A survey of military and paid civilian pilots has revealed that they may avoid seeking medical advice out of fear of losing certification to fly. Two-thirds of military and paid civilian pilots answered “yes” to at least one of four survey questions on reluctance to seek formal medical advice about health problems, reported William R. Hoffman, MD, who presented a poster at the American Academy of Neurology annual meeting.
Hoffman, a US Air Force employee, noted that both civilian and military pilots can be grounded if they have certain medical symptoms or diagnoses, with a range of negative repercussions for the pilot. As a result, pilots are disinclined to be truthful about their health if their employers or officials might find out.
In a previous survey of pilots led by Hoffman, more than three-quarters reported that they “felt worried about seeking medical care due to concern for their career or hobby.” The new survey probed this reluctance, with respondents asked whether they agreed or disagreed with the following:
Sought informal medical advice for fear of certificate loss
Flew despite experiencing a new symptom (physical or psychological) that warranted evaluation
Did not disclose prescription medication use
Misrepresented or withheld information on a written healthcare questionnaire for fear of certificate loss
Respondents to the web-based survey included 2383 nonprofessional civilian pilots, 1097 paid civilian pilots, and 261 military pilots.
Just over half of the unpaid civilian pilots denied ever hiding any of the four types of information. But that was true for only 33.6% of the paid civilian pilots and 32.2% of the military pilots.
Fortunately, among all respondents, only 6.8% said they had not disclosed prescription drug use as required, and just 16.8% acknowledged that they had kept new symptoms secret. But 45.7% acknowledged seeking informal advice in place of seeing a professional, and 26.8% said they had withheld or overtly misrepresented information on written forms. A few (2.2%) admitted to all four types of avoidance.
Female pilots reported slightly more avoidance of disclosure (62.0% of all female respondents vs 55.4% of men; P not reported). Younger pilots were also less open, especially those aged 25–40 (69.1% vs 40.7% in those older than 60). Union membership and active-duty military status were linked to high rates of avoidance (70.1% and 75.8%, respectively, vs 51.8% among non-unionised civilian and military reservist pilots).
Hoffman suggested that neurologists recognise that pilots may be shy about revealing their true health condition. “This might be mitigated through developing rapport with the pilot, asking questions about concerns related to their flying status, and clear communication about documentation and clinic course.”
Additionally, he recommended, “it is good technique to order only the necessary tests for all patients, to include pilots to avoid false positives.”
Despite this, medical professionals have an obligation to communicate a pilot’s health concerns to those responsible for evaluating fitness to fly.
Modern Media Publishing is pleased to announce the inaugural issue of the Wits Journal of Neuroscience*, a new academic journal aiming to connect those in the field of neuroscience and broaden its horizons in South Africa.
The new publication will feature articles from clinician researchers in the fields of neurosurgery, neurology, ophthalmology and ears, nose and throat (ENT). The journal features original research and case reports and MMed articles selected by its distinguished editorial board. It also reports on local neuroscience news and events as well as international research highlights. Readers also get a peek behind the curtain at upcoming research.
Professor John R. Ouma, Head of Department of Neuroscience at Wits said, “The aim of this new journal is to fill a gap that has been existing, wherein there has not hitherto been a common platform for academicians and others interested in neurosciences to come together and share ideas as well as generate new science.
“This journal will be widely circulated within the Neuroscience community of this University and its associated hospitals, and then further afield to sister Universities, hospitals and entities to ensure that the ideas generated and expressed in it achieve the widest exposure and impact.
“We hope you enjoy it, both now, and in future editions.”
*The Wits Journal of Neuroscience is Produced and Distributed on behalf of the Wits Dept of Neuroscience by Modern Media Publishing (Pty) Ltd. They can be contacted on 011-326-4171 or by email on info@modernmedia.co.za
Patients-turned-social-media-influencers routinely offer prescription drug advice to their followers and often have close ties with pharmaceutical companies, according to new research the Journal of Medical Internet Research – though they often have good intentions.
In recent weeks, social media has pushed the diabetes drug Ozempic as a weight loss drug, while patients who need the medication to manage their disease have faced global shortages. Those taking it “off-label” to slim down have experienced surprising side-effects, including violent diarrhoea and extreme facial thinning.
The study by University of Colorado Boulder provides some of the first insights into the burgeoning, loosely regulated world of so-called “patient influencers”.
“The bottom line here is that patient influencers act as a form of interactive direct-to-consumer (DTC) advertising, sharing their knowledge and experiences on pharmaceutical drugs with communities of followers in which they wield great influence,” said author Erin Willis, an associate professor of advertising, public relations and media design. “This raises ethical questions that need more investigation.”
A new kind of advertising
Controversial from its start in the 1980s, and still only available in the United States and New Zealand, DTC advertising enables drug companies to target consumers directly, rather than exclusively through physicians. About half of the people who ask their doctor about a drug after seeing a TV ad get it.
With trust in pharmaceutical companies and traditional media declining, drug makers are now turning to real patients as messengers, with companies like Health Union connecting them for partnerships.
Willis conducted interviews with 26 influencers with a range of conditions, including lupus, HIV and chronic migraines. Eighteen of the 26 collaborated with a pharmaceutical company in some way.
Most had between 1000 and 40 000 followers. Such “micro influencers” tend to be less expensive for advertisers to work with than celebrities, and research has shown they have the most influence on purchasing behaviours, said Willis.
Some interviewees posted company press releases directly. Others read studies about drugs and translated results for followers. Some were paid to post content for drug companies.
“Health literacy and digital literacy are both concerningly low in this country,” said Willis, noting that consumers often fail to recognise the difference between a sponsored ad and an altruistic personal post. “The fact that patients with no medical training are broadly sharing drug information should alarm us.”
Good intentions
On the positive side, Willis was heartened by the reasons participants become influencers. Almost all said they were drawn to their roles by a sense that the answers they sought as patients, didn’t exist in other channels.
“I spent a lot of time looking for diabetes information that related to me – an African American woman from the South,” reported one study participant. “I didn’t see what I needed, so I created it.”
Others were motivated by a wish to destigmatise disability in certain communities.
“There’s still not a lot of talk about Latinos and HIV,” said another participant. “When there was information, it wasn’t culturally appropriate.”
Five said they never share information about drugs, stating that they believed it was “borderline unethical.”
Others said they would only post about drugs they personally had been prescribed and taken and always encouraged followers to consult with their doctor. They all said they generally strived to behave ethically.
“It’s comforting that the people we interviewed generally want to stay abreast of the science and be a credible source,” said Willis. “But I also know that doctors go to medical school for a reason.”
Concerns abound
Several influencers reported that followers frequently private message them to get detailed information about dosage and side effects.
“In an online community, there are other people there to say, ‘That’s not true or that’s not what I experienced.'” Willis said. “But with social media, a lot of the conversation happens privately.”
Willis also worries that influencers may stress the upsides of medications without fully disclosing the side-effects. For instance, she references a famously controversial 2015 post by celebrity influencer Kim Kardashian, singing the praises of a “#morningsickness” drug called Diclegis to her tens of millions of followers on Instagram.
The Food and Drug Administration swiftly flagged the post for omitting the drug’s long list of risks, required Kardashian to remove the post and dinged the drug maker with a warning letter. The Federal Trade Commission (FTC) now requires influencers to disclose whether they are paid via hashtags, such as #ad or #sponcon, and the Food and Drug Administration has rules on what can be said on social posts. But those rules are open to interpretation, and videos, disappearing content and direct messaging can be tough to track.
Willis acknowledged that her sample was a small one and that because many of her interviewees were referred to her by Health Union, they likely skew to the responsible side. In future studies, she intends to include broader sample sizes, explore how influencers impact treatment decisions and investigate compensation for and regulations around patient influencers.
Analysts predict the influencer marketing industry as a whole will be valued at $21.1 billion in 2023.
As patient influencers increasingly find their place in it, Willis contends that regulators should work harder to keep up with all the new platforms.
“This is happening, with or without regulation, and people should be aware of it,” Willis said.
Over the past fifty years, there have been remarkable claims about the effects of Wolfgang Amadeus Mozart’s music. Reports about alleged symptom-alleviating effects of listening to Mozart’s Sonata KV448 in epilepsy attracted a lot of public attention. However, the empirical validity of the underlying scientific evidence has remained unclear. Now, University of Vienna psychologists Sandra Oberleiter and Jakob Pietschnig show in a new study published in the journal Nature Scientific Reports that there is no evidence for a positive effect of Mozart’s melody on epilepsy.
In the past, Mozart’s music has been associated with numerous ostensibly positive effects on humans, animals, and even microorganisms. For instance, listening to his sonata has been said to increase the intelligence of adults, children, or foetuses in the womb. Even cows were said to produce more milk, and bacteria in sewage treatment plants were said to work better when they heard Mozart’s composition.
However, most of these alleged effects have no scientific basis. The origin of these ideas can be traced back to the long-disproven observation of a temporary increase in spatial reasoning test performance among students after listening to the first movement allegro con spirito of Mozart’s sonata KV448 in D major.
More recently, the Mozart effect experienced a further variation: Some studies reported symptom relief in epilepsy patients after they had listened to KV448. However, a new comprehensive research synthesis by Sandra Oberleiter and Jakob Pietschnig from the University of Vienna, based on all available scientific literature on this topic, showed that there is no reliable evidence for such a beneficial effect of Mozart’s music on epilepsy. They found that this alleged Mozart effect can be mainly attributed to selective reporting, small sample sizes, and inadequate research practices in this corpus of literature. “Mozart’s music is beautiful, but unfortunately, we cannot expect relief from epilepsy symptoms from it” conclude the researchers.
By Yanga Nokhepheyi, Marlise Richter, and Fatima Hassan for Spotlight
A frightful piece of information came to light recently. The pharmaceutical giant Pfizer announced its 2022 revenue at $100 billion. This is more than the combined health spending of 108 countries in 2020 according to calculations of The People’s Vaccine Campaign. The Pfizer COVID vaccine, of course, helped the dollars roll in. In fact, some reports suggest that Pfizer charged some countries $130 per dose of vaccine, while it is estimated that it costs less than $2 per dose to make. That equated to a markup of a stupefying 10 000% but we don’t know the full pricing details because the contracts are marked ‘secret’.
Figures like these make one’s eyes water.
In this pandemic, tackling the pharmaceutical sector and the perversities of its pandemic profiteering has been the focus of an international movement of health activists united under the banner of the People Vaccine Campaign. Partly because of severe resistance by governments in the global north and inaction locally, access to timely supplies of affordable and essential COVID vaccines, medicines and diagnostics has not materialised. But the struggle continues not only to tackle these structural barriers to beat COVID and future pandemics but also to help ensure implementation of Universal Health Coverage (UHC) systems. UHC means that everyone would be able to get the quality health services they need and benefit from scientific progress – irrespective of their ability to pay and without having to face financial hardship.
A Herculean task
South Africa, too, has committed to attaining UHC by 2030 as part of a set of promises made on the United Nation’s Sustainable Development Goals. South Africa’s main strategy to attain UHC is to implement a National Health Insurance (NHI) system. Unfortunately, progress has been historically slow, but in the build-up to the 2024 elections, the African National Congress (ANC) Members of Parliament (MPs) are rushing the law reform process despite an acknowledgement even from the health ministry that progress and timelines are hampered by the socio and mainly economic impacts of the pandemic. This includes a fiscus crisis with additional pandemic-related debt, and according to Dr Nicholas Crisp, Deputy Director-General in the health department responsible for NHI, “the NHI could take decades to be implemented at full scale”.
It will require a Herculean task to unify our apartheid-era two-tiered healthcare system, with the right skills, funding base, and transparency in decision-making around health policy and medicine selection. The pandemic has highlighted why all these elements are critical for healthcare for everyone.
We provide a short overview of our research below.
Law reform
Last year, the Portfolio Committee on Health in Parliament deliberated on the ‘NHI Bill’, but there were no significant changes made to it. It needs major revision. Many serious concerns and recommendations from parliamentary submissions by multiple stakeholders have gone unaddressed. The Health Justice Initiative (HJI) has focused on medicine procurement provisions in the Bill and in 2022 raised at least 17 questions that require greater attention before the law is passed. Neglecting to address the public’s submissions is not surprising seeing that ANC MPs serving on the committee were resolute in having the National Assembly adopt the Bill before the ANC Conference in December 2022. However, time ran out before the adoption of the Bill by Parliament, and the Parliamentary process is seemingly going to resume this month.
Stakeholder submissions to Parliament on the Bill (of which there were 64 000 written submissions following Parliament’s call for comment in 2019) and various commentators have warned about the ‘looming disaster’ that the Bill in its current form poses, but they are often divided on the main reasons. A tiny minority resists the principle of unified health systems and Universal Health Care for all (meaning, also for the poor). Many more groups agree that NHI is an ethical necessity but are concerned about South Africa’s disintegrating public health system, energy crisis, high levels of state corruption involving health product procurement, and the in/ability of the Department of Health to actually implement NHI in its current proposed form.
Other groups have rightfully pointed out concerns over conferring too much power on the Minister of Health, inadequate financing models, the feasibility of NHI in SA post-COVID, and the exclusion of specific categories of people from NHI. (For a curated archive of critical submissions, please see here).
Risks to medicine access
Regrettably, the provisions in the Bill on Medicine Selection, Pricing, and Procurement are ambiguous at best, and as the HJI pointed out in 2022, the entire shift of our medicine selection, procurement, and reimbursement system to “NHI reimbursement” has not been adequately thought through, potentially posing a great risk for the future of medicine selection and access in the country for all people. This requires immediate attention at the highest levels of the executive and the legislature too – and likely needs a multi-department and stakeholder technical group to urgently determine the exact trajectory of this planned process.
The World Health Organization has emphasised that UHC programmes will only be successful if there is “affordable access to safe, effective, and quality medicines and health products”. In addition, the COVID pandemic has taught us that timely and fairly priced access to essential diagnostics, therapeutics, and vaccines is key to addressing any public health emergency and improving health outcomes. We cannot safeguard public health without access to medicines – procured fairly, delivered on time, and based on expert and transparent decision-making and approval.
The cost of medicine, as elsewhere in the world where there are national health systems, remains a key concern. The Minister of Health last November in the National Assembly said that the funds for the NHI would be collected through a combination of taxes, including the reallocation of medical scheme credits paid to medical schemes, provincial health budgets to the NHI Funds, and payroll tax.
The financial feasibility of implementing the NHI is still unclear and a huge risk to the fiscus in a post-COVID economy that is dealing with a recession, load shedding, and high unemployment rates.
In late 2022, HJI argued that the Bill does not adequately consider the complexities of medicines access and that our medicines system could be severely jeopardised if poorly drafted sections in the current Bill become law. We said that government should set up a task team to urgently determine the exact trajectory of this planned process.
The Health Department’s recent response to submissions and its own recommendations on amendments to the Bill sadly does not realise the gravity of the threat to the future of medicine selection and access.
17 questions
In HJI’s 2022 analysis of the Bill, we raised 17 key questions that we believe must be addressed by lawmakers in the next version of the Bill and before NHI comes into effect. These include:
What specific measures are envisaged to enable and promote public transparency related to medicine selection, procurement, and contracting processes under the NHI?
How will the price of medicines not included in or covered by the NHI be regulated? And what role will External Reference Pricing (ERP) methodology play in the NHI and beyond?
How will the NHI Fund (e.g., the Office of Health Products Procurement, the NHI Board) negotiate with global pharmaceutical manufacturers and suppliers to procure for government and how will that process be transparent and accountable?
How will the Minister determine that the NHI is ‘fully implemented’, and what will take place in terms of what medical schemes can and cannot offer members during the transition period, and after the (undefined) date?
Has consideration been given to designing a competitive and different single medicine pricing system for SA?
Drawing on our work on medicine access during the HIV and COVID pandemic, we appreciate that there are powerful vested interests located in the multi-trillion-dollar pharmaceutical industry – this is why there is a need for legal safeguards, sound legislation, and independent and transparent institutions to ensure access to affordable medicines for all of us living here.
The pandemic showed that a lack of transparency, autonomy, and information around expert advice can bedevil open government decision-making. Secret procurement contracts for essential vaccines could become the norm even under NHI as they did in COVID, something we are fighting in our courts to open up, later this year.
Figuring out a sound system for a unified medicine access system under NHI is a formidable undertaking that requires a multi-disciplinary task team with experts from various fields, experience, and technical know-how. It is not easy to simply merge two parallel medicine procurement and selection systems. The risk is that the status quo could continue – where the rich and insured access the best medicines at a higher price.
We believe that the principles underpinning NHI for our highly regressive, unequal two-tiered healthcare system are too important for our collective health, well-being, and our Constitutional democracy to have lacklustre legal provisions and worrying gaps on the essential issues of medicine procurement and selection.
As the Bill currently stands, it will strengthen the private healthcare sector’s stranglehold on us and our fiscus. It will leave us at the mercy of advisory committees that bear no duty to be transparent in deciding which medicines you and I will be able to access under NHI.
We can and need to do better.
* Nokhepheyi and Richter are researchers and Hassan the Director of the Health Justice Initiative.
One in ten early deaths could be prevented if everyone managed at least half the recommended level of physical activity, say a team led by researchers at the University of Cambridge.
In a study published today in the British Journal of Sports Medicine, the researchers say that 11 minutes a day (75 minutes a week) of moderate-intensity physical activity – such as a brisk walk – would be sufficient to lower the risk of diseases such as heart disease, stroke and a number of cancers.
Cardiovascular diseases – such as heart disease and stroke – are the leading cause of death globally, responsible for 17.9 million deaths per year in 2019, while cancers were responsible for 9.6 million deaths in 2017. Physical activity – particularly when it is moderate-intensity – is known to reduce the risk of cardiovascular disease and cancer, and the NHS recommends that adults do at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity a week.
To explore the amount of physical activity necessary to have a beneficial impact on several chronic diseases and premature death, researchers from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge carried out a systematic review and meta-analysis, pooling and analysing cohort data from all of the published evidence. This approach allowed them to bring together studies that on their own did not provide sufficient evidence and sometimes disagreed with each other to provide more robust conclusions.
In total, they looked at results reported in 196 peer-reviewed articles, covering more than 30 million participants from 94 large study cohorts, to produce the largest analysis to date of the association between physical activity levels and risk of heart disease, cancer, and early death.
The researchers found that, outside of work-related physical activity, two out of three people reported activity levels below 150 min per week of moderate-intensity activity and fewer than one in ten managed more than 300 min per week.
Broadly speaking, they found that beyond 150 min per week of moderate-intensity activity, the additional benefits in terms of reduced risk of disease or early death were marginal. But even half this amount came with significant benefits: accumulating 75 min per week of moderate-intensity activity brought with it a 23% lower risk of early death.
Dr Soren Brage from the MRC Epidemiology Unit said: “If you are someone who finds the idea of 150 minutes of moderate-intensity physical activity a week a bit daunting, then our findings should be good news. Doing some physical activity is better than doing none. This is also a good starting position – if you find that 75 minutes a week is manageable, then you could try stepping it up gradually to the full recommended amount.”
Seventy-five minutes per week of moderate activity was also enough to reduce the risk of developing cardiovascular disease by 17% and cancer by 7%. For some specific cancers, the reduction in risk was greater – head and neck, myeloid leukaemia, myeloma, and gastric cardia cancers were between 14 and 26% lower risk. For other cancers, such as lung, liver, endometrial, colon, and breast cancer, a 3–11% lower risk was observed.
Professor James Woodcock from the MRC Epidemiology Unit said: “We know that physical activity, such as walking or cycling, is good for you, especially if you feel it raises your heart rate. But what we’ve found is there are substantial benefits to heart health and reducing your risk of cancer even if you can only manage 10 minutes every day.”
The researchers calculated that if everyone in the studies had done the equivalent of at least 150 min per week of moderate-intensity activity, around one in six (16%) early deaths would be prevented. One in nine (11%) cases of cardiovascular disease and one in 20 (5%) cases of cancer would be prevented.
However, even if everyone managed at least 75 min per week of moderate-intensity physical activity, around one in ten (10%) early deaths would be prevented. One in twenty (5%) cases of cardiovascular disease and nearly one in thirty (3%) cases of cancer would be prevented.
From Shakespeare’s Macbeth to Star Wars’ Darth Vader, people love fictional villains. No matter how despicable they may be, audiences are still drawn to the dark side. In fact, according to a new behavioural experiment published in the journal Cognition, both adults and children more often reported that villains were inwardly good than that heroes were inwardly bad.
“In other words, people believe there is a mismatch between a villain’s outward behaviours and their inner, true self, and this is a bigger gap for villains than for heroes,” said study lead author Valerie Umscheid, University of Michigan psychology doctoral student.
Inside, villains are a little less evil than they outwardly seem while heroes are fully good guys inside and out.
Umscheid and colleagues conducted three studies with 434 children (ages 4–12) and 277 adults to determine how individuals make sense of antisocial acts committed by evil-doers. They focused on participants’ judgments of both familiar and novel fictional villains and heroes, such as Disney’s Ursula from The Little Mermaid and Pixar’s Woody from Toy Story.
Study 1 established that children viewed villains’ actions and emotions as overwhelmingly negative. This suggests that children’s well-documented tendency to judge people as good does not prevent their appreciation of extreme forms of villainy.
Studies 2 and 3 assessed children’s and adults’ beliefs regarding heroes’ and villains’ moral character and true selves, using an array of converging evidence, including how a character felt inside, whether a character’s actions reflected their true self and whether a character’s true self could change over time.
Across these measures, the research indicated that both children and adults consistently evaluated villains’ true selves to be overwhelmingly evil and much more negative than heroes’. At the same time, researchers also detected an asymmetry in the judgments, wherein villains were more likely than heroes to have a true self that differed from their outward behaviour.
Both children and adults believed characters like Ursula had some inner goodness, despite the bad/immoral actions they regularly engage in, Umscheid said.
Following established guidelines about prescription drugs would seem an obvious choice, especially for the professionals that do the prescribing. Yet doctors – and their family members – are less likely than other people to comply with those guidelines, according to a large-scale study published in the American Economic Review: Insights.
This result could be surprising or else prompt a knowing nod. In any case, the finding flies in the face of past scholarly hypotheses. Previously, it was assumed that greater knowledge and easier communication with medical providers leads patients to follow instructions more closely.
The new study is based on over a decade of population-wide data from Sweden and includes suggestive evidence about why doctors and their families may ignore medical advice. Overall, the research shows that the rest of the population adheres to general medication guidelines 54.4% of the time, while doctors and their families lag 3.8% behind that.
“There’s a lot of concern that people don’t understand guidelines, that they’re too complex to follow, that people don’t trust their doctors,” says Amy Finkelstein, a professor in MIT’s Department of Economics. “If that’s the case, you should see the most adherence when you look at patients who are physicians or their close relatives. We were struck to find that the opposite holds, that physicians and their close relatives are less likely to adhere to their own medication guidelines.”
The paper, “A Taste of Their Own Medicine: Guideline Adherence and Access to Expertise,” is The authors are Finkelstein, the John and Jennie S. MacDonald Professor of Economics at MIT; Petra Persson, an assistant professor of economics at Stanford University; Maria Polyakova PhD ’14, an assistant professor of health policy at the Stanford University School of Medicine; and Jesse M. Shapiro, the George Gund Professor of Economics and Business Administration at Harvard University.
Millions of data points
To conduct the study, the scholars examined Swedish administrative data from 2005 through 2016, for 63 prescription drug guidelines. Doctors and their close relatives were selected. All told, the research involved 5 887 471 people to whom at least one of the medication guidelines applied. Of these people, 149 399 were doctors or their close family members.
Using information on prescription drug purchases, hospital visits, and diagnoses, the researchers could see if people were adhering to medication guidelines by examining whether prescription drug decisions matched these patients’ medical circumstances. In the study, six guidelines pertained to antibiotics; 20 involved medication use by the elderly; 20 focused on medication attached to particular diagnoses; and 17 were about prescription drug use during pregnancy.
Some guidelines recommended use of a particular prescription drug, like a preference of narrow-spectrum antibiotics for an infection; other guidelines were about not taking certain medications, such as the recommendation that pregnant women avoid antidepressants.
Out of the 63 guidelines used in the study, doctors and their families followed the standards less often in 41 cases, with the difference being statistically significant 20 times. Doctors and their families followed the guidelines more often in 22 cases, with the difference being statistically significant only three times.
“What we found, which is quite surprising, is that they [physicians] are on average less adherent to guidelines,” says study author Maria Polyakova PhD, an assistant professor of health policy at the Stanford University School of Medicine. “So, in this paper we are also trying to figure out what experts do differently.”
Ruling out other answers
Since doctors and their close relatives adhere to medical guidelines less often than the rest of the population, what exactly explains this phenomenon? While homing in on an answer, the research team examined and rejected several hypotheses.
First, the lower compliance by those with greater access to expertise is unrelated to socioeconomic status. In society overall, there is a link between income and adherence levels, but physicians and their families are an exception to this pattern. As the researchers wrote, special “access to doctors is associated with lower adherence despite, rather than because of, the high socioeconomic status” of those families.
Additionally, the researchers did not find any link between existing health status and adherence. They also studied whether a greater comfort with prescription medication – due to being a doctor or related to one – makes people more likely to take prescription drugs than guidelines recommend. This does not appear to be the case. The lower adherence rates for doctors and their relatives were similar in magnitude whether the guidelines pertained to taking medication or, alternately, not taking medication.
“There are a number of first-order alternative explanations that we could rule out,” Polyakova says.
Resolving a medical mystery
Instead, the researchers believe the answer is that doctors possess “superior information about guidelines” for prescription drugs – and then deploy that information for themselves. In the study, the largest difference in adherence to guidelines is for antibiotics: Doctors and their families are 5.2% less in compliance than everyone else.
Most guidelines in this area recommend starting patients off with “narrow-spectrum” antibiotics, which are more targeted, rather than “broader-spectrum” antibiotics. The latter might be more likely to eradicate an infection, but greater use of them also increases the chances that bacteria will develop resistance to these valuable medications, which can reduce efficacy for other patients. Thus for things like a respiratory tract infection, guidelines call for a more targeted antibiotic first.
The issue, however, is that what is good for the public in the long run – trying more targeted drugs first – may not work well for an individual patient. For this reason, doctors could be more likely to prescribe broader-spectrum antibiotics for themselves and their families.
“From a public-health perspective, what you want to do is kill it [the infection] off with the narrow-spectrum antibiotic,” Finkelstein observes. “But obviously any given patient would want to knock that infection out as quickly as possible.” Therefore, she adds, “You can imagine the reason doctors are less likely to follow the guidelines than other patients is because they … know there’s this wedge between what’s good for them as a patients and what’s good for society.”
Another suggestive piece of data comes from different types of prescription drugs that are typically avoided during pregnancies. For so-called C-Class drugs, where empirical evidence about the dangers of the drugs is slightly weaker, doctors and their families have an adherence rate 2.3 percentage points below other people (meaning, in this case, that they are more likely to take these medications during pregnancy). For so-called D-Class drugs with slightly stronger evidence of side effects, that dropoff is only 1.2 percentage points. Here too, doctors’ expert knowledge may be influencing their actions.
“The results imply that probably what’s going on is that experts have a more nuanced understanding of what is the right course of action for themselves, and how that might be different than what the guidelines suggest,” Polyakova says.
Still, the findings suggest some unresolved tensions in action. It could be, as Polyakova suggests, that guidelines about antibiotics should be more explicit about the public and private tradeoffs involved, providing more transparency for patients. “Maybe it’s better for the guidelines to be transparent and say they recommend this not because it is [always] the best course of action for you, but because it is the best for society,” she says.
Additional research could also aim to identify areas where lower expert adherence with guidelines may be associated with better health outcomes –to see how often doctors have a point, as it were. Or, as the researchers write in the paper, “An important avenue for further research is to identify whether and when nonadherence is in the patient’s best interest.”
The year 2022 finally saw the COVID pandemic petering out, largely through the less-lethal but still highly contagious Omicron variant. Significant strides were made in cancer and Alzheimer’s research, although not without controversy. Amid growing public healthcare challenges in South Africa, the NHI Bill advanced closer to reality.
As Omicron displayed greatly reduced severity compared to prior strains, South African medical experts were some of the first to justify no longer being at ‘code red’. This brought an end to the cycles of lockdowns and travel restrictions characterised by the two previous years.
A number of key medical advances were made during the year for a variety of conditions. Studies showed that administering steroids after COVID hospitalisation with severe inflammation reduced mortality up to one year post-infection.
COVID was found to be linked to a spate of new-onset Type 1 diabetes, but this may just have been due to medical checkups as a result of developing COVID. The rheumatoid arthritis drug auranofin was found to relieve diabetes symptoms. And research suggested a possible way to deliver insulin and cancer drugs orally, by adding a ‘tag’ that lets them enter the bloodstream through the intestines.
The fields of cancer and Alzheimer’s research was rocked by findings of numerous red flags. This controversy did not stop real progress: the first new drug that had any real effectiveness against Alzheimer’s disease was confirmed in a historic trial. Fortunately, the flu jab also seems to protect against developing the disease. Indeed, serious infections appear to increase the risk of both Alzheimer’s and Parkinson’s.
In advanced ER-positive, HER-2 negative breast cancers, the new drug capivasertib halved the rate of progression.
Despite lessons learned in the COVID pandemic, South Africa saw the progression of systemic problems in healthcare such as a critical shortage of nurses. Dr Tim de Maayer’s open letter on appalling conditions at Rahima Moosa exposed deep-seated problems in Gauteng’s public healthcare system. This was followed by the shock resignation of top cancer surgeon Professor Carol-Ann Benn. The appointment of Nomantu Nkomo-Ralehoko as Gauteng Health MEC should hopefully change the province’s situation.
After nearly three years of its harsh and extremely unpopular zero-COVID policy, the Chinese government announced on Wednesday the suspension of key parts of the contentious restrictions.
One of the ways some Chinese people expressed relief at the news was to go to the social media account of Dr Li Wenliang, the whistleblowing doctor who warned of the emerging coronavirus Wuhan and who was himself one of the virus’s early victims.
According to BBC News, they left messages “as if stopping by the graveside of a family elder” in which they shared their feelings.
“On the train, I suddenly remembered you and burst into tears. Dr Li, it’s over now, it’s dawn. Thank you,” read one message.
Another wrote: “I’ve come to see you and let you know – the dust has settled. We’re reopening.”
Chinese authorities punished the 33-year-old ophthalmologist for spreading “false statements”. He later died from COVID as he battled to save patients, prompting an outpouring of public grief and anger.
Xi Jinping’s campaign of zero-COVID aimed to completely eradicate the virus in China. The leadership hailed it as a success while other countries battled with surges of infections and deaths. Crucially, however, the policy made no use of Western-developed vaccines, mainly relying on the Chinese-developed and produced Sinovac.
Thus, with the lifting of the strictest parts of zero-COVID, people turned Dr Li’s page into a place to express their frustrations, hopes and grief. They also remembered his heroism in the face of authority.
“Those who blow the whistle are always worth remembering,” wrote one user. “I look forward to a more transparent society.”
China’s zero-COVID policy did appear to keep the country safe from the pandemic. There were 5200 deaths officially recorded in the pandemic while the US has recorded over one million.
The zero-COVID policy did not come without other costs. Sudden lockdowns saw people unable to get food. People testing positive for COVID were prevented from being with their families and were forced into centralised quarantine facilities. Gatherings and travel were subject to restriction.
Recently, workers broke out of a Foxconn factory which was supposed to be locked down for a quarantine. The event made international headlines as the authorities engaged in a manhunt for the escapees.
Some questioned whether the restrictions had been worth it.
“I took the subway this morning and for the first time did not have to look at the health code,” one user from Sichuan wrote.
“Some people say the epidemic has only started now after three years of hard work. So was it a waste of time? What of all those who paid a huge price, and even their lives for it?”
Others worried for China’s elderly population, many of whom are still unvaccinated.
“Dr Li, the real test of the three-year epidemic has begun. The epidemic is not as serious as yours, but I am exhausted,” one person wrote.
