Month: June 2024

Categories : CancerTags :

‘Potentially Game Changing’ Immunotherapy Trial for Colorectal Cancer

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Human colon cancer cells. Credit: National Cancer Institute

Results from a new trial indicate that immunotherapy could successfully be used to treat the most common form of colorectal cancer, also known as bowel cancer.

The findings of the new study, a phase 1 trial involving the immunotherapy drugs botensilimab and balstilimab, have been published in the journal Nature Medicine, and it is the first time that consistent and durable responses to immunotherapy have been reported in difficult-to-treat patients.

Co-authored by Professor Justin Stebbing of Anglia Ruskin University (ARU), who describes the results as “potentially game changing”, the study focused on the most common type of colorectal tumours, known as MSS mCRC, or microsatellite stable metastatic colorectal cancer.

Although immunotherapy has previously been shown to work on patients with specific mismatch repair deficient (dMMR) tumours, only a small percentage of colorectal cancer patients have this type of tumour, and immunotherapy has so far been ineffective in patients with more common MSS mCRC tumours.

The new study involved using the immunotherapy drug botensilimab in conjunction with balstilimab on a group of patients in the United States. These drugs are both monoclonal antibodies, which work by triggering the body’s immune system to attack the cancer.

Of the patients in the phase 1 trial, 101 took part in a six-month follow-up and of these, 61% of them saw their tumour shrink or remain stable after receiving a combination of botensilimab (BOT) and balstilimab (BAL). The most common side-effects, or treatment-related adverse events, were diarrhoea and fatigue.

Justin Stebbing, Professor of Biomedical Sciences at Anglia Ruskin University (ARU) and communicating author of the study, said:

“These results are incredibly exciting. Colorectal or bowel cancer is one of the most common forms of cancer worldwide and this is the first time there has been convincing evidence that immunotherapy can work in all forms of colorectal tumours, so this is potentially game changing.

“This is now progressing into later phase clinical trials and we hope the FDA in the United States approve its use very soon. And because this is such an important area, affecting so many people, we hope authorities in the UK are also able to move quickly.”
Joint first author Dr Andrea Bullock, Assistant Professor in Medicine at Beth Israel Deaconess Medical Center, said:

“This study sheds light on the potential of the BOT/BAL combination to treat microsatellite stable metastatic colorectal cancer, the most common form of colorectal cancer which has historically not responded to immunotherapy, and we hope our results will offer new hope for those diagnosed.”
Joint last author Dr Anthony El-Khoueiry, Associate Director of Clinical Research and Chief of Section of Developmental Therapeutics at the USC Norris Comprehensive Cancer Center, said:

“This phase 1 study of botensilimab highlights its promising anti-tumour activity that encompasses immunologically cold tumours such as MSS colorectal cancer. The efficacy noted highlights the potential of botensilimab through its broader engagement of anti-tumour immunity.”

The full open access paper, published in , is available here 

Source: Anglia Ruskin University

Categories : AntibioticsTags :

Temperature may be a New Weapon in the Battle against Antibiotic Resistance

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Scientists from the University of Groningen in the Netherlands, together with colleagues from other European universities, have tested how a fever could affect the development of antimicrobial resistance. In laboratory experiments, they found that a small increase in temperature from 37 to 40 degrees Celsius drastically changed the mutation frequency in E. coli bacteria, which facilitates the development of resistance. If these results can be replicated in human patients, fever control could be a new way to mitigate the emergence of antibiotic resistance.

There are two ways to fight the threat of antimicrobial resistance: by developing new drugs, or by preventing the development of resistance. ‘We know that temperature affects the mutation rate in bacteria’, explains Timo van Eldijk, co-first author of the paper published in JAC-Antimicrobial Resistance. ‘What we wanted to find out was how the increase in temperature associated with fever influences the mutation rate towards antibiotic resistance.’

‘Most studies on resistance mutations were done by lowering the ambient temperature, and none, as far as we know, used a moderate increase above normal body temperature,’ Van Eldijk reports. Together with Master’s student Eleanor Sheridan, he cultured E. coli bacteria at 37 or 40 degrees Celsius, and subsequently exposed them to three different antibiotics to assess the effect. ‘Again, some previous human trials have looked at temperature and antibiotics, but in these studies, the type of drug was not controlled.’ In their laboratory study, the team used three different antibiotics with different modes of action: ciprofloxacin, rifampicin, and ampicillin.

The results showed that for two of the drugs, ciprofloxacin and rifampicin, increased temperature led to an increase in the mutation rate towards resistance. However, the third drug, ampicillin, caused a decrease in the mutation rate toward resistance at fever temperatures. ‘To be certain of this result, we replicated the study with ampicillin in two different labs, at the University of Groningen and the University of Montpellier, and got the same result,’ says Van Eldijk.

The researchers hypothesized that a temperature dependence of the efficacy of ampicillin could explain this result, and confirmed this in an experiment. This explains why ampicillin resistance is less likely to arise at 40 degrees Celsius. ‘Our study shows that a very mild change in temperature can drastically change the mutation rate towards resistance to antimicrobials,’ concludes Van Eldijk. ‘This is interesting, as other parameters such as the growth rate do not seem to change.’

If the results are replicated in humans, this could open the way to tackling antimicrobial resistance by lowering the temperature with fever-suppressing drugs, or by giving patients with a fever antimicrobial drugs with higher efficacy at higher temperatures. The team concludes in the paper: ‘An optimized combination of antibiotics and fever suppression strategies may be a new weapon in the battle against antibiotic resistance.’

Source: University of Groningen

Categories : HospitalsTags :

Global Trial Confirms Benefit of Antacids on Bleeding Prevention for Ventilated Patients

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Photo by Rodnae Productions on Pexels

A widely available drug helps prevent upper gastrointestinal bleeding in critically ill adults on a breathing machine, according to the results of a global study and meta-analysis led by researchers at McMaster University. 

The research, published on June 14, 2024 in The New England Journal of Medicine and NEJM Evidence, investigated the effect of the gastric acid suppressant pantoprazole, which is primarily used to treat heartburn caused by gastroesophageal reflux disease (GERD). 

Patients in the intensive care unit (ICU) who need a breathing machine (mechanical ventilator) also receive pantoprazole to prevent upper gastrointestinal bleeding, caused by stress-induced ulcers in the stomach. Concerns emerged about whether this complication of critical illness had disappeared over the years, and about side effects of pantoprazole, including increased risk of death in the sickest patients. The research provides critical care teams with certainty about whether the medications should be used in practice.   

“This is the largest randomized trial on this topic in the world, led by Canada. Physicians, nurses, and pharmacists working in the ICU setting will use this information in practice right away, and the trial results and the updated meta-analysis will be incorporated into international practice guidelines,” said lead author and principal investigator Deborah Cook, a professor in the Department of Medicine at McMaster. 

Global randomized control trial  

The Reevaluating the Inhibition of Stress Erosions (REVISE) Trial was a randomised control trial that compared the effect of pantoprazole to placebo in critically ill adults on a breathing machine. The trial was run in 68 centres in eight countries and over 4800 patients underwent randomization. Among patients undergoing invasive ventilation, pantoprazole resulted in a significantly lower risk of clinically important upper gastrointestinal bleeding than placebo but not in a lower risk of death. 

Clinically important upper gastrointestinal bleeding occurred in 25 of 2417 patients (one per cent) receiving pantoprazole and in 84 of 2404 patients (nearly four per cent) receiving placebo. At 90 days, death was reported in 696 of 2390 patients (29 per cent) in the pantoprazole group and in 734 of 2379 patients (30 per cent) in the placebo group.   

Updated systematic review 

Researchers conducted a meta-analysis of 12 randomised trials of proton-pump inhibitors for GI bleeding prevention in 10 000 critically ill patients to summarise the current evidence on the outcomes of gastrointestinal bleeding, mortality, pneumonia and C. difficile infection. 

The medications were associated with a reduced incidence of clinically important upper gastrointestinal bleeding and may have little or no effect on mortality. The evidence also showed the medications may have no effect on pneumonia and little or no effect on C. difficile infection. 

The research was funded by the Canadian Institutes for Health Research, the Accelerating Clinical Trials Fund, Physicians Services Incorporated of Ontario, Hamilton Association of Health Sciences Organization, and the National Health Medical Research Council of Australia. 

The original text of this story is licensed under a Creative Commons Attribution-No Derivs 2.5 Canada (CC BY-ND 2.5 CA).

Source: McMaster University

Categories : Diet and Nutrition Mental HealthTags :

High-fat Diets can Interfere with Serotonin Pathways, Fuelling Anxiety

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Photo by Jonathan Borba

New research from CU Boulder shows that turning to junk food when we’re stressed out may backfire. The study found that in animals, a high-fat diet disrupts resident gut bacteria, alters behaviour and, through a complex pathway connecting the gut to the brain, influences brain chemicals in ways that fuel anxiety.

“Everyone knows that these are not healthy foods, but we tend to think about them strictly in terms of a little weight gain,” said lead author Christopher Lowry, a professor of integrative physiology at CU Boulder. “If you understand that they also impact your brain in a way that can promote anxiety, that makes the stakes even higher.”

For the study, published in the journal Biological Research in May, Lowry worked with first author Sylvana Rendeiro de Noronha, a doctoral student at the Federal University of Ouro Preto in Brazil.

In a previous study, the team found that rats fed a high-fat diet consisting primarily of saturated fat showed increases in neuroinflammation and anxiety-like behaviour.

While evidence is mixed, some human studies have also shown that replacing a high-fat, high-sugar, ultra-processed diet with a healthier one can reduce depression and anxiety.

The dark side of serotonin

To better understand what may be driving the fat-anxiety connection, Lowry’s team divided male adolescent rats into two groups: Half got a standard diet of about 11% fat for nine weeks; the others got a high-fat diet of 45% fat, consisting mostly of saturated fat from animal products.

The typical American diet is about 36% fat, according to the Centers for Disease Control and Prevention.

Throughout the study, the researchers collected faecal samples and assessed the animals’ gut microbiome. After nine weeks, the animals underwent behavioural tests.

When compared to the control group, the group eating a high-fat diet, not surprisingly, gained weight. But the animals also showed significantly less diversity of gut bacteria. Generally speaking, more bacterial diversity is associated with better health, Lowry explained. They also hosted far more of a category of bacteria called Firmicutes and less of a category called Bacteroidetes. A higher Firmicutes to Bacteroidetes ratio has been associated with the typical industrialised diet and with obesity.

The high-fat diet group also showed higher expression of three genes (tph2, htr1a, and slc6a4) involved in production and signalling of the neurotransmitter serotonin – particularly in a region of the brainstem known as the dorsal raphe nucleus cDRD, which is associated with stress and anxiety.

While serotonin is often billed as a “feel-good brain chemical,” Lowry notes that certain subsets of serotonin neurons can, when activated, prompt anxiety-like responses in animals. Notably, heightened expression of tph2, or tryptophan hydroxylase, in the cDRD has been associated with mood disorders and suicide risk in humans.

“To think that just a high-fat diet could alter expression of these genes in the brain is extraordinary,” said Lowry. “The high-fat group essentially had the molecular signature of a high anxiety state in their brain.”

A primal gut-brain connection

Just how a disrupted gut can change chemicals in the brain remains unclear. But Lowry suspects that an unhealthy microbiome compromises the gut lining, enabling bacteria to slip into the body’s circulation and communicate with the brain via the vagus nerve, a pathway from the gastrointestinal tract to the brain.

“If you think about human evolution, it makes sense,” Lowry said.  “We are hard-wired to really notice things that make us sick so we can avoid those things in the future.”

Lowry stresses that not all fats are bad, and that healthy fats like those found in fish, olive oil, nuts and seeds can be anti-inflammatory and good for the brain.

But his research in animals suggests that exposure to an ultra-high-fat diet consisting of predominantly saturated fats, particularly at a young age, could both boost anxiety in the short-term and prime the brain to be more prone to it in the future.

His advice: Eat as many different kinds of fruits and vegetables as possible, add fermented foods to your diet to support a healthy microbiome and lay off the pizza and fries. Also, if you do have a hamburger, add a slice of avocado. Research shows that good fat can counteract some of the bad.

Rodrigo Cunha de Menezes, professor of physiology at Federal University of Ouro Preto in Brazil, is co- senior author on this paper.

Source: University of Colorado Boulder

Categories : Cancer Healthcare Politics and RegulationsTags :

Increasing SA’s Blood Cancer Survival Rate Starts with the State Healthcare System

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Credit: National Cancer Institute

While cancer survivors are increasing in countries like the United States, South Africa faces a different reality, with 4000 people dying from blood cancer every year. Dr Sharlene Parasnath, Head of the Department of Clinical Haematology and Stem Cell Transplant Unit at Inkosi Albert Luthuli Central Hospital and DKMS Africa board member, believes that this discrepancy is largely due to the quality of care provided to patients who rely on the state healthcare system. 

Counting the costs

She explains that South Africa’s state sector relies predominantly on conventional chemotherapy to treat patients as opposed to newer targeted immunotherapies. “These may be accessible to some patients in the private sector and standard care in developed countries but are out of reach for public healthcare due to their unaffordability. Countries that use more targeted therapies not only improve overall survival but also decrease the undesirable adverse effects of cancer treatments. These therapies may be given with chemotherapy or on their own and work by attacking specific genetic mutations in cancer cells. Examples include monoclonal antibodies (MABs) and Bispecific T cell engagers (BiTES), which mimic the immune system to destroy cancer cells. There are also tyrosine kinase inhibitors (TKIs) which block the signals that promote cancer cell growth.”

“The prohibitive costs of these treatments are why stem cell transplants are being encouraged in South Africa since they offer those with blood cancers a chance of a cure,” points out Dr Parasnath. “However, this approach comes with challenges. For instance, the state will not pay for a transplant from an unrelated donor, despite two thirds of patients in need of a transplant being unable to find a suitable donor from within their family.”

Fewer nurses, fewer transplants

“Human resource constraints, particularly the shortage of specialist nurses, is another factor hindering more stem cell transplants from being carried out,” she notes. “Currently, there is no formalised training for nurses in haematology in South Africa. So, what tends to happen is that the majority of blood cancer patients end up being cared for either by oncology-trained nurses or registered general nurses with limited practical education and training in the kind of care they require. Important aspects of nursing which can improve patient outcomes include dietary restrictions, visitor guidelines, decreasing bleeding risk, infection control and early detection of potential complications such as graft rejection, graft vs. host disease and veno-occlusive disease that can develop following a stem cell transplant.”

Referring to an article in the South African Medical Journal titled Haematopoietic Stem Cell Transplantation in South Africa: Current limitations and future perspectives, Dr Parasnath adds that lack of staff ultimately leads to implicit rationing of healthcare, thereby limiting access to this life-changing medical procedure.

Mental health is health

She stresses that human resource constraints in terms of mental health support is also detrimental to patients with blood cancers. “Unfortunately, this tends to be the case both in the public and private sectors, as one out of three people diagnosed with cancer ends up struggling with a mental health disorder such as anxiety or depression as well, yet  less than 10% of patients are referred to seek help. The South African Society of Psychiatrists has even warned that if left untreated or undiagnosed, this could impact the patient’s ability to function on a daily basis, including undergoing treatment.”

Dr Parasnath emphasises another glaring gap in mental health support. “NGOs offer on-site social workers for hospitalised children with blood cancer, but adults, especially those who are not members of medical aid schemes, often have no options available to them. Not only do they grapple with the emotional toll of their diagnosis and treatment side effects, but this is further complicated by anxieties around their finances and the wellbeing of their children.”

The Cancer Association of South Africa’s (CANSA) Fact Sheet on Cancer and Mental Health highlights that there remains a huge unmet need for mental health in cancer care, calling for more effective clinical integration of relevant services, which must be informed by patient choice and clinical need, and accessible throughout the patient’s whole cancer journey. It also stresses the need for measurement of patient quality of life as a marker of treatment effectiveness.

“The Department of Health must recognise clinical haematology as a discipline in its own right with its own unique needs. For too long, it has had to feed off of the limited oncology budget. But if we are to up the blood cancer survival rate, funding must be provided for necessities such as more modern treatments, unrelated stem cell transplantation and formalised training of nurses,” says Dr Parasnath.

She also urges South Africans to increase the pool of available stem cell donors either by registering themselves or supporting organisations like DKMS Africa which connects patients with potential matches by providing access to a global registry of over 12 million donors. Financial donations directly address two critical needs: funding the registration of new donors and assisting patients facing financial challenges as a result of the transplant process.”

“With focused efforts, South Africa can join the global trend of increasing blood cancer survival rates, offering a brighter future for patients and their families,” concludes Dr Parasnath.

To register visit https://www.dkms-africa.org/register-now or for more information, contact DKMS Africa on 0800 12 10 82.

Categories : Uncategorized

More Blood Transfusions may Improve Major TBI Outcomes 

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Photo by Charliehelen Robinson on Pexels

Increased use of blood transfusions after major traumatic brain injury could help patients in intensive care units to regain greater functional independence and a better quality of life.

Six months after a major traumatic brain injury (TBI), patients who benefited from this approach regained more functional independence and had a better quality of life than those subjected to a more restrictive approach, even though the combined incidence of death and major disability was not significantly different between the two treatment groups.

This is the conclusion of an international research team led by Alexis Turgeon, professor at Université Laval, Canada Research Chair in Neurological Critical Care and Trauma, critical care physician and researcher at CHU de Québec-Université Laval, whose work is published today in the New England Journal of Medicine.  

“This randomized clinical trial, initiated in 2017, was carried out in 34 hospital centres in Canada, the United Kingdom, France and Brazil. Its aim was to compare two blood transfusion strategies – one so-called restrictive and the other liberal – employed to care for people hospitalized in an intensive care unit following a TBI. These approaches differ in the degree of anemia, or the minimum hemoglobin concentration that must be present in patients’ blood before a blood transfusion can be given,” explains Professor Turgeon. 

“Most patients hospitalised after a TBI suffer from anemia, defined as low haemoglobin concentration, which could reduce oxygen transport to the brain during a period when it is most vulnerable,” points out François Lauzier, also a professor at Université Laval and who co-led the study with Professor Dean Fergusson of the Ottawa Hospital Research Institute. 

The restrictive approach consists in tolerating a low haemoglobin level before giving a transfusion, while a liberal approach aims to maintain high haemoglobin levels, thus giving more blood transfusion.  

“By improving oxygen transport to the brain during the acute phase of care, it may be possible to save more nerve cells in the days following a TBI, thereby preventing additional brain damage,” says Professor Turgeon. 

To conduct the study, the research team recruited 742 critically ill patients with moderate or severe TBI and anaemia defined as a haemoglobin level of 10g/dL or less during hospitalisation. Randomly divided into two groups, these individuals were subjected to one or other of the transfusion strategies during their stay in the intensive care unit. To maintain these thresholds, the care teams administered blood transfusions whenever necessary. 

Six months after TBI, the research team assessed the level of overall recovery for each group, including neurovegetative status, dependence on activities of daily living and impairments preventing resumption of activities that had been performed prior to TBI. “The combined incidence of death and major disability was not statistically different between the two groups, but seemed favouring the liberal strategy in all analyses,” says Professor Turgeon. What’s more, those treated using the liberal approach showed a higher functional independence measure and quality of life index than those treated using the restrictive approach.  

“In light of the overall results of our study and considering the safety of current blood transfusions, the liberal strategy is probably the option that should be preferred in the acute phase of care to improve long-term prognosis following TBI,” concludes Professor Turgeon. 

Source: Université Laval

Categories : Diseases, Syndromes and Conditions Pain ManagementTags :

In Knee Osteoarthritis, Inactivity may be more Complex than Believed

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Photo by Towfiqu barbhuiya

Knee osteoarthritis (OA) is a common cause of pain and joint stiffness. And while physical activity is known to ease symptoms, only one in 10 people regularly exercise. Understanding what contributes to patients’ inactivity is the focus of a world first study from the University of South Australia. Here, researchers have found that people with knee OA unconsciously believe that activity may be dangerous to their condition, despite medical advice telling them otherwise.

The study, published in PAIN, found that of those surveyed, 69% of people with knee pain had stronger implicit (unconscious) beliefs that exercise was dangerous than the average person without pain. It’s an interesting finding that not only highlights the conflicted nature of pain and exercise, but also that what people say and what people think, deep down, may be entirely different things.

Lead researcher, and UniSA PhD candidate based at SAHMRI, Brian Pulling, says the research provides valuable insights for clinicians treating people with knee OA.

“Research shows that physical activity is good for people with knee OA, but most people with this condition do not move enough to support joint or general health,” Pulling says.

“To understand why people with OA might not be active, research studies typically use questionnaires to assess fear of moving. But unfortunately, questionnaires are limited – what we feel deep down (and how our system naturally reacts to something that is threatening) may be different to what we report. And we still know that many people are avoiding exercise, so we wanted to know why.”

To assess this, the researchers developed a tool that can detect and evaluate people’s implicit beliefs about exercise; that is, whether they unconsciously think activity is dangerous for their condition.

“We found that that even among those who said they were not fearful about exercise, they held unconscious beliefs that movement was dangerous,” Pulling says.

“Our research shows that people have complicated beliefs about exercise, and that they sometimes say one thing if asked directly yet hold a completely different implicit belief.

“People are not aware that what they say doesn’t match what they choose on the new task; they are not misrepresenting their beliefs.

“This research suggests that to fully understand how someone feels about an activity, we must go beyond just asking directly, because their implicit beliefs can sometimes be a better predictor of actual behaviour than what people report. That’s where our tool is useful.”

The online implicit association test presents a series of words and images to which a participant must quickly associate with being either safe or dangerous. The tool intentionally promotes instant responses to avoid deliberation and other influencing factors (such as responding how they think they should respond).

Associate Professor Tasha Stanton says that the new tool has the potential to identify a group of people who may have challenges increasing their activity levels and undertaking exercise.

“What people say and what people do are often two different things, Assoc Prof Stanton says.

“Having access to more accurate and insightful information will help health professionals better support their patients to engage with activity and exercise. It may also open opportunities for pain science education, exposure-based therapy, or cognitive functional therapy…things that would not usually be considered for someone who said that they were not scared to exercise.”

Researchers are now looking to see if implicit beliefs are directly associated with behaviour and are asking for people to complete the Implicit Association Test (takes seven minutes). At the end of the test participants are given their results in comparison to the rest of the population.

To take the test, please click here: https://unisasurveys.qualtrics.com/jfe/form/SV_0OZKUqzBNtiKGF0

Source: University of South Australia

Categories : Lab Tests and ImagingTags :

New Biomarker Database for Astronaut Health may be Useful to Earthlings

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Photo: Pixabay CC0

As space travel becomes more frequent, a new biomarker tool was developed by an international team of researchers to help improve the growing field of aerospace medicine and the health of astronauts.

Dr Guy Trudel (Professor in the Faculty of Medicine), Odette Laneuville (Associate Professor, Faculty of Science, and Director of the Biomedical Sciences) and Dr Martin Pelchat (Associate Professor in the Department of Biochemistry, Microbiology and Immunology) are among the contributors to an international study led by Eliah Overbey of Weill Cornell Medicine and the University of Austin. Published today in Nature it introduces the Space Omics and Medical Atlas (SOMA), a database of integrated data and sample repository from a diverse range of space missions, including from SpaceX and NASA.

Space travel creates cellular, molecular, and physiological shifts in astronauts. SOMA is expected to provide a much necessary biomedical profiling that can help tease out the short and long-term health impacts of spaceflight. This will bring needed health monitoring, risk mitigation, and countermeasures baseline data for upcoming lunar, Mars, and exploration-class missions. It is meant to help keep astronauts and space travellers alive and healthy.

It may also have some intended use here on Earth.

“This represents a breakthrough in the study of human adaptation and life in space. Since many of the changes in astronaut in space resemble those of people who are immobile in bed, these studies can be clinically relevant. The data are therefore important for future space exploration while also providing a correlation to people on Earth with limited mobility or who are bedridden before their rehabilitation,” says Dr Trudel, a rehabilitation physician and researcher at The Ottawa Hospital who has focused on space travel and its effects on the human immune system.

Highlights of the study, include:

  • The Atlas includes extensive molecular and physiological profiles encompassing genomics, epigenomics, transcriptomics, proteomics, metabolomics, and microbiome data sets, which reveal some consistent features across missions.
  • Samples were taken pre-flight, during, post-flight and throughout the recovery period.
  • Comprehensive profile of the physiological changes of the I4 crew (ages 29, 38, 42, 51) and 13 unique biospecimen sample types were collected and processed.
  • 2911 samples were banked with over 1000 samples processed for sequencing, imaging, and biochemical analysis creating the first-ever aerospace medicine biobank.
  • The SOMA resource represents an over 10-fold increase in total publicly available human space omics data.

“The University of Ottawa’s Faculty of Medicine, its Faculty of Science, and The Ottawa Hospital’s Bone and Joint Research laboratory have a long history of contributions and successes in studying human adaptation to space. They also involve students from different programs, providing a unique learning experience in both bone and joint health, and in the rapidly developing field of aerospace medicine,” adds Dr Trudel.

Source: University of Ottawa

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

Debunking Myths: The Truth About Medical Schemes in South Africa 

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Despite the promise of Universal Health Coverage (UHC) for all, the recent signing of the NHI Bill has brought with it several misconceptions around medical schemes that undermine the very foundation of our healthcare system, writes Dr Katlego Mothudi, Managing Director at the Board of Healthcare Funders (BHF).

In a historic move aimed at transforming the South African healthcare landscape, President Cyril Ramaphosa signed the National Health Insurance (NHI) Bill into law. This landmark decision promises to move South Africa towards Universal Health Coverage (UHC) for all citizens, regardless of socio-economic status.

While the goal of UHC is commendable, the rhetoric leading up to the NHI Act’s announcement has created misconceptions about the role of medical schemes. 

With many believing that they should cancel their memberships immediately to enjoy free health services for the foreseeable future. However, Dr Katlego Mothudi clarifies that the implementation of NHI will take several years, dispelling this misconception.

The NHI Act introduces a single-payer system, central to the idea is that healthcare is a ‘public good’, suggesting all healthcare funding should exclude medical schemes, and should be government-funded. Dr Mothudi counters that healthcare is more accurately described as a social good. A public good, like military services, is one that the government must provide and from which no one can be excluded, regardless of payment. While healthcare is essential, it is not feasible to provide it as a public good.

The Board of Healthcare Funders (BHF), concerned about the numerous misconceptions propagated by government representatives since 2009, commissioned Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at Wits Health Consortium, to investigate these claims. Despite their hyperbolic nature and lack of systematic research, these statements have significant weight due to their endorsement by influential individuals. Prof van den Heever’s report identified frequently repeated assertions that he concluded were unsubstantiated and untrue.

Key Findings from the Report:

1. Medical Schemes are Unsustainable – False

In 2009, claims suggested that many medical schemes were headed for collapse due to unsustainable financing models, with 18 schemes reportedly nearing insolvency. Prof van den Heever’s report refutes this, showing stability in medical schemes from 2005 to 2022. The number of beneficiaries increased by over one million from 2009 to 2022, with consolidated reserves of R114 billion in 2022, far exceeding the required 25% reserve ratio. Broker costs have not been a systemic concern, and total non-health costs per average beneficiary per month for all medical schemes decreased by 34.7% in real terms from 2005 to 2020.

2. Health Services are a Public Good – False

   In 2011, Health Minister Aaron Motsoaledi claimed that private healthcare was a “brutal system” due to commercialisation. However, Prof. van den Heever clarified that healthcare is not a public good in the economic sense, as it does not meet the criteria of being jointly consumed without exclusion. Healthcare is a crucial service but providing it as a public good is not feasible.

3. Most Medical Scheme Beneficiaries are White – False

Last year, Prof Olive Shisana, an honorary professor at the University of Cape Town and special advisor to President Ramaphosa, stated that the private sector predominantly serves the privileged white population. However, Statistics South Africa’s 2021 research indicates that of the total population utilising private healthcare services, 50.2% are Black African, 32.3% are White, 9.8% are Coloured, and 7.6% are Indian/Asian.

Need for Balanced Perspectives

While the BHF supports healthcare reform, it raises concerns about the NHI Act’s constitutionality and calls for a factual review of claims about medical schemes. It is crucial to present both sides of the debate to understand the implications fully. Including government perspectives and addressing how the NHI will affect individual citizens would provide a more comprehensive view.

Medical schemes remain a valuable national asset that plays a crucial role in ensuring the long-term viability of South Africa’s healthcare ecosystem. BHF advocates for a balanced approach to healthcare reform that considers both public and private sectors’ strengths and weaknesses.

For a comprehensive look at findings from the report commissioned by BHF, see Prof van den Heever’s presentation at the 2024  Annual BHF Conference here. (Click to download PDF)

Categories : Healthcare Politics and Regulations Substance UseTags :

Almost Half of State-funded Drug Rehab Beds in Gauteng Under Threat

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Organisations are “under investigation” but have not been told why

Photo by Colin Davis on Unsplash

By Daniel Steyn, Masego Mafata and Raymond Joseph

The Gauteng Department of Social Development has decided to defund more than half of its existing capacity for inpatient drug rehabilitation in the province.

The department funded 571 beds in 13 non-profit organisations in the 2023/24 financial year, but at least five organisations, with 246 of these beds, will not be funded in the 2024/25 financial year.

The five organisations to be defunded – Westview Clinic Empilweni Treatment Centre, Golden Harvest Treatment Centre, Freedom Recovery Centre and Jamela Rehabilitation Centre – have been providing inpatient treatment for several years, but they have not received subsidies since the end of the last financial year.

Organisations GroundUp spoke to said they received letters from the department in the past few weeks informing them that they would not receive funding due to ongoing investigations. But they had not been told why they are under investigation, they said.

Representatives of FSG Africa, a forensic auditing firm appointed by the department, briefly visited some of the centres earlier this year, but the centres received no feedback on the progress or outcome of these investigations.

The auditors spent less than two hours at most of the facilities, asking only a few questions before leaving, the organisations said.

The organisations said they are yet to receive a report on the findings of the investigations. Queries they sent to the department have gone unanswered.

In previous years, the funding process was managed at a regional level, but this financial year it was centralised, cutting out the regional officials who would usually be in direct contact with the organisations. This has caused catastrophic delays.

Several of the organisations have been operating without departmental funding since March, depleting their savings and taking on debt, and having to short-pay staff salaries.

The department’s spokesperson Themba Gadebe confirmed to GroundUp that the organisations are under investigation, but did not provide details on the allegations.

In October 2022, Premier Panyaza Lesufi said treatment for substance abuse disorder was a priority. Yet the department has decided to defund beds in treatment centres without a clear plan to replace the lost capacity.

Gadebe said the department’s state-owned facility in Cullinan, near Pretoria, which has 288 beds, is undergoing renovation to increase its capacity. But he did not provide further details or timelines for completion.

Sedibeng’s only inpatient centres face closure

The only two drug rehabilitation centres with an inpatient programme in the Sedibeng region of Gauteng, with 116 funded beds between them, will be defunded this financial year.

One of these, Freedom Recovery Centre, was funded last year for 52 of its 94 beds (the remainder are for private patients). CEO Derick Matthews says when they received the department’s letter on 23 May “our world came crashing down”. What shocked him most was that there had been no warning that funding would stop.

Freedom Recovery Centre received a visit from the forensic auditors in March, who spent just two hours at the centre. They asked to see vehicles that the centre had supposedly received from the department.

“I was shocked by this request because we have never received vehicles from the department. But the auditor said that, according to their list, we had received vehicles from the department,” said Matthews.

“We are being punished for something. But we don’t even know what our transgression is,” he said.

On Monday, Freedom Recovery Centre began the process of discharging patients who were nearing the end of their treatment plans, as they can no longer afford to care for or feed them.

“We’ve had to take out loans for the past few months because of the delays in finalising service-level agreements and paying subsidies,” said Matthews. The centre has racked up more than R2-million in debt.

“Our staff are entering the third month of working without pay. Eskom is going to cut our electricity some time this week, because we are in arrears, and then we won’t even have water, because we rely on electricity to pump our boreholes. There are no funds left to keep the centre going,” said Matthews.

He said the centre will have no choice but to close completely in the coming weeks.

The other inpatient programme in the Sedibeng region, Jamela Recovery Centre, funded for 64 beds in 2023/24, faces a similar fate. CEO George Sibanda said they were relying on food donations from community members to feed their patients.

“We have been fully funded by the department since 2018 and our services are offered at no cost,” Sibanda said.

“We always had a backlog of patients. Our waiting list is sitting at 60 people so we were relieved when the department informed us that we would be getting additional beds in March this year. But what we don’t understand is how we must now provide a service to those patients if the department is not funding us this year?” said Sibanda.

Jamela also received a visit from the forensic auditors in March.

Despite not receiving any subsidies this financial year, Sibanda said the centre has been operating at full capacity.

“The department continued to refer people to us and we couldn’t turn them away,” he said.

Social workers at the centre have had to use their own money to pay for petrol for the centre’s car, which they use for outreach programmes.

Department spokesperson Themba Gadebe said that the closure of both centres in Sedibeng was not a concern as “the department prefers the placement of individuals within inpatient facilities far from where they reside, to limit the risk of them checking out or being contacted by those within their substance use networks.”

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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