Stemming the Damage from Stroke?

UK based stem cell technology company ReNeuron announced this week that it has treated its first patient in the Phase I PISCES (Pilot Investigation of Stem Cells in Stroke) study.

The trial is designed to recruit a total of 12 men (> 60 years of age). Participants will receive a direct injection of ReN001 cells into the affected brain region between six and 24 months following their stroke. While the study will primarily evaluate the safety of the stem cells, a number of efficacy measures will also be evaluated over two years of follow-up.

The first patient was treated with the stem cells at the Institute of Neurological Sciences, Southern General Hospital, in Glasgow, Scotland; and was safely discharged two days after the straightforward neuro-surgical procedure. Southern General is one of Europe’s most innovative and well-recognized stroke treatment centers and is perhaps best known as the place where the Glasgow Coma Scale was developed.

Assuming a satisfactory independent Data Safety Monitoring Board review of the first patient’s progress in December 2011, the additional patients will be treated shortly thereafter. Subject to satisfactory safety data ReNeuron intends to pursue an accelerated clinical development pathway with ReN001, focusing on particular stroke patient groups who are expected to most benefit from the therapy.

Principal investigator Professor Keith Muir suggested that “if the therapy works it may allow new nerve cells to grow or regeneration of existing cells and actual recovery of function in patients who would not otherwise be able to regain function.”

Stroke is the third largest cause of death and the single largest cause of adult disability in the developed world.  It occurs when blood flow leading to, or in, the brain is blocked (ischemic stroke) or a blood vessel in the brain ruptures (hemorrhagic stroke). This results in damage to the nerve cells in the brain and a loss of bodily functions.

Stroke is the single largest cause of adult disability in the developed world. Over 700,000 people suffer a stroke each year in the US, of which, approximately 80% are ischemic in nature.

In the US, the annual direct and indirect costs of stroke are estimated to be in excess of $50 billion.

The type of stroke treatment a patient should receive depends on the stage of disease:

  • Prevention – treatments to prevent a first or recurrent stroke are based on treating associated risk factors, e.g. high cholesterol, smoking and diabetes
  • Immediately after the stroke – treatments attempt to arrest a stroke whilst it is happening by dissolving the blood clot that has caused the infarct
  • Post stroke rehabilitation – aims to improve both functional and cognitive recovery in the patient weeks or months after the event.

ReN001 stem cell therapy seeks initially to target ischemic stroke patients in the third stage.  These patients constitute approximately one half of stroke survivors.

SRxA’s Word on Health will be following this story and will bring you updates as they happen.

Fewer Dollars for Primary Care

Word on Health has learned that disparities in healthcare don’t just apply to patients.

According to a new national study of physicians’ salaries, Primary Care Physicians (PCP’s) earn as little as half of what some specialty physicians do.  Conducted by the University of California Davis School of Medicine, the research examined salary differences across medical specialties in 2004-2005.

Investigators collected detailed salary information from more than 6,000 practicing physicians in the U.S.  Overall, the average annual income of physicians was $187,857; but that number varied widely from specialty to specialty.  The study’s analysis of broad categories of specialty showed that compared to wages for primary care, wages were 48% higher for surgery, 36% higher for internal medicine, and 45% higher for pediatric care.

The study estimates the average hourly wages paid to PCP’s amounts to $60.48.  The amount is surprising when compared to more lucrative specialties: neurologic surgery ($132/hour), radiation oncology ($126/hour), and plastic surgery (($114/hour).  Among the low-earning specialists were child psychiatrists and infectious disease specialists, both earning close to $67/hour.

The disparities in pay held after accounting for age, race, and region.  However, researchers did find that a gender salary gap remained, with women earning $9 less per hour than male counterparts.

In quantifying wage disparities between primary care and specialty care, this study will be important in the shaping of health care reform.  Reformers will likely lean heavily on this study when considering any changes to the pay structure for primary care and specialty care.

Whatever their salary scale, if you are looking to reach physicians with educational or marketing messages, SRxA is here to help.

Contact us today to see how our team of Clinical Advisors can help you disseminate your message.

Asthma Through the Ages

SRxA’s Word on Health prides itself on bringing you the latest, cutting edge health and medical new stories. Today, however we’re going back in time and looking at an issue close to our heart (and lungs) – asthma.

The earliest recorded reference to wheezing and respiratory distress was recorded in China around 2,600 B.C.  Huang Ti, legendary leader of China wrote: “Man is afflicted he cannot rest and when his breathing has a sound.”  At the time, it was believed that asthma was caused by an imbalance of the yin and yang.

A thousand or so years later, the Babylonian “Code of Hammurabi” (1792-1750 B.C.) recorded symptoms of breathlessness: “If a man’s lungs pant with his work … When the breath of a man’s mouth is difficult.”

Around 300 B.C. Hippocrates first used the word “Asthma” (Greek for “wind” or “to blow”) for panting and respiratory distress. He is believed to be the first physician to understand the relationship between the environment and respiratory ailments, correlating illness with climate and location.

When Alexander the Great invaded India in 321 B.C. , he found locals smoking the herb stramonium, which they claimed relaxed the lungs. Today, a number of similar atropine-based compounds are still  used in asthma treatment.

The Greco-Roman doctor Galen ( 201-130 B.C.), identified asthma symptoms and established that asthma was caused by bronchial obstruction.  His treatment for the condition was owl’s wine.

Around the same time, other Roman physicians described asthma as “gasping” and the “inability to breathe without making noise.”  They also claimed: “If from running, gymnastic exercises or any other work, the breath becomes difficult, it is called asthma.” Today the American Lung Association calls this “silent asthma”.

A little later, another Roman, Gaius Plinius Secundus (23 A.D.) better known as Pliny the Elder noted that pollen was a source of respiratory distress and recommended use of ephedra (better known today as an FDA banned diet drug) and red wine as asthma remedies.   He also suggested that drinking the blood of wild horses and eating 21 millipedes soaked in honey could help!

Approximately  400 years later, the Jewish Talmud describes “drinking three weights of hiltith,” a resin of the carrot family, as a remedy for asthma.   While seven hundred or so years later, the philosopher and physician Maimonides published his “Treatise on Asthma.” In this he recommended comprehensive treatment including rest, good personal hygiene and environment, avoidance of opium, a small quantity of wine and special diet. Nuts, fowl, milk, cool vegetables and legumes were forbidden, while the soup of fat hens was considered beneficial.

Chicken noodle soup anyone?

Bad Breath? – Doctors speak doctor while Patients speak patient

While attending the ACAAI congress in Phoenix, SRxA’s Word on Health learned that despite the increasing availability of effective treatments, overall asthma care in the U.S. is suboptimal.

In a survey of almost 4,000 asthma patients, doctors and members of the general population, 71% of the asthma patients had disease that was either not well or very poorly controlled according to definitions established by current guidelines.

On the other hand, the majority of asthma patients said they thought their disease was well controlled, suggesting that many patients don’t understand the meaning of the term “adequate asthma control”.

The so-called Asthma Insight and Management study was a national survey of three populations, with responses from 2,500 asthma patients age 12 and older, 1,090 adults in the general population, and 309 health care providers.  It was conducted by SRxA Advisors, Michael Blaiss,  Eli Meltzer and colleagues, Drs Kevin Murphy, Robert Nathan and Stuart Stoloff

Among some of the more surprising results, researchers found:

  • 64% of asthma patients thought their disease was well controlled because they had two or more months between exacerbations.
  • 61% thought their asthma was well controlled because they had only been forced to go to the emergency room for asthma once in the previous year.
  • Only 6% agreed their disease was either not well or very poorly controlled.
  • Only 48% of patients reported that they followed the advice of their doctor.

Despite this, the disease burden is high.  63% of the patients said their asthma persisted throughout the year and 41% reported that the illness interfered with their life “some” or “a lot.”  Compared with the general population, Blaiss and colleagues found, asthma patients reported poorer general health, greater limitations on activity, and taking more than twice as many sick and disability days off work.

According to another SRxA Advisor, Dr. John Oppenheimer,  the study confirms what many clinicians have long suspected. He told us, “While there are many possible causes for suboptimal management, one of the problems is doctors speak doctor and patients speak patient.”

Both physicians and the manufacturers of asthma drugs need to make more of an effort to understand why asthma patients don’t use medications as directed  in order to help them improve both their health and quality of life.

What are your thoughts on this?  Word in Health is waiting to hear from you.