Measles outbreak, gene therapy and the invisible epidemic: have we gotten healthier in 10 years

ON THE Eve of 2020, WE ARE SUMMING UP THE RESULTS OF A DECADE – and in the “Health” heading we understand how medicine, people’s health and the health care system in Russia and the world have changed over this decade. The news is contradictory: we learn about a complete cure of HIV infection or a successful face transplant, then about epidemics of measles or tuberculosis . Scientific breakthroughs do not immediately (and not always) lead to changes in real medical practice, effective drugs are unavailable in the country, and sometimes they face punishment for their import. Let’s see what discoveries are already beneficial and what should be seriously feared.                              

With the onset of HIV in the 1980s, when the infection quickly passed into the stage of AIDS, and killing, a lot has changed – and for the past ten years, the life expectancy of people with the virus has become the same as that of people without. Key factors are early diagnosis and timely treatment of the infection itself, as well as a healthy lifestyle in general and treatment of concomitant diseases. In addition , it turned out that when the level of HIV in the blood is undetectable, the virus is not transmitted – and this is important, for example, for the abolition of prosecutions of those who did not report their HIV-positive status to a partner, and for the self-esteem of people living with HIV.                          

It is important that treatment regimens are constantly being improved – in the past, people more often stopped taking drugs because of poor tolerance or because the daily regimen could contain up to twenty tablets. The current combination antiretroviral therapy (ART) regimen is one tablet a day. No more difficult than taking vitamins or birth control. The availability of drugs is also growing – at least their manufacturers are trying to enter into contracts with governments or large funds to medication could get those who are not on the pocket. In addition , the WHO reported that circumcision reduces the risk of contracting HIV through heterosexual intercourse by 60% – another plus of the procedure , which, as was already known, reduces the spread of the papilloma virus.                    

Among thirty-forty-year-old Russians, 3-4% are infected with HIV. The problem is based on low awareness, due to which people believe that only drug users and men who have sex with men are at risk 

In Russia, as usual, your way – in the country, a real epidemic of HIV infection. The virus has at least in each one hundredth person in 13 regions of the country, and in 35 regions – in every two hundred. According to Academician Vadim Pokrovsky, 3-4 % of 30-40 -year-old Russians are infected with HIV. The problem is based on low awareness, due to which people believe that only drug users and men who have sex with men are at risk ; stigmatization leads to the fact that people sometimes do not seek medical help . Add the conservative position of the state, in which officials do not say the word “condom” out loud, lack of sex education in schools, high cost of condoms, lack of awareness of PrEP drug prevention, insufficient budget for treating all people with HIV – it is understandable why the problem remains acute.                 

The treatment of viral infections is one of the most actively developed areas in pharmacology. So, infection with the hepatitis C virus is cured by modern drugs in more than 95% of cases, and the course of treatment can be relatively short – from 12 to 24 weeks. True, problems with the availability of diagnostics and treatment, as well as with awareness, remain. The hepatitis C virus is transmitted through blood, and the risk factors are the same as for HIV: injecting drugs, sex with a person with HCV, violations of the rules of asepsis and antiseptics in medical facilities. The disease is highly stigmatized – Meduza says that people often wear wigs or dark glasses to conferences in order not to be recognized. In 2017 , Novaya Gazeta released a whole project called Together S, which tells what tricks people go to to get therapy – from importing unregistered drugs to changing citizenship.                                     

As for not viral, but bacterial infections , they seem to be playing catch-up with the pharmaceutical industry . Drugs are being developed that can defeat extensively drug-resistant tuberculosis – but while they become available in the United States and Europe, Russia remains on the list of countries with a tuberculosis epidemic. There are new antibiotics – but and the resistance of microbes to the drugs is growing. In 2018 , the WHO identified antibiotic resistance as one of the biggest threats to public health and food safety, and the germs that are often resistant to treatment included tuberculosis, gonorrhea, salmonellosis and pneumonia.                            

Another real threat on the list of the World Health Organization is the anti-vaccination movement , the next wave of which is gaining momentum. In particular, it was the refusal of vaccinations that caused the outbreak of measles in Samoa, which killed 80 people. And yet , thanks to vaccination, it is possible to cope with serious diseases: for example, the incidence of polio has decreased by 99% in forty years, and in 2018 only 33 new cases were reported . If everything goes according to plan, polio will eventually be eradicated – but as long as even one child on the planet is infected , the risk remains, and therefore vaccination should be mandatory (and free).                          

The anti-vaccination movement is gaining momentum. In particular, it was the refusal
of vaccinations that caused the outbreak of measles
in Samoa, which killed 80 people.

Vaccine affordability works predictable miracles: Australia was one of the first countries to introduce an HPV vaccination program for girls and then boys . This happened back in 2007 year – and on current projections, it is in Australia will disappear cervical cancer caused by the virus. Presumably, by 2022 , it will occur with a frequency of less than 6 per 100 thousand people, that is , it will go into the category of very rare diseases, and by 2035 it will reach the extinction threshold. In the world, the incidence of cervical cancer averages 13.1 per 100 thousand women, and in some regions it is very high – up to 75 per 100 thousand in a number of African countries.                                     

In oncology, things are not bad – more and more often, for example, immunotherapy is used , forcing the body to defeat tumors on its own. People who have been diagnosed with cancer undergo molecular tests to determine which gene mutations are present in the tumor tissue; sometimes even a blood sample is sufficient to carry out such an analysis – this is called a liquid biopsy. In Depending on the results can be more or less accurate assessment of prognosis and understanding will be there to act those or other drugs – and then if there is an effective drug, then you can not waste time and money on the selection of treatment. There are drugs that are shown in the presence of certain mutations in the tumor – and the tumor itself can be localized anywhere. As a result, medical organizations began to note that cancer mortality is decreasing at a rate of about 1% per year. With 2012 on 2016 year, the decline was even more pronounced – by 1.8% a year among men and to 1.4% among women.                                 

But mortality from other preventable diseases is only growing: diabetes mellitus in 2016 became the seventh leading cause of death in the world. It is now owned by about half a billion people on the planet, and the rate at which it is spreading is fastest in low- and middle-income countries . For many people in poor countries, in fact, for the first time in history, there is an opportunity to eat their fill – and they are not up to understanding the dangers of fast food and sugary soda. And while a revolutionary guide issued in Canada recommends “cooking more,” “eating with loved ones,” and “reading labels,” millions of people in Africa and Asia are just beginning to scramble out of real hunger. True, treatment standards are also changing – the medical community has recognized that diabetes mellitus should be treated in combination with the diseases that usually accompany it (or actively prevent them ); these are primarily heart and kidney problems.                                          

In general, preventable diseases, from which most people die and, apparently, will continue to die, are called an invisible epidemic . And, unlike infections, more effort is needed to prevent them : vaccinations against cardiovascular problems, diabetes mellitus or obesity do not exist. As usual, action is taken primarily in wealthy countries – more and more places where smoking is banned , where things like trans fats in food are regulated , and urbanists are working on ways to get citizens to move more. The statistics remain disappointing there : in the United States , only every third adult fulfills recommendations on physical activity, and only every twentieth person is active for half an hour a day.                   

While a revolutionary guide issued in Canada recommends “cooking more,” “eating with loved ones,” and “reading labels,” millions of people in Africa and Asia are just beginning to climb out of real hunger.

In the last ten years, the world has started talking about mental disorders, recognizing the problems associated with the taboo of this topic. Thanks to flash mobs like #faceofdepression, many have sought and received medical care for the first time . Still less the problem persists, and every forty seconds someone in the world brings with scores of life – on the data of WHO, suicide prevention programs have only 38 countries of the world.                

The important developments of the decade include gene therapy – editing genes in such a way that cells function normally. For example, the CAR-T method, in which the genome of T-lymphocytes is edited, has already been registered and is used for the treatment of leukemia, including in Russia. In clinical trials, the development of similar drugs for cystic fibrosis is underway , and the first gene therapy drug for congenital blindness has already been registered in the US and the EU. Another actively explored area is the microbiota of the gut, skin, genitals and other parts of the body. It appears that the composition of the microbiome is associated at least with obesity and some mental health problems.                

In Russia, over the past ten years, there has also been a reform of the healthcare system. On the one hand, even its first stage has not yet been completed , on the other hand , they have been talking about its failure for several years. There are fewer hospitals, it is more difficult to get into them, doctors are leaving the profession, fearing accusations of mistakes, for which one can literally go to jail. Prices for drugs are growing, manufacturers are building obstacles to their registration or re-registration in the country – and it is becoming more and more difficult to import a drug for yourself or your child from abroad. And still there are positive trends, but chief among them – is the promotion of evidence-based medicine in the first place the efforts of the doctors, bloggers and media. Clinics appear that work exclusively on the principles of evidence-based medicine, and their doctors do not spare their own free time to educate the public. And, of course, we can say at least for the beginning of telemedicine – there are boats in the telegram, ready to enlighten the readers in matters of contraception and if your clinic is working with system Ondoc , then a doctor can be contacted online via the secure channel.                                                

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