Covid spreads too easily to think it can be confined to the young.
Scott Gottlieb
Covid is likely to persist once its pandemic phase has passed and circulate each winter alongside the flu. Even after more of us contract coronavirus infection and develop immunity to it or even after an effective vaccine arrives, some people will still get very sick.
Confronting a dangerous pandemic requires containing spread wherever it is reasonably possible. Sensible measures such as universal masking, testing and widespread and rapid contact tracing can help. The best way to protect the vulnerable is to try to protect everyone.
Limiting Covid's impact requires us to think differently about confronting respiratory pathogens in the winter.
Americans broadly consent to funding clinical research because they believe in the promise of medical research. But people support scientific work only if they trust that it serves societal interests, respects patient dignity and operates with guardrails.
One of the noxious features of Obamacare was its forced march into a single, federally designed package of health benefits.
America tolerates a heavy toll from the flu on health and productivity. But if Covid becomes a twin risk, the heath-care system will struggle to fight both at once.
President Obama famously promised that the Affordable Care Act would not only slow the growth in health care costs, but would also reverse these trends, making the average health insurance plan cheaper. That isn't happening.
When I was a medical student, a pulmonary professor of mine cajoled me into joining a clinical trial that she was running. The general aim of the tests was to determine whether prolonged periods of short and shallow breathing would cause a person's lungs to go into spasm. It turns out, as I can attest, that they do.
The convergence of information technology and biology allows scientists to translate the human genome into digital data that can accelerate diagnoses and cures.
The first nation to develop a vaccine for Covid-19 could have an economic advantage as well as a tremendous public-health achievement. Doses will be limited initially as suppliers ramp up, and a country will focus on inoculating most of its own population first.
Covid-19 has altered world history.
When some states introduced mandatory smallpox vaccinations during the epidemic of 1898-1903, Americans resisted by the thousands. The ensuing battles produced medical conventions and case law that altered the balance between government authority and medical practice, in favor of federal control.
It's important to protect the old and the vulnerable, who are at the highest risk of severe illness and bad outcomes. But like most issues of medicine, it isn't a binary choice. Given the uncertainties of how this virus spreads and its high risk of infirmities, it would be unwise to abandon efforts to limit Covid spread wherever possible.
Smallpox can be personally devastating. After a 14-day incubation period, patients experience high fevers, headaches, and sometimes severe abdominal pain. A rash resembling chicken pox appears in the mouth and throat, face, and forearms, and spreads to the trunk and legs. As patients recover, scabs break and pitted scars appear.
There are two main types of immunity to an infection. Innate immunity comes from circulating cells that attack any invader the body views as foreign. Adaptive immunity is specific to the pathogen presented. Through adaptive response, immune cells are programmed to secrete antibodies that are primed to target a viral invader.
One thing about Covid-19 is clear: We don't fully understand its severity and transmission. At various turns, we've both underestimated and overestimated the virus.
There's instinctual discomfort about using evidence of past immunity as a factor for decisions about health, work or even questions like whether it's safe to visit someone in a nursing home. But there are ways to deploy immunity information to help us understand our own health status and keep us safer from Covid, without surrendering privacy.
The pace at which fundamental discoveries of basic science are being uncovered is accelerating, as is the speed at which medical practice is being transformed by these inventions.
The ability of working class Americans to bargain for health coverage at work gave them access to the same basic packages of benefits as executive management teams.
More government control of doctors and their reimbursement schemes will only create more problems.
Creative destruction is an increasingly prominent feature of modern medical practice.
Among the most common reasons why people come to an emergency room are bouts of heart failure or pneumonia. Sometimes they have a touch of both.
Under Obamacare, doctors have been strained by costly new regulations, intricate payment 'reforms' that tie their Medicare reimbursement to complex federal reporting requirements, and mandates that they install and make 'meaningful' use of electronic health records.
As Apple advances the medical promise of its watch and smartphones, it has also made clear that its foremost aim is to steer clear of Food and Drug Administration regulation.
It's now evident that public health is part of national security.
Why do physicians prescribe powerful antibiotics? Generally not because our patients ask for them. Most people who come in with a sore throat would be just as happy leaving my office with a prescription for Chloraseptic as clarithromycin.
Many inherited disorders can perpetuate poverty by leading to disabilities that disrupt people's ability to work. In turn, someone's capacity to secure an effective new cure for these diseases can mean the difference between a life led productively, or one plagued by infirmity.
Health-assessment software such as CareEvolution's 'Safer Covid' tool can combine multiple health factors to evaluate a person's total risk of contracting Covid or suffering a bad outcome.
Gene therapies and other treatments that can cure - not just treat - disease are going to be expensive. All of the cost of innovating and reaping an economic return may need to be recouped in a single payment.
The key to the generic-drug economic model is to keep entry prices low enough to attract multiple competitors.
What makes the EpiPen unique is its delivery vehicle - an auto-injector that's packaged in a convenient, pen-like device. The product's key attribute is its ability to reliably deliver accurate doses of the essential medicine.
From West Nile to swine flu to Ebola to the global outbreak of dengue fever, the capacity to deal with threats like Zika must be designed into our preparedness posture.
Biologics must be grown in living systems - fermented, for example, in large vats of bacteria cells. This makes them hard to replicate. For decades, biologics weren't subject to competition from copycat generic medicines, even once patents and exclusivities had lapsed on originals.
The nature of food processing had changed substantially in America. Much of it owed to corresponding changes in food packaging and the logistics for faster shipping. The scope of outbreak from foodborne illness no longer has a clear geographic boundary.
Antibiotic resistance is as old as the dirt that coats our planet.
The spread of HIV through contaminated blood was a tragic illustration of the risk that blood products could harbor undetectable and latent infection that's only revealed once it's widely distributed.
Gene editing will be used to alter DNA to erase the origins of a range of debilitating inherited disorders.
ObamaCare has accelerated many of the detrimental trends doctors see in their profession, and introduced new ones.
When gene therapy was believed to harbor latent risks, research was largely put on hold until the risks were better understood. Sometimes, the theoretical risks have led to a principle of absolutist precaution that impedes progress.
Zika is an addressable threat. While it falls outside of the regular routine of public health preparedness, we shouldn't be scrambling for new resources each time a threat like Zika starts to emerge.
Before Obamacare, insurance networks typically covered an entire state. Under Obamacare, insurers are able to bid to offer coverage mostly on a county-by-county basis. It means that health plans only need to fashion doctor networks as wide as the county that they're bidding to offer coverage in.
EpiPen is not unique. It falls into a category of old drugs, many of which should have long been subject to generic competition.
Once an effective drug is approved to treat a deadly condition, introducing a second drug to treat the same disease can be hard. It's tough to recruit patients with a debilitating disease for a clinical trial when a proven medicine is already available.
Science offers the chance to cure debilitating and once-intractable disorders like hemophilia and sickle cell disease. But we need to make sure the ability to access these therapies, or the risk that someone can be locked out of them, doesn't widen gaps between the rich and poor.
In the U.S, Zika outbreaks are hopefully going to be easy to isolate. The biggest threat is likely to be from the fear Zika sows, especially among expectant moms.
Politicians wage broad wars on medicine to claim thin strips of ideological terrain. This would be good political theater if there weren't so many human victims.
One of the biggest factors fueling the angst over drug prices in the U.S. is that some older medicines that should be sold cheaply as generics are still priced very high, often owing to a dwindling number of generic competitors and the rising cost of producing these drugs.
If drug development becomes the domain of government researchers, it's a sure bet that political lobbying will eventually trump scientific promise and commercial viability when it comes to investment decisions.
When people age, the main valve carrying blood out of the heart becomes brittle. As this aortic valve narrows, it can cause debilitating heart failure, and even death.
