No differences in blood glucose, insulin, or cholesterol levels seen in children born via frozen versus fresh embryo transfer regardless of age, gender, or method of assisted conception
Children born via frozen embryo transfer have similar metabolic profiles to those born via fresh embryo transfer, according to a study published June 6th in the open-access journal PLOS Medicine by Linlin Cui and Zi-Jiang Chen from Shandong University, China, and colleagues.
Prior studies have shown inconsistent results on the long-term metabolic health impacts of assisted reproductive technology. Some have shown that children born via frozen embryo transfer have a higher risk of metabolic disorders, such as obesity, and unfavorable lipid profiles. Other studies have failed to find any significant metabolic differences between those born via frozen or fresh embryo transfer.
In this study, researchers compared the glucose and lipid profiles of more than 4000 children between 2 and 5 years of age – approximately half had been born via fresh embryo transfer and half had been born via frozen embryo transfer.
Researchers followed the children for an average of 3.6 years and assessed metabolic factors often associated with heart disease and diabetes, such as fasting blood glucose, insulin, cholesterol, and triglycerides.
They found no difference in any of the metabolic factors among children born via fresh embryo transfer and those born via frozen embryo transfer.
Given the relatively large number of participants in this study, the researchers were able to conduct subgroup analyses. After dividing the children into groups based on gender, age, embryo transfer state, and method of conception, there were still no differences in metabolic factors among the frozen and fresh embryo transfer groups.
The study provides more information to women and couples weighing the pros and cons of different techniques offered for assisted reproduction, but the researchers noted the need for additional data on the effect of assisted reproductive technology on long-term metabolic health.
The authors add, “Frozen embryo transfer shows no significant adverse effects on metabolic profiles in early childhood, providing crucial evidence for counseling couples undergoing assisted reproductive technology treatment on its safety.”
A humorous remark at just the right time can go a long way. Benevolent humour helps medical assistants (MAs) cope positively with their stressful working day, according to a new study published in the journalBMC Primary Care. Researchers surveyed more than 600 MAs to find out how they experience their work and what style of humour they use in their daily working lives. They found that if the respondents preferred light, well-intended humour, they were more satisfied with their work and received more positive feedback. Dark humour, such as sarcasm, was more likely to have disadvantages.
Medical assistants mostly work in primary health care, especially medical practices. In Germany, working as an MA requires a three-year vocational training. The daily work routine of MAs can be very demanding. They are responsible for administrative work and, for example, taking blood samples and applying wound dressings. This new study by Martin Luther University Halle-Wittenberg (MLU) and the Federal Institute for Vocational Education and Training (BIBB) aimed to investigate how humour helps them get through their day.
“Medical assistants are in very close contact with patients for most of the day. They have a lot of responsibility and experience a lot of stress,” says Julia Raecke from BIBB, who is doing her doctorate at MLU. It has long been known that humour can help healthcare workers cope with stress. “However, little is known about the consequences of different humour styles. We set out to investigate those, as it should make a big difference, whether MAs use puns or sarcasm when dealing with patients. Talking to people that are potentially sick requires a lot of empathy and verbal dexterity,” explains Professor René Proyer, a psychologist at MLU.
The two researchers conducted an online survey of more than 600 MAs. The aim was to understand better the relationship between job satisfaction and different humour styles. In addition to the kind of humour they prefer, respondents also provided information about their well-being in the workplace and how competent they feel at work.
If the respondents preferred positive and benevolent humour, they were in general also more satisfied with their work. But not only that: “MAs with a preference for light humour stated that they received more positive feedback and were more likely to feel that they were making a difference at work,” says Julia Raecke. Surprisingly, presumably negative or dark humour did not score worse across the board. “Even though satire and irony are considered dark humour, we found no negative correlation with the respondents’ well-being,” adds Raecke. In contrast, cynicism and especially sarcasm had negative effects. Yet, this does not mean that sarcasm should be condemned completely. “A short sarcastic remark among colleagues might help to release frustration,” says René Proyer.
According to the researchers, humour is one of several factors that influence well-being at work. “Knowing about the effects of humour and different styles can help to make conversations with patients more pleasant. That said, waiting rooms are not supposed to become comedy clubs. It’s more about using humour consciously and appropriately,” concludes Proyer.
The results of the study could help to develop new training programmes. For example, Raecke is investigating whether the social and emotional skills of MAs can be improved with the help of online training.
Blocking a protein known as CDK7 could prevent heart damage associated with the commonly used cancer chemo drug doxorubicin, according to a study led by scientists at Washington State University. Importantly, the researchers also found that inhibiting CDK7 could help enhance the drug’s cancer-killing capability.
Based on an animal model, the study findings could provide a foundation for future treatment strategies to reduce chemotherapy-related heart toxicity and increase treatment effectiveness. This could ultimately help increase the lifespan of people with cancer. Heart damage related to chemotherapy treatment can surface decades after treatment and can result in heart attacks, heart failure, cardiomyopathy and other types of heart disease.
Published in the journal Cardiovascular Research, the WSU study focused on doxorubicin, a chemotherapy drug used to treat breast cancer, lymphoma, leukaemia and other cancers. Capable of killing a wide range of cancer cells, doxorubicin and other similar chemotherapy medications are known to be toxic to the heart. Despite this toxicity, the drug still sees a lot of use.
“Doxorubicin remains the mainstay treatment for certain cancer types for which targeted therapies or other better treatments are not available,” said senior study author Zhaokang Cheng, an associate professor in the WSU College of Pharmacy and Pharmaceutical Sciences.
Cheng has been working to unravel the underlying mechanisms of doxorubicin-induced heart toxicity to make the use of doxorubicin safer for patients who rely on the drug. This new study builds on findings from earlier research that showed that doxorubicin activates a protein known as CDK2. That protein then activates another known as FOXO1, which causes heart cells to die. Cheng’s team collaborated with WSU cancer biology researcher Boyang (Jason) Wu to take a closer look at CDK7, a protein that helps fuel cell growth and has been shown to play a role in the development of cancer.
The researchers found that CDK7 activated CDK2, which set off the chain of molecular signals that eventually led to heart cell death. They also showed that mice that lacked the CDK7 gene were protected from doxorubicin-induced heart toxicity. Next, they used a CDK7 inhibitor drug known as THZ1 to block the protein’s activity and examine the impact on heart health and cancer growth. A similar inhibitor is currently being tested as an anticancer drug in clinical trials, but its effect on the heart is still not clear.
“We are the first to study the effect of THZ1 on the heart and on tumor growth in the same model,” said study first author Jingrui Chen, a WSU research associate. “And what we found is that this CDK7 inhibitor drug can increase heart function and at the same time inhibit tumour growth.”
Though more research is needed, the researchers said their findings suggest that combining doxorubicin and THZ1 could help prevent heart damage and increase the effectiveness of chemotherapy treatment.
The researchers’ next step is to test the effect of THZ1 on heart damage and cancer growth in younger mice and follow them longer. This would more closely mimic long-term doxorubicin-induced heart toxicity seen in childhood cancer survivors. They also plan to look at other proteins that may somehow be involved in the signaling pathway that underlies doxorubicin-related heart damage.
Gut Microbiome. Credit Darryl Leja National Human Genome Research Institute National Institutes Of Health
Researchers have developed a new antibiotic that reduced or eliminated drug-resistant bacterial infections in mouse models of acute pneumonia and sepsis while sparing healthy microbes in the mouse gut. The drug, called lolamicin, also warded off secondary infections with Clostridioides difficile, and was effective against more than 130 multidrug-resistant bacterial strains in cell culture.
“People are starting to realise that the antibiotics we’ve all been taking – that are fighting infection and, in some instances, saving our lives – also are having these deleterious effects on us,” said University of Illinois Urbana-Champaign chemistry professor Paul Hergenrother, who led the study with former doctoral student Kristen Muñoz. “They’re killing our good bacteria as they treat the infection. We wanted to start thinking about the next generation of antibiotics that could be developed to kill the pathogenic bacteria and not the beneficial ones.”
“Most clinically approved antibiotics only kill gram-positive bacteria or kill both gram-positive and gram-negative bacteria,” Muñoz said.
The few drugs available to fight gram-negative bacteria, which are protected by their double cell walls, also kill other potentially beneficial gram-negative bacteria. For example, colistin, one of the few gram-negative-only antibiotics approved for clinical use, can cause C. difficile-associated diarrhoea and pseudomembranous colitis, a potentially life-threatening complication. The drug also has toxic effects on the liver and kidney, and “thus colistin is typically utilised only as an antibiotic of last resort,” the researchers wrote.
To tackle the many problems associated with indiscriminately targeting gram-negative bacteria, the team focused on a suite of drugs developed by the pharmaceutical company AstraZeneca. These drugs inhibit the Lol system, a lipoprotein-transport system that is exclusive to gram-negative bacteria and genetically different in pathogenic and beneficial microbes. These drugs were not effective against gram-negative infections unless the researchers first undermined key bacterial defenses in the laboratory. But because these antibiotics appeared to discriminate between beneficial and pathogenic gram-negative bacteria in cell culture experiments, they were promising candidates for further exploration, Hergenrother said.
In a series of experiments, Muñoz designed structural variations of the Lol inhibitors and evaluated their potential to fight gram-negative and gram-positive bacteria in cell culture. One of the new compounds, lolamicin, selectively targeted some “laboratory strains of gram-negative pathogens including Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae,” the researchers found. Lolamicin had no detectable effect on gram-positive bacteria in cell culture. At higher doses, lolamicin killed up to 90% of multidrug-resistant E. coli, K. pneumoniae and E. cloacae clinical isolates.
When given orally to mice with drug-resistant septicemia or pneumonia, lolamicin rescued 100% of the mice with septicemia and 70% of the mice with pneumonia, the team reported.
Extensive work was done to determine the effect of lolamicin on the gut microbiome.
“The mouse microbiome is a good tool for modeling human infections because human and mouse gut microbiomes are very similar,” Muñoz said. “Studies have shown that antibiotics that cause gut dysbiosis in mice have a similar effect in humans.”
Treatment with standard antibiotics amoxicillin and clindamycin caused dramatic shifts in the overall structure of bacterial populations in the mouse gut, diminishing the abundance several beneficial microbial groups, the team found.
“In contrast, lolamicin did not cause any drastic changes in taxonomic composition over the course of the three-day treatment or the following 28-day recovery,” the researchers wrote.
Many more years of research are needed to extend the findings, Hergenrother said. Lolamicin, or other similar compounds, must be tested against more bacterial strains and detailed toxicology studies must be conducted. Any new antibiotics also must be assessed to determine how quickly they induce drug resistance, a problem that arises sooner or later in bacteria treated with antibiotics.
The study is a proof-of-concept that antibiotics that kill a pathogenic microbe while sparing beneficial bacteria in the gut can be developed for gram-negative infections – some of the most challenging infections to treat, Hergenrother said.
For years, Prof Bozhi Tian’s lab has been learning how to integrate the rigid, metallic and bulky world of electronics with the soft, flexible and delicate world of the body. In their latest work, published in Science, they have created a prototype for what they call “living bioelectronics”: a combination of living cells, gel, and electronics that can integrate with living tissue and treat psoriasis.
The patches are made of sensors, bacterial cells, and a gel made from starch and gelatin. Tests in mice found that the devices could continuously monitor and improve psoriasis-like symptoms, without irritating skin.
“This is a bridge from traditional bioelectronics, which incorporates living cells as part of the therapy,” said Jiuyun Shi, the co-first author of the paper and a former PhD student in Tian’s lab (now with Stanford University).
“We’re very excited because it’s been a decade and a half in the making,” said Tian.
The researchers hope the principles can also be applied to other parts of the body, such as cardiological or neural stimulation.
A third layer: cells
Pairing electronics with the human body has always been difficult. Though devices like pacemakers have improved countless lives, they have their drawbacks; electronics tend to be bulky and rigid, and can cause irritation.
But Tian’s lab specialises in uncovering the fundamental principles behind how living cells and tissue interact with synthetic materials; their previous work has included a tiny pacemaker that can be controlled with light and strong but flexible materials that could form the basis of bone implants.
In this study, they took a new approach. Typically, bioelectronics consist of the electronics themselves, plus a soft layer to make them less irritating to the body.
But Tian’s group wondered if they could add new capabilities by integrating a third component: living cells themselves. The group was intrigued with the healing properties of certain bacteria such as S. epidermidis, a microbe that naturally lives on human skin and has been shown to reduce inflammation.
They created a device with three components. The framework is a thin, flexible electronic circuit with sensors. It is overlaid with a gel created from tapioca starch and gelatin, which is ultrasoft and mimics the makeup of tissue itself. Lastly, S. epidermidis microbes are tucked into the gel.
When the device is placed on skin, the bacteria secrete compounds that reduce inflammation, and the sensor monitors the skin for signals like skin temperature and humidity. In tests with mice prone to psoriasis-like skin conditions, there was a significant reduction in symptoms.
Their initial tests ran for a week, but the researchers hope the system, which they term the ABLE platform, for Active Biointegrated Living Electronics, could be used for a half-year or more. To make the treatment more convenient, they said, the device can be freeze-dried for storage and easily rehydrated when needed.
Since the healing effects are provided by microbes, “It’s like a living drug – you don’t have to refill it,” said Saehyun Kim, the other co-first author of the paper and a current PhD student in Tian’s lab.
In addition to treating psoriasis, the scientists can envision applications such as patches to speed wound healing on patients with diabetes.
They also hope to extend the approach to other tissue types and cell types. “For example, could you create an insulin-producing device, or a device that interfaces with neurons?” said Tian. “There are many potential applications.”
On 13 April 2024,the South African Health Products Regulatory Authority (SAHPRA) initiated a precautionary recall of two batches of Benylin Paediatric Syrup (batch numbers 329303 and 329304), in response to reported high levels of diethylene glycol in an alert by the Nigerian National Agency for Food and Drug Administration and Control (NAFDAC). The recall was implemented as a precaution to protect lives while SAHPRA investigated the reported high levels of diethylene glycol.
As the national regulatory authority for health products in South Africa, SAHPRA implements health product recalls as a crucial measure to address safety concerns or quality issues in the interest of public health.
As part of the investigation of the reported high levels of diethylene glycol, SAHPRA tested samples of the two affected batches of Benylin Paediatric syrup through an independent laboratory and a method developed by the World Health Organisation for testing products for the presence of diethylene glycol. The tests did not find traces of diethylene glycol in the recalled batches. This indicates that units of batches 329303 and 329304 that were stored at the required temperature would not contain unacceptable levels of diethylene glycol.
SAHPRA also wishes to indicate that there is no record of any adverse drug reactions relating to diethylene glycol for the two recalled batches in South Africa or anywhere else where they were exported to on the continent.
SAHPRA is mandated to regulate and apply due diligence to health products to ensure that products in circulation in South Africa and those exported from SAHPRA-licensed manufacturers are safe for public consumption. SAHPRA applies this due diligence throughout the product life cycle, from registration through to post-market monitoring.
“SAHPRA will continue to closely monitor medical products that have the potential of containing unacceptable levels of diethylene glycol. And we will continue to address safety concerns or quality issues so that the health of the public is protected,” says SAHPRA CEO, Dr Boitumelo Semete-Makokotlela.
Image-based online study shows no benefits, however, of virtual room designs incorporating the golden ratio
In an online study, virtual hospital rooms designed according to the principles of evidence-based design or the principles of Feng Shui were associated with greater potential benefit for viewers than virtual representations of standard hospital rooms. Emma Zijlstra of Hanze University of Applied Sciences in the Netherlands and colleagues present these findings in the open-access journal PLOS ONE on June 5.
Hospital designers might consider employing specific design principles in an effort to improve patients’ experiences. Growing evidence suggests there are beneficial outcomes from an approach known as evidence-based design. For instance, exposure to more daylight in hospitals is associated with lower stress and pain. Other well-known design approaches include Feng Shui, a Chinese system based on hypothetical energy flow, and the use of proportions following the golden ratio.
Despite these well-known options, experimental evidence on their relative benefits in hospitals is lacking. To help clarify, Zijlstra and colleagues randomly assigned each of 558 study participants to view online representations and information about a virtual hospital room designed with one of four approaches: Feng Shui, the golden ratio, evidence-based design or, as a control, a standard design from a real-life hospital. Only people who had previously been hospitalized at some point in their lives were invited to participate.
After experiencing the virtual rooms, participants completed a questionnaire that included standard measures of anxiety and other outcomes. Statistical analysis of their answers showed that, compared to participants who viewed the standard rooms, those who viewed rooms with evidence-based design reported less anxiety and greater senses of control, social support, distraction from negative thoughts, and pleasantness of the room.
Feng Shui design was not directly associated with lower anxiety, but participants who viewed the Feng Shui rooms did have greater senses of social support, positive distraction, and pleasantness of the room. There was no evidence for any benefits of golden ratio-based design.
On the basis of their findings, the authors suggest that rooms designed according to the principles of evidence-based design or Feng Shui might benefit patients. They note similarities between the two approaches, such as incorporation of greenery. However, they caution, it is unclear how well these online findings might translate to real-life hospital settings.
The authors add: “To our knowledge, this is the first and largest randomized controlled trial linking design principles, partly ancient and world-renowned, directly to anxiety in hospital rooms. This study showed that both Feng Shui and Evidence-Based Design are capable in effecting anxiety and it is important that large follow-up studies are conducted to examine the effect of specific design features.”
Gut Microbiome. Credit Darryl Leja National Human Genome Research Institute National Institutes Of Health
A study conducted by researcher Juan Du’s research group at the Karolinska Institutet sheds light on the capabilities of our gut microbes and their metabolites. The findings reveal potent inhibitory effects on the growth of antibiotic-resistant bacteria and suggest interactions and signaling between gut microbes and pathogens.
The study,published in the journal Gut Microbes, focuses on identifying key microbes within the gut microbiome that inhibit the growth of pathogens, particularly antibiotic-resistant strains.
Strains from Clostridium perfringens, Clostridium butyricum, and Enterobacter maltosivorans and their metabolites were found to directly inhibit the growth of pathogens, including multi-drug-resistant ones. The study also reveals novel dipeptide features, suggesting interactions and signaling between gut microbes and pathogens.
“Multidrug-resistant microorganisms pose a global threat, and understanding the role of gut microbiota is crucial. Metabolites derived from these microbial communities play a significant role in regulating biochemical processes in the human body. Despite this, only a limited number of gut microbes and their bioactive metabolites have been explored so far”, explains author Juan Du. She continues:
“We plan to expand our screening to include a broader collection of commensal bacteria from various body sites. We’ll conduct mechanism studies to understand how these compounds function on pathogens, especially antibiotic-resistant strains”, says Juan Du.
Dr Kenneth Jacobs entered Parliament as an ANC MP in 2019, and two years later was elected chairperson of the Portfolio Committee on Health. (Photo: Parliament)
By Biénne Huisman
The chairperson of the National Assembly’s Portfolio Committee on Health Dr Kenneth Jacobs played a pivotal role in deliberations on the National Health Insurance Bill. Spotlight’s Biénne Huisman asked Jacobs about some criticisms of NHI and about his plans for life after Parliament.
Back in Cape Town, Jacobs tells Spotlight the NHI signing was the culmination of his own work dating back fifteen years. He says he started working on public health projects relating to universal health coverage and the NHI in 2009, as a consultant to the National Department of Health.
For him, at the heart of the bill lies fairness.
“We should be able to provide all of the people of South Africa the opportunity to access quality healthcare,” he says.
Jacobs entered Parliament as an ANC MP in 2019, and two years later was elected chairperson of the Portfolio Committee on Health after his predecessor, Dr Sibongiseni Dhlomo, became the Deputy Minister of Health. Committee chairpersons are elected by and from among the members of each committee, meaning the majority party in Parliament has the most influence in selecting chairpersons.
As chairperson, a large part of Jacobs’ job was to hold the country’s executive and the National Department of Health to account on behalf of South Africa’s citizens.
Amongst other tasks, he played a pivotal role in overseeing public deliberations around the NHI Bill, which included 338 891 written submission and presentations by 133 organisations. These included political parties, trade unions, medical aid schemes, health technology organisations, the South African Medical Association, and university departments.
“It is never in the history that the committee had such an engagement by the public,” says Jacobs. “So I’ve been very blessed and fortunate to go to Parliament in the final process of the NHI Bill.”
‘Disheartening’ criticism
Both before and after its signing into law, NHI has been deeply divisive, with several political parties and other role players threatening litigation. One line of criticism is that, while many people and organisations made submissions to the committee chaired by Jacobs, the final bill did not changed substantially from what it was prior to the public hearings.
Interviewed on the topic, Business Leadership South Africa CEO Busi Mavuso, said government rushed populist policy through Parliament – an electioneering ploy – as the significant public input into the Bill and its socioeconomic ramifications had not been considered.
Jacobs voices his frustration at such criticism of the NHI public participation process, saying it is “disheartening”, adding that criticism are doled out by South Africans who are “in better financial positions”.
He explains the process of collating so much information: “Well, firstly it’s driven by the chairperson [him]… We appointed a team through Parliamentary processes, who looked at the submissions, and interpreted the submissions using computerised systems. It’s thematic – what are the themes, really? These are developed into reports; the reports on all the public hearings, those reports are all available.”
He adds: “So people who want to write and say all these negative things, they really should go and access these documents and see what the submissions were.”
‘It’s attractive to make people insecure’
Another aspect of NHI over which many have expressed concern is the potential for corruption, particularly in light of massive healthcare corruption during the height of the COVID-19 pandemic and more recent alleged corruption at Tembisa Hospital in Gauteng. Here criticism ranges from a simple distrust in government to run such funds, to more nuanced criticisms of aspects of the bill that critics say increases the risk of corruption – such as the Minister of Health’s expansive powers and accountability to cabinet rather than to Parliament.
In an interview following the signing of the bill, DA Chief Whip who was also a health portfolio committee member, Siviwe Gwarube, said: “The NHI will not address the underlying issues in our healthcare system; it is financially unfeasible, an election gimmick, and will burden South Africans with increased taxes.” She added: “The potential for corruption is staggering, and the flawed parliamentary process further erodes public trust…”
When asked about fears that money might disappear from centralised NHI coffers – to be governed by a board appointed by the minister of health – and accountability to prevent such, Jacobs says: “I think that people are putting the cart before the horse. You must remember this will be an entity [with tender procedures], and then who is supposed to appoint them [board members] in any case? Somebody has to have the responsibility. Why can that not be the minister, for example. But remember that it will be a transparent process, the same as the appointment, I think, as what we do with the appointment of judges.”
The NHI fund will be a schedule 3A entity, similar to, among others, the Road Accident Fund, the National Lotteries Commission, the National Laboratory Service, the Office of Health Standards Compliance, the Competition Commission, and the Council for Medical Schemes.
Jacobs says checks will be provided by the country’s forensic investigation agency, the Special Investigating Unit (SIU). “And there are many ways to put checks and balances into place,” he says, “we talk [in the bill] about the interventions which can be made, or the investigations which can be made by the SIU and other law enforcement agencies”.
Shortly after taking over as health committee chairperson, Jacobs told Spotlight that rooting out corruption in the health sector was a priority. At the time, he stressed the importance of safety nets for whistle-blowers, and of establishing systems to enforce accountability. Around the time of his appointment in 2021, whistle-blower Babita Deokaran was murdered for exposing R1 billion worth of allegedly irregular tenders issued at the Tembisa Hospital in Gauteng.
Asked about these particular earlier priorities, Jacobs responds: “I have no answer on that, I don’t think I want to talk about corruption now…” Upon reflection, he adds: “Of course corruption is important. Losses to the fiscal is important; people doing wrong is important. People need to be brought to book, be held accountable for doing wrong…”
Later on in the interview, when the issue of corruption comes up again, he says that corruption has decreased in South Africa: “I think we’ve advanced quite a bit from the time when corruption was more rife. I think nowadays you hardly hear about these things and it’s because unprecedented intensive programmes were put in place to address these issues of corruption and fraud. I really think what they [critics] are doing is fear-mongering, telling people that you need to be frightened, and I’m going to say again, those who are telling others to feel frightened, are in a better financial position. So it’s attractive to make people insecure.”
Money for NHI?
Another common argument against implementing NHI is that it is not affordable. Government’s spending on health has declined in real terms for much of the last decade and the South African economy is struggling by most measures.
Asked about crippling budget cuts in the health sector as it stands, and questions around the NHI’s affordability, Jacobs says South Africa has insufficient central funds because of unemployment, and that South Africa needs more jobs and more workers to increase its tax-base.
“My personal view is that we need to understand why there’s a budget problem,” he says. “So where is government supposed to get money? Who are supposed to contribute? Those who are employed. And look at our employment rate – is it government’s responsibility? No, the emphasis is wrong. It is businesses’ responsibility.
“When people have employment they can contribute to the coffer… and I’m going to keep on saying, the narrative is in the wrong place. We need to say to South Africans: ‘don’t all of us have a responsibility?’ Those who have the economy in their hands and those who don’t have the economy in their hands, all of the responsibility to drive our country forward.”
How to drive South African healthcare forward, remains contested. Several organisations representing healthcare workers, such as the South African Medical Association, do not support the NHI Act in its current form. Others, including the South African Medical Association Trade Union, welcome it.
Meanwhile, Jacobs expresses empathy for his clinician colleagues: “As a medical doctor, I have absolute respect for all of my colleagues. I would like you to write it; I understand the conditions under which our medical and or health personnel have to function. And I don’t think that National Health Insurance be a negative thing for healthcare professionals.”
‘Why should there be people who profit from the ill health of other people?’
Another concern in some quarters is that NHI will over time squeeze out medical aid schemes and leave people with no alternative to health services provided through NHI. This because, according to Section 33 of the NHI Act, medical schemes will not be allowed to cover services that are already covered by the NHI fund.
Asked about the future of medical aid schemes in South Africa, Jacobs says: “What is the medical aid system? It’s a profit driven system by people who are in business. Is it correct that there are people who make profit off the lives of people, and the health of people? I don’t think that is correct.” (Note: Medical schemes are non-profit entities while medical scheme administrators are for-profit.)
He adds: “What is wrong with having one single system, in which everybody has access to the same healthcare? Why do we need to keep exclusionary rights for some people, based on them having a better income than others? I think that’s the bottom-line on the answer of the medical aid. Whether medical aid will stop functioning or not. I think that’s not the question to ask. The question is why should there be people who profit from the ill health of other people?”
‘From policy to practice’
Going forward, given that he won’t be returning to Parliament, Jacobs hopes to resume doing public health consulting work for the National Department of Health.
“I have a project which is very dear to me,” he says. “I want to start an institute for health governance, and it’s called, ‘from policy to practice’. It’s on health governance, universal health coverage… and will be instrumental in influencing dialogue. So, I can’t wait to stay active in the health sector, but not being restricted in that I’m no longer a member of Parliament, not feeling that there’s some sort of conflict.”
Jacobs will now move from the Acacia Park Parliamentary Village on Cape Town’s northern fringes back to his family home in Wellington.
Jacobs says that they will soon have seven public health doctors in his family – that is, when his son completes medical school at Stellenbosch University. His daughter recently finished medical school and is contracted as a doctor at a clinic in Khayelitsha.
Originally from Gqeberha, Jacobs holds a Bachelor of Medicine and Bachelor of Surgery degree from Stellenbosch University where he also obtained a Master of Medicine degree in family medicine. He went on to get a Master of Science degree in sports medicine from the University of Pretoria. In earlier years, he served as a physician to the Stormers and Springbok rugby teams.
In the previous interview with Spotlight, Jacobs relayed how his formative years were tough. His family were forcibly evicted from sea-facing South End, in what was then Port Elizabeth, and moved to Gelvandale, in the city’s northern suburbs. His father worked in a shoe factory, but lost his job when Jacobs was in grade 10.
“South End was like Port Elizabeth’s District Six,” said Jacobs, in the earlier interview. “So yes, honestly, that was something that had a huge impact on me. I decided then that I would not allow somebody to suppress or oppress me and I think it is probably why I just kept on studying and improving.”
At 65 years old, Jacobs exudes ambition and enthusiasm. Wrapping up, he quotes an Afrikaans aphorism: “Die mens wik maar God beskik” (Humanity proposes, God disposes).
Lung cancer metastasis. Credit: National Cancer Institute
A new study led by investigators from Mass General Cancer Center, a founding member of the Mass General Brigham healthcare system, reveals that statins may block a particular pathway involved in the development of cancer that results from chronic inflammation. The findings are published in Nature Communications.
“Chronic inflammation is a major cause of cancer worldwide,” said senior author Shawn Demehri, MD, PhD. “We investigated the mechanism by which environmental toxins drive the initiation of cancer-prone chronic inflammation in the skin and pancreas. Furthermore, we examined safe and effective therapies to block this pathway in order to suppress chronic inflammation and its cancer aftermath.”
Demehri and his colleagues’ study relied on cell lines, animal models, human tissue samples and epidemiological data. The group’s cell-based experiments demonstrated that environmental toxins (such as exposure to allergens and chemical irritants) activate two connected signaling pathways called the TLR3/4 and TBK1-IRF3 pathways. This activation leads to the production of the interleukin-33 (IL-33) protein, which stimulates inflammation in the skin and pancreas that can contribute to the development of cancer.
When they screened a library of U.S. Food and Drug Administration–approved drugs, the researchers found that a statin, pitavastatin, effectively suppresses IL-33 expression by blocking the activation of the TBK1-IRF3 signalling pathway. In mice, pitavastatin suppressed environmentally-induced inflammation in the skin and the pancreas and prevented the development of inflammation-related pancreatic cancers.
In human pancreas tissue samples, IL-33 was over-expressed in samples from patients with chronic pancreatitis and pancreatic cancer compared with normal pancreatic tissue. Also, in analyses of electronic health records data on more than 200 million people across North America and Europe, use of pitavastatin was linked to a significantly reduced risk of chronic pancreatitis and pancreatic cancer.
The findings demonstrate that blocking IL-33 production with pitavastatin may be a safe and effective preventive strategy to suppress chronic inflammation and the subsequent development of certain cancers.
“Next, we aim to further examine the impact of statins in preventing cancer development in chronic inflammation in liver and gastrointestinal tract and to identify other novel, therapeutic approaches to suppress cancer-prone chronic inflammation” said Demehri.
