 15 to 20% of patients with operable pancreatic cancer.

The single-arm Phase II trial evaluated a modified form of the chemotherapy treatment FOLFIRINOX. This combination treatment consisting of leucovorin calciumfluorouracilirinotecan hydrochloride, and oxaliplatin received US Food and Drug Administration approval in 2011 as a first-line treatment for patients with metastatic pancreatic cancer. Patients in the trial received six cycles of the modified FOLFIRINOX before surgery, followed by an additional six cycles of the chemotherapy treatment after surgery. The modified regimen consisted of slightly lower doses of FOLFIRINOX to improve tolerability, which was previously shown in a 2016 publication not to impact outcomes negatively.

Of the 46 patients who started the modified treatment, 37 completed all six cycles of chemotherapy before surgery and 27 had successful tumour removal operations. For all enrolled patients, the 12-month progression-free survival rate was 67%, indicating significant progress in controlling the disease. Furthermore, 59% of all patients lived at least two years after completing the full chemotherapy treatment plan and surgery.

The study was the first of its kind for patients with PDAC when senior author and Yale Cancer Center member Jill Lacy, MD, started it in 2014. The study goal had been a 12-month progression-free survival rate of at least 50% of patients.

“When the study launched, even with operable pancreatic cancers, 90% of patients were still relapsing and dying from their cancer eventually,” said Michael Cecchini, MD, the first author of the study. “We sought to move chemotherapy up in their treatment regimen and give it before surgery to see if we could improve the outcome for our patients.”

The study used advanced techniques to monitor the progress of treatment, including analysing circulating tumour DNA (ctDNA) and using the cancer biomarker keratin 17 to help predict outcomes. For example, patients with detectable ctDNA four weeks post-surgery had significantly worse progression-free survival than those who had no detectable ctDNA.

Cecchini said larger randomised clinical trials are needed to continue to investigate the role of FOLFIRINOX before surgery for patients with operable PDAC.

“I think even though there have been changes in standard of care for patients with this aggressive pancreatic cancer type, we have here very promising data to justify a larger study,” said Cecchini.

Source: Yale School of Medicine

Could Drugs for Enlarged Prostate also Protect against Lewy Body Dementia?

Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

A new study published in Neurology suggests that certain drugs commonly used to treat enlarged prostate may also decrease the risk for dementia with Lewy bodies (DLB). This observational finding may seem surprising, but it mirrors previous work by the University of Iowa Health Care team that links the drugs to a protective effect in another neurodegenerative condition: Parkinson’s disease. 

The UI researchers think that a specific side effect of the drugs targets a biological flaw shared by DLB and Parkinson’s disease, as well as other neurodegenerative diseases, raising the possibility that they may have broad potential for treating a wide range of neurodegenerative conditions. 

“Diseases like dementia with Lewy bodies, or Parkinson’s disease, or Alzheimer’s disease are debilitating, and we don’t really have any good treatments that can modify the disease progression. We can treat symptoms, but we can’t actually slow the disease,” explains lead study author Jacob Simmering, PhD, UI assistant professor of internal medicine. “One of the most exciting things about this study is that we find that same neuroprotective effect that we saw in Parkinson’s disease. If there is a broadly protective mechanism, these medications could potentially be used to manage or prevent other neurodegenerative diseases.” 

Large observational study links prostate drugs to lower risk of dementia with Lewy bodies

DLB is a neurodegenerative disease that causes substantial and rapid cognitive decline and dementia. It affects about one in 1000 people per year, accounting for 3 to 7% of all dementia cases. 

For the new study, the UI researchers used a large database of patient information to identify more than 643 000 men with no history of DLB who were newly starting one of six drugs used to treat benign prostatic hyperplasia (enlarged prostate). 

Three of the drugs, terazosin, doxazosin, and alfuzosin (Tz/Dz/Az), have an unexpected side effect; they can boost energy production in brain cells. Preclinical studies suggest that this ability may help slow or prevent neurodegenerative diseases like PD and DLB.  

The other drugs, tamsulosin and two 5-alpha-reductase inhibitors (5ARIs) called finasteride and dutasteride, do not enhance energy production in the brain and therefore provide a good comparison to test the effect of the Tz/Dz/Az drugs. 

The team then followed the data on these men from when they started taking the medication until they left the database or developed dementia with Lewy bodies, whichever happened first. On average, the men were followed for about three years. 

Because all the participants were selected to start a drug that treats the same condition, the researchers reasoned that the men were likely similar to each other at the outset of the treatment. The men were all propensity score-matched for characteristics like age, year of medication start, and other illnesses they had before starting the treatment, to further reduce the differences between the groups. 

“We found that men who took Tz/Az/Dz drugs were less likely to develop a diagnosis of dementia with Lewy bodies,” Simmering says. “Overall, men taking terazosin-type medications had about a 40% lower risk of developing a DLB diagnosis compared to men taking tamsulosin, and about a 37% reduction in risk compared to men taking five alpha reductase inhibitors.” 

Meanwhile, there was no statistically significant difference in risk between men taking tamsulosin and alpha reductase inhibitors. 

Approved drugs show potential

Since this was an observational study, causation cannot be established, only an association. In addition, the study only included men because the drugs are prescribed for prostate problems, which means that the researchers don’t know if the findings would apply to women. However, Simmering and his colleagues are excited by the potential of these drugs, which are already FDA approved, inexpensive, and have been used safely for decades. 

“If terazosin and these similar medications can help slow this progression – if not outright preventing the disease – this would be important to preserving cognitive function and quality of life in people with DLB,” Simmering says. 

Source: University of Iowa Carver College of Medicine

Progress, the Unreasonable Man and Technology

Is complementing in-person care with virtual care (hybrid care) a key part of the answer to South Africa’s NHI aspirations, asks Deon Bührs, Managing Director of Genie Health SA, who suggests that technology is the ‘unreasonable man’ in complementing decent universal healthcare and that self-empowerment is the only solution to sustainable wellness.

“The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.”

George Bernard Shaw

There is a school of thought that a young democracy can benefit from a well-considered blend of socialism and capitalism, particularly when it comes to healthcare and education. I would second that, to a degree.  That South Africa requires a more equitable health system goes without saying though, as the apparent disparity and divisions between the haves and have nots is ever widening.   

The status of our public healthcare system and the spiralling costs of the private offering need to find parity.  A sad situation indeed, because at one stage, South Africa had one of the best public health sectors in the world, where groundbreaking heart transplants, for example, were done.

To the question of universal healthcare then.  If it means that universal healthcare is a fundamental human right that everyone should aspire to, then it’s a yes, the NHI is essential.  It should not be a matter of political affiliation, and let’s be clear, there is already healthcare for all in South Africa, through the public health system, free at the point of care for those who cannot afford care.  But it is the quality of this care, and the effective management of these services that lie in stark contrast to that of the private healthcare system. 

Signed in literally at the 11th hour before the country went to general elections, the National Health Insurance (NHI) bill is a polarising topic for many.  The massive cost of providing a functioning NHI as per the bill, has been estimated conservatively at more than R200 billion a year, while some estimate closer to R1 trillion. With an already strained tax base, we must adopt new thinking as to how to deliver healthcare in a cost sensitive and effective way.

To my mind, one of the most effective ways of ensuring there is universal care that works, is recognising and supporting the role the patient plays in empowering their own health, recovery and wellness journey.  They appear, however, to have been forgotten in the conversation that is the NHI bill to date.

For me, in its current guise, the NHI will unfortunately not bridge the quality divide. In fact, if we are not careful and if we do not find common ground, and hold government and the private sector to account, our entire healthcare system could well be in danger of failing – completely. 

The unreasonable man test – laying the groundwork for new ways of healthcare delivery

Although expediently signed into law with little regard to comments or concerns raised from many sectors including health and business, the NHI does lay the groundwork for new ways of delivering healthcare and sets the scene for changing the mindset from the current sick-care system mentality to one of a patient-empowered HEALTHcare system. 

Change must happen, but the extent of that change often depends on what Irish playwright and political activist, George Bernard Shaw, once stated as: “The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.”

At present, Prof. Nicholas Crisp who has been tasked with helming the delivery of the NHI, could be seen as Shaw’s “unreasonable man” in his efforts to equalise and deliver universal healthcare.  Ensuring that the lever of technology is utilised in an effective way is critical though, to ensure that we don’t try and replicate previous perceived successes, and not move forwards.

With a challenged healthcare system, both public and private, we are called to not give up hope, but to lean into the solution, and at the same time, avoid a defensive posture of that which only served the few.  I believe that these circumstances force us to innovate, and to seriously consider new ways of providing healthcare for all. It should be seen as an exciting time of just where we can push the future of healthcare.

For instance, we already know that a traditional healthcare delivery system, with its associated costs and accessibility challenges for those living in remote parts of our country just won’t cut it.   But unlocking technology as the new delivery channel of healthcare complimented by affordable and fast internet, could well be the solution to cracking the code of healthcare for all.

Through technology we can drive the patient-centric approach to health and open the door for patients to more easily access the multi-disciplinary team of healthcare professionals they need.

The best of both worlds – prevention, and when required, recovery

An example of doing things differently, is a new approach to musculoskeletal health that has been facilitated by digital transformation, and which is finding growing adoption in South Africa.  With objective improvements in patient outcomes, satisfaction scores and recovery times, virtual care teams can support patients through their recovery programmes, ensuring improved compliance and ownership of their health journey.  And empowering patients to embrace exercise and activity over surgery and pharmaceuticals where appropriate, has a dramatic impact on the overall healthcare spend. 

Imagine patients having the choice to access a multi-disciplinary team of experts anywhere in the country – from the comfort and convenience of their own home or workplace, all at the tips of their fingers.  No need to be transported to a clinic or hospital every time they need healthcare services.  This is entirely possible, with platforms like Genie Health, that provide a hybrid approach in complimenting in-person care with virtual care.

NHI needs a strong front loader like these hybrid platforms that provide the full range of allied healthcare services, to reduce the burden of care and cost on an already strained system, by reducing unnecessary hospital admissions, surgeries, medication and travel costs and allowing for the existing framework to be brought up to date and even surpass expectations.  

With ICASA reporting over 75% of the population having Internet access in South Africa and more than 90% smartphone penetration, pressure on Mobile Network Operators to provide zero rated data for healthcare applications (as they have done in education and other areas) mounts. 

If measures like this can be implemented, they will have a tremendous impact on reducing the burden on the existing healthcare system through a self-health-empowered approach, with the backing of a full clinical team on the ready to assist the patient.

The ultimate question is how do we make healthcare more affordable and accessible to all South Africans, which is the core aim of the NHI?  

The answer – we need to renew our focus on the key stakeholder, our patients – and empower them to drive their own health, by using technology as the backbone for sustainable wellness. It could well be, that with a renewed mindset and health-empowered citizens, the NHI is the true gamechanger for progress in HEALTHcare that we all need.