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HEALTH<br />

THURSDAy,<br />

JULy <strong>11</strong>, <strong>2019</strong><br />

5<br />

Magnetic resonance of a medulloblastoma in a child's brain.<br />

Rodrigo de Oliveira Andrade<br />

Brazilian researchers have developed a<br />

low-cost method of classifying the most<br />

common malignant brain tumour in<br />

children, which they say can help<br />

medics diagnose and treat the<br />

condition. Medulloblastoma, a tumour<br />

of the central nervous system, affects<br />

one in every 200,000 children and<br />

adolescents worldwide and represents<br />

20 per cent of all childhood brain<br />

tumours.<br />

The World Health Organisation<br />

(WHO) divides the disease into four<br />

molecular subgroups according to<br />

their clinical and molecular<br />

characteristics. Categorising patients<br />

into one of these groups helps<br />

oncologists choose an appropriate<br />

treatment, with some groups<br />

requiring more aggressive therapy<br />

than others. However, low- and<br />

middle-income countries cannot<br />

afford to routinely use modern<br />

sequencing platforms to carry out<br />

this molecular classification.<br />

Gustavo Alencastro Cruzeiro, a<br />

geneticist at the University of São<br />

Paulo's Ribeirão Preto Medical School<br />

and lead developer of the method, said<br />

it was "faster and cheaper" than similar<br />

techniques used in developed<br />

countries. He said it costs US$26 per<br />

sample analysis compared with an<br />

average of US$60 for tests used in<br />

richer countries. "It should make this<br />

new method widely available in lowand<br />

middle-income countries, helping<br />

oncologists make rapid clinical<br />

decisions," he added.<br />

To develop the new method,<br />

researchers analysed 92 samples of<br />

frozen medulloblastoma' tissue<br />

gathered from children and young<br />

adults up to 24 years old undergoing<br />

treatment in three hospitals in the state<br />

of Sao Paulo.<br />

They extracted ribonucleic acid<br />

(RNA) sequences from each sample<br />

and converted them into stable<br />

complementary DNA (cDNA), which<br />

was processed using a technique called<br />

real-time polymerase chain reaction<br />

(PCR), which amplifies the signal of<br />

genes activated by the multiplication of<br />

cDNA molecules.<br />

This allowed researchers to identify a<br />

Photo: Reytan<br />

New method to classify brain<br />

tumour in children<br />

set of 20 genes associated with all four<br />

of the medulloblastoma molecular<br />

subgroups: SHH, WNT, Group 3 and<br />

Group 4. By using algorithm<br />

assessment and bioinformatic analysis<br />

techniques, the team identified the<br />

minimal number of genes needed to<br />

molecularly classify medulloblastoma,<br />

without losing accuracy.<br />

"We found that a set of six<br />

differentially expressed genes would be<br />

sufficient to distinguish SHH and WNT<br />

from the other two subgroups", said<br />

Cruzeiro. Roger Chammas, an<br />

oncologist at University of São Paulo<br />

School of Medicine, who was not part of<br />

the team, said the method was<br />

"undoubtedly a step forward," as it<br />

allowed for more cost-effective<br />

diagnosis.<br />

But he cautioned that it would take<br />

time for the new method to become<br />

available in hospitals. "We are now<br />

trying to obtain financial support for<br />

opening a start-up focused on<br />

childhood and central nervous system<br />

tumours," he said. "This will allow the<br />

achievement of molecular classification<br />

at the national level."<br />

How human's deepest<br />

fears being exploited<br />

Medicine dispensing innovation<br />

wins engineering prize<br />

Sally Nyakanyanga<br />

The innovator of a smart locker<br />

system designed to dispense<br />

medicines to patients in less than 36<br />

seconds has won the <strong>2019</strong> Africa<br />

Prize for Engineering Innovation.<br />

Public health institutions are<br />

resource-constrained and healthcare<br />

workers are overwhelmed, resulting<br />

in them being unable to attend to<br />

patients faster.<br />

South Africa alone has close to five<br />

million patients on anti-retroviral<br />

treatment and collecting their refills<br />

monthly, according to the WHO.<br />

Patients collecting chronic medicines<br />

wait for close to four hours at public<br />

health centres, says Neo Hutiri, a 31-<br />

year-old South African engineer who<br />

invented the innovation called Pelebox.<br />

"Pelebox takes pressure off medical<br />

teams and gives patients on chronic<br />

medicines valuable time back, ensuring<br />

the collection process is tracked and<br />

auditable," explains Hutiri. "This is the<br />

highest stamp of approval that our<br />

innovation could have hoped for. As an<br />

engineer, building a socially-minded<br />

solution was important to me and this<br />

award is a nudge that we are in the right<br />

direction." Hutiri received the first<br />

prize of £25,000 (about US$31,000)<br />

from the Royal Academy of<br />

Engineering, the founder of the<br />

competition.<br />

"Pelebox will improve healthcare for<br />

everyone using and working in a<br />

severely strained public healthcare<br />

system," adds John Lazar, one of the<br />

competition's judges, in a statement<br />

released this month (4 June) by the<br />

Royal Academy of Engineering.<br />

According to Hutiri, his team started<br />

working on the project in 2015 but the<br />

first unit became operational in 2017<br />

and was pilot-tested in 2018.<br />

"Each Pelebox unit has 72-99 doors<br />

and can serve 1,200 patients per<br />

month," Hutiri says. The innovation,<br />

according to Hutiri, shows that science<br />

in Africa can now drive a digitally<br />

connected Africa particularly to inspire<br />

young people by elevating the<br />

standards of applied science and how<br />

they can shape innovations.<br />

Patient Dhliwayo-Chiunzi, a<br />

biotechnologist at the Harare Institute<br />

of Technology in Zimbabwe, tells that<br />

Medicine displayed in a pharmacy.<br />

the Pelebox is a needed innovation,<br />

which has incorporated aspects of<br />

patient privacy to a large extent.<br />

"You realise the Pelebox operates like<br />

those food dispenser machines, hence<br />

it is quite user-friendly," Dhliwayo-<br />

Chiunzi explains. She advises patients<br />

using the Pelebox to access their<br />

medications at designated times to<br />

ensure that they take their medicines as<br />

expected. Hutiri tells that six Pelebox<br />

units have been installed at public<br />

hospitals in South Africa, with 42 units<br />

expected to be available by the end of<br />

the year partly through a contract with<br />

the South African government.<br />

Photo: Anouk Delafortrie<br />

How much does the<br />

world trust vaccines?<br />

Health Desk<br />

Public trust in vaccination is on shaky<br />

ground. Earlier this year, the WHO<br />

named 'vaccine hesitancy' one of its top<br />

ten threats to global health, defining<br />

hesitancy as "the delay in acceptance or<br />

refusal of vaccines despite the<br />

availability of vaccination services".<br />

Health experts fear that when people<br />

question whether vaccines are safe or<br />

effective, they may decide not to<br />

vaccinate themselves or their children -<br />

and that puts everyone at higher risk.<br />

There is some evidence on how people<br />

feel about vaccines, but until now<br />

health experts had few details about<br />

these views in different parts of the<br />

world. Do most parents believe<br />

vaccination is safe, effective, and<br />

important for their children? And how<br />

do their views relate to how much they<br />

trust scientists and health<br />

professionals?<br />

This interactive visualisation<br />

explores these questions through the<br />

Wellcome Global Monitor - the first<br />

study of public attitudes to science and<br />

health on a global scale. Questions over<br />

how public views on vaccination are<br />

changing are more pressing than ever.<br />

If enough people decide against<br />

getting a vaccine, outbreaks become<br />

more common and diseases more<br />

difficult to control. If people lose<br />

confidence in vaccination, they are<br />

more likely to opt against it. It's a<br />

decision that can affect not only their<br />

own health but that of others around<br />

them.<br />

This is because each person that gets<br />

immunised adds to a collective or 'herd'<br />

immunity that can stop a disease from<br />

spreading - but only if a large enough<br />

number of people get the vaccine. How<br />

large is 'large enough'? It depends on<br />

the disease. For measles, 90-95 per<br />

cent of the population needs to be<br />

vaccinated for this collective immunity<br />

to work. For polio, which is less<br />

contagious, it takes 80-85 per cent.<br />

This loss of vaccine confidence is<br />

reflected in a global resurgence of<br />

measles, with a 30 per cent rise in cases<br />

from 2016 to 2017. Outbreaks have also<br />

become more common, as seen in<br />

Brazil, India and the United States. The<br />

loss of confidence has been fuelled by<br />

anti-vaccination theories that began<br />

with a false claim of a link with autism.<br />

Globally, about eight out of 10 people<br />

have confidence in the safety of<br />

vaccines. Though encouraging, this also<br />

means one in five people question<br />

vaccine safety.<br />

And it's the pockets of scepticism<br />

that matter, according to Heidi Larson,<br />

director of the Vaccine Confidence<br />

Project who was involved in the study.<br />

Confidence is lowest in Eastern and<br />

Western Europe, where just over half<br />

the population agrees that vaccines are<br />

safe (50 and 59 per cent). It gets a little<br />

stronger in Northern<br />

But confidence in safety is at its<br />

highest in low-income regions. South<br />

Asia tops the chart at 95 per cent,<br />

followed by 92 per cent in East Africa.<br />

Across the African continent and Latin<br />

America, about 84 per cent of people<br />

surveyed agree that vaccines are safe.<br />

The figure is slightly lower across Asia<br />

(80 per cent) and in the Middle East<br />

(79 per cent).<br />

Published June <strong>2019</strong>, the study was<br />

based on nationally representative<br />

surveys of people aged 15 years or older<br />

in over 140 countries. More than<br />

140,000 people were asked questions<br />

about their views on vaccination, their<br />

trust in health professionals and in<br />

science, as well as how science benefits<br />

society. Before the questionnaire was<br />

rolled out it was tested across 10<br />

countries, in local languages. One<br />

reason was to make sure that everyone<br />

could understand the technical terms.<br />

To get a measure of scepticism about<br />

vaccination, researchers based their<br />

questions on an index developed by the<br />

Vaccine Confidence Project. According<br />

to Larson, the index was designed to get<br />

a better picture of the spectrum of<br />

views. The idea was to capture not just<br />

strong opinions for or against<br />

vaccination, but also the views of<br />

people in between who still question<br />

and look for answers.<br />

There is nothing in a vitamin drip that can't be got from a well-balanced diet.<br />

Photo : Alpgiray Kelem<br />

Rebecca Schiller<br />

Of couples trying for a baby, 84% will<br />

conceive naturally within the first year,<br />

others after a little more time, but the<br />

one in seven who continue to have<br />

problems are increasingly at the mercy<br />

of unproven "treatments" that promise<br />

to boost fertility for a hefty price tag.<br />

This week, intravenous wellness<br />

company Get A Drip was forced to<br />

withdraw a £250 "fertility boost" after<br />

the British Pregnancy Advisory Service<br />

highlighted the product's lack of proven<br />

benefits. It accused the company of<br />

"causing real damage to women's<br />

emotional wellbeing".<br />

The UK fertility industry is estimated<br />

to be worth more than £320m, and is<br />

growing all the time. An expensive<br />

vitamin drip (that contains ingredients<br />

that are all available - and more easily<br />

absorbed - in a balanced diet) is just the<br />

tip of the commercial fertility iceberg.<br />

The age at which men and women<br />

have their first child keeps rising, and<br />

the older they are, the less fertile. As the<br />

demand for fertility assistance grows,<br />

the chances of accessing NHS<br />

treatments diminish due to long<br />

waiting lists, the rationing of treatment<br />

and ever-narrowing eligibility criteria.<br />

The intense pressure to boost<br />

chances of conceiving naturally or<br />

make the most of a single shot at NHS<br />

treatment provides many opportunities<br />

for companies to exploit. In addition to<br />

a range of diet supplements and<br />

alternative therapies, private fertility<br />

clinics have been accused of profiting<br />

from unproven "add-on" treatments<br />

that can increase by thousands of<br />

pounds an already hefty bill for assisted<br />

conception.<br />

The Human Fertilisation and<br />

Embryology Authority (HFEA) found<br />

that 74% of private patients had bought<br />

add-on treatments. Its chair, Sally<br />

Cheshire, says: "The 'fertility drip' is<br />

just one more item on the list of myths<br />

that claim to increase or support<br />

fertility, targeting individuals who are<br />

often already going through emotional<br />

turmoil in their quest to conceive."<br />

The HFEA is working with the British<br />

Fertility Society to provide guidance to<br />

fertility clinics on how unproven<br />

treatments should be ethically<br />

introduced and it already offers a<br />

traffic-light system that rates add-on<br />

therapies by efficacy. Yet many of these<br />

commercial enterprises fall outside any<br />

hope of regulation.<br />

Some alternative treatments (such as<br />

acupuncture) have proven benefits for<br />

some - and can boost wellbeing and a<br />

sense of control at a stressful time.<br />

Sadly, desperation - especially in such<br />

an emotive area - will always be met<br />

with exploitation as well as support. For<br />

many couples, cheap lifestyle and diet<br />

changes, time, medical support where<br />

necessary and a more equal offer of<br />

NHS treatments will be far more<br />

effective than expensive treatments -<br />

whether they are dispensed in a<br />

shopping centre or by a white-coated<br />

professional in a clinic.<br />

More than 80 per cent of children were vaccinated in Bangladesh by 2014.<br />

Photo: Collected

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