New ways to beat superbugs, a Malaysian doctorate student discovered?

A Malaysian doctorate student is causing a buzz in the medical research field.

 Lam Shu Jie (pic), 25, and her team of researchers may have found a solution to the antibiotic-resistant bacteria commonly known as “superbugs”.

The team from Melbourne School of Engineering published a paper on Monday on a new treatment method.

Shu Lam A 25 year-old Melbourne Uni student has made a discovery that could be a game-changer for modern medicine and avert a serious health crisis.

The method uses star-shaped structures called structurally nano-engineered anti-microbial peptide polymers (SNAPPs).

SNAPPs are found to be highly effective in killing Gram-negative bacteria – a class of bacteria which is antibiotic resistant – without hurting healthy cells, according to the team’s article in Nature Microbiology.

Unlike antibiotics which attempt to kill the bugs chemically, the star-shaped protein molecules defeat them by “ripping apart their cell walls”.

She also found that it was important to have outside interest due to the research work's long hours and possibility of failure..

"I've just watched the Korean movie called 'Train to Busan'. I also like trying new cuisines and exploring cafes here because the food culture's very strong," she laughed..

She lamented that the initial experiments were daunting, which left her in fear..

"My experiments kept failing, but later I learned what went wrong. I like the investigating part of research. It's beyond being in the labs or reading books; it's also about speaking with other experts," she said..

The second child of three siblings still has strong ties with home..

"I try to come back for the Chinese New Year because I miss my family," she said while lamenting the loss of her father last year..

Despite her supervisor Prof. Greg Qiao reportedly saying that her research is still at its early stage, Lam has plans to continue her research in the field, while in the long-term, she expressed hope to establish a research group with experts upon returning home and also lecture..

She will complete her PhD in two months time..

The scientific breakthrough was picked up by many news portals including Science Daily, the Australian Broadcasting Corporation and the South China Morning Post.

Lam told South China Morning Post that she spent the past three and a half years researching polymers and how they can be used to kill antibiotic-resistant bacteria.

The Batu Pahat lass, who is to submit her PhD thesis in two months, admitted that she hoped to continue to work in research, rather than opt for medical training like her father who is a paediatrician.

“I think my career will be mainly focused on research in the medical field,” said Lam.

Her supervisor Prof Greg Qiao, who is also one of the 10 co-authors of the scientific journal, said the research was still in its early stages.

He told South China Morning Post that more work was needed to verify the best formula and structure, as well as determine dosage and test for toxicity, before the substance could be deemed safe for human use.

“Even with all the money in the world, it would take at least five years to get to the first human-test stage because many resources and much work are needed before commercialisation,” he said.

Superbugs stem from misuse or overuse of antibiotics, according to the World Health Organisation.

It lists anti-microbial resistance as a global concern that threatens our ability to treat common infectious diseases, resulting in prolonged illness, disability and death. The Star/Asia News Network.

Related:

The 25-year-old Malaysian Chinese who may have just solved the ...

www.scmp.com › This Week in Asia › Society

South China Morning Post

6 days ago - South China Morning Post .... The World Health Organisation lists superbugs as a key threat to human ... I have developed an interest in food and really like exploring new cafes ... Lam moved to Australia for her foundation studies after finishing .... Peter Wong says tougher banking regulation is on the way.

Doctors alarmed as nightmare superbug, resistant to every antibiotic, is found in first US patient

“I think my career will be mainly focused on research in the medical field,” said Lam, who has already begun pursuing her passion in polymer research during her four-year undergraduate degree in chemical and biomolecular engineering.

“As an undergraduate, she would come to our group for summer work when she had time,” Qiao recalled of Lam.

These days when Lam finds the rare downtime between researching polymers, she likes to watch TV and explore the city. “Being in Melbourne, I have developed an interest in food and really like exploring new cafes and brunch places, so I spend a lot of time trying new food and walking around when I’m not working,” Lam said.

Lam moved to Australia for her foundation studies after finishing primary and secondary school in Malaysia, and is likely stay on in Australia after graduating at the end of the year.

“My main preference would be to continue to stay in research, but I am also looking at career fields outside of polymer research,” she said. “This research is going in different directions,” said Qiao. “One is killing the bug, the other is treating cancer.”

That sinking feeling: ‘superbugs’ may be multiplying in China’s tap water due to world-low hygiene standards, scientists say

Her group is also examining the use of polymers as a drug carrier for cancer patients as well as the treatment of other diseases.

A key project at the moment is the synthetic transplant of cornea in the eye, which involves the use of polymers grown from the patient’s own cells in the lab to replace the damaged cornea.

The operation has already been tested multiple times successfully on sheep, and Qiao hopes to begin the first human trials in Melbourne within two years, working with the Melbourne Eye and Ear Hospital.

Related posts:

Superbug lurking! Drug resistance now a nightmare!

Mar 18, 2013 ... In addition, no new major antibiotics have been made since the late 1980's because antibiotics can have a short lifespan before superbugs ...

WHO's Alarm Bells: Antibiotic Resistance Now a 'Major Threat to ...

May 5, 2014 ... WHO's Alarm Bells: Antibiotic Resistance Now a 'Major Threat to Public ... There hasn't been a new class of antibiotics developed since the late ..

 Clean hands save lives, wash your hands to combat ...

May 6, 2014 ... ... Bacteria , hand hygiene , Health , health and wealth , Hepatitis , Immunity , Medicare , medicines , MRSA , superbugs , Vaccines , WHO ...

right-waystan.blogspot.com

 

Counterfeit medicines and drugs, a public health menance !

Fake medicines may contain toxic substances that include heavy metals (e.g. aresenic) and additives (e.g. steroids). – AFP

The drugs you are taking may be fake

Counterfeit drugs are a booming criminal industry with serious consequences for public health.

Many of us have a strong faith in the power of modern medicine.

We go to the doctor or pharmacist, get the prescribed pills, take them religiously and expect to be cured of whatever ails us.

Oftentimes, this faith is justified, but in an age where fake products abound, have you ever wondered about the authenticity and quality of the drugs that you are ingesting?

According to a 2013 Emerging Markets Health Network report, 3-5% of all medicines being circulated in Malaysia were fakes.

Health Minister Datuk Seri Dr S. Subramaniam has also been reported as saying that the ministry had seized some 33,704 unregistered products worth RM43.22mil last year alone.

While this is not high compared to other middle- and low-income countries – for example, the International Pharmaceutical Manufacturers Group in Indonesia estimates that about one-quarter of medicines on the Indonesian market are fake – it is certainly something to be worried about as it concerns our health.

University of Oxford’s Reader in Tropical Medicine, Prof Dr Paul Newton says that it is difficult to estimate the global size of the problem as there is not enough data.

According to him, there are very few studies, and very few of those are done in a scientifically-rigorous manner, adding that there are certainly hotspots of such problems around the world.

Pfizer Global Security director Mark Robinson shares that the pharmaceutical company sees the highest number of fake drug seizures in Asia, compared to the rest of the world.

But he adds: “That’s because we are targeting (illegal) labs, seizing the drugs before they reach the market.” He observes that in 60 countries around the world, patients went into a legitimate, licensed pharmacy and got counterfeit drugs.

In addition, he notes that the World Health Organisation (WHO) estimates that over half of those who buy drugs online from unverified websites receive counterfeit medicines.

Two types of fake

Fake drugs, also called poor quality drugs, can be divided into two types: counterfeit and substandard.

Prof Newton explains that counterfeit medicines are made by criminals with the intent to deceive patients and healthcare workers for monetary gain.

According to Robinson, these criminals include entrepreneurs, terrorist organisations, drug syndicates and weapons dealers.

 Brick dust, used to hold the fake pill together, as well as boric acid, leaded highway paint to provide the yellow colour, and floor wax to provide shine, were found to be used in the production of counterfeit mefenamic acid by an illegal lab in Colombia. - AFP

They do it, he says, because it is profitable, because they are pretty sure they won’t get caught, and because even if they do get caught, the penalties are very low compared to the amount of money they can make.

The danger of these drugs is that they can vary from not having any active pharmaceutical ingredient to containing toxic materials. (See What’s in your fake drug)

Active pharmaceutical ingredients are the chemical compounds that treat the medical condition.

Unlike counterfeit drugs, substandard drugs are made by the original or licensed manufacturer, but do not conform to the proper standard of quality.

They are “medicines with mistakes”, says Prof Newton.

These medicines occur due to errors in the factories. Sometimes, they can be small errors, and sometimes, they can be large errors, like using the wrong active ingredient, he says.

He opines that this problem is more likely to occur in low-income countries where there is a lack of drug regulation and quality control measures.

However, as with counterfeit drugs, it is difficult to estimate the size of this problem due to the lack of data.

“Not many people are actually looking (for this problem), so we might have an unpleasant surprise,” he says, adding that in terms of public health, substandard medicines are as dangerous as counterfeit drugs.

He adds that some companies are very active in ensuring that their products are good, but, like any human activity, some cut corners and skip the quality control.

Poor regulation

According to the WHO, only one-fifth of its member states have well-developed drug regulation; half have varying levels of regulation and enforcement; and the remaining 30% have either very limited or no drug regulation at all.

In Malaysia, Dr Subramaniam was reported as saying that online drug sales are a particularly hard area to enforce as the Customs Department does not screen packages valued below RM500, due to the very high number of such packages.

“We have asked the Customs Department to screen all packages, and they are trying to do it, but I think it is quite expensive to put such a system in place,” he said after opening the Access to Safe Medicines Training Conference organised by Mediharta Sdn Bhd in January.

Prof Newton was a speaker at the same conference, while Robinson was a speaker at the launch of Pfizer’s anti-counterfeit technology, Patient Authentication for Safety via SMS (PASS), in Malaysia.

According to Robinson, the top three drugs produced by Pfizer that are found to be counterfeited in Malaysia are erectile dysfunction drug, sildenafil; non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation, celecoxib; and hypertension drug, amlodipine.

He adds that it is not only branded drugs that are counterfeited, but also generic drugs that are no longer patented, like the NSAID mefenamic acid.

“People just want to use our good name (to sell fake drugs),” he says.

Prof Newton notes that antibiotics and cardiovascular drugs are also being increasingly counterfeited in South-East Asia.

He adds that it is not only drugs that are counterfeited, but also medical devices like cardiac stents, rapid diagnostic tests and insecticide-treated bed nets – a problem particularly rampant in Africa.

Bad effects

The effects of fake drugs can be felt both on the individual level, as well as on a wider scale. For the patient, taking counterfeit drugs can range from death to developing more serious health complications.

These health complications may be caused by the actual illness being untreated due to a lack of active ingredients in the counterfeit drug, or the drug containing either toxic ingredients or the wrong active ingredients.

The latter will also make it more complicated for doctors to treat the patients, as they might be confused by the incongruent symptoms.

Counterfeit or substandard drugs that contain less active ingredients than required can also cause drug resistance, particularly if they are antibiotics.

Prof Newton adds that consuming fake drugs also ends up incurring more expense on the patients’ part, as they don’t get better and keep on buying more medications.

Patients might also lose faith in the healthcare system, he says. “If you don’t trust the pharmaceutical companies or doctors, you won’t go back and might seek other alternatives.

He notes that fake drugs will also affect genuine pharmaceutical companies, as well as government healthcare systems and non-governmental organisations that inadvertently purchase these drugs.

Both Prof Newton and Robinson hope that governments around the world will take a stronger stance against counterfeit medicines, both in terms of enacting relevant legislation with much stronger penalties for those producing fake drugs, as well as in terms of enforcement.

Patients should also be more careful of what they consume.

For example, signs that a medicine could be fake include an excessively low price, flimsy or unprofessional packaging, and not requiring a doctor’s or pharmacist’s prescription for non-OTC (over the counter) drugs.


An example of the holographic security label for registered Malaysian drugs, which features the hibiscus symbol, serial number and the letters PBKD and DCA. All drug packaging must have this label. – Photo:
An example of the holographic security label for registered Malaysian drugs, which features the hibiscus symbol, serial number and the letters PBKD and DCA. All drug packaging must have this label. – Photo: Health Ministry

In Malaysia, registered drugs also have a holographic security sticker on their packaging.

By Tan Shiow Chin The Star/Asia News Network

Related:

The counterfeit menace - Health 

 

Clean hands save lives, wash your hands to combat germs!

PETALING JAYA: The role of hand hygiene in preventing the spread of drug-resistant germs is the focus of the World Health Organisation’s annual “SAVE LIVES: Clean Your Hands” campaign this year.

Launched yesterday, the campaign is in line with WHO’s recently-released report on Antimicrobial Resistance: Global Report on Surveillance.

How bacteria become resistant

Bacteria grow resistant to antibiotics through natural selection. When drugs are used, some organisms may have ways of surviving. As they reproduce or pass DNA to other bacteria, those traits become more common, weakening antibiotics’ power.

The report states that there are increasingly more types of bacteria which cannot be killed by antibiotics. The report also stated that no one in the world is safe from this menace.

However, WHO also reported that should compliance with hand hygiene in health facilities increase from under 60% to 90%, there could be up to a 24% reduction in the infection of methicillin-resistant Stap­hylococcus aureus (MRSA).

MRSA, most commonly contracted in hospitals, is rapidly becoming more difficult to treat with current drugs.

“Whether it is the hands of the patient, their visitors or the healthcare team, people must remember to practise good hand hygiene in a healthcare setting, especially in hospitals,” said Patient Safety Council of Malaysia member Dr Milton Lum.

Good hand hygiene means washing the hands thoroughly with soap and water before and after touching a patient.

“Everyone has germs on his or her body so despite our good intentions in visiting our sick relatives or friends, we may actually pass on a bug unintentionally,” said Dr Lum.

Patients for Patients Safety Malaysia chairman J. Manvir said he believed that patients should also wear masks to protect themselves from airborne infections.

“Children under 12 should not be visiting patients, especially in hospitals.

“You may not be able to teach them to practise good hand hygiene but you can keep them at home to prevent them from passing on an infection to the patient as well as preventing them from getting ill,” said Manvir.

Antibiotic resistance has been around since the 1940s when the first antibiotic, penicillin, allowed doctors to kill off the many bacteria that were the source of different infections.

However, subsequent misuse of penicillin accelerated the natural evolution of the bacteria, resulting in the microbes becoming resistant.

Contributed by Tan Shiow Chin The Star/Asia News Network

Related post:

WHO's Alarm Bells: Antibiotic Resistance Now a 'Major Threat to Public Health'

The world's leading health organization is sounding serious alarm bells about the problem of antibiotic resistance.

Related: Good hand hygiene can save lives - SDHB

WHO's Alarm Bells: Antibiotic Resistance Now a 'Major Threat to Public Health'

The world's leading health organization is sounding serious alarm bells about the problem of antibiotic resistance.

In its first report on the issue ever, the World Health Organization (WHO) is sounding alarms about the issue of antibiotic resistance and the global public health threats it poses to our increasingly interconnected world.

"The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century," the report states.

Antibiotic resistance occurs when bacteria no longer die when treated with antibiotics. As a result, doctors have to use stronger, more potent antibiotics, and the more those are used, the more resistance bacteria develop to those as well. The WHO is warning that we're reaching a point in which the strongest antibiotics doctors have in their arsenal, the "treatment of last resort" drugs as they're called, no longer work.

And in fact, it's no longer just bacteria that are becoming resistant. The WHO has stopped referring to the problem as "antibiotic resistance" and now calls it "antimicrobial resistance," to encompass other organisms, such as viruses and parasites, that no longer respond to the drugs of choice. Namely, treating the viruses tuberculosis and HIV, and malaria (a parasite), has become harder as these diseases become resistant to medications. Even H1N1, the so-called "swine flu" that reached pandemic levels in 2009, has begun developing resistance to potent antiviral drugs.

Resistance Is a Worldwide Problem

One of the major points of the report is that diseases that used to be restricted to certain locales are now spreading internationally:

Among their key findings:
• Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumonia—carbapenem antibiotics—has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections.

• Treatment failure to the last resort of treatment for gonorrhea—third generation cephalosporins—has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.

• People with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64 percent more likely to die than people with a non-resistant form of the infection. MRSA, which can cause septic bloodstream infections when exposed to broken skin, is one of the most common "community-acquired" resistant infections, meaning you're likely to pick it up anywhere other people are—your gym, place of worship, a nearby park or even at schools. In the Americas, as many as 90 percent of staph infections are reported to be MRSA.

• There hasn't been a new class of antibiotics developed since the late 1980s.

We Can't Track What We Don't Know

The WHO is calling on countries all over the world to step up their surveillance of these deadly infections, something that happens rarely, if at all. An investigative report, "Hunting the Nightmare Bacteria," that ran on the PBS program Frontline in October 2013 revealed that public health officials in the U.S. have little to no data on the extent of antimicrobial resistance in this country. Healthcare facilities aren't required to report outbreaks, the report found, and many don't because they don't want to scare people or have to deal with bad PR.

“It is frankly embarrassing that we as a country do not know where resistance is occurring, how bad the problem is for various organisms or who’s using what antibiotics when,” Brad Spellberg, MD, an infectious disease doctor at Harbor-UCLA Medical Center, said in the documentary.

The Centers for Disease Control and Prevention has estimated that antimicrobial resistant infections hit two million people a year and kill at least 23,000. But the WHO notes that in most countries around the world, including the U.S., often only the most severe infections are documented and minor community-acquired infections (which can get passed along repeatedly and wind up as a severe infection) go unreported.

Clean Up the Food Supply!

For quite possibly the first time, the WHO also called out the food industry for its contribution to antimicrobial resistance. " The use of antibiotics in animal husbandry—including in livestock, poultry and fish farming—are leading to increasing recognition that urgent action is needed to avoid inappropriate use, and to reduce antibiotic usage in animal husbandry and aquaculture, as well as in humans," the report states. In the U.S., 80 percent of antibiotics sold go into animal feed to prevent infections in healthy animals or to speed growth. And we're not alone. "In many countries, the total amount of antibiotics used in animals (both food-producing and companion animals), measured as gross weight, exceeds the quantity used in the treatment of disease in humans," the authors found.

The same classes of antibiotics used on these animals are the same as those given to humans. In particular, fluoroquinolones, antibiotics used widely in the poultry industry, are increasingly ineffective against urinary tract infections caused by drug-resistant E. coli bacteria, which have been detected on all forms of supermarket meat, and against MRSA soft-tissue and skin infections.

Numerous groups in the U.S. have sued the Food and Drug Administration to revoke its approvals in animals for antibiotics that are valuable for humans. The agency's only response has been to set voluntary guidelines for the industry.

What You Can Do

Despite the damage factory farming has done to antibiotic effectiveness, the WHO and other public health officials insist that the first line of defense in controlling the problem of antimicrobial resistance is the healthcare setting: Stopping doctors from giving patients antibiotics for conditions they aren't designed to treat, for instance, when you're given antibiotics for a cold that's caused by a virus, not bacteria.

• Don't automatically ask for antibiotics when you feel sick and visit a doctor.

• If your doctor prescribes an antibiotic, ask if there's an alternative before just accepting the advice. Some doctors feel compelled to offer the drugs to make people feel better, but asking for an alternative can open up a dialogue about other options.

• When you do need an antibiotic, take the full course, even if you're feeling better.

• Wash your hands frequently to protect yourself from community-acquired infections, and keep your hands away from your nose, eyes and mouth, where infections can enter.

Contributed by  By EMILY MAIN

 


Alarm bells over antibiotic resistance 

The World Health Organisation’s most comprehensive report to date sounds a warning that we are entering a world where antibiotics have little effect.

THE World Health Organisation (WHO) has sounded a warning that many types of disease-causing bacteria can no longer be treated with the usual antibiotics and the benefits of modern medicine are increasingly being eroded.

The comprehensive 232-page report on anti-microbial resistance with data from 114 countries shows how this threat is happening now in every region of the world and can affect anyone in any country.

Antibiotic resistance – when bacteria evolve so that antibiotics no longer work to treat infections – is described by the report as “a problem so serious that it threatens the achievements of modern medicine”.

“A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” said Dr Keiji Fukuda, WHO assistant director-general who coordinates its work on anti-microbial resistance.

“Without urgent, coordinated action, the world is headed for a post-antibiotic era in which common infections and minor injuries which have been treatable for decades can once again kill.

“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine.

“Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

The report, “Antimicrobial Resistance: Global Report on Surveillance”, shows that resistance is occurring in many bacteria causing different infections.

It focuses on antibiotic resistance in seven bacteria responsible for common, serious diseases, such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

What is especially alarming is that the bacteria’s resistance has also breached “last resort” antibiotics, which are the most powerful medicines that doctors resort to when the usual ones do not work.

When patients do not respond to the usual medicines (known as first-line or first-generation medicines), doctors prescribe newer (second line medicines) which also usually also cost more.

When these also don’t work, newer and often more powerful (but sometimes with also more side effects) antibiotics are used, and they are even more expensive.

If these third-line or “last resort” medicines are not available or too costly for the patient, or if they don’t work on a patient because of antibiotic resistance, the patient remains ill or dies if the infection is a serious one.

New antibiotics have been discovered in the past to treat infections when the old ones became useless due to resistance.

But these discoveries dried up in the past 25 years.

The last completely new classes of anti-bacterial drugs were discovered in the 1980s.

Pathogens that are becoming increasingly resistant including to the more powerful antibiotics include E. coli, K. pneumonia, S. aureus, S. pneumonia, salmonelia, shigella and n. gonorrhoeae.

Key findings from the report include:

> Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, K. pneumonia — carbapenem antibiotics — has spread worldwide.

K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients.

In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections;

> Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli – fluoroquinolones – is very widespread.

In the 1980s, when these drugs were first introduced, resistance was virtually zero.

In many countries today, this treatment is ineffective in more than half of patients;

> The sexually transmitted disease, gonorrhoea may soon be untreatable unless there are new drugs. Treatment failure to the last resort of treatment for gonorrhoea – third generation cephalosporins – has been confirmed in several countries; and

> Antibiotic resistance causes people to be sick for longer and increases the risk of death.

For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.

There are many cases of patients being infected by MRSA in hospitals.

The report also gives useful information on the worrisome building up of resistance in four serious diseases — tuberculosis, malaria, HIV and influenza.

A major factor accelerating resistance is in the animal husbandry sector, where there is a liberal use of antibiotics mainly to promote the growth of the animals used for food, for commercial purposes.

This builds up resistance in the bacteria present in the animals.

These resistant germs are passed on to humans who consume the meat.

The report has a small section on the animal-food chain, which has been identified as a major problem.

The European Union has banned the use of antibiotics as growth promoters in animals, but it is still allowed in other countries.

A WHO press release on the report calls for some actions. These include:

> Setting up basic systems in countries to track and monitor the problem;

> Preventing infections from happening in the first place to reduce the need for antibiotics;

> Only prescribing and dispensing antibiotics when they are truly needed, and prescribing and dispensing the right antibiotic(s) to treat the illness;

> Patients using antibiotics only when prescribed by a doctor and completing the full prescription; and

> Developing new diagnostics, antibiotics and other tools to stay ahead of emerging resistance.

Contributed by Global Trends by Martin Khor

Martin Khor is executive director of the South Centre, a research centre of 51 developing countries, based in Geneva. You can e-mail him at director@southcentre.org. The views expressed are entirely his own.

Related posts: 

• Do You need jabs, antibiotics?

•   Are antibiotics an end to modern medicine?

•  Superbug lurking! Drug resistance now a nightmare!

Do You need jabs, antibiotics?

OUR population is getting more and more educated and knowledgeable. With the convenience of internet and smart phone, information can be assessed anytime and anywhere.

Facebook and Google have become the source of reference for most people. Many can now be “experts” in many specialised fields, including engineering, law and even medicine.

Nowadays, the medical practitioners enounter some patients who are so-called internet savvy, and refuse antibiotics and vaccines.

This issue arose due to the spread of such information in the internet, claiming antibiotics could lead to “superbug” and are associated with many adverse effects, while vaccines could cause autism or death.
Well, the risks of administration of both drugs are certainly debatable.

What we know for a fact is that since Alexander Flemming discovered penicillin and the pox vaccine, many lives were saved.

Nevertheless, I am not in the position to comment on the good and bad of both antibiotics and vaccines. But, it is more important for the general public to understand more about the need for antibiotics and vaccines.

Antibiotics or more specifically antibacterial, is a medicine indicated to kill (bactericidal) or inhibit the growth (bacteriostatic) of the bacteria.

There are various types of antibiotics with different mode of actions and indications. Strictly speaking, the mechanism of action for antibiotics is rather complicated.

However, it works mainly to counter attack the rapid reproduction of bacterial colonies, so that our immune system has enough time to defeat the illness.

Thus, the usage of antibiotics is strictly limited to the bacterial infection. In common clinical conditions, like acute exudative tonsillitis, abscess formation and urinary tract infection, antibiotics are strongly prescribed.

It must be understood that antibiotics have no role in curing diseases caused by fungus, virus or other parasites.

Therefore, it should not be overprescribed in cases like common cough and cold, flu and fungal infection of skin.

As for vaccines, they are biological preparations that help to boost immunity. Its primary focus is on disease prevention. It is always better to prevent a disease than to treat it.

Vaccines work by introducing the weakened form of “disease germ” into the body. The body will respond by producing antibodies to fight these invaders. At this stage, technically, the immune system is being sensitised. If the actual disease germ attacks the body, more antibodies will be produced to destroy the real enemy.

Vaccines are responsible for the control of many infectious diseases that were once common in this country and around the world, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, Hepatitis B and Haemophilus influenzae type b (Hib).

Many patients question the need for further vaccination as diseases such as diphtheria, pertussis are very rare these days.

Furthermore, there are people that do not get vaccination, yet able to live healthily until old age. This is the myth behind “herd immunity”.

Herd immunity serves as a preventive barrier as most of the population had been vaccinated, thus, the disease is contained from spreading. If herd immunity is compromised, the widespread of the disease may occur.

A piece of advice to all, a little knowledge is a dangerous thing. Before you start to tell doctors about the negative effects of antibiotics and vaccines, why not, give them a chance to explain to you before you make a decision.

Contributed by DR H.B. CHEE, Muar, Johor The Star/Asia News Network

Related posts:
1.Love your liver! World Hepatitis Day today
2. Life is not meant to be lived alone

A victory for patients & generic drugmakers vs Novartis in landmark patent case

The Indian Supreme Court’s ruling that only genuinely new inventions should be granted patents means that medicines can still be affordable.

The front office of Novartis in Mumbai, India, Monday, after India's Supreme Court rejected drug maker's attempt to patent a new version of a cancer drug Glivec. 

PATIENTS around the world who look to India for low-cost medicines to treat their ailments heaved a sigh of relief last week when the Indian Supreme Court turned down a claim for a patent for a cancer drug.

This means that drug companies in India can continue to produce generic versions of the same drug, Glivec or Gleevec, at a much lower price, thus making it affordable to thousands more cancer patients.

Glivec, produced by the Swiss-based company Norvartis, can cost a patient up to US$70,000 (RM217,000) for a year of treatment, whereas the generic versions of the same medicine made by Indian companies cost around US$2,500 (RM7,750). The drug is used to treat some forms of leukaemia as well as a rare type of stomach cancer.

The Supreme Court decision also seems to open the road for patents not to be granted for more medicines, since it confirmed that only drugs that are genuinely a new invention can be granted patents.

When a patent is granted to a company for a drug, other companies are not permitted to produce generic versions of the medicine for a period of 20 years or so.

The monopoly given to the patent holder enables it to charge high prices since there is a lack of competition.

Many or even most patients are unable to buy the medicines, giving rise to frustration and despair especially when their lives are at stake.

Some companies whose patents are about to expire apply for a new patent for the same drug after changing the composition slightly or changing the form of the drug.

The “new” drug is often not a new invention, but only a minor modification that is made with the aim of having the patent renewed for another period. This practice is popularly termed “evergreening” of the patent.

An extension of the patent term means that the company continues to enjoy the monopoly and high prices, which continue to be out of reach to many patients.

Although governments are obliged to have laws allowing for patents to be given for inventions under the World Trade Organisation’s TRIPS agreement, each country is allowed to set its own definition and standards for what is an invention.

The Supreme Court decision confirms that the Indian patent authorities exercised their powers lawfully and properly when they rejected the patent application for Gleevec on the ground that the medicine was not a new invention.

Novartis had challenged the interpretation given by the Indian Patent Office to Section 3 (d) of the Indian Patents Act that seeks to prevent the grant of patents for non-inventive new forms of known medicines.

The Novartis application had claimed a patent for a new salt form (imatinib mesylate), a medicine for the treatment of chronic myeloid leukaemia, sold under the brand name Gleevec (or Glivec in other countries).

The Indian patent office had rejected the patent application on the ground that the claimed new form was anticipated in an earlier US patent of 1996 for the compound imatinib and that the new form did not enhance the therapeutic efficacy of the drug. The decision was upheld by the Indian Patents Appellate Board.

The legal challenge from Novartis had caused anxiety among patients groups, governments of developing countries and some international organisations in view of the possible negative implications for access to affordable medicines if the Norvatis petition succeeded.

Most developing countries rely on Indian generic drug companies for the supply of low-priced medicines for many diseases.
A weakening of the interpretation or use of Section 3 (d) would have enabled multinational drug companies to extend their patent monopolies based on “evergreening” or “trivial” incremental improvements which could delay the supply of generic medicines for the treatment of HIV/AIDS, cancer and other diseases.

The decision by the Indian Supreme Court is thus of major significance not only for India but for patients and health authorities in the developing countries.

In interpreting Section 3 (d), the Supreme Court observed that this section was introduced in the 2005 amendment to the Patents Act to ensure that while India allowed product patents on medicines in accordance with its WTO obligations, it did not compromise public health through “evergreening” of pharmaceutical patents.

The court hence took into account the concerns about the impact of the TRIPS agreement on public health and on the development of an indigenous pharmaceutical industry.

Moreover, it considered the implications of the Novartis case for the availability of essential medicines at affordable prices globally.

The court decision reproduced two letters from Dr Jim Yong Kim, the former director of the Department of HIV/AIDS at the World Health Organisation (current president of the World Bank) and from UNAIDS to the Indian health minister expressing their concerns relating to the continuous availability of affordable Indian generic drugs in other developing countries.

Thus, the Supreme Court decision has implications beyond India. It upholds the high standards by which drug patent applications can be processed. While genuinely new inventions are granted patents, drugs that are not really new need not.

The implication is that Indian generic companies can be expected to produce many more medicines in future, and continue their reputation as the “pharmacy of the developing countries”.

It is also heartening that the court decision reaffirms the priority for concerns for the patients’ right to receive treatment at more affordable prices.

The court decision is also likely to spark interest among other developing countries about the Indian patent law and the policies guiding it. Developing countries can learn from the Indian approach of balancing patents and public health.

Global Trends
By MARTIN KHOR
Related posts:
 The US Pacific free trade deal that's anything but free?
ASEAN plans world's largest trading bloc in Asia, the ... 

Superbug lurking! Drug resistance now a nightmare!

Top health officials in the UK and US warn that resistance of bacteria to medicines is a catastrophe and nightmare, and as serious a threat as terrorism and climate change.



MANY a Malaysian has lost a family member because of an infection contracted during an operation while in a hospital.

Several office colleagues and friends have told me that a close relative had died after being infected by a superbug that was so toxic that it could not be eliminated by antibiotics.

This, in essence, is the problem of antibiotic resistance – that a bacterium can evolve and change so that it becomes immune to the medicines given to a sick patient that are meant to kill it.

When a bacterium becomes resistant to one antibiotic, scientists develop a more powerful antibiotic to kill it. But bacteria can then change to also become immune to the new medicine.

When the dangerous pathogens out-run the drugs developed to combat them, humanity is at risk of losing the race between life and death.

Equally problematic is that many of these incurable diseases are contracted when patients stay in hospitals, especially during operations.

In the past two weeks, two top health officials – the Chief Medical Officer of the United Kingdom Dame Sally Davies and the director of the United States Centres for Disease Control and Prevention (CDC) Dr Thomas Frieden – have sounded the alarm bells.

Davies, the top health official in the UK, warned of a looming “catastrophe” of antibiotic resistance being so widespread that we would be back to a 19th century medical situation, a pre-antibiotic era when many diseases were difficult or impossible to treat.

Frieden evoked a “nightmare” scenario, a “very serious” problem caused by the advance of highly drug-resistant bacteria known as CRE.

A major cause of the acceleration of antibiotic resistance is the inappropriate use of the medicines and the inadequate action (or even inaction) of health authorities.

Drug companies often over-promote the use and sales of their medicines; some doctors over-prescribe or wrongly prescribe antibiotics (sometimes for the wrong ailment); and patients who are not informed enough sometimes pressure their doctors for antibiotics for a quick cure and often do not use the medicines properly by not completing the course of medicines.

There’s not enough action to make the public aware of the proper use of antibiotics, and not enough regulations (or their implementation) to ensure drug companies and medical personnel sell or prescribe the medicines properly.

The alarm raised by the two top health officials was aimed at pushing the regulators and also the patients into action.

Davies, during media interviews, even placed antibiotic resistance on par with terrorism and climate change as critical risks facing the nation.

She said: “Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics.

“Routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.

“That’s why governments and organisations across the world, including the World Health Organisation and G8, need to take this seriously.”

Although there has been a great reduction in cases in English hospitals of MRSA (methicillin-resistant Staphylococcus aureus), which is a skin disease, this has been replaced by many times more cases of gram-negative bacteria which are found in the gut.

These bacteria include E. coli and Klebsiella (which causes pneumonia) which are resistant to many drugs.

Besides the new drug-resistant pathogens, resistance is also emerging in old pathogens.

In particular, the report cites tuberculosis, which has re-emerged in Europe in the form of new strains that are resistant to many or even all available drugs.

Another classical disease with increasing drug resistance is gonorrhoea.

Davies’ 152-page report also warned of a “discovery void” with few new antibiotics developed in the past two decades.

“While a new infectious disease has been discovered nearly every year over the past 30 years, there have been very few new antibiotics developed leaving our armoury nearly empty as diseases evolve and become resistant to existing drugs,” said a press release on the report.

Meanwhile, Frieden warned about the rapid spread of CRE or the carbapenem-resistant variety of Enterobacteriaceae, a gro­up of more than 70 bacteria which dwell in the gut, including Klebsiella, Salmonella, Shigella and E. coli.

Carbapenems are powerful drugs that are used as a last resort when the bacteria have become resistant to other drugs.

The occurrence of resistance has risen four-fold in 10 years.

According to Frieden, CRE was found in 4.6% of hospitals and 17.8% of long-term care in 2012.

While resistance is building up, there have been few new antibiotics.

No new classes of antibiotics have been developed since 1987, and none is in the pipeline across the world, said Davies.

“Antimicrobial resistance is a ticking time-bomb not only for the UK but also for the world.
“We need to work with everyone to ensure the apocalyptic scenario of widespread antimicrobial resistance does not become a reality. This threat is arguably as important as climate change.”

 

GLOBAL TRENDS By MARTIN KHOR

Foot-Notes:

Superbug lurking

 No, not this “Superbug.” W’ere talking about something much more sinister!

Patients receiving long-term or complex medical care in hospitals and nursing homes are at the greatest risk for CRE infection.

The bug is spread mainly by unclean hands, but medical devices like ventilators and catheters increase the risk of infection because they allow the bacteria to get deep into a patient’s body, Frieden said. - RYOT

Overprescribing of antibiotics creates superbugs

These bugs are named and defined by their resistance to the Carbapenem class of antibiotics. Unlike previous superbugs, there are no 'last resort' antibiotics after resistance develops and these stop working.

CRE infections can lead to pneumonia, meningitis, wound infections, sepsis and a host of deadly infections.

"CRE are nightmare bacteria," said Dr. Tom Frieden, director of the U.S. Centers for Disease Control.

"Our strongest antibiotics don’t work and patients are left with potentially untreatable infections."

Resistance to antibiotics continues to be an issue worldwide, with overprescribing and overuse of broad-spectrum antibiotics being the main culprits.

In this week’s Lancet magazine, UK's chief medical officer Dame Sally Davis, said that that antibiotic resistance is "as great a threat to our future as terrorism."

That's because routine surgeries, treatments for cancer and autoimmune disease all leave patients vulnerable to superbug infections.

"If we don't take action then we may all be back in an almost 19th century environment where infections kill us as a result of routine operations. We won't be able to do a lot of our cancer treatments or organ transplants," Davis warned.

The problem is that much of the antibiotic resistance occurs in developing countries where antibiotics are readily available, resources scarce and education around resistance non-existent.

“Antibiotic stewardship has to be a global effort in order to make an impact on resistance,” said Romney, the medical microbiologist in Vancouver.

In addition, no new major antibiotics have been made since the late 1980's because antibiotics can have a short lifespan before superbugs become resistant, making them unprofitable for pharmaceutical companies when compared to the other drugs.

But there is hope. Over the last decade, recognition of antibiotic resistance has led to decreased rates of other superbug classes such as Methicillin-resistant staphylococcus aureus (MRSA) in parts of Canada. - CBS