Wellness

(Fortune) How Big Data is Helping Fight AIDS in Africa

Photo Credit: sorbetto — Getty Images

Photo Credit: sorbetto — Getty Images

By  |  | DECEMBER 14, 2015, 11:57 AM EST

Sometimes knowing the facts leads to surprising solutions.

HIV transmission from mother to child is a major, and preventable, factor in the ongoing prevalence of AIDS in Africa. While transmission rates are below 5% with effective prenatal treatment, the World Health Organization says they can range up to 45% without treatment—unfortunately, a common situation in the developing world.

Postnatal testing, then, is often vital in spotting infections in newborns, and treating them. But even as testing has become more accessible in Africa, it has remained slow, with devastating results—untreated infant HIV is usually fatal within a year. The problem isn’t just the time needed for the actual tests, but also the unpredictable ways that samples traveled from clinics to labs.

To tackle the problem, Mozambique brought in logistics expert Jérémie Gallien, a professor at the London Business School. Before looking at health systems, Gallien had consulted on retail logistics, including for the fast-fashion chain Zara and a dominant online seller he prefers not to name. And he’s found common ground between selling sweaters and saving lives.

Gallien says the basic conundrum of medical planning is the same as that in retail—striking the right balance between instant gratification and system-wide agility. When a retailer puts all its stock in stores instead of distribution centers, or a medical authority puts all of its drugs in clinics instead of a central facility, they can sell or treat patients at those locations much more quickly. But if they bet wrong on demand, moving materials where they’re needed becomes much more challenging.

Balancing those concerns comes down to understanding a specific problem, and in Mozambique, Gallien, with co-authors Sarang Deo and Jónas Oddur Jónasson, found a surprising answer. To speed the return of test results, they recommended that testing facilities, instead of dispersed, be highly centralized. While slightly slowing average sample transportation times, the added efficiency in test processing would more than make up for it.

That conclusion was based on tons of data, gathered through partnerships with the Clinton Health Access Initiative and the National Institute of Health in Mozambique. “We got access to a data set of more than a year of shipments from clinics to the labs, then back, time stamped,” says Gallien. That was more than 30,000 records, also including information on patient outcomes and engagement.

Those records let Gallien get a precise but broad-scale view of transit times, which averaged 10 days.

“Increasing the transportation time to 13 days, you end up needing two lab locations,” he says. That would have led to a more complex problem of which samples go to which lab—which Gallien compares to the retail relationship between customers and warehouses.

The data also revealed a more complex human component of the problem—the relationship between turnaround time and caretaker followup. When test results took more than 30 days, babies’ mothers were much less likely to come back to get their results—or treatment.

“There’s all kinds of stigma and psychological impact having to do whether you transmitted the virus to your infant,” says Gallien. “It’s [a] very challenging, difficult psychological context in the first place,” and the discouragement of slow test results can trigger disengagement. Though far less dire, it’s not hard to see the parallels in retail—speedy fulfillment makes it easier for customers to make decisions, and stick with them.

Authorities in Mozambique are still processing Gallien’s recommendations, but he says Uganda has already begun to implement a similar set of solutions. The move to data-based planning, he says, opens up big possibilities for improving global healthcare.

“Particularly in these environments where there’s limited resources, limited time—this could really improve outcomes.”

The article was published on Fortune.

(New American Media) Slaves, Experiments and Dr. Marion Sims’ Statue: Should It Stay or Go?

a_caballero_statue_500x279New America Media, News Report, Andres Caballero, Posted: Dec 08, 2010

NEW YORK CITY—The statue of Dr. James Marion Sims, a surgical pioneer considered the father of modern gynecology, stands amid fallen autumn leaves in northeast Central Park, bowing to passersby who look with curiosity, but fail to recognize him.

Sims’ contributions to science and medicine are revered by many, but reviled by those who know of the pain endured by female slaves on whom he operated without anesthesia in the mid-1800s: he was trying to find the cure for a painful post-birth condition known as vesico-vaginal fistula.

“There is no doubt that he carried out experiments on women, and that he was only able to do so because they were slaves,” says Deborah McGregor, a history professor at the University of Illinois and author of From Midwives to Medicine: The Birth of American Gynecology.

The issue now is whether the city should continue to honor Sims’s achievements or signal its disapproval of his methods by removing his statue from its place at Fifth Avenue near 103rd Street, opposite the New York Academy of Medicine, a historically African-American neighborhood that is now largely Puerto Rican.

“Should the NYC Parks Department remove the statue of Dr. Marion Sims from its East Harlem location considering his experiments on female and infant slaves?” asked a recent poll on EastHarlemPreservation.Org, an advocacy organization that promotes and preserves the neighborhood’s cultural, architectural and environmental history.

Of the 650 respondents, 62 percent voted for removal, while 16 percent wanted to keep the statue in place, and 23 percent said they needed more information.

A 2007 petition by the office of New York City Councilmember Charles Barron to remove the statue went nowhere, said Marina Ortiz, president and founder of East Harlem Preservation. But Councilwoman Melissa Mark-Viverito has told the group that she is open to advocating for the statue’s removal.

Meanwhile, a spokesman from the NYC Parks and Recreation department says there have been no requests to get rid of the statue. Frances Mastrota, chair of the Community Board 11 Parks and Recreation Committee, says she did not know about the statue, but added that she would look into possible requests to have it removed.

Sims was a controversial figure even in his lifetime. Born in South Carolina in 1813, he attended medical school in his home state and in Philadelphia, and spent the early part of his career practicing in Alabama, where he owned slaves. In addition to his pioneering work in the field of gynecology —among other things — he invented the speculum, an instrument that allows doctors to see into the vagina—he boasted of being the first doctor in the South to successfully treat clubfoot and cross-eyes.

A major focus of his gynecological work was finding a way to repair vesico-vaginal fistula, a painful and embarrassing disorder caused by prolonged labor that results in the complete loss of urinary (and often fecal) control, as well as other side effects. In Sims’s era, the condition was “a physical and social calamity,” as one researcher puts it, and women with the condition were forced to avoid contact with other people, and were sometimes sent away from their families.

Sims operated on at least 10 slave women from about 1845 to 1849.

Although anesthesia became available in 1846, at least three of the slaves—Lucy, Anarcha and Betsey — endured surgery without it.

A New York Times article in October 1894 explains how Sims’s “first operation was on a female slave and was unsuccessful. He operated again and again on the same subject [Anarcha], and finally, in his thirtieth trial, he was successful.”

In his autobiography, Sims wrote about Lucy: “The poor girl, on her knees, bore the operation with great heroism and bravery. Lucy’s agony was extreme.”

After perfecting his technique and repairing the fistulas successfully in Anarcha. Sims then repaired those of several other slave women. Only after these surgeries proved successful did he try the procedure on his white female patients, this time with anesthesia. (According to McGregor and others, Sims also operated on infants born to slaves).

Sims moved to New York in 1853, becoming famous over the next few decades for a number of advances in the treatment of female patients. During the Civil War, he traveled to London and Paris, where his patients included Empress Eugenie. He was named president of the American Medical Association in 1875 and the Gynecological Society in 1879. He died in New York in 1883.

Sims’s bronze and granite statue, designed by German sculptor Ferdinand von Miller II, was first erected in Bryant Park, near the New York Public Library in midtown Manhattan, in 1892, and moved to East Harlem in 1934. A placard on the monument reads: “Surgeon and philanthropist, founder of the Woman’s Hospital State of New York. In recognition of his services in the cause of science and mankind.”

The current backlash against Sims has its roots in the women’s movement of the mid-1970s. But Sims also has his defenders, including L. Lewis Wall, a doctor and professor at Washington University School of Medicine in St. Louis. “Sims’s modern critics have discounted the enormous suffering experienced by fistula victims, Wall wrote in a 2005 article in the Journal of Medical Ethics, adding that Sims’s failure to use anesthesia on his black patients in the 1840s was not necessarily racist:

“Acceptance [of anesthesia among doctors at the time] was not universal, and there was considerable opposition to its introduction from many different quarters, for many different reasons.”

Walls noted: “The evidence suggests that Sims’s original patients were willing participants in his surgical attempts to cure their affliction—a condition for which no other viable therapy existed at that time.”

“I think it’s important to add that he did help some of the women by creating a working treatment for a miserable condition,” agrees McGregor, the history professor. Still, she adds, “I sympathize with the desire to remove the statue. Perhaps the best compromise is to make a statue honoring Anarcha, Betsy and Lucy.”

But Ortiz, of East Harlem Preservation, believes the Sims statue should go.

“I don’t think that the average Puerto Rican in East Harlem would find this statue representative of their community,” she says, adding. “Building a statue of the three [slave] women won’t solve the issue.”

Andres Caballero is currently an MS student at Columbia  School of Journalism.

The article was published on New American Media.

Researchers Look to MRI and Biomarkers to Help Improve Detection of Aggressive Prostate Cancers

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JAMA

A patient’s wife once told urology surgeon Peter Pinto, MD, that there was no way she’d agree to have a dozen biopsy needles stuck blindly into her breast just because a blood test suggested she might have cancer.

But that’s exactly what happens with many men whose cancer screening test reveals an elevated level of prostate-specific antigen, or PSA, in their blood. Although mammography provides images of suspicious breast lesions to guide biopsy needles, prostate cancer is the only type of solid organ tumor that is usually diagnosed sight unseen with hit-or-miss tissue biopsies.

Magnetic resonance (MR)/ultrasound fusion combines MR images of the prostate (bottom left, red line) with real-time ultrasound images of the prostate (top left, red line) to assist in targeted biopsy of a previously identified lesion (green line). The location of the biopsy can be recorded (yellow line), and a reconstructed 3-dimensional map of the prostate can be generated at the conclusion of the biopsy (right). Standard biopsy cores and targeted biopsy cores are highlighted here for comparison.

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