Sustainable R&D framework needed to address essential health needs of developing countries

Logo DNDi Português do Brasil: Logo DNDi (Photo credit: Wikipedia)

From the 21 May 2012 EurekAlert

DNDi welcomes World Health Organization expert recommendations to begin negotiations for an R&D convention at the World Health Assembly

After a decade-long process of analysis and deliberations on ways to better address the health needs of developing countries, a recently released report of the Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) will be discussed this week at the 65th World Health Assembly (agenda item 13.14). The Drugs for Neglected Diseases initiative (DNDi), a not-for-profit research and development (R&D) organization, welcomes the experts’ conclusion that ‘the time has now come for WHO Member States to begin a process leading to the negotiation of a binding agreement on R&D relevant to the health needs of developing countries’.

A decade ago, R&D for poverty-related neglected diseases was at a virtual standstill. Since then, there have been significant changes in the landscape for these diseases, with now some 150 new R&D projects, including for drugs, diagnostics, and vaccines, in the pipeline. This progress stems from international pressure and the engagement of new public and private actors and donors in both endemic and non-endemic countries, as well as initiatives such as product development partnerships (PDPs), which were set up to fill the gaps left by policy and market failures.

However, despite incremental progress, the essential health needs of the vast majority of the world’s population are still largely unmet, current R&D efforts are still too fragmented, and financing is still far too fragile. Genuine therapeutic breakthroughs that are adapted to the needs of patients in resource-limited settings and that have the potential to fundamentally transform the treatment of many neglected diseases, notably those with the highest death rates, have yet to make their way through costly clinical trials and reach patients in need.

Related articles

• Expert Group Recommend That World Health Assembly Should Adopt An International Convention On Global Health R&D (medicalnewstoday.com)
• WHO: Sixty-fifth World Health Assembly (crofsblogs.typepad.com)
• Global Health R&D Needs To Be Harmonized (medicalnewstoday.com)
• World Health Assembly should adopt an international convention on global health R&D: Expert group (medicalxpress.com)
• An international treaty is needed to improve medical research worldwide (eurekalert.org)
• We need a global treaty on health research for the poor (scidev.net)

Journal of Visualized Experiments

The Journal of Visualized Experiments is a peer reviewed, PubMed indexed journal devoted to the publication of biological, medical, chemical and physical research in a video format.

The editors believe that videos of techniques and procedures will greatly aid scientists in learning and keeping abreast of new advancements in scientific methods. They will be able to focus their time and thought more on other experimental aspects and thus speed up the process from hypothesis generating to publication.

PBS NewsHour’s Global Health Watch : Diseases, Conditions, Medical Advances and Related Policies

PBS NewsHour’s Global Health Watch features news and on-the-ground reports exploring the diseases, conditions, medical advances and policies affecting the health of people around the world.

Earthquake victims gather at the evacuation center in Kamaish
(Kamaishi.Perawongmetha/Getty Images)

BLOG  MARCH 24, 2011 Slideshow: TB a Silent KillerJust 22 countries contribute 80 percent of the global burden of tuberculosis.

A sampling from the March 25 2011 contents.
Each section includes Browse, Subscription, and Related Information options.

• Global Health
  • Recent Global Health Trips – Guatamala includes videos, a blog, and news updates
  • Blogs and reports on emerging news from Tokyo, Bangladesh, and Haiti
• The World’s Most Destructive Diseases
  • Information on the top 5 non-communicable diseases and also top 5 infectious diseases
  • Each disease or condition has information in these areas: global impact, causes, symptoms, prevention, and treatment
• From the Field (Archive) has links to current and past postings. There is a drop down menu organized by country.
• The For Teachers link  has the heading For Teachers and Students. It includes lesson plans.

Related Articles

• Japan Crisis: What’s next for nuclear energy in the U.S.? (boingboing.net)
• PBS Newshour: Wind Turbines and Health (windconcernsontario.wordpress.com)

Disaster Medicine and Public Health Preparedness (Journal Article)

From the March 18 2011 DISASTR-OUTREACH-LIB **posting

Disaster Medicine and Public Health Preparedness
The March 2011 issue of this journal includes an article titled,
“Supporting Evidence-based Health Care in Crises: What Information Do Humanitarian Organizations Need?” ***as well as a selection of open access articles relevant to the Japan earthquake. [Submitted by Anna Gieschen]

Abstract

Supporting Evidence-based Health Care in Crises

What Information Do Humanitarian Organizations Need?

Tari Turner, PhD, Sally Green, PhD and Claire Harris, MBBSAuthor Affiliations: Dr Turner and Dr Green are with the Australasian Cochrane Centre, Monash University, Victoria, Australia; and Dr Harris is with the Centre for Clinical Effectiveness, Southern Health, Victoria, Australia.

In crisis situations, there is an enormous burden of disease and very limited resources. To achieve the best possible health outcomes in these situations and ensure that scarce resources are not wasted, knowledge from health research needs to be translated into practice. We investigated what information from health research was needed by humanitarian aid workers in crisis settings and how it could be best provided. Semistructured interviews were conducted by telephone with 19 humanitarian aid workers from a range of organizations around the world and the results analyzed thematically. Participants identified a clear and currently unmet need for access to high-quality health research to support evidence-based practice in crisis situations. They emphasized that research into delivery of health care was potentially morevaluable than research into the effectiveness of particular clinical interventions and highlighted the importance of includingcontextual information to enable the relevance of the research to be assessed. They suggested that providers of health research information and humanitarian aid organizations work together to develop these resources. [editor Flahiff’s emphasis]

**DISASTR-OUTREACH-LIB is a discussion group for librarians, information specialists and othersinterested in disaster information outreach to their communities and responding to information needs for all-hazards preparedness, response and recovery.
The DISASTR-OUTREACH-LIB archives are available at
https://list.nih.gov/archives/disastr-outreach-lib.html.

*** For information on how to get this article for free or at low cost, click here

Related Articles

• U.S. Unprepared for Major Radiation Emergency: Survey (jflahiff.wordpress.com)
• Emergency mental health lessons learned from Continental Flight 3407 disaster (scienceblog.com)
• Disaster Preparedness: Is Your Family Ready? (abcnews.go.com)
• Japan earthquake – disaster relief information sources (openmedicine.ca)
• Japan’s Disaster and the Limits of Self-Sufficiency (scienceblogs.com)
• Health care needs public acceptance of evidence based medicine (kevinmd.com)

Research Matters (National Institutes of Health) – Medical Research News

National Institutes of Health: Research Matters

The National Institutes of Health (NIH) is the largest source of medical funding in the world.  Trying to locate and keep up with NIH research items can be overwhelming. Through the NIH Web site Research matters, one can find research related news items through a number of ways.

Here are some good starting points to locate NIH research news releases

• News releases are arranged by date, most current date is at the top. Items include research results, events, lecture series, and seminar series. Some items have accompanying audio, video, and/or images.
  Want to subscribe to the news releases? There are RSS and email options.
• Editor’s Picks area is in the right hand column of the home page.
• The Multimedia area links to a page with NIH (24 hour) radio audio reports, podcasts, the NIH YouTube Channel
  
• News in Health Newsletter with options for print subscription and email alerts
• The search box in the upper right corner allows for both word and phrase searching.
  The search help link gives tips on how to search, including the use of AND and OR as well as complex searches (through the example –>   (stock OR market) AND NOT president)
  

 

How to obtain free and low cost articles from biomedical journals

Heard about a new treatment for Alzheimer’s disease and want to read about the original research? Need to go to the source about a new surgical procedure? Medical articles, written by physicians and scientists just might be the answer.**

Most  medical articles are quite technically written and are published in journals which require paid subscriptions (even tho’ they are online!). Examples of medical journals include the New England Journal of Medicine, the Journal of the American Medical Association, and the Lancet.

Medical journals (a type of scholarly journals) differ from popular magazines (as Psychology Today) in appearance, audience, and purpose. Duke University has a great comparison chart on the differences between scholarly journals and popular magazines.

A few great places to get free and low cost medical articles

• Libraries Many public libraries have at least some medical journals. Most college, university, and medical school libraries (and all receiving some state funding) are open to the public and provide some reference services to the general public. These academic libraries vary in the number of subscribed medical journals.
  Some hospital libraries are also open to the public.It is best to call ahead and ask a reference librarian to see if the library is open to the public, if they have the article you need, and if you can use their computers and printers. Ask about interlibrary loan from any library where you have borrowing privileges. Your library will try to get any article they do not have from another library (there usually is a charge, upwards of $11.00 or more  an article).
• PubMed Centra****l provides access to free articles submitted by authors and publishers. Some articles are free immediately when they are published, others are free on a delayed basis (ranging from a few months to a year). Check the PubMed Central home page for additional information. PubMed Central is a service of the US National Institutes of Health.
• Free Full PDF – Over 80 million free scientific publications
  Life sciences | Health sciences | Physics sciences and Engineering | Social sciences and Humanities
• Docline is the National Library of Medicine’s automated interlibrary loan (ILL) request routing and referral system. The purpose of the system is to provide efficient document delivery service among libraries in the National Network of Libraries of Medicine (NN/LM).

Individual users of NLM’s PubMed and the NLM Gateway do not have access to DOCLINE, but they can make use of its services by ordering documents through Loansome Doc, a document ordering service. All PubMed or NLM Gateway users ordering documents must identify a DOCLINE library or libraries that are willing to serve them (Ordering Library). The health professional performs a PubMed or NLM Gateway search, reviews the citations retrieved, and identifies specific documents to be ordered. Orders are sent to DOCLINE from either PubMed or the NLM Gateway. The NLM PubMed server manages all document-ordering activities.

LoansomeDoc is for people who are not affiliated with a health or medical institution that has a library. (If your institution has a library, just ask a librarian about ordering articles through interlibrary loan). To register for LoansomeDoc, contact the closest medical library.
They can help you set up an account, including payments for articles. You should be able
receive most, if not all, ordered articles via email.

• How to Access Journal Articles provides links to information resources and services.Includes links to free articles, strategies for obtaining articles, and paying for full text articles. By Partners in Information Access for the Public Health Workforce.

• Contact the Author Email, fax, or write the author. Most authors are happy to provide a free copy of their articles if asked. Cannot locate an address or fax number? Ask a reference librarian!
• Contact the Publisher An increasing number of publishers are providing free copies of articles to patients, caregivers, and others who do not subscribe to their journals but only need a specific article for personal use.
  If the publisher does not advertise this free service, consider contacting them and requesting a specific article.  Need help contacting a publisher? Again, ask a reference librarian!

Some publishers which provide free or low cost articles (via PatientInform)

Elsevier Patient Research provides single copies of articles for $4.95. Elsevier publishes over 2,000 journals.

AACR’s (American Association for Cancer Research) policy for free patient access to medical articles—“If You Need It, You Can Read It”—can be found under Information for Readers/Subscribers.

The Endocrine Society For Patients page provides information on how to obtain free articles from its six endocrine research journals.

****Also, note that “The NIH Public Access Policy ensures that the public has access to the published results of NIH funded research. It requires scientists to submit final peer-reviewed journal manuscripts that arise from NIH funds to the digital archive PubMed Central upon acceptance for publication. To help advance science and improve human health, the Policy requires that these papers are accessible to the public on PubMed Central no later than 12 months after publication.”
I hear health sciences librarians are keeping busy advising researchers on how to comply with this.
http://publicaccess.nih.gov

**When a good summary of an article will do, check out the resources at Summaries for Patients” help patients and others understand medical studies and guidelines

Related articles

• Patients want to understand the medical literature (with links to resources for patients) (jflahiff.wordpress.com)
• PubMed Health – A Growing Resource for Clinical Effectiveness Information (jflahiff.wordpress.com)
• Save Scholarly Ideas, Not the Publishing Industry – A Rant (Social Media Collective Research Blog at Microsoft)

Medical Research Article: Lies, Damned Lies, and Medical Science

Excerpts from the Atlantic October 20 article by David H. Freedman

[Summary] Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.[end of Summary]

…..wasn’t it possible, he asked, that drug companies were carefully selecting the topics of their studies—for example, comparing their new drugs against those already known to be inferior to others on the market—so that they were ahead of the game even before the data juggling began? “Maybe sometimes it’s the questions that are biased, not the answers,”[Flahiff’s emphasis] he said, flashing a friendly smile. Everyone nodded. Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted?….

…..

[Biostatistician and physician] Ioannidis was shocked at the range and reach of the reversals he was seeing in everyday medical research. “Randomized controlled trials,” which compare how one group responds to a treatment against how an identical group fares without the treatment, had long been considered nearly unshakable evidence, but they, too, ended up being wrong some of the time. “I realized even our gold-standard research had a lot of problems,” [Flahiff’s emphasis] he says. Baffled, he started looking for the specific ways in which studies were going wrong. And before long he discovered that the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.[Flahiff’s emphasis]

This array suggested a bigger, underlying dysfunction, and Ioannidis thought he knew what it was. “The studies were biased,” he says.

…….He chose to publish one paper, fittingly, in the online journal PLoS Medicine, which is committed to running any methodologically sound article without regard to how “interesting” the results may be. In the paper, Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time. Simply put, if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right. His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials. [Flahiff’s emphasis]
The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process—in which journals ask researchers to help decide which studies to publish—to suppress opposing views. “…

….he peer-review process often pressures researchers to shy away from striking out in genuinely new directions, and instead to build on the findings of their colleagues (that is, their potential reviewers) in ways that only seem like breakthroughs…

…He looked at three prominent health studies from the 1980s and 1990s that were each later soundly refuted, and discovered that researchers continued to cite the original results as correct more often than as flawed—in one case for at least 12 years after the results were discredited…..

…he’s concerned that, like many patients, he’ll end up with prescriptions for multiple drugs that will do little to help him, and may well harm him. “Usually what happens is that the doctor will ask for a suite of biochemical tests—liver fat, pancreas function, and so on,” she tells me. “The tests could turn up something, but they’re probably irrelevant. Just having a good talk with the patient and getting a close history is much more likely to tell me what’s wrong.”[Flahiff’s emphasis] Of course, the doctors have all been trained to order these tests, she notes, and doing so is a lot quicker than a long bedside chat….

…

 

 

Clinical Trials and Systematic Reviews: Managing Information Overload

From the blog Open Medicine dated October 4th, 2010

Bastian H, Glasziou P, Chalmers I (2010) Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med 7(9): e1000326. doi:10.1371/journal.pmed.1000326

Published: September 21, 2010

• When Archie Cochrane reproached the medical profession for not having critical summaries of all randomised controlled trials, about 14 reports of trials were being published per day. There are now 75 trials, and 11 systematic reviews of trials, per day and a plateau in growth has not yet been reached.
• Although trials, reviews, and health technology assessments have undoubtedly had major impacts, the staple of medical literature synthesis remains the non-systematic narrative review. Only a small minority of trial reports are being analysed in up-to-date systematic reviews. Given the constraints, Archie Cochrane’s vision will not be achieved without some serious changes in course.
• To meet the needs of patients, clinicians, and policymakers, unnecessary trials need to be reduced, and systematic reviews need to be prioritised. Streamlining and innovation in methods of systematic reviewing are necessary to enable valid answers to be found for most patient questions. Finally, clinicians and patients require open access to these important resources. [editor Flahiff’s emphasis]
  

If the results of a clinical study are published in a scientific journal, PubMed is the best way to search for information about the article. If you are having challenges searching PubMed, consider the tutorial at the home page of PubMed. You may also ask a reference librarian at a local public, academic, or medical library. Call ahead to see what level of assistance they offer.

Clinicaltrials.gov has the voluntary summaries of some clinical trials. Advanced search has the option Study results (select Studies With Results). Some results may be labelled “proprietary” (information not released to the public, sometimes called “industry secrets” ).

How to Read a Research Paper (and also Understand Health News Research Items)

Biomedical research results are increasingly available to the public. However, caution is urged in interpreting results. For example, be very careful to not confuse causation with association.

(A recent news item about insulin use and cancer is very controversial. Some say insulin use can cause cancer, while others insist insulin users are predisposed to cancers.)

The MedlinePlus Topic Page Understanding Medical Research has links to tutorials, overviews, and more

A sampling of links

**Increasing Knowledge — How to Read a Research Paper(Lewy Body Dementia Association)

** Clinical Research & Clinical Trials(National Institute of Child Health and Human Development)

**Making Sense of Medical News (Nemours Foundation)

Related Blog Items

“Summaries for Patients” and other plain language summaries help patients and others understand medical studies and guidelines

Related articles

• NLM released several exciting enhancements that improve users’ ability to share and consume MedlinePlus content: (jflahiff.wordpress.com)
• Improving Health Care Decisions By Putting Research Into Practice (jflahiff.wordpress.com)