Leading funders and researchers this week agreed that all their clinical trials for vaccines and devices would in future be publicly registered and the results published. The pledge — made by nearly a dozen groups including the Wellcome Trust and the UK Medical Research Council — is a boost for innovation and safety.
Some estimates suggest that half of all trial findings, notably those that do not yield positive results, are not made public. This is a significant waste of research, burying information that could help to better direct future work, reduce dangers to patients and boost efficiency. In an era of big data and partnership between medical research and IT, there is considerable potential to improve number crunching and identify patterns in trial data.
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These moves do not go far enough. The pharmaceutical industry is notable for its absence and trials the sector funds should follow the same example. Academics and their journals often publish too slowly and have little interest in analysing and sharing failures in detail. Releasing summaries is also inadequate. To be useful to other researchers, “raw data” — not analysed for use — on individual participants in trials also needs to be made available. The supervision and management involved, as well as guarantees of anonymity, will be costly. But this week’s declaration is at least a step in the right direction.
Babatunde Osotimehin, head of the United Nations Population Fund. The US says it will no longer support the fund after years of substantial financing, which last year alone amounted to $69m.
What is your reaction to the US decision to stop funding UNFPA?
We are disappointed. The State Department claimed we broke the rules of the Kemp-Kasten Amendment, opposing coercive abortion or involuntary sterilisation. UNFPA does neither. It vigorously counters them. The State Department [previously] wrote that there was no evidence UNFPA was engaged in either practice in China. The budget cuts will affect our ability to save women’s lives and health when they face death or disability while giving birth in developing nations. It will also hurt our capacity to support voluntary family planning.
Does the agency offer good value for money?
Yes. During 2014-16, we helped prevent 35m unwanted pregnancies, 11m unsafe abortions and 93,000 maternal deaths. UNFPA’s work offers great value for money. It invests in youth, especially girls. A recent study in The Lancet showed that investing $4.60 per head in a country’s adolescents each year till 2030 could pay that back more than 10 times over.
What are your top priorities?
We are focused on filling the unmet demand for family planning for all women, working to prevent forced and child marriage, female genital mutilation, maternal death and teenage pregnancy.
WHO scorecard World Health Organization statistics show how health service coverage has improved since 2000. Treatment for HIV and bednets to prevent malaria have increased the most, while there have been steady rises in access to antenatal care and improved sanitation. A separate report acknowledges global health improvements but says that inequality between nations is growing. (WHO, Lancet)
Health leadership The World Health Assembly meets in Geneva from Monday to vote on a new director-general. This is why it matters. The Lancet says the ideal winner should mix “proven managerial competence with a clear and deliverable vision for WHO’s next five years”.
The candidates are: Sania Nishtar, whose advocates say improved access to the poor and fought corruption; David Nabarro, described as a passionate and seasoned health reformer; and Tedros Adhanom Ghebreyesus, who overhauled Ethiopia’s health system and raised international funds, but who has been accused of concealing cholera outbreaks. (FT, Lancet, NYT)
Cholera crisis The disease continues to spread in war-torn Yemen. Health workers have been left unpaid while pumps to sanitise water supplies lie idle for lack of fuel. A UNHCR spokesperson said: “Yemen now is an inventory of misery — what more will it take to get the world’s attention?” (Reuters)
Ebola returns Ebola has returned to Congo for the eighth time. The infected region is remote, which is likely to help stop the disease spreading, but is also hampering the delivery of aid. The WHO is preparing an experimental vaccine. (WSJ, Foreign Policy, @EbolaAlert, Stat)
Brazil on alert The country declared an end to its 18-month Zika emergency but an outbreak of yellow fever could pose an even greater global danger. The emergency vaccine stockpile stands at 6m doses, yet there are around 12m people living in and around Rio alone. (Washington Post, NYT)
US and global health The US must continue its pivotal role in health development, not just for altruistic reasons but to secure its own protection against global threats. Priorities should be anti-microbial resistance; improving emergency response co-ordination; and stepping up the fight against Aids, TB, malaria and cancer. Separately, President Donald Trump said he would extend the ban on US aid helping fund abortion services. (National Academies, NYT)
Venezuela health crisis The country’s health minister was fired after new data showed a big jump in infant and maternal death rates and cases of malaria. About 20 per cent of Venezuela’s medical workforce have left the country in recent years. (CNN)
Healthcare in wartime As well as handling casualties, medical staff in conflict-torn parts of the Middle East are also having to deal with collapses in vaccination programmes, increased resistance to antibiotics and fast-spreading infections as populations flee fighting. (Reuters)
Adolescent deaths More than 1.2m adolescents die each year from largely preventable causes and more than two-thirds live in the poorer countries of Africa and Southeast Asia. Road traffic injuries, respiratory infections and suicide are the biggest causes. (WHO)
Hack attack The WannaCry cyber attack that last week hit more than a third of the UK’s 260 hospital trusts focused attention on their high degree of autonomy over their own IT systems and why some trusts had failed to implement a security patch that could have repelled the ransomware. (FT, BMJ)
Data fears DeepMind, the artificial intelligence company owned by Google, was given “legally inappropriate” access to the records of 1.6m British patients. The data were shared to trial a mobile app that triggers alerts when a patient’s vital signs are abnormal. (FT)
Aids as security threat The fight against HIV/Aids was transformed when governments began to view the disease as an international security issue that could wipe out vital workers who hold a country together and leave room for extremist groups to take hold. (Mosaic)
Cancer in Africa Cancer now kills more people than malaria in sub-Saharan Africa, where medicines are too expensive, often unavailable and of dubious quality. An initiative using artificial intelligence to help authorities forecast chemotherapy needs is being tested in Uganda and Ethiopia. (Scientific American)
Drug prices in China China is the world’s second-largest pharmaceutical market — worth $116.7bn in 2016 — but reforms giving provincial governments greater power over prices are hurting western drugmakers. (FT)
TV advertising The role of direct-to-consumer advertising on US TV has been called into question following astonishing sales for a drug said to prevent uncontrolled outbursts of crying or laughing. The US is only one of two countries that allows advertising of prescription drugs: TV ad expenditure has risen 62 per cent since 2012 to $6.4bn. (NYT)
Tracking flu via Twitter The study of tweets alongside official data can predict the spread of seasonal flu and help health services to stockpile drugs and better target campaigns. (Times)
Politics and plagues A mini-documentary about the eradication of polio and why it remains the only infectious disease to be globally extinguished. (NYT, 10m)
Fact-checking Martin Shkreli the musical
Best of the journals
Antimicrobial resistance New strategies are needed in developing countries where drugs can be bought without prescription and from untrained street sellers, a situation made worse by poor surveillance and dissemination of research. Antimicrobials are also used to prevent diseases in animals and as growth promoters. (Antimicrobial Resistance & Infection Control)
Earthquake response Data from seismologists give fast and reliable estimates of death tolls from earthquakes but are rarely used by authorities to co-ordinate rescue efforts. (Nature)
Abortion advice Medical abortions using pills found online can be highly effective and safe, says a study. This has important implications for women in areas where access to clinical procedures is restricted. (BMJ)
Cancer clues DNA sequences from 100-year-old tumour samples in the archives of London’s Great Ormond Street Hospital for Children offer new insights into rare childhood cancers and could lead to the development of new drugs. (Nature)
Vaccination warning Half of US travellers are failing to have vaccinations against measles, mumps and rubella, leading many to contract measles and spread the disease at home. A single case can make a dozen or more unvaccinated people ill. (CBS, Annals of Internal Medicine)
Plant-based contraceptives Certain plant extracts can help to block fertilisation by preventing human sperm from propelling themselves towards a woman’s egg. Although research is at an early stage, scientists are encouraged that the active chemicals work at very low doses and without the side-effects of hormone-based contraceptives. (PNAS, BBC)
3D-printed ovaries Experiments with “bio-prosthetic ovaries” made via 3D printing have been successful in enabling infertile mice to become pregnant and give birth. Researchers say a human implant could be five years away. (Nature)
Doctors and age Patient mortality rates may depend on the age of their doctors. Despite their experience, the medical skills of older physicians are often less up to date than their younger colleagues. The exception is for those who manage a large number of patients, suggesting this may help to maintain clinical skills. (BMJ)
Podcasts of the week
Why is Alzheimer’s — a disease identified as far back as 1901 — still so difficult to cure? And in the Being Patient Podcast, a sufferer explains why it took a year for him to get a diagnosis and what it’s like to live with disease. (The Guardian, 28m; Being Patient, 30m)
In case you missed it
FT Health last issue: Road safety, Chelsea Clinton on aid, fair drug pricing
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The WannaCry hack attack is a stark reminder that governments and companies alike must not skimp on resources for the systems that keep us safe. As health costs spiral, investing in smarter — and more secure — technology is the only way to achieve better health outcomes at lower costs. (FT)