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WHO updates list of essential medicines to include heart ‘polypills,’ MS treatments but not weight-loss drugs

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The World Health Organization updated its guidelines for essential medicines Wednesday to include drugs to treat multiple sclerosis, heart conditions, cancer and more. But obesity medications were not added to the list, despite requests this year from researchers in the United States.

During its meeting in April, WHO’s review committee considered over 100 therapeutics before recommending 24 medicines for adults and 12 for children to be added to the Model Lists of Essential Medicines (EML) and Essential Medicines for Children (EMLc).

The additions bring the total number of medications on the EML and EMLc to 502 and 361, respectively.

Updated every two years, the lists are registers of medications that WHO considers to be minimum requirements for every health care system to have available. The lists are internationally recognized guides for countries’ health systems, helping them prioritize medications that are effective and affordable. Each addition, according to WHO, is considered “essential to address key public health needs.”

WHO advisers to consider whether obesity medication should be added to Essential Medicines List

 

“Essential medicines are those that satisfy the priority health care needs of a population,” the report says. “They are intended to be available in functioning health systems at all times, in appropriate dosage forms, of assured quality and at prices individuals and health systems can afford.”

New on the 2023 list are medications to treat multiple sclerosis, or MS, a chronic, often fatal nervous system disease that affects 2.8 million people around the world, according to WHO. The new guidelines include three medications to slow its progression.

One of them, rituximab, is normally used to treat some cancers and autoimmune diseases, but the WHO guidelines recommend off-label use for MS due to “strong evidence of its efficacy and safety.”

“Given the evidence base and the increased affordability of rituximab … it has been prioritized over on-label alternatives as an essential medicine to treat relapsing-remitting and progressive MS,” said Dr. Benedikt Huttner, the EML team lead, in a statement.

The guidelines also recommend, for the first time, “polypills” to treat heart disease and other cardiovascular issues. The term refers to a combination of medicines to treat heart issues: medication to lower blood pressure, a statin to lower cholesterol, a medication to make the heart beat with less force and sometimes aspirin.

A growing body of research shows that polypills can be an inexpensive, effective way to reduce the risk of heart problems, with studies indicating that they can cut the risk of cardiovascular problems by almost 40%. But even though heart complications like heart disease and heart attacks kill 18 million people each year, only a few companies manufacture polypills, and few people take them.

Combination ‘polypills’ can help solve world’s heart problems, experts say, if more people can get them

 

The inclusion of polypills on the WHO guidelines could change that. Some health officials believe that their place on the Essential Medicines List would encourage governments and insurance companies to recommend them, particularly in low- and middle-income countries.

“These treatments could have a very large public health impact globally, without jeopardizing the health budgets of low- and middle-income countries,” said Dr. Tedros Adhanom Ghebreyesus, WHO’s director-general, in a news briefing Wednesday.

WHO rejected the inclusion of several patented cancer medications due to concerns over their high price, but the guidelines did add two cancer treatments: a medication for Kaposi sarcoma, a cancer that causes lesions in the skin and gastrointestinal tract, and cancer treatments that improve white blood cell production and reduce some cancer medicines’ toxic effects on the bone marrow.

Other additions include ceftolozane and tazobactam, a combination antibiotic used to treat multidrug-resistant bacteria, and monoclonal antibodies against Ebola.

Notably absent from the Essential Medicines List are compounds called GLP-1 receptor agonists, commonly used in some diabetes and obesity medications like Ozempic and Wegovy.

A request to add GLP-1 receptor agonists to the list came in March from four researchers at Yale University, Brigham and Women’s Hospital, and the University of California, San Francisco. However, the WHO committee rejected the application, citing the compounds’ “uncertain long-term clinical benefit and safety in this patient population.”

Amid celebrity promotion and their rising popularity for weight loss, some medications containing GLP-1 receptor agonists have been in shortage in the United States.

Shortages have also affected several essential medications on WHO’s list, including the hormone insulin for diabetes control and the antibiotic bicillin, a long-acting injectable form of penicillin.

“Rising prices and supply chain disruptions mean that all countries now face increasing problems in ensuring consistent and equitable access to many quality-assured essential medicines,” Ghebreyesus said. “WHO is committed to supporting all countries to overcome these obstacles to increase equitable access to essential medicines.”

 

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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