New X-ray imaging technologies may soon offer a lot more information than the simple black-and-white images we are used to. Photo by Tima Miroshnichenko on Pexels
New technology developed by researchers at the University of Houston could revolutionise medical imaging and lead to faster, more precise and more cost-effective alternatives to traditional diagnostic methods.
For years, doctors have relied on conventional 2D X-rays to diagnose common bone fractures, but small breaks or soft tissue damage like cancers often go undetected. More expensive and time-consuming MRI scans are not always suitable for these tasks in these detection or screening settings. Now, Mini Das, UH professor, has developed a 3D solution.
In a paper featured on the cover of the Journal of Medical Imaging, Das explains how photon counting detectors along with novel algorithms allow for more precise 3D visualisation of different tissues and contrast agents by capturing X-rays at multiple energy levels simultaneously, which helps differentiate materials inside the body.
“There are so many other potential applications for this technology including in materials imaging, baggage scanning for security, imaging for geophysics, and micro- and nano-electronics imaging – it’s very promising.”
Mini Das
“Right now, X-rays used in medical clinics and other industries collect incoming photons as a whole, similar to how white light contains all the colours, but they aren’t separated,” Das says. “So, while they can show differences in density – like distinguishing between bone and soft tissue – they can’t tell us exactly what materials are present.”
Medical and Industrial Applications
The photon counting detectors developed by Das’s team at UH can separate X-ray photons by their energy levels, similar to how a prism splits white light into different colours – and they can help identify specific materials, such as distinguishing between aluminium, plastic, iodine or other contrast agents like gadolinium used in medical imaging.
“This could improve cancer detection, for example,” Das says. “If you inject two different contrast agents – one targeting a tumor and another targeting inflammation – you could see where each one accumulates. Right now, we can see bright areas in an image, but we can’t always tell what they are. This technology would give us a much clearer, quantitative analysis. It would allow us to determine not just what’s inside an object, but what different materials are present and in what quantities.”
However, even with this advanced detection, some materials have similar X-ray properties, so distinguishing more than two or three at once can be a challenge. This is also amplified due to errors in the detectors as they separate photons by energy. But Das is working on a solution to that problem.
“We have developed a method that compensates for these detector distortions by calibrating the detector using known materials,” Das says. “Once corrected, we can use the data along with the proposed novel algorithm, for accurate material decomposition – breaking down an image into its component materials. We do this in a multi-step solution from the same CT data collected improving accuracy.”
Still Work to Do
Before the detectors can be widely used, there is still a lot of work to do. But Das says her team is working with industry partners in Europe to develop larger versions of these novel detectors and optimize their performance.
“We’re still in the research and development phase,” Das says. “Right now, the detectors are small, and we need to refine their measurement accuracy. But once we solve those challenges, we can begin testing in real-world medical and industrial settings. There are so many other potential applications for this technology including in materials imaging, baggage scanning for security, imaging for geophysics, and micro- and nano-electronics imaging – it’s very promising.”
Previously, Das addressed a century-old problem in another innovative area related to the exploration of the wave nature of X-rays to significantly enhance soft material contrast. This research was featured in the prestigious scientific journal Optica last year.
Das’s research is funded through multiple agencies including NSF, CDMRP and NIH. The latest funding from the National Institute of Biomedical Imaging and Bioengineering aims to develop low-dose Micro-CT that utilises multiple novel contrast mechanisms, thereby reducing radiation dose and imaging time which continues to be a significant issue.
Scientists have a new target to prevent cold sores after University of Virginia researchers discovered an unexpected way the herpes virus re-activates in the body. The finding, published in PNAS, could also have important implications for genital herpes caused by the same virus.
The discovery from UVA’s Anna Cliffe, PhD, and colleagues seems to defy common sense. She and her team found that the slumbering herpes virus will make a protein to trigger the body’s immune response as part of its escape from dormancy. You’d think this would be bad for the virus – that activating the body’s antiviral defences would be like poking a bear. But, instead, it’s the opposite: The virus hijacks the antiviral process in infected neurons to make the type of comeback nobody wants.
“Our findings identify the first viral protein required for herpes simplex virus to wake up from dormancy, and, surprisingly, this protein does so by triggering responses that should act against the virus,” said Cliffe of UVA’s Department of Microbiology, Immunology and Cancer Biology. “This is important because it gives us new ways to potentially prevent the virus from waking up and activating immune responses in the nervous system that could have negative consequences in the long term.”
Herpes Simplex Virus-Associated Disease
Cold sores are caused primarily by herpes simplex virus 1 (HSV-1), one of two forms of the herpes virus. HSV-1 is very contagious, and worldwide more than 60% of people under 50 (more than 3.8 billion) have been infected, the World Health Organization estimates.
In addition to causing cold sores, herpes simplex virus 1 can also cause genital herpes, a condition most often associated with HSV-1’s cousin, herpes simplex virus 2. Now, however, there are more new cases of genital herpes in the United States caused by HSV-1 than HSV-2. Notably, the UVA researchers found that herpes simplex virus 2 also makes this same protein and may use a similar mechanism to reactivate. So UVA’s new discovery may also lead to new treatments for genital herpes.
In addition to cold sores and genital herpes, HSV-1 can also cause viral encephalitis (brain inflammation) and has been linked to the development of Alzheimer’s disease.
Once HSV-1 makes its way into our bodies, it stays forever. Our immune systems can send it into hiding, allowing infected people to be symptom free. But stress, other infections and even sunburns are known to cause it to flare. UVA’s new discovery adds another, surprising way it can spring back into action.
The researchers found that while the virus can make a protein called UL12.5 to reactivate, the protein was not needed in the presence of another infection. The scientists believe this is because the infections trigger certain “sensing pathways” that act as the home security system for neurons. Detection of a pathogen alone may be sufficient to trigger the herpes virus to begin replicating, the scientists believe, even in instances of “abortive infections” – when the immune system contains the new pathogen before it can replicate.
“We were surprised to find that HSV-1 doesn’t just passively wait for the right conditions to reactivate – it actively senses danger and takes control of the process,” researcher Patryk Krakowiak said. “Our findings suggest that the virus may be using immune signals as a way to detect cellular stress – whether from neuron damage, infections or other threats – as a cue to escape its host and find a new one.”
With the new understanding of how herpes flares can be triggered, scientists may be able to target the protein to prevent them, the researchers say.
“We are now following up on this work to investigate how the virus is hijacking this response and testing inhibitors of UL12.5 function,” Cliffe said. “Currently, there are no therapies that can prevent the virus from waking up from dormancy, and this stage was thought to only use host proteins. Developing therapies that specifically act on a viral protein is an attractive approach that will likely have fewer side effects than targeting a host protein.”
A new study of more than 2900 patients provides evidence that it’s likely best to use as little corticosteroid medicine as possible when treating people who have lupus pericarditis, a common heart complication of the autoimmune disease Systemic Lupus Erythematosus (SLE).
This study, funded by the National Institutes of Health’s (NIH) National Heart, Lung, and Blood Institute (NHLBI) and led by Johns Hopkins Medicine cardiologists and rheumatologists who led the study say their analysis of data affirms that using steroids to curb heart inflammation and other painful symptoms for lupus patients is also a risk factor for recurring pericarditis,.
The American Heart Association defines pericarditis as inflammation of the pericardium, the twin-layered sac-like structure surrounds the heart to hold it in place and help protect it. Pericarditis typically presents as chest pain that can be exacerbated by lying flat and improved by leaning forward. This pain can last anywhere from a few days to several months. Treatment options for pericarditis include use of colchicine, an anti-inflammatory medication that prevents the recurrence of pericarditis, and corticosteroids.
Pericarditis occurs in 15% to 30% of patients with SLE, a chronic autoimmune disease that causes the body’s immune system to attack its own tissues. “It is well known that, in the general population, one fifth of patients who experience pericarditis end up experiencing one or more recurrences. Surprisingly, even though pericarditis is the most common cardiac complication of Lupus, we could not find any information on recurrent of pericarditis in this patient population,” says Dr Luigi Adamo, MD, PhD, director of Cardiac Immunology at Johns Hopkins University and co-senior author of this study.
Researchers set out to address this gap in knowledge and examine the risk factors contributing to the recurrence.
For the new analysis, researchers used data gathered among the Hopkins Lupus Cohort, a large ongoing study group that includes information on 2,931 patients diagnosed with SLE between 1988 to 2023 and the investigators focused on data from 590 patients also diagnosed with pericarditis. Pericarditis in the data set was identified using the Safety of Estrogens in Lupus Erythematosus National Assessment – SLE Disease Activity Index (SELENA-SLEDAI), a standard tool in the assessment of SLE clinical activity.
Study results showed that 20% of patients with Lupus who experienced pericarditis had a recurrence. Recurrent pericarditis was most prevalent among patients within the first year of pericarditis onset, with recurrence decreasing in the following years. Younger patients and those with uncontrolled disease were at greater risk of recurrence. It was noted that oral prednisone therapy, a tool frequently used to treat pericarditis in patients with autoimmune diseases, was associated with a higher chance of pericarditis recurrence in patients with SLE.
“The cardiology literature has shown that use of corticosteroids increases the risk of recurrent pericarditis in the general population. Nevertheless, steroids are very frequently used by rheumatologists to treat lupus pericarditis. Therefore, the findings from this study underscore the importance of minimising oral corticosteroid use in patients with lupus and indicate the need for alternative strategies.” said Andrea Fava, MD, a rheumatologist who specialises in care of patients with lupus and co-senior author of the study.
It’s common knowledge that sugar causes cavities, but new research provides evidence that – depending on your genetic makeup – starches could also be a contributing factor.
The study, published in Microorganisms, explores the response of the oral microbiome to starch, finding that the number of copies of a particular gene, AMY1, in combination with starch, alters the complex composition of bacteria that play a role in oral health.
“Most people have been warned that if you eat a bunch of sugar, make sure you brush your teeth,” said Angela Poole, senior author and assistant professor of molecular nutrition in the College of Agriculture and Life Sciences and the College of Human Ecology. “The takeaway finding here is that depending on your AMY1 copy number, you may want to be just as vigilant about brushing your teeth after eating those digestible starches.”
Researchers, including first author Dorothy Superdock, PhD ’23, collected saliva samples from 31 subjects with a range of AMY1 copy numbers – copies of the AMY1 gene in the DNA – and added starch to the cultured samples, or biofilms, to see how the bacterial makeup changed. They found that, in general, the diversity of bacteria decreased when starch was added. For those samples with high numbers of AMY1, the starch significantly reduced the proportions of two bacteria, Atopobium and Veillonella, while Streptococcus appeared to increase.
All three bacteria are associated with tooth decay or gum disease, Poole said.
“Some increased and some decreased, so it’s not so straightforward as saying, ‘The whole thing is good or bad,’” Poole said. “It’s an interaction, but it looks like the AMY1 copy number, as well as which species are present in people’s mouths when they eat starch, is affecting the risk for developing these diseases.”
AMY1 codes for the salivary amylase enzyme, which helps break down starch in the mouth. Previous studies have associated AMY1 with cavities and periodontal disease. Poole, in prior studies, found that a high AMY1 copy number is associated with higher levels of the species Porphyromonas endodontalis, which is strongly associated with periodontitis and gum disease.
But how the salivary amylase enzyme interacts with its main substrate, starch, to alter the oral microbiome and increase disease risk was unclear.
“That’s what we wanted to know in this experiment,” Poole said. “What’s going on in the mouth if someone eats starch, and is the answer different if their copy number is high or if it’s low? What we found was that there are other bacteria involved in these processes and that the changes depended on AMY1.”
The researchers also found evidence that the oral microbiome has co-evolved in response to increasing copies of AMY1, which is found in higher numbers in populations where there’s a long history of agriculture and starch consumption. In the pool of 31 samples, taken locally in Ithaca, the AMY1 number ranged from two to 20 copies.
“The populations that historically had greater access to starch tend to have more copies,” Poole said, “which makes sense from a practical standpoint, because it would have given you a survival advantage when food is scarce, to be able to break down those starches more efficiently.”
In saliva samples with a high AMY1 copy number, the researchers saw increased populations of bacteria, like Streptococcus, that feed off the starch’s sugars.
“If someone has a high copy number, they break down starch efficiently, and bacteria that like those sugars are going to grow more in that person’s mouth,” Poole said. “So you can have species behave differently based on the different substrates. It’s pretty incredible – how we adapt and these microbes turn around and adapt, too.”
For many years, scientists assumed that blood production took place in the bone marrow, providing the 200 billion blood cells needed per day. But now, researchers at UCSF are showing it’s also happening in the lungs.
They found haematopoietic stem cells (HSCs) in human lung tissue that make red blood cells, as well as megakaryocytes, which produce the platelets that form blood clots. The findings appear in the journal Blood.
The work, which was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), suggests the lungs could be a potent source for life-saving stem cell transplants.
“For decades, bone marrow transplants have been a lynchpin in the treatment of cancers like leukemia,” said Mark Looney, MD, professor of medicine and laboratory medicine at UCSF and senior author of the paper. “The lung HSCs could prove to be a second and significant reservoir of these precious stem cells.”
They also discovered lung stem cells in mice that made all the constituents of blood, including red blood cells, megakaryocytes and several types of immune cells.
Looney’s group wanted to prove this was also happening in people. So, they obtained donated samples of lung, bone marrow and blood, and compared what they found in each tissue.
Screening a golf-ball-sized volume of lung tissue, the scientists found stem cells in the lung that strongly resembled the well-known HSCs of bone marrow. Surprisingly, the HSCs were found at similar rates in both lung and bone marrow.
“The lung HSCs weren’t one-offs – they were a reliable presence in the lungs,” said Catharina Conrad, MD, PhD, postdoctoral scholar in Looney’s lab and first author of the paper. “But we still needed to know that they were actually capable of making blood.”
So, the scientists coaxed lung and bone marrow HSCs to mature in petri dishes and found the lung HSCs were productive just like the bone marrow HSCs.
“Both types of HSCs thrived in our gold-standard stem cell experiment, but the lung HSC colonies made more red blood cells and megakaryocytes, while the bone marrow colonies tended to make more immune cells,” Looney said.
The human lung HSCs also could restore bone marrow in HSC-deficient mice. The discovery confirmed Looney’s earlier discovery that the mouse lung and bone marrow complemented one another in producing blood, even sending stem cells to restore one another.
“We think these HSCs could be a reservoir of haematopoiesis in a particular organ, in this case the lung, that gets activated whenever the body needs more of any part of the blood, whether it’s platelets, red blood cells or immune cells,” Looney said.
Getting to know the new HSC in town
To show that the lung HSCs truly resided in the lung, and weren’t just escapees from the bone marrow, Conrad and Looney looked for the HSCs in human lung tissue samples.
They found them between blood vessels in an arrangement that was reminiscent of what’s seen in bone marrow.
“They really seem to live there and aren’t just passing through,” Conrad said.
Lastly, the team analysed the output of routine bone marrow transplants, which today begin with a blood draw from a donor followed by a screen for stem cells.
Remarkably, nearly a fifth of the stem cells isolated for bone marrow transplant carried the signature of lung HSCs – suggesting that cells in “bone marrow transplants” aren’t only from bone marrow.
There’s a lot more to learn about the lung HSCs. Could the different pools of HSCs serve different therapeutic roles in medicine? Why do the lungs themselves need to make blood?
“The lungs are critical to blood circulation, so it’s tantalising to see the lung HSCs as an emergency reservoir for red blood cell and platelet production,” Looney said. “Now that we know they exist, it opens up a lot of new opportunities for a therapy, hematopoietic stem cell transplantation, that is very commonly used for patients with the need.”
One in eight patients in hospitals in Africa is critically ill, and one in five of the critically ill die within a week, according to a new study in The Lancet.The researchers behind the largest study of critical illness in Africa to date conclude that many of these lives could have been saved with access to cheap life-saving treatments.
The study is the first large-scale mapping of critically ill patients in Africa. Nearly 20 000 patients in 180 hospitals in 22 African countries were surveyed in the study.
Being critically ill means having severely affected vital functions, such as extremely low blood pressure or low levels of oxygen in the blood. In the new study, researchers show that one in eight patients in African hospitals, 12.5%, is in this condition. Of these, one in five, 21%, die within a week, compared to 2.7% of those who are not critically ill.
A large proportion of critically ill patients, 69%, are treated in general wards rather than intensive care units. More than half of critically ill patients, 56%, do not receive even the basic critical care they need, such as oxygen therapy, intravenous fluids or simple airway management.
“Our study shows that there is a large and often neglected group of patients with critical illness in Africa,” says first author Tim Baker, Associate Professor at the Department of Global Public Health at Karolinska Institutet.
The researchers behind the study emphasise that these are basic but crucial health interventions that can make a big difference.
“If all patients had access to essential emergency and critical care, we could significantly reduce mortality. Moreover, these interventions are inexpensive and can be provided in general wards,” says Carl Otto Schell, researcher at the Department of Global Public Health at Karolinska Institutet and one of the initiators of the study.
From early ocean dips to ice-cold polar plunges, cold-water immersion is increasingly popular among athletes and wellness warriors. But how much of the hype is backed by science?
In the most comprehensive systematic review and meta-analysis of its kind, University of South Australia researchers have taken a deep dive into the effects of cold-water immersion on health and wellbeing.
Analysing data from 11 studies with 3177 participants, researchers found that cold-water immersion may lower stress, improve sleep quality, and boost quality of life.
UniSA researcher Tara Cain says the study, which appears in PLOS ONE, reveals time-dependant and nuanced effects on health and wellbeing measures.
“Cold-water immersion has been extensively researched and used in sporting contexts to help athletes recover, but despite its growing popularity among health and wellbeing circles, little is known about its effects on the general population,” Cain says.
“In this study, we noted a range of time-dependant results. Firstly, we found that cold-water immersion could reduce stress levels, but for only about 12 hours post exposure.
“We also noted that participants who took 20, 60, or 90 second cold showers reported slightly higher quality of life scores. But again, after three months these effects had faded.
“Benefits may be gained from cold showers as well, with one study reporting that participants who took regular cold showers experiencing a 29% reduction in sickness absence.
“We also found some links to cold-water immersion and better sleep outcomes, but the data was restricted to males, so its broader application is limited.
“And while there have been many claims that cold-water immersion experiences can boost your immunity and mood, we found very little evidence to support these claims.”
Cold-water immersion involves immersing the body partially or fully in cold water, in temperatures typically ranging from 10-15°C, and in this study, data was only included if exposure was at or above chest level, and for a minimum time of 30 seconds. It included cold showers, ice baths and cold plunges.
Co-researcher, UniSA’s Dr Ben Singh says the study also showed that cold-water immersion caused a temporary increase in inflammation.
“At first glance this seems contradictory, as we know that ice baths are regularly used by elite athletes to reduce inflammation and muscle soreness after exercise,” Dr Singh says.
“The immediate spike in inflammation is the body’s reaction to the cold as a stressor. It helps the body adapt and recover and is similar to how exercise causes muscle damage before making muscles stronger, which is why athletes use it despite the short-term increase.
“Knowing this, people with pre-existing health conditions should take extra care if participating in cold-water immersion experiences as the initial inflammation could have detrimental health impacts.”
Researchers say that while the findings highlight the potential benefits of cold-water immersion, they also underscore the highly time-dependent and contextual nature of its effects.
“Whether you are an elite athlete or everyday wellness seeker – it’s important to understand the effects of what you put your body through,” Cain says.
“Right now, there isn’t enough high-quality research to say exactly who benefits most or what the ideal approach is to cold-water immersion. More long-term studies, among more diverse populations, are needed to understand its lasting effects and practical applications.”
The government took its first steps towards the implementation of the recommendation of Health Market Inquiry into the private healthcare sector.
By Chris Bateman
Medical aid schemes will be given collective power to negotiate prices, according to draft regulations published last week. While some see the move as an important step toward reining in private healthcare prices, others argue that they do not go far enough and are legally unsound. We spoke to several leading experts about the proposed reforms.
Complaints about the high cost of private healthcare services in South Africa are nothing new. For the last two decades, above inflation increases to medical aid scheme premiums have been the norm. Added to this, many of the 16 or so percent of the population who are members of a scheme will have been asked to pay unexpected out-of-pocket co-payments at some point.
To understand why all this is happening, the Competition Commission launched a Health Market Inquiry (HMI) in 2014. The final HMI report, published in 2019, found that government had failed in its duty to regulate the private health sector, which it described as “neither efficient [nor] competitive”.
This failure in regulation has resulted in a private healthcare market that is “highly concentrated”, “characterised by high and rising costs of healthcare and medical scheme cover, and significant over utilisation without stakeholders being able to demonstrate associated improvements in health outcomes”, Justice Sandile Ngcobo, chairperson of the HMI panel, said at the time.
A key regulatory failure identified by the HMI was the absence of any effective mechanisms to keep prices under control. Medical aid schemes would set a price that they would cover – but there is nothing stopping healthcare providers from charging much higher prices. This is particularly a problem for prescribed minimum benefits (PMBs) – a set of healthcare services that schemes have to cover in full.
The HMI recommended the establishment of a supply side regulatory authority (SSRA) that would be independent from both government and the private sector. Among others, the SSRA would set maximum tariffs for PMBs as well as reference tariffs for all other health services.
In September 2020, around a year after the HMI report was released, the Competition Commission published a notice that seemed to set the ball rolling on establishing a new tariff negotiating framework along the lines of the HMI recommendation. Their proposed multilateral negotiating forum would have been governed by the Council for Medical Schemes until the SSRA could be established. But things then largely went silent, until earlier this month.
A new tariff-setting framework
On 14 February 2025, draft regulations published by the Minister of Trade Industry and Competition, Parks Tau, set out a new tariff determination framework for private healthcare in South Africa. At its core are two structures. The Tariffs Governing Body (TGB), consisting mainly of experts responsible for providing oversight in the tariff determination process, and the Multilateral Negotiating Forum (MLNF) made up of multiple stakeholders “which shall serve as the primary forum for collectively determining the maximum tariffs for prescribed and non-prescribed minimum benefits for healthcare services”.
In short, the work of negotiating and determining tariffs will be done by the MLNF, with the TGB providing some oversight and support. The TGB is also empowered to make a tariff determination when the MLNF fails to reach agreement.
The National Department of Health will have substantial control over both structures. Members of the MLNF will be appointed by the Director General of Health, and will include representatives of government, associations representing healthcare practitioners, healthcare funders, civil society, patient and consumer rights organisations, and any other regulatory body within the healthcare sector. The TGB will be located in the National Department of Health and will be chaired by an official of the department.
The regulations came in the form of a draft interim “block exemption” from certain provisions in the Competition Act. Such an exemption is required in order to enable the tariff governing body and the multilateral negotiating forum to function legally. The stated purpose of the exemption is to “contribute to the affordability of quality healthcare services…reduce costs and prevent the overutilization of healthcare services”.
In addition to the “collective determination of healthcare services tariffs”, the exemption also provides for “the collective determination of standardised diagnosis, procedure, medical device and treatment codes”, and “the collective determination of quality measurements/metrics, medicines formularies and treatment protocols/guidelines with the purpose of contributing to affordability of quality healthcare services across both PMBs and non-PMBs, contributing to reducing costs and contributing to the prevention of overutilization of healthcare services”.
The exemption doesn’t apply to everyone in the health sector. While healthcare providers like GPs and specialists are included, hospitals are not included.
Not an independent entity
While generally in favour of implementing the HMI recommendations, several experts Spotlight consulted are critical of how the government is going about it.
One line of criticism has been that the new framework is not sufficiently independent from the health department, as recommended in the HMI report.
Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at the University of the Witwatersrand (Wits), said the regulations deviate from the requirement for independence of any price regulator from political interference – which he points out is expressly addressed by the HMI.
In a media conference on Monday, Health Minister Dr Aaron Motsoaledi cited financial constraints for failing to set up an independent regulatory body. He also said that the department had a “mandate to manage healthcare systems”.
“We’re still looking at various options on an independent regulator, but National Treasury has severe constraints,” he said.
The exemption is for a period of three years and has been described as an interim measure.
Piecemeal implementation?
Another line of criticism is that only some HMI recommendations are being implemented, whereas the HMI stressed the need for an “inter-related” approach. While the tariff-determinations may bring down prices, it will not prevent doctors from, for example, sending people for medically unnecessary scans (a form of overutilisation).
Sharon Fonn, a professor in the School of Public Health at Wits and who was part of the HMI panel, said implementing aspects of the HMI piecemeal will neither foster competition nor protect the consumer.
“Controlling prices achieves little in the absence of the recommended holistic framework, which addresses the incentives of schemes to contract on cost, quality and demand,” she said.
Costs are influenced by both price and demand. The HMI did extensive work to show that supplier-induced demand was a problem – clearly indicating that price controls would achieve nothing in the absence of broader interventions, said Van den Heever.
“You’ll be hard pressed to find tariffs rising much faster than CPI (Consumer Price Index),” said Van den Heever. “Costs rise because of claims volumes, not the tariffs. This is because the frequency of patient consultations or in-patient days can rise in response to a fixing of prices. Providers are in a position to influence this demand. Annually you could have a 3% actual cost increase, with only a third of the increase (one percentage point) due to original price (tariff) changes. This is fully addressed in the HMI,” he added.
In response to criticism over the piecemeal implementation of HMI recommendations, Motsoaledi stressed that the HMI conceded that its recommendations would be implemented in phases.
Questions of scope
Elsabe Klink, an independent healthcare legal consultant and former advisor to the South African Medical Association, said government is mixing up the coding, protocols and Health Technology Assessments (HTA) which, on the HMI recommendations, are not up for negotiation in the MNLF.
“The HMI recommended that those functions be separate. How on earth can people negotiate on how a diabetic patient can be treated. That is a scientific question,” she said.
Klink said the HTA seems to be a veiled attempt at price control, directly for healthcare professionals and indirectly, to bar from the market devices and medications that did not make it onto the protocols or formularies.
“It [the draft regulations] purports to implement Health Market Inquiry recommendations but seems to stray into issues that are integral to NHI implementation as well, notably the HTA Committee,” said Dr Andy Gray, pharmaceutical sciences expert at the University of KwaZulu-Natal and Co-Director of the WHO Collaborating Centre on Pharmaceutical Policy and Evidence Based Practice.
Justifying the HTA measures, Motsoaledi said it was to prevent “the medical arms race” where healthcare practitioners prioritised patient volumes to enable them to beat their opponents in offering the latest technology. “This behaviour ruled by a medical arms race must end,” he said. He did not specifically explain why HTA was included in the exemption and not addressed through other regulations.
Questions of legality
Questions have also been raised over the legality of the regulations and whether or not they’d be vulnerable to litigation.
Van den Heever described the new regulations as “quite strange and extremely untidy, exposing the entire enterprise to legal challenge from the outset”. He said that the exemption bypasses normal legislative processes, that require evidence-based motivations and wide consultation.
He said the exemption went beyond competition concerns by establishing new governance structures that resembled a regulatory framework rather than a competition-related exemption.
“Furthermore, the structures and framework apply to a different minister (Health) – who has the legal authority to establish such a framework – not the Minister of Trade Industry and Competition. The Competition Act provides for exemptions, but only to facilitate competition-related objectives,” he said.
Dr Rajesh Patel, the Head of the Health System Strengthening Department at the Board of Healthcare Funders, had similar concerns. He said he finds it strange that “you need the Department of Trade Industry and Competition to tell the Department of Health to do their work”.
Could providers opt out?
Another contentious, and not entirely clear, aspect of the new framework is whether healthcare providers will be able to charge higher prices than those agreed through the MLNF.
“Perhaps one of the most problematic elements is that to protect patients, there needs to be some system to prevent opting out. It is likely that providers will opt out of this system and pass on additional costs to patients,” warned Fonn.
But, when asked about healthcare providers potentially opting out, Motsoaledi said that if that happened, “we’d be back to square one where everybody can charge whatever they want. I don’t think the HMI wanted that.” He didn’t specifically clarify how the current reforms would prevent healthcare professionals from opting out.
According to the draft regulations, the tariffs determined by the MLNF are “binding on all parties to the agreement”. It does however leave the door open for bilateral negotiations outside of the MLNF, but “only for the purpose of concluding an agreement on reductions, but not increases, on the tariffs for PMBs and non-PMBs as determined by the MLNF process”. There appears to be nothing in the regulations that would prevent healthcare providers from opting out altogether and charging what they like – although it is unclear to what extent, if at all, schemes would reimburse in such instances.
Concerns over timing
On timing, there are both concerns over how long the process has taken so far, and how long it might take going forward. This month’s draft regulations were published roughly five and a half years after the publication of the HMI report. For most of this period, Motsoaledi was not health minister.
Motsoaledi blamed the COVID-19 pandemic and the national elections that followed shortly afterward for the delay.
Health Minister Dr Aaron Motsoaledi. (Photo: Kopano Tlape/GCIS)
Patel expressed serious reservations about the ability of the health department to implement the block exemption process. “If their history is anything to go by, we will see similar delays and consequently, rising healthcare costs,” he said.
Patel said that the quickest solution to render private healthcare more affordable would be if the Competition Commission granted exemptions to allow medical schemes to collectively negotiate tariffs with willing healthcare providers. The health department, he said, need not be involved at all.
“We have serious reservations about the Department of Trade, Industry and Competition putting the power in the Department of Health’s hands to manage the block exemption process. They have actively kept private healthcare expensive and inaccessible to justify the implementation of the NHI,” he claimed.
Spotlight sent written questions to the Department of Health last week and during Monday’s media conference. Though some of our questions were addressed in the media conference, others had not been responded to by the time of publication.
Researchers at Mayo Clinic are exploring the use of a new drug called ataciguat to manage aortic valve stenosis (AVS). Results from preclinical and clinical studies, published in Circulation, show that ataciguat has the potential to significantly slow disease progression. The final step to establish the drug’s long-term effectiveness and safety is a phase 3 trial, and efforts to launch that pivotal trial are soon to be underway with an industry partner.
In AVS, calcium deposits build up and narrow the aortic valve, forcing the heart to work harder to move blood. The condition typically progresses over time, with symptoms like chest pain, shortness of breath and fatigue affecting people over age 65. The current standard of care, watchful waiting, often leads to reduced quality of life before the condition is severe enough for the patient to have a surgical or interventional valve replacement.
“This research represents a significant advancement in the treatment of aortic valve stenosis,” says Jordan Miller, PhD, director of the Cardiovascular Disease and Aging Laboratory at Mayo Clinic. “Ataciguat has the potential to substantially delay or even prevent the need for valve replacement surgery, significantly improving the lives of millions.”
Dr Miller notes that the impact extends beyond simply delaying surgery. Younger patients with aggressive disease or congenital valve defects may develop symptoms in midlife. If a patient requires valve replacement before the age of 55, there is a more than 50% likelihood they will require multiple valve replacement surgeries over their lifetime due to recalcification of the implanted valve. Ataciguat, which slowed progression of native aortic valve calcification in the clinical trial, offers the potential for a once-in-a-lifetime procedure if they can reach the age of 65. The older a patient is, the less likely the implanted valve is to calcify.
Over the past decade, Mayo Clinic’s research revealed that ataciguat reactivates a pathway crucial in preventing valvular calcification and stenosis. Preclinical studies in mice showed that this drug substantially slowed disease progression even when treatment began after the disease was established.
Clinical trials in patients with moderate AVS demonstrated that once-daily ataciguat dosing was well tolerated, with minimal side effects compared to placebo. This latest phase 2 trial in 23 patients showed a 69.8% reduction in aortic valve calcification progression at six months compared to placebo, and patients receiving ataciguat tended to maintain better heart muscle function. Crucially, the research team confirmed that, despite its profound effect on slowing valve calcification, ataciguat did not negatively impact bone formation.
Photo by Christina Morillo: https://www.pexels.com/photo/software-engineer-standing-beside-server-racks-1181354/
Artificial Intelligence (AI) is reshaping healthcare globally, and Africa stands to benefit immensely. AI-driven telemedicine is revolutionising access to care, offering innovative solutions to overcome healthcare challenges across the continent. From remote diagnostics to virtual consultations, AI is enhancing medical services, improving efficiency, and ultimately making healthcare more accessible to millions.
Understanding Telemedicine and AI
Telemedicine leverages telecommunications technology to provide remote healthcare services. It includes virtual consultations, remote patient monitoring, electronic health records, and AI-powered diagnostics. AI, through machine learning and natural language processing, analyses vast amounts of data rapidly, identifies patterns, and provides valuable insights. With AI doing the heavy lifting in healthcare, medical professionals can focus on patient care while benefiting from advanced decision-making support.
The Importance of Healthcare Access in Africa
The World Health Organization (WHO) estimates that over 60% of Africans lack access to essential healthcare services. A shortage of healthcare professionals and inadequate infrastructure exacerbates this challenge.
In South Africa alone, 50 million people rely on state healthcare, making cost-effective, high-quality solutions a necessity. Addressing healthcare access issues is crucial for improving public health, reducing mortality rates, and enhancing overall well-being.
The Role of AI in Telemedicine
AI-driven tools are enhancing medical diagnostics, improving accuracy and efficiency. For example, AI algorithms can analyse imaging scans, such as X-rays and MRIs, to detect conditions like tuberculosis and cancer. In South Africa, AI solutions developed by Qure.ai and EnvisionIT have demonstrated remarkable accuracy in interpreting chest X-rays, often surpassing general radiologists in detecting tuberculosis.
Velocity Skin Scanning further enables rapid dermatological screenings, providing timely and accurate diagnoses.
AI-powered chatbots, such as those used in Ghana’s mPharma initiative, assist in symptom assessment, medication stock predictions, and patient guidance. Virtual consultation platforms like DabaDoc in Nigeria and CareFirst, Unu Health, and Hello Doctor in South Africa enable seamless patient-doctor interactions, particularly in underserved areas. AI streamlines these services, ensuring better patient screening, appointment scheduling, and treatment accuracy.
Challenges in AI-Driven Telemedicine Adoption
Many African regions face limited internet connectivity, device accessibility issues, and electricity shortages, hindering telemedicine implementation. Satellite internet solutions, such as Starlink and solar-powered connectivity, present potential solutions.
Supportive regulatory frameworks are crucial for AI-driven healthcare success. Governments must develop policies that encourage innovation while safeguarding patient data. Collaborative efforts between policymakers and tech companies can facilitate AI integration into healthcare systems. The African Medical Council (AMCOA) plays a key role in shaping such regulations.
Educating healthcare professionals on AI technologies is essential for effective implementation. Upskilling programs empower medical staff to utilise AI tools efficiently. Additionally, cultural acceptance of telemedicine varies, making community outreach and education initiatives vital for overcoming skepticism.
Technology costs often pose adoption challenges, particularly when solutions are not developed locally. However, virtual primary healthcare services are cost-effective and can serve as an entry point for widespread AI adoption. Strategies to enhance affordability include subscription models, public education, media promotion, healthcare practitioner reimbursement, cross-border medical registration, and economic incentives for AI adoption.
AI-Driven Solutions in Practice
CareFirst offers on-demand virtual doctor consultations, available 24/7 via video calls, telephonic consultations, and AI-driven vital scans.
Patients can access AI-driven vital scans to measure stress levels, blood pressure, heart rate, respiratory rate, glucose levels (HbA1C), and oxygen saturation. These tools provide real-time health insights, aiding proactive healthcare management.
Powered by Belle AI and endorsed by WHO, this AI-driven technology enables real-time dermatological assessments, facilitating early detection of skin conditions.
ER Consulting Inc. has adopted Scribe MD to improve medical record-keeping. This AI solution reduces doctor burnout, enhances patient interactions, lowers documentation time, mitigates medicolegal risks, and improves clinical data analysis.
Conclusion
AI-driven telemedicine has the potential to revolutionise healthcare accessibility in Africa. By addressing critical adoption barriers, fostering collaborations between governments, tech companies, and healthcare organizations, and leveraging AI-powered innovations, we can create a more connected, efficient, and inclusive healthcare ecosystem.
The future of healthcare in Africa is digital, and AI is paving the way toward a healthier, more accessible future for all.
