New research on human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) looks promising, but researchers are still far from finding a cure for this global epidemic. With new HIV/AIDS studies looking at everything from vaccines to stem cell research to bone marrow transplants, it seems like researchers have thought of every approach to defeat HIV/AIDS. That being said, there’s plenty of good reason to keep trying.
According to the U.S. government, there are more than 1.2 million Americans living with an HIV infection (1). When left unregulated or in very severe HIV cases, the symptoms of HIV cause serious damage to the immune system, which causes HIV to develop into AIDS. In 2014, about 20,896 Americans were diagnosed with AIDS and since the beginning of this epidemic in 1880, an estimated 1,210,835 Americans have been diagnosed (2). These numbers pale in comparison to the number of people diagnosed with HIV/AIDS in developing countries, where the standard of healthcare is well below that of the United States.
According the World Health Organization (WHO), “more than 95% of HIV infections are in developing countries, two-thirds of them in sub-Saharan Africa, where over 28 million people are living with HIV” (3). The reasons why HIV/AIDS is so prevalent is sub-Saharan Africa are not completely known by epidemiologists. The rates of sexual activity are similar in both the United States and sub-Saharan Africa and despite the increasing number of sexual education programs, the incidences of HIV/AIDS in sub-Saharan Africa are roughly the same. Some epidemiologists attribute the disparity to cultural differences between the U.S. and Africa, such as a higher rate of polygamy in Africa (4).
Regardless of the reasons why this epidemic is so prevalent in the developing world, any foreseeable cure for HIV/AIDS must take these staggering statistics into account. The ideal cure for HIV/AIDS would be a treatment that is inexpensive, only needs to be administered once, and doesn’t require follow up visits with a doctor. One treatment that is still in the development stages, but would fit the bill, is an HIV vaccine.
One promising vaccine trial, known as HVTN100, isn’t necessarily focusing on treating HIV/AIDS, but rather increasing a patient’s immunity in order to prevent him or her from contracting HIV in the first place. An earlier trial that took place in Thailand in 2009 showed that a vaccine like the one in the HVTN100 trial could improve immunity by 31% (5). Modifications to the HVTN100 vaccines have made it specifically viable for sub-Saharan populations. Linda Gail Bekker, deputy director of the Desmond Tutu HIV Centre and president-elect of the International AIDS Society (who is leading the vaccine trials) said that focusing on providing immunity might be a better strategy for combatting HIV/AIDS because “[she doesn’t] think we are going to treat [our] way out of this epidemic. We are ultimately going to need a vaccine to shut it down” (6).
However, Bekker acknowledges that the HVTN100 vaccine alone will not be enough to stop the HIV/AIDS epidemic right away. It will need to be paired with other preventative measures, education programs, and treatment methods at least until the vaccine can achieve higher rates of immunity. Furthermore, the WHO says that optimism surrounding HIV/AIDS vaccines is hindered by lack of investment in HIV vaccines. The WHO estimates “that approximately $600 million a year is invested in HIV vaccine R&D, the majority which comes from the U.S. National Institutes of Health. However, not enough is being spent to develop candidate vaccines based on HIV subtypes circulating in developing countries (7). More resources need to be directed towards finding a vaccine for HIV because it will be the most widely accessible treatment, especially in developing countries.
(1) “U.S. Statistics.” U.S. Statistics, AIDS.gov, www.aids.gov/hiv-aids-basics/hiv-aids-101/statistics/.
(3) “HIV / AIDS.” World Health Organization, www.who.int/immunization/topics/hiv/en/index1.html.
(4) Epstein, Helen, and Kristen Ashburn. “Why Is AIDS Worse in Africa?” Discover Magazine, 5 Feb. 2004, discovermagazine.com/2004/feb/why-aids-worse-in-africa.
(5) Senthilingham, Meera. “HIV Vaccine to Be Trialled in South Africa.” CNN, Cable News Network, 19 July 2016, www.cnn.com/2016/07/19/health/hiv-vaccine-go-ahead-aids-conference/.
(7) World Health Organization. Ibid.
Image: © Photosanda | Dreamstime.com - Blood Tubes Photo
The image of 5-year-old Omran Daqneesh sitting in an ambulance covered in blood and ash has been shared so many times on social media that he is now being referred to as just “the Aleppo boy.” The picture sparked outrage and protest on social media from people across the world and finally brought attention to this war-torn city. However, the responses focused mainly on what could be done to stop the bombing and who was to blame. When asked in the second U.S. presidential debate in early October, “If you were president, what would you do about Syria and the humanitarian crisis in Aleppo?” nominee Hillary Clinton blamed Russia and Syrian President Bashar al-Assad for the crisis and her opponent Donald Trump blamed Clinton (1). In the U.S., little has been discussed about what can be done to help the victims of the Aleppo bombings, except for whether or not the United States should accept Syrian refugees.
The bombs that have been dropped on Aleppo in recent months are not being dropped indiscriminately. They are specifically targeting hospitals and schools. Currently, there are 3 major state-run hospitals – Al-Razi, Aleppo University Hospital, and Ibn-Rushd Hospital – left to provide for over 1.5 million residents living in the government-controlled half of Aleppo (2). Several humanitarian groups, namely the American Red Cross and Doctors Without Borders, are doing their best to provide emergency care for bombing victims like Omran. But what about the chronically ill people of Aleppo, who are depending on these few remaining hospitals for services like dialysis treatment, chemotherapy, insulin shots, and prescription medicine?
According to the Syrian government, “Aleppo’s healthcare facilities provided residents of government-controlled areas with 280,000 discrete medical services – everything from major war-related surgeries to diabetes insulin treatments” (3). With hospitals under attack and physicians fleeing Aleppo for their own safety, there is little to be done for chronically ill patients. Dialysis machines need great amounts of electricity and insulin shots need to be refrigerated (neither of which can be done with the recurring power outages), and everything needs to be administered by a physician. Dr. David Nott, a British surgeon who volunteers in Syria with Doctors Without Borders, says little can be done for people with chronic illness during a war: “People with cancer, diabetes, hypertension are in trouble,” Nott said, “they just die at home” (4). A Syrian doctor, Dr. Hamza, says that sometimes the best he can do for cancer patients is give them pain killers, “They suffer horribly,” he says (5).
Al-Kindi Hospital in Syria used to be one of the top facilities for cancer treatment in the Middle East, but it has since been reduced to rubble. Nott says that “makeshift doctors without degrees are setting up shop” to make extra money. He even came across a mechanic-turned-doctor, saying “He reckons he can fix cars so he can fix people” (6). With 60% of Syrian hospitals destroyed and half the physicians fleeing, medicine in Syria is taking several steps backward when it could be moving forward.
Several new medical innovations could provide some aid to the chronically ill in Aleppo and other war-torn cities like it. For example, telemedicine could help the few remaining physicians to provide care to more patients. Using just a smartphone, the physician or the patient can relay symptoms, injury pictures, or vital signs to a network of available and qualified doctors around the world, who can provide a diagnosis and advice. While this wouldn’t necessarily help patients needing dialysis or chemotherapy, it could help alleviate some symptoms and make “doctors without degrees” quite useful. This technology is often used in rural parts of the United States, where there are not physicians on call 24/7. Vinaya Sermadevi, a critical-care specialist, says “It’s almost like being at the bedside—I can’t shock a patient [restart his heart with electrical paddles], but I can give an order to the nurses there” (7). It’s possible that by using telemedicine, qualified doctors can talk regular citizens through providing simple healthcare like administering vaccinations or checking blood pressure.
Furthermore, some medical machine manufacturers are changing their products to be usable in “predictably unpredictable environments” such as war zones. Often times, hospitals and manufacturers will donate used machines to developing countries, but these machines frequently end up in storage closets because the rural hospitals don’t have the tools for machine maintenance or cannot get replacement parts when the machine breaks. Guardian Healthcare makes a Universal Anesthesia Machine that can convert room air into usable oxygen and has a rechargeable battery that can last up to 10 hours. It can be repaired using only a hex wrench, a screwdriver, and minimal training (8). Embrace BabyWrap is a low cost newborn incubator that can work during intermittent power outages. Another company, Daktari, makes a portable CD4 counter that counts white blood cell levels for HIV, AIDS, and cancer patients. There are several new portable technologies, including ultrasounds and blood pressure monitors, that can be used anywhere by linking to a smartphone.
Solar power is also playing a large role in medical devices for unpredictable environments. For example, TrueEnergy has created a solar-powered vaccine refrigerator that could be very useful in Syria for refrigerating immunizations and insulin shots when there are power outages for several days. There are also solar-powered blood pressure monitors that can do up to 300 readings without being recharged do not require a physician, which means patients with chronic hypertension can monitor their blood pressures from home. Finally, and most importantly, the Solarclave is a solar-powered medical instrument sterilizer. One of the leading causes of death in war zones is infection from using non-sterilized equipment during emergencies. Often times, nurses have to resort to using boiling water or swabbing instruments with alcohol, neither of which truly sterilizes equipment.
No single technology can help chronically ill patients, who also happen to be living in the middle of a warzone, survive the terrible things that are happening in Aleppo. However, many of these technologies could decrease the number of “excess deaths”, or deaths that are caused by byproducts of war rather than the war itself. Humanitarian efforts from the Syrian government, private companies, non-profits, and even the American government should focus more on providing long-term health solutions to the people of Aleppo, rather than just emergency care. They should focus their efforts on getting some of these new devices to the few remaining hospitals in Aleppo. Regardless of whose fault this humanitarian crisis is, the bottom line is that it is happening and it will not end soon. Though the bombings in Aleppo may have only come into the public spotlight recently because of the picture of Omran Daqneesh, Aleppo has been a divided warzone for over four years. The goal should be to give the people remaining in Aleppo the best chance of survival by not letting them die of preventable diseases.
(1) “Presidential Candidates Debates: Presidential Debate at Washington University in St. Louis, Missouri.” The American Presidency Project, 9 Oct. 2016, http://www.presidency.ucsb.edu/ws/index.php?pid=119038.
(2) Aboud, Rami. “Devastating Fighting Has Left Aleppo’s Hospitals In Critical Condition.” The Huffington Post, 9 Aug. 2016, http://www.huffingtonpost.com/entry/aleppo-healthcare-system_us_57a9f9ffe4b0ba7ed23d87e6.
(4) Giovanni, Janine di. “Frontiers Without Medicine.” Newsweek, 15 Feb. 2016, http://www.newsweek.com/2014/03/28/war-torn-syria-health-crisis-emerges-248001.html.
(7) Beck, Melinda. “How Telemedicine Is Transforming Health Care.” The Wall Street Journal, 26 June 2016, http://www.wsj.com/articles/how-telemedicine-is-transforming-health-care-1466993402?mg=id-wsj.
(8) Miesen, Mike. “Designing Medical Devices for Predictably Unpredictable Environments | The Lancet Global Health Blog.” The Lancet Global Health Blog, 4 Mar. 2014, http://globalhealth.thelancet.com/2014/03/04/designing-medical-devices-predictably-unpredictable-environments.
Image: © Dinosmichail | Dreamstime.com - Refugee camp in Greece
The applications of virtual reality technology go far beyond gaming and recreational use. In fact, virtual reality is finding a new niche in healthcare and medicine. The ability to simulate emergency situations, visualize a surgery before performing it, or simulate psychological situations is providing a new level of understanding of medicine.
For example, virtual reality is being used to help soldiers returning from war overcome post-traumatic stress disorder (PTSD). PTSD “can occur after someone has been exposed to a significant stressor and often includes symptoms such as avoidance, hyper-vigilance, anger issues and mood swings” (1). Virtual reality can help soldiers deal with PTSD by exposing them to triggers in a controlled environment. Skip Rizzo, a clinical psychologist at the University of Southern California Institute of Creative Technologies, created several virtual “worlds” that mimic battlefield scenarios and has been successfully using them to help soldiers returning from war deal with PTSD. Before virtual reality, psychologists would use “exposure therapy,” where patients would imagine scenarios that triggered their PTSD and narrate them to the psychologist, to help soldiers face their triggers. Dr. Rizzo notes that the advantage of using virtual reality is that you can achieve the same result without having to rely on the patient’s imagination (1). Chris Merkle, a U.S Marine and patient of Dr. Rizzo, said that using virtual reality helped put his healing process in the right direction. “I’m still a work in progress obviously, but I’m so far forward – leaps and bounds beyond where I would have been without virtual reality” (1).
Virtual reality is also being used in two different ways to help treat cancer patients. First, cancer patients, especially those who have terminal diagnoses and have to spend many months in the hospital, often experience depression. Virtual reality can be used to help patients “escape” from the hospital. The Norris Comprehensive Cancer Center at the University of Southern California has partnered with Springbok, a non-profit organization that provides entertainment and technology programs for the patient population, to create escapist entertainment for young cancer patients. Dr. James Hu, a clinical professor at the USC Keck School of Medicine who is working on this partnership, says that providing this escapist entertainment for young cancer patients could have clinical benefits as well (2). Studies show that virtual reality decreases the negative psychological effects of cancer, which gives patients a better a prognosis for recovery (2).
Second, virtual reality is helping the oncologists too. Tumors are particularly difficult to visualize and virtual reality can give oncologists the opportunity to “see” the tumor before they start operating on it. Alex Sigaras, a research associate at Weill Cornell Medicine, says, “I can zoom in [on the] protein structure. By moving my hands around, I can rotate [the] model” (3). Virtual reality also has genetic applications. Olivier Elemento, another researcher at Weill Cornell Medicine and the Englander Institute for Precision Medicine, said, “virtual reality can help doctors better understand how a mutation or the protein it makes transforms a cell into cancer which, in return, will help them find a drug to better target it” (3).
Furthermore, virtual reality is being used in plastic surgery. Plastic surgeons can use virtual reality to help their patients visualize what they will look like after the surgery. bodySCULPT, a Manhattan-based plastic surgery practice, is the first in the United States to use the Oculus Rift 3D for consultations for breast augmentations, liposuction, and Brazilian buttocks lifts (4). Now practices all over the country from Careaga Plastic Surgery in Miami to Genesis Plastic and Cosmetic Surgery in Oklahoma City are utilizing virtual technology to bridge the gap between the plastic surgeon’s vision and the patient’s expectations. Dr. Spero Theodorou, a renowned plastic surgeon from bodySCULPT, said, “The relationship between the plastic surgeon and the patient is now enhanced to the point of bringing virtual as close to reality as technically possible" (4).
These are just a few of the ways that virtual reality is changing the way we approach medicine. It’s also being used to train surgical residents and rehabilitate patients with brain damage, for cognitive training in children with autism, and even for meditation. This is also just the beginning of the medical applications of virtual reality. With more innovations in both virtual reality and medicine, virtually reality could potentially help paralyzed patients walk again or help find cures for cancer, Alzheimer’s, and other diseases.
(1) Quart, Justine. “Treating PTSD With Virtual Reality Therapy: A Way to Heal Trauma.” ABC News, ABC News Network, 16 July 2016, http://abcnews.go.com/technology/treating-ptsd-virtual-reality-therapy-heal-trauma/story?id=38742665.
(2) Dacuma, Mary. “Virtual Reality Program Enhances Treatment for Young Cancer Patients | Keck Medicine of USC.” Virtual Reality Program Enhances Treatment for Young Cancer Patients | Keck Medicine of USC, 3 Oct. 2016, http://snip.ly/79hbg?utm_content=bufferce330&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer#http://www.keckmedicine.org/virtual-reality-program-enhances-treatment-for-young-cancer-patients/.
(3) “Doctors Using Virtual Reality to Treat Cancer Patients.” Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, 13 July 2016, https://meyercancer.weill.cornell.edu/news/2016-07-13/doctors-using-virtual-reality-treat-cancer-patients.
(4) “BodySCULPT Brings Oculus Rift 3D Imaging and Virtual Reality to Breast Surgery and Body Sculpting.” 24-7 Press Release Newswire, 8 Dec. 2015, http://www.24-7pressrelease.com/press-release/bodysculpt-brings-oculus-rift-3d-imaging-and-virtual-reality-to-breast-surgery-and-body-sculpting-416529.php.
Image: © LagartoFilm | Dreamstime.com - Virtual reality smart-phone headset concept
International BRAIN Initiative Could Mean Cures for Alzheimer’s, Parkinson’s, and Other Brain Diseases
Doctors have long searched for an effective opioid painkiller without the high risk of addiction and debilitating withdrawals that have turned opioid abuse into an epidemic. Dr. Susruta Majumdar, a chemist at Memorial Sloan Kettering Cancer Center, argues that the “holy grail of painkillers would not induce the seductive euphoria of common opioids or their less-pleasant side effects like itching or constipation” (1). In fact, he thinks he might have found such a drug. The drug, Kratom, is derived from the Mitragyna speciosa tree of Southeast Asia and is a natural painkiller with much less severe withdrawals and a lower tendency towards addiction. However, the Drug Enforcement Administration (DEA) is attempting to ban Kratom (classifying it as a Schedule I banned substance) and thus, is putting an end to Majumdar’s and others’ extensive research on the medical potential of Kratom.
The DEA argues that the addictive effects of Kratom (though significantly milder than other opioids) and the fact that it may have been responsible for 15 deaths between 2014 and 2016 (2) are grounds for classifying Kratom as a Schedule I controlled substance. To put things in perspective, other Schedule I drugs include ecstasy, heroin, and other drugs that are considered to be dangerously addictive with no known medical use. However, the conundrum lies in the fact that once Kratom is banned by the DEA, medical researchers like Majumdar can’t prove its medical benefits through lab research without obtaining a special license that allows them to experiment with the controlled substance. That means that if Kratom is banned, current Kratom researchers will have to destroy all their current samples and essentially start over. Furthermore, they’ll have to obtain the Schedule I license (which is very difficult to do) and prove Kratom’s medical benefits within the next two years. After 2 years, the DEA can move to permanently ban Kratom (based on its lack of medical use) at which point any demonstrated medical benefits of Kratom won’t matter.
Consequently, there has been much backlash from protestors and Congressmen, who defend the medical potential of Kratom and do not want to see Kratom research halted. The earliest date that the DEA could have banned Kratom was on September 30th, but they haven’t done so yet. However, the DEA has been very clear that they won’t drag their feet for long. DEA spokesperson Russ Baer went so far as to say, “We have determined that it [Kratom] represents an imminent hazard, so… It's not a matter of if, it's just a matter of when" (3). Several Congressmen, including top-ranking Senator Orrin Hatch (R-Utah), are attempting to persuade the DEA to hold off on banning Kratom until more medical research is completed. Mark Pocan (D-Wisconsin) and Matt Salmon (R-Arizona), who organized a letter signed by 50 House Representatives, stated in their letter that, “The DEA’s decision to place Kratom as a Schedule I substance will put a halt on federally funded research and innovation surrounding the treatment of individuals suffering from opioid and other addictions—a significant public health threat” (4).
On top of being useful as a replacement for addictive opioids, Kratom has also helped many people overcome addiction to opioid painkillers. On September 13th, hundreds of protestors marched down Pennsylvania Avenue with signs that read “Kratom Saved Me.” Andras Varadi, a colleague of Majumdar who is a medicinal chemist at Columbia University and Sloan Kettering, says that Kratom, like other powerful opiates, binds to the body’s mu-receptors, blocking pain receptors and making it an effective opioid. However, it also lowers tolerance and lessens withdrawal symptoms making it a “double whammy” (1). Opioid overdoses were responsible for 18,893 deaths last year in the United States (5), which calls into question why the DEA would ban Kratom over just 15 cases that weren’t definitively tied to Kratom. Alicia Lydecker, a toxicologist at the University of Massachusetts who is not exclusively studying Kratom, said, “In terms of death, we really only get into that issue when it’s combined with other substances” (1). Some Kratom bought in the US was found to be compounded with other, more serious drugs like hydrocodone.
Based on the current research, it seems that the DEA may be acting too hastily in banning Kratom. Many Kratom researchers understand and support the need to regulate Kratom, however, they disagree with the DEA’s classification of Kratom as a Schedule I drug (1). Not only do they feel that it’s an inaccurate classification because of the medical potential they’ve seen for Kratom, but also assigning Kratom Schedule I classification will almost definitely halt important medical research that could help thousands of people.
(1) Chen, Angus. "Kratom Drug Ban May Cripple Promising Painkiller Research." Scientific American. N.p., 26 Sept. 2016. Web. 01 Oct. 2016.
(2) "DEA Announces Intent to Schedule Kratom." Drug Enforcement Administration. N.p., 30 Aug. 2016. Web. 01 Oct. 2016.
(3) Nelson, Steven. "Kratom Will Remain Legal for Days, Possibly Longer." US News. U.S.News & World Report, 30 Sept. 2016. Web. 01 Oct. 2016.
(4) Mole, Beth. "DEA Has Kratom Users Holding Their Breath, Lawmakers Write More Letters." Ars Technica. N.p., 30 Sept. 2016. Web. 01 Oct. 2016.
(5) "Opioid Addiction 2016 Facts & Figures." American Society of Addiction Medicine. N.p., n.d. Web. 30 Sept. 2016.
Image: © Ratree Fuangnakhon | Dreamstime.com - Mitragyna speciosa Korth.
Currently, Olivia is a senior at USC majoring in Biology and minoring in Spanish. She is the President of USC Health Sciences Education Program, a student organization that seeks to inspire young students to pursue careers in STEM and to foster excitement about the sciences among K-12 students. For the past two years, Olivia has been conducting clinical research on sports injuries in conjunction with the Human Performance Lab at USC's physical therapy school, which is where her interest and experience in biomedical innovation comes from. In her free time, she loves reading about new medical technologies, volunteering at schools around USC, and cheering on the Oklahoma City Thunder (her hometown team). After graduation, Olivia plans on going to medical school and eventually becoming an orthopedic surgeon.