Oxford study shows doctors’ communication style crucial for patient weight loss success
A groundbreaking study from the University of Oxford, recently published in the Annals of Internal Medicine, has revealed that the manner in which doctors communicate with patients about obesity plays a pivotal role in their weight loss success. This innovative research delves into the nuances of communication, showing that not only do the words doctors use matter, but also their tone and delivery have a profound impact over both short and long-term patient outcomes in a medical setting.
Conducted by the Nuffield Department of Primary Care Health Sciences, the study analysed 246 recordings of consultations and discovered that even subtle elements like the choice of words and vocal tone significantly affect patient responses. The findings have emerged amidst obesity treatment guidelines urging doctors to initiate weight loss discussions and suggest weight loss services. However, effective communication on this front occurs for only about 5% of those affected annually, indicating a significant gap between policy and practice.
Many doctors express reluctance to broach sensitive topics like obesity due to fears of offending patients or feeling uncertain about handling such discussions. From the patients’ perspective, negative experiences stemming from certain tones or word choices can inadvertently harm the doctor-patient relationship.
This research, funded by the National Institute for Health and Care Research School for Primary Care Research and Foundation for the Sociology of Health and Illness, utilised conversation analysis techniques on audio recordings from the BWel trial. In this trial, doctors offered patients referrals to a 12-week weight loss programme, and the researchers observed how different communicative approaches – categorised as ‘good news’, ‘bad news’, or neutral – influenced patient engagement and satisfaction.
Statistical analysis revealed that patients were more likely to enrol in, attend, and lose more weight in programmes when the referral was framed as ‘good news’. Specifically, 83% of patients offered programmes in a positive light attended, compared to only 50% for neutrally framed offers. Those who received ‘good news’ also lost about half a stone (3.6kg) more compared to the ‘neutral’ or ‘bad’ news groups.
Dr Charlotte Albury, the study’s lead author, emphasised that framing weight loss conversations positively encourages patients to participate more actively in programmes, yielding better weight loss outcomes. She noted that while both ‘neutral’ and ‘negative’ framings led to similar levels of programme acceptance and weight loss, the ‘good news’ approach stood out for its effectiveness.
The study identified specific characteristics of ‘good’ and ‘bad’ news delivery. In the ‘good news’ approach, doctors focused on the benefits of weight loss in an optimistic manner, confidently shared advantages, and communicated fluently and cheerfully. In contrast, the ‘bad news’ framing centred on health issues related to overweight and emphasised patient effort, often marked by slower delivery and hesitations. The neutral approach maintained a steady tone without leaning towards either benefits or issues.
Dr Albury highlighted the importance of these findings for medical professionals, suggesting that adopting a ‘good news’ approach could significantly enhance patient motivation and success in weight management. By transforming discussions into positive and empowering dialogues, doctors can effectively encourage patients to adopt healthier lifestyles.
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Swiss pharmaceutical giant Roche enters obesity drug race with $2.7 billion Carmot deal
Swiss pharmaceutical giant, Roche, has announced a significant strategic move in the obesity treatment market with its $2.7 billion acquisition of Carmot Therapeutics, a U.S.-based obesity drug developer. This places Roche among leading contenders like Novo Nordisk and Eli Lilly in the weight-loss drug sector. Carmot’s flagship product, CT-388, a once-a-week dual GLP-1/GIP receptor agonist injection similar to Lilly’s Mounjaro, has shown promise in Phase I trials and is poised for Phase II testing. Its market introduction is anticipated in the 2030s.
The move has generated optimism, reflected in a 2.4% rise in Roche shares, as the weight-loss drug market, potentially worth $100 billion, appears to have room for multiple players. Roche’s Teresa Graham, head of the pharmaceuticals division, expressed ambitions beyond merely competing on price, envisioning CT-388 as a leading obesity drug in its class.
This acquisition marks Roche’s re-entry into the GLP-1 field, following a previous exit in 2018 when subsidiary Chugai sold experimental drug rights to Lilly. The Carmot deal, expected to conclude in early 2024, includes additional payments of up to $400 million subject to achievement of certain milestones.
The deal is part of Roche’s broader strategy, under new CEO Thomas Schinecker, to diversify its therapeutic fields and rejuvenate its development pipeline, especially after setbacks in Alzheimer’s and cancer immunotherapy. Besides the Carmot acquisition, Roche recently committed $7.1 billion for rights to a new drug for inflammatory bowel disease.
Carmot, founded in 2008, has a portfolio of various gut-hormone drug candidates, in both pill and injectable forms, designed to treat obesity in patients with and without diabetes. This acquisition underlines Roche’s commitment to expanding its presence in the evolving field of obesity treatment.
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UK’s obesity epidemic costs economy almost £100 billion per year
Britain is grappling with an obesity crisis that is inflicting a staggering economic toll of nearly £100 billion annually, as per a comprehensive report by the Tony Blair Institute. This figure, highlighted in a report published by The Times, indicates that the impact of obesity on national productivity is far more severe than previously estimated, being ninefold higher.
The financial implications are forecasted to escalate by an additional £10 billion over the coming 15 years. This total cost, inclusive of the £63 billion attributed to shorter life spans and compromised health due to obesity, equates to roughly 4% of the nation’s GDP.
Henry Dimbleby, the former government advisor on food, is advocating for stringent measures akin to those applied to tobacco, targeting junk food. He warns that without decisive action, Britain risks becoming a nation burdened by illness and economic decline. Dimbleby is poised to highlight these concerns in a speech at a Royal Society conference, stressing the potential strain on the NHS and consequent economic stagnation.
Amid these warnings, the government has postponed initiatives like the 9pm junk food advertising watershed and restrictions on promotional deals for unhealthy food products until 2025. Health Secretary Victoria Atkins has expressed a desire to offer health guidance in a non-patronising manner.
A Department of Health spokesperson reiterated the government’s commitment to tackling obesity, pointing to initiatives like food-labelling standards, investment in school sports, and healthy food vouchers for underprivileged families.
Hermione Dace from the Tony Blair Institute underscored the critical link between the nation’s health and its economic prosperity, calling for a revamped approach to promote healthier food options and discourage the profitability of ultra-processed and junk food.
The obesity epidemic has intensified, with two-thirds of British adults now classified as having overweight or obesity, a significant rise from half a generation ago. Notably, the average weights of British men and women have increased by 6kg and 5kg, respectively, since 1993.
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Pomegranate proves potent in metabolic health management
A comprehensive study featured in Nutrients journal has cast a spotlight on pomegranate (Punica granatum l., PG) and its polyphenolic compounds, scrutinising their potential to modulate metabolic irregularities. Historically embraced for its therapeutic properties against bacterial infections, diabetes, and various metabolic syndromes, pomegranate’s efficacy is being re-evaluated amidst concerns over the side effects of conventional pharmacological treatments.
The review delves into pomegranate’s pharmacokinetic profiles, safety, and bioavailability, particularly focusing on its capacity to combat metabolic disorders such as type 2 diabetes, obesity, dyslipidemia, and cardiovascular diseases. It outlines how PG’s consumption could attenuate insulin resistance, inflammatory cytokines, redox gene expression, blood pressure elevation, vascular damage, and lipoprotein oxidation.
In animal models, pomegranate seed oil has been found to reduce fat mass and enhance insulin sensitivity, corroborating previous research indicating significant reductions in lipid levels. The study further explains how enzymes and nuclear receptors involved in lipid metabolism are positively influenced by PG’s floral components.
Despite some contradictory findings regarding PG’s impact on food intake and weight gain, the review suggests genetic differences may account for varied physiological reactions to phytochemicals. PG polyphenols are also being explored for their anti-diabetic properties through diverse mechanisms, including modulation of PPAR-γ activity and adiponectin gene expression.
The review also evaluates the pharmacodynamics and safety of PG’s ellagitannin compounds, noting individual differences in urolithin production and absorption, which are influenced by factors such as gut microbiota composition and pH. Although high doses of PG have shown cellular and nuclear alterations in toxicological studies, conventional uses of PG and its compounds appear safe, with adverse effects only predicted at dosages exceeding those traditionally used in ethnomedicine.
In conclusion, the research indicates that PG could play a beneficial role in preventing metabolic disorders. However, the outcomes of clinical and pharmacokinetic studies remain variable, attributed to factors like plant part selection, cultivar differences, environmental conditions, bioavailability, organ accessibility, and individual genetic profiles. Despite these discrepancies, the therapeutic potential of PG in addressing components of metabolic syndrome highlights the need for integrated treatment strategies.
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Japan’s healthcare system to include new obesity treatment in insurance coverage
Japan’s healthcare system is set to introduce a novel obesity treatment covered by public medical insurance starting Wednesday (22nd of November, 2023), marking the first such inclusion in thirty years. Wegovy, produced by the Danish firm Novo Nordisk, will be accessible under the national health insurance following its approval for manufacture and sale in March.
The treatment contains semaglutide, a GLP-1 receptor agonist that not only enhances insulin production and lowers blood sugar but also suppresses appetite by inducing satiety and curbing cravings.
Coverage is specifically tailored for patients who are significantly overweight or have weight-related health complications such as high blood pressure, hyperlipidemia, and Type 2 diabetes, and who have not seen results from lifestyle changes alone. Criteria for eligibility include having a Body Mass Index (BMI) of 35 or above, or a BMI of 27 with associated comorbidities.
Wegovy is administered weekly through self-injection, with a monthly supply consisting of four pens. The cost varies according to the dose, from ¥1,876 (£9.99) for the smallest dose to ¥10,740 (£57.19) for the highest.
The drug joins Ozempic, also a GLP-1 receptor agonist with semaglutide by Novo Nordisk, on the market. While Ozempic targets Type 2 diabetes at lower doses, Wegovy is dosed higher specifically for weight loss.
Despite its medical purposes, there’s growing concern over Wegovy’s use for aesthetic weight loss, leading to potential drug shortages for those in medical need. This has prompted Japanese medical bodies to warn against such misuse, especially with the trend of “medical diets” offered by clinics to individuals without obesity or diabetes.
Research has pointed out the risk of severe gastrointestinal issues with these medications, a concern highlighted in the Journal of the American Medical Association. Yet, Novo Nordisk has cited an August report claiming Wegovy can cut the risk of major adverse cardiovascular events by 20% in adult individuals with overweight or obesity.
Previously, Japan’s insured treatment for obesity was limited to Mazindol, introduced in 1992, designated for severe obesity and capped at three months of use due to addiction risks.
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Novo Nordisk’s $2.3 billion French investment to enhance obesity drug output
Novo Nordisk has declared a substantial $2.3 billion investment aimed at amplifying the output of its highly sought-after obesity and diabetes medications at its Chartres facility in France, in a move to satiate the escalating demand. This financial injection will notably enhance the manufacturing capabilities for existing products such as Ozempic and Wegovy, alongside other burgeoning obesity treatments, according to the Danish pharmaceutical giant.
Europe is currently grappling with a supply crisis of the diabetes medication Ozempic, which shares the active ingredient semaglutide with the widely acclaimed weight management drug Wegovy—yet to be broadly distributed across Europe.
In response to the off-label consumption of Ozempic, Novo Nordisk has imposed restrictions within the European Union. Concurrently, Germany is considering export prohibitions, while Belgium has already enacted a ban on prescribing the weekly injection for non-diabetes purposes.
Despite efforts by the UK government to restrict the use of Ozempic to non-weight loss purposes in July, a Reuters investigation discovered the drug is still being acquired by individuals without diabetes for weight management.
This announcement follows Novo Nordisk’s recent proclamation of a $6 billion expenditure in Denmark to augment production capabilities. Additionally, this venture represents a significant endorsement for French President Emmanuel Macron’s economic strategies amidst a looming global downturn, aiming to sustain the momentum in reducing French unemployment figures.
President Macron had advocated for this investment during his “Choose France” summit, which reportedly persuaded Novo Nordisk’s CEO Lars Fruergaard Jorgensen to commit to the expansion. The investment also echoes Eli Lilly’s recent decision to construct a $2.5 billion manufacturing plant in Germany, similarly motivated by heightened demand for diabetes and obesity treatments.
Analysts predict the obesity drug market could reach a staggering $100 billion by 2030. Novo Nordisk’s French investment will notably expand its capacity for intricate manufacturing processes, specifically the intricate filling of injection pens with semaglutide, and the subsequent assembly and packaging of these pens.
Though details were scant earlier this month regarding the augmentation of in-house production for Ozempic and Wegovy’s European variant, Novo Nordisk has confirmed that the Chartres expansion has commenced, with completion slated between 2026 and 2028, promising the creation of 500 new job opportunities, adding to the near 2,000-strong workforce currently employed at the factory.
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AstraZeneca launches Evinova, aiming to revolutionise clinical trials with digital solutions
AstraZeneca has initiated a foray into the burgeoning field of health technology with the introduction of its new subsidiary, Evinova. Officially unveiled this past Monday (20th of November, 2023), Evinova is poised to redefine how clinical trials are conducted for biotechnology entities, pharmaceutical corporations, and Contract Research Organisations (CROs). By integrating digital health solutions, Evinova aims to significantly curtail the duration and financial outlay required in the medicine development process.
With Evinova’s debut, AstraZeneca has announced several key partnerships. CROs Parexel and Fortrea are set to incorporate Evinova’s digital services into their operations. Furthermore, Evinova is working in conjunction with Accenture and Amazon Web Services to bolster the adoption of its digital products globally and enhance the scalability of its digital offerings.
Evinova will concentrate on three primary service domains within the health-tech sector. First, it will provide unified trial solutions that streamline the collection of clinical trial data, incorporating innovative digitally-enabled endpoints. This data acquisition will be supported by connected medical devices and sensors both onsite at clinical trial locations and remotely in patients’ residences. These solutions aim to bolster telehealth practices, enable remote patient monitoring, and facilitate direct-to-patient medicine dispatches.
Secondly, Evinova is channelling state-of-the-art technologies such as artificial intelligence and machine learning to architect optimally structured clinical trials. This involves assessing and quantifying a multitude of trial characteristics, from environmental impact to patient experience implications.
Lastly, the portfolio management services offered by Evinova seek to provide clients with a comprehensive overview of their drug development portfolio across various stages. This is achieved through predictive algorithms that forecast crucial milestones and allow study leaders to identify and rectify deviations from planned trajectories.
Cristina Duran, Evinova’s newly appointed president, expressed confidence that this strategic move will significantly advance the digital health sector. The objective is to meet the digital solution needs of healthcare professionals and regulators across the pharmaceutical landscape, ultimately enhancing patient care.
This development aligns with AstraZeneca’s recognition of the digital health market’s potential, which is anticipated to grow at a compound annual growth rate of 13.6% from 2022 to 2032, reaching a valuation in excess of $900 billion by the end of the forecast period. Evinova stands as a testament to AstraZeneca’s adaptive innovation strategy, aiming to navigate and lead in the digital transformation era of healthcare.
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OECD highlights digital health as key to enhancing healthcare system performance
The latest Organisation for Economic Co-operation and Development (OECD) report throws light on the financial strains faced by health systems in member countries, driven by the allocation competition for public funds. The report, ‘OECD Health at a Glance 2023‘, unveils that healthcare expenditure in OECD nations represented 9.2% of GDP in 2022, a slight reduction from 9.7% in the previous year. This figure, though higher than pre-pandemic levels, saw a decline in 11 countries compared to 2019.
On average, health spending per person in OECD countries approached USD 5,000 in 2022, with the United States, Switzerland, and Germany leading the expenditure chart. In contrast, Mexico, Colombia, and Costa Rica marked the lower end of the spectrum. OECD Secretary-General Mathias Cormann highlighted the urgent need for health systems to provide more timely and cost-effective healthcare, especially in light of ageing populations and the residual impacts of the COVID-19 pandemic on mental and physical well-being.
Cormann emphasised that digitising healthcare systems and embracing digital health technologies is crucial to enhance system efficiency and effectiveness, underscoring the economic and social necessity of accessible high-quality healthcare.
The ‘Health at a Glance 2023’ report focuses particularly on the role of digital health in revolutionising health systems, a process catalysed by the COVID-19 pandemic. Despite progress, there remains significant work to be done in digital health governance, as outlined by a policy checklist in the report.
Current health indicators reflect a society still grappling with the pandemic’s aftermath, with a general decline in life expectancy and ongoing mental and physical health challenges. The health and social care workforce is expanding, yet staffing shortages and deteriorating work conditions are raising concerns. Salary erosion due to inflation is another challenge, with several OECD countries witnessing stagnant or falling real wages in the healthcare sector over the past decade.
Cardiovascular diseases remain a leading cause of mortality, and nearly one-third of deaths could have been prevented with better healthcare interventions. Despite the widespread adoption of universal health coverage, financial barriers continue to make healthcare inaccessible for low-income groups, with the poorest often foregoing necessary care.
The pandemic has exacerbated waiting times for elective surgeries like hip and knee replacements, and while there has been some improvement, wait times are still generally above pre-pandemic levels. However, there have been gains in the quality of care, particularly in terms of safety and effectiveness, and a move towards more patient-centred healthcare is evident with safer prescribing practices in primary care.
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CCH expands educational horizons in Indonesia with key partnership
JAKARTA, Indonesia – In a significant move to expand educational opportunities in Indonesia, the College of Contemporary Health’s (CCH) Dzidek Sabat has successfully forged a new path of collaboration with one of Indonesia’s most prestigious educational institutions. During his recent visit, Dzidek met with officials from the Makara UI Academy, a division of the esteemed University of Indonesia (UI), the UI Faculty of Nursing, and representatives from the Indonesian Nurses Association Educational Institution. These meetings highlighted a shared vision for educational advancement and underscored the importance of global partnerships in enriching learning experiences.
The visit reached a remarkable milestone with the signing of a Memorandum of Understanding (MOU) between CCH and the University of Indonesia. This gala event marked the beginning of a significant collaboration, wherein CCH will provide its cutting-edge online training courses to Indonesian learners. This agreement opens up new avenues for students and professionals in Indonesia to access CCH’s renowned online educational resources, thus bridging geographical barriers and fostering a more interconnected world of knowledge and skills.
Further deepening this educational exchange, Dzidek engaged in an enriching all-day workshop with the staff of Makara UI Academy. This session focused on the exchange of online course development expertise and best practices, setting the stage for a robust and dynamic educational partnership. Such interactions not only enrich the educational fabric of both organisations but also pave the way for innovative learning solutions tailored to the evolving needs of students globally.
This partnership is a testament to CCH’s commitment to extending its educational reach and impact, while also enriching the learning landscape in Indonesia. It’s a step towards a future where education knows no bounds, and learning is a shared, global journey.
About the College of Contemporary Health (CCH):
CCH is a leader in online education, providing top-tier learning resources across various disciplines. With a focus on making high-quality education accessible, CCH continues to break new ground in online learning, fostering academic excellence and innovation worldwide.
Contact:
Nicholas Feenie
Business Development Manager
College of Contemporary Health Ltd.
nicholas.feenie@contemporaryhealth.co.uk
+44 (0)20 3773 4895
www.contemporaryhealth.co.uk
Eli Lilly announces multibillion-euro German plant to scale up obesity drug production
Eli Lilly and Company, the American pharmaceutical giant, has announced plans to establish its first production facility in Germany, situated in the western town of Alzey, with an investment of 2.3 billion euros ($2.5 billion). This move, initially reported by Reuters, comes in response to the rapidly escalating demand for innovative diabetes and obesity treatments. The strategic investment will expand the production capabilities for key diabetes and obesity medications, including Mounjaro and Trulicity, as well as the injection devices required for their administration.
On Friday, Eli Lilly highlighted the significant role Germany’s skilled workforce will play in enhancing the company’s supply of incretin-based treatments, with the site expected to become operational in 2027. Incretins, a class of peptide-based medications like Mounjaro, are designed to mimic intestinal hormones that curb appetite and promote insulin release.
The expansion of Eli Lilly’s manufacturing footprint into Germany aligns with broader industry trends, where pharmaceutical companies are facing mounting political pressure to localise the production of critical healthcare products. The COVID-19 pandemic brought to light the fragility of global supply chains, prompting a reevaluation of manufacturing strategies to better serve market demands.
The German Health Minister, Karl Lauterbach, expressed his support for the investment at a press briefing in Berlin. He underscored the importance of this development for Germany’s stature as a pharmaceutical hub, emphasising the potential for more rapid access to novel treatments and reduced reliance on precarious supply chains.
The selection of Alzey as the site for this new production complex was influenced by several factors, including the availability of a skilled workforce, the existing infrastructure, and the prospect of creating a manufacturing nexus in conjunction with Eli Lilly’s existing site in Fegersheim, France. Edgardo Hernandez, the head of manufacturing at Eli Lilly, pointed out Germany’s rich heritage in engineering and science, as well as the proximity to numerous equipment manufacturers, as pivotal in the site selection process.
Mounjaro is on the cusp of gaining approval for weight loss treatment in the European Union, following the EU drugs regulator’s recommendation for its approval. However, Germany’s public health insurance currently does not cover weight-loss medications, meaning that patients seeking Mounjaro for non-diabetic weight loss will likely have to bear the costs independently. Minister Lauterbach indicated that there are no immediate plans to reassess these regulations.
Over the past three years, Eli Lilly has made public commitments exceeding $11 billion towards global manufacturing. In their third-quarter financial disclosure, the company earmarked over $8 billion for expansion projects in Indiana, North Carolina, and Limerick, Ireland, over the coming years. Despite this, Eli Lilly anticipates continued supply constraints while it ramps up manufacturing capacity. Concurrently, the firm has appealed to medical professionals outside the United States to halt new patient prescriptions of Trulicity due to heightened demand.
This investment announcement occurs amidst vigorous debate over the European Union’s proposal to reduce the standard period for market exclusivity, prompting Eli Lilly to invest strategically in the region and partake in shaping industry dialogue.
Eli Lilly, with a longstanding presence in Germany since 1960 and a current workforce of 1,000 employees in various domains, anticipates the new Alzey facility will create up to 1,000 high-calibre jobs for engineers, technicians, and scientists, further reinforcing the company’s commitment to innovation and healthcare advancement.
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NHS introduces AI solutions to tackle winter healthcare demands and minimise hospital admissions
As winter approaches, the NHS is set to deploy artificial intelligence (AI) technology to identify patients at risk of hospitalisation, enabling community healthcare teams to provide preemptive care and alleviate the strain on Accident and Emergency (A&E) services. This initiative is part of a broader introduction of technological and data-driven solutions to enhance the NHS’s response to the seasonal increase in healthcare demands.
In Somerset, four GP practices have initiated a pilot programme using an AI system designed to identify registered patients with complex medical needs who are at heightened risk of hospital admission or those who seldom contact their GP. The system facilitates proactive outreach for health discussions. Subsequently, individuals identified as high-risk will be contacted by health coaches, nurses, or GPs. These healthcare professionals are equipped to offer an array of preventive services, which include the provision of food parcels for vulnerable patients, intensification of care to specialist doctors, implementation of preventative measures to reduce the risk of falls, or connection to local volunteer organisations to combat isolation.
Innovative use of AI in Buckinghamshire involves it being linked to electronic sensors on household appliances such as kettles and refrigerators. These sensors monitor changes in patients’ eating and drinking patterns, triggering alerts to a non-clinical Onward Care team. The team can address up to 95% of issues raised by interacting with patients directly, escalating clinical matters when necessary. Patients have the option to avail themselves of these community-based, practical support measures that not only offer monitoring but also assistance with household chores, shopping, and the provision of food parcels, which has been instrumental in preventing hospital readmissions among frail patients.
Some regions in Birmingham are trialling a different approach, employing an algorithm that forecasts the top 5% of individuals at risk of potential A&E visits or hospital admissions. The team conducts wellness checks to offer social care assessments, medication reviews, or other community support initiatives to circumvent A&E admissions. Over the upcoming two years, this programme aims to prevent approximately 4,500 non-essential A&E visits, reduce overnight hospital stays by 17,000, and liberate around 23,000 GP appointments for other patients.
These innovative measures are being implemented in the context of an NHS already under significant pressure, with recent data indicating that A&E departments experienced their busiest October on record, while ambulance services reported the highest monthly demand witnessed this year. The NHS has been diligently preparing for winter, guided by the urgent and emergency care recovery plan published earlier in the year. The plan includes strategies to augment capacity and fortify resilience across the NHS, such as the establishment of care ‘traffic control’ centres to expedite patient discharges, the provision of additional ambulance hours, and the increase of available beds.
The NHS has also been expanding its globally acclaimed virtual ward programme, achieving its target of establishing 10,000 virtual ward beds by the end of September. These virtual wards allow patients to receive hospital-grade care in the familiar surroundings of their own homes, surrounded by family, friends, and carers.
Amanda Pritchard, NHS Chief Executive, commended the suite of technological and data solutions being introduced: “These advances demonstrate the innovative spirit of NHS staff across the nation, who are leveraging the latest technology and AI to provide patient care and significantly reduce unnecessary A&E visits. Not only are these strategies more beneficial for patients, who can receive care in the comfort of their homes, but they also support the NHS, especially as we anticipate an incredibly challenging winter season.”
Chris Holt, Chief Transformation Officer at Birmingham Community Healthcare NHS FT, emphasised the crucial role of data and AI in healthcare delivery: “Intelligently using data and harnessing AI is now essential in aiding our most vulnerable patients. Identifying those at greatest risk of hospitalisation during the winter allows us to intervene earlier with tailored support.”
In preparation for the winter season, the NHS recently launched its annual 111 campaign to encourage the use of NHS 111 services for urgent, non-life-threatening medical advice. The campaign, which will run until the end of March across various media platforms, informs the public about accessing advice from a range of NHS professionals, including clinicians, nurses, and GPs, all from the convenience of their homes. However, in emergencies that are life-threatening, the campaign reiterates the importance of calling 999.
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Personalised healthcare revolution: The rise of digital twins in medicine
The trajectory of medicine is being redefined by pioneering research into computational models, advancing towards a future where medical treatments are tailored not to the average patient, but to each individual. Envision possessing a ‘digital twin’—a virtual counterpart that can undergo trials and treatments, sparing you the need for direct medication or surgical intervention. Scientists project that within the next decade, we could witness the routine use of ‘in silico’ trials, utilising virtual organs to evaluate drug safety and effectiveness, while bespoke organ models might be employed to customise patient care and avert medical complications.
Digital twins represent sophisticated computer-generated replicas of physical entities or processes, continuously refined with data from their actual counterparts. In the medical realm, this entails the fusion of extensive biological data—including genetic, proteomic, cellular, and systemic information—with individual patient data to craft detailed virtual models of their organs, and potentially, in time, their entire body.
Professor Peter Coveney, Director of the Centre for Computational Science at University College London and co-author of ‘Virtual You’, suggests that much of current medical practice lacks a scientific underpinning. He compares it to navigating by looking in the rear-view mirror—basing treatment for the patient at hand on historical cases. “A digital twin utilises your own data within a model that encapsulates your unique physiology and pathology. It’s a move away from decisions based on potentially unrepresentative population data to truly personalised medicine,” explains Prof. Coveney.
Cardiology is at the forefront of this cutting-edge model. Companies are already harnessing patient-specific heart models to aid in the design of medical devices. Meanwhile, the Barcelona-based enterprise ELEM BioTech is at the forefront, granting companies the capability to test drugs and devices on simulated human hearts. “We’ve conducted numerous virtual human trials on several compounds and are on the cusp of launching a new phase, with our cloud-ready product accessible to pharmaceutical clients,” shares Chris Morton, co-founder and CEO of ELEM.
At the recent Digital Twins conference hosted by the Royal Society of Medicine in London, Dr. Caroline Roney from Queen Mary University of London detailed the development of tailored heart models which could significantly aid surgeons in planning interventions for atrial fibrillation patients. “Surgeons typically resort to average-based approaches, but crafting patient-specific predictions that forecast long-term outcomes remains a formidable challenge,” Dr. Roney stated. She foresees widespread application of this technology in cardiovascular treatments, including decisions on valve selection and placement during replacements.
The field of oncology is also poised to benefit from digital twins. Teams from GSK and King’s College London are joining forces to construct virtual duplicates of patient tumours, amalgamating imaging, genetic, and molecular data with 3D cultures of cancer cells, and observing their drug responses. Leveraging machine learning, researchers can foresee how individual patients may react to various treatments, drug combinations, and dosages. “Conducting repetitive trials on a real patient with multiple treatments isn’t viable. Our aim is to devise a strategy while the patient is still with us, preparing us for any recurrence of cancer,” said Professor Tony Ng from King’s College.
The advent of digital twins extends even to the realm of pregnancy, offering the potential to develop treatments for conditions such as placental insufficiency or pre-eclampsia, and deepening our grasp of pregnancy and labour physiology. Professor Michelle Oyen, Director of the Center for Women’s Health Engineering at Washington University in St Louis, is crafting placenta models from ultrasound scans and post-birth high-resolution imagery to predict complications during pregnancy. “We’re striving to identify measures in a live person that could forewarn us of placental issues, aiming to preempt adverse outcomes like stillbirth,” Prof. Oyen elucidates.
In collaboration, Professor Kristin Myers from Columbia University is modelling the cervix, uterus, and foetal membranes, with the overarching goal to merge these into a comprehensive individual model to predict pregnancy outcomes. “We hope to analyse a simple ultrasound scan to understand how the uterus will adapt and when labour might occur,” Prof. Myers aspires, potentially guiding decisions on interventions like caesarean sections.
Moreover, the concept of digital twins is being expanded to model entire hospitals to enhance patient flow and healthcare system efficiency. Dr. Jacob Koris, a trauma and orthopaedic surgeon and digital lead at Getting It Right First Time, describes how tracking digital footprints left by patient interactions—from X-rays to outpatient appointments—can provide a granular, real-time view of patient treatment pathways. “Such insights could pinpoint areas for improvement and exemplary practices that could revolutionise patient care,” Dr. Koris believes.
This ambitious step forward in computational medicine promises a leap from the traditional, one-size-fits-all model to a future where every treatment is as unique as the patient it serves.
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Survey highlights doctors’ concerns with AI influencing medical diagnoses and treatments
A sizable portion of medical practitioners harbour reservations about the burgeoning role of artificial intelligence (AI) in shaping diagnostic and treatment protocols, as indicated by a recent survey’s findings.
The study, unveiled by Medscape on Monday (13th of November, 2023), suggests that a majority, approximately 65 per cent, of the surveyed physicians harbour either significant or moderate concerns regarding AI’s burgeoning role in informing diagnostic and therapeutic decisions. Conversely, a smaller group, constituting 36 per cent, expressed minimal or no concern over the incorporation of AI in these critical areas of healthcare.
The survey also shed light on the varying degrees of receptivity towards AI among healthcare professionals. While 42 per cent of respondents expressed enthusiasm about the prospects of AI integration in their daily work, a notable 30 per cent remained ambivalent, and an apprehensive 28 per cent displayed reservations regarding its future implications.
Echoing the sentiments of caution, former Food and Drug Administration Commissioner Scott Gottlieb, in a July opinion piece, prognosticated that AI’s integration into medical practice could supplant certain functions traditionally performed by physicians, and that such a shift might occur sooner than anticipated.
“Whilst the question of ‘if’ AI will replace some of the doctors’ responsibilities is becoming obsolete, the more pressing issue is ‘when’. For certain tasks, this technologically driven future is closer than we might envisage,” Gottlieb asserted.
The responses to the Medscape survey, however, revealed a more welcoming stance towards AI as a collaborative tool in diagnosis and treatment, with a significant 56 per cent of physicians indicating keen or moderate enthusiasm for AI as a complementary aid. The remaining 44 per cent reported feeling some degree of apprehension towards AI assistance.
Interestingly, the survey highlighted a generational divide in perceptions of AI, with younger doctors, particularly those under 35, displaying less enthusiasm compared to their middle-aged counterparts aged between 45 and 54 years.
This comprehensive survey, which ran from July 12 to August 11, garnered responses from 1,043 participants spanning over 29 medical specialties. The results carry a sampling error margin of 3.03 percent, ensuring 95 per cent confidence in the data gathered.
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Obesity triggers neurodegeneration by inducing brain insulin resistance
In a pivotal study conducted by Mroj Alassaf and colleagues at the Fred Hutchinson Cancer Research Center in the United States, a novel connection between obesity and the onset of neurodegenerative diseases, such as Alzheimer’s, has been uncovered.
The research, employing the biological model of the common fruit fly, indicates that diets high in sugar, which are commonly associated with obesity, lead to insulin resistance within the brain. This resistance hampers the brain’s capacity to eliminate cellular waste, which in turn elevates the risk of neurodegenerative conditions.
The findings, released on November 7 in the open-access publication PLOS Biology, promise to be influential in the development of medical interventions aimed at mitigating the chances of neurodegenerative disease onset.
While the correlation between obesity and neurodegenerative diseases like Alzheimer’s and Parkinson’s has been acknowledged in scientific circles, the causal mechanisms at play have eluded researchers until now.
The team’s research delved into this conundrum by leveraging the genetic and physiological parallels between fruit flies and humans. Building on prior knowledge that a diet rich in sugar instigates insulin resistance in the peripheral tissues of fruit flies, the focus now shifted to their neural tissues. The study zoomed in on glial cells, as abnormalities in microglia are recognised contributors to neuronal decay.
The study measured the protein PI3k—a biomarker for insulin sensitivity in cells. The high-sugar diet was found to diminish PI3k levels in glial cells, suggesting a state of insulin resistance. The team also examined the fruit fly’s version of microglia, known as ensheathing glia, responsible for clearing out neuronal waste, including deteriorating axons.
These glial cells exhibited depleted levels of Draper, a protein integral to their waste-removal function, indicating a compromised ability. Subsequent experiments demonstrated that artificially reducing PI3k levels not only caused insulin resistance but also led to decreased Draper levels in the ensheathing glia. Moreover, when the team inflicted damage on olfactory neurons, the ensheathing glia of sugar-fed flies failed to clear the resulting neuronal debris due to their unresponsive Draper levels.
The researchers conclude by stating that their work with fruit flies has established that high-sugar diets induce insulin resistance in glial cells, which disrupts their neuronal cleanup role. This study sheds light on the potential pathways through which diets leading to obesity may elevate the risk of neurodegenerative diseases.
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The limited impact of Ozempic on the U.S. obesity epidemic
The term ‘obesity’ elicits a range of interpretations. Some view it as merely another way to describe excess weight, while others perceive it as a derogatory label for larger body sizes. Still, some consider it a reflection of personal failings, such as a lack of discipline or willpower. However, for over a decade, the medical field has acknowledged obesity as a chronic health condition, akin to diseases like cancer, diabetes, and hypertension. This disease significantly elevates the risk of severe COVID-19 outcomes, is connected to numerous health complications, and is responsible for approximately 4 million preventable deaths annually. Moreover, obesity manifests in various forms, with diverse origins, clinical signs, and treatment responses.
The surge in popularity of GLP-1 medications such as Ozempic, Wegovy, and Mounjaro has somewhat simplified this complex issue. These drugs are often hailed as the ultimate solution to obesity, a perspective that overlooks the multifaceted nature of the condition. Unfortunately, Ozempic alone cannot address America’s obesity crisis. Obesity extends beyond mere physical inactivity or excessive eating. It’s influenced by a range of factors including genetic predispositions, mental health, socio-economic conditions, and environmental factors.
In clinical settings, the variation in obesity cases is significant. For instance, a mutation in the MC4R gene is associated with an 18% increased likelihood of obesity, while certain antipsychotic medications can lead to substantial weight gain. Although GLP-1 medications can be beneficial, they primarily address hormonal imbalances and do not tackle other contributing factors. This reductionist approach is also evident in the use of Body Mass Index (BMI) to diagnose obesity. BMI, initially designed for white European males, often inaccurately represents obesity levels in different ethnic groups, leading the American Medical Association to advise against its sole use. Currently, a global commission of experts is redefining obesity, moving away from height and weight measurements to focus on specific symptoms and signs.
The response to treatment among patients with obesity also varies greatly. For example, the GLP-1 drug Wegovy showed an average body weight reduction of 16% in a study, yet individual results ranged widely. This underscores the need for personalised treatment plans rather than a singular drug-based approach. However, the U.S. healthcare system faces significant challenges in this regard. With only a small number of physicians specialised in obesity treatment and federal restrictions on covering obesity medications, only a fraction of those who could benefit from such treatments receive them. Instead, many are advised to simply eat less and exercise more, a strategy that overlooks the complexity of obesity.
Effective obesity treatment involves a multidisciplinary approach, combining diet, exercise, behavioural therapy, medication, and sometimes surgery. Unfortunately, the scarcity of specialised physicians and the prevalence of misleading diet products and scams exacerbate the issue. The U.S. weight loss market, valued at $160 billion in 2023, is a testament to this. Moreover, misconceptions about GLP-1 medications, such as the idea that they are a cure-all for obesity, lead to unrealistic expectations and criticisms. Like insulin or hypertension treatments, discontinuing GLP-1 drugs can result in a reversal of their effects, a fact that should be recognised rather than criticised.
Addressing obesity, which costs the U.S. around $1.7 trillion annually, requires acknowledging the progress made with GLP-1 drugs while also understanding their limitations. A holistic, patient-centred, and empathetic approach to obesity treatment is essential. This approach should not only address the unique needs and circumstances of each individual but also aim to improve overall health and well-being. While medications like Ozempic, Wegovy, and Mounjaro offer significant potential, they are not the all-encompassing solution often portrayed in the media. A broader, more nuanced understanding and response to obesity is crucial for effective management and treatment.
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AstraZeneca makes big push into obesity treatment with new pill partnership
AstraZeneca, the United Kingdom’s pharmaceutical giant, has entered a strategic partnership with Eccogene, a Shanghai-based biotech firm, to co-develop a groundbreaking pill designed to combat obesity and type 2 diabetes.
This alliance marks AstraZeneca’s significant foray into the burgeoning sector of weight management medications, underpinned by an exclusive licensing contract focusing on an investigational drug, ECC5004. The said compound is touted to address not only obesity but also a spectrum of cardiometabolic disorders, including heart disease and stroke, ailments afflicting over a billion people worldwide.
Eccogene is poised to receive payments that could sum up to a substantial $2 billion, which is approximately £1.6 billion, as per the agreed terms.
ECC5004 is currently undergoing phase 1 trials, with AstraZeneca setting its sights on advancing to phase 2 clinical evaluations by the subsequent year’s end. Additionally, the pharma titan is nurturing two other nascent-stage injectable obesity therapies.
The innovative ECC5004, if it passes clinical muster, is envisioned to be administered orally once daily, a standalone treatment or potentially in conjunction with other drugs targeting various cardiometabolic diseases. This positions it distinctively against the prevailing injectables that are typically administered weekly.
Operating as a GLP-1 agonist, ECC5004 is designed to replicate the function of the GLP-1 hormone, which is naturally secreted post-food intake.
Pascal Soriot, AstraZeneca’s CEO, highlighted the critical demand for effective obesity interventions across Western nations, Latin America, and South Asia, where abdominal obesity is rampant, precipitating heightened risks of hypertension and diabetes.
Soriot indicated that while the journey to market might span several years, ECC5004 could potentially be more economically accessible than existing options. Due to its simplified chemical structure that permits cheaper production costs, the drug could cater to a wider demographic, including those in lower-income nations where AstraZeneca maintains a robust footprint.
As the competition intensifies in the international market for obesity drugs, demand has surged for Novo Nordisk’s Wegovy and Ozempic, prompting supply challenges. With Wegovy’s pricing set at £73.25 per pack monthly on the NHS and reaching £199 at retail pharmacies, its sales and profits have climbed sharply, elevating Novo Nordisk to be Europe’s highest-valued company by market capitalisation.
Notably, Eli Lilly’s Mounjaro has demonstrated superior weight loss outcomes compared to Wegovy and recently secured approvals for weight management in the UK and US. Market analysts from UBS have predicted that Mounjaro could emerge as one of the most successful pharmaceuticals ever, with projected peak sales around £20 billion.
Pharmaceutical titans Novo Nordisk, Eli Lilly, and Pfizer are all in the race to create oral anti-obesity medications, which promise cost-effectiveness and ease of administration over injections.
Bolstered by its oncology drugs and the diabetes treatment Forxiga, AstraZeneca has reported a 5% revenue increase, totaling $33.8 billion in the year’s first three quarters. The firm also lifted its revenue and profit forecasts for the full year, announcing approvals for additional cancer treatments.
AstraZeneca’s COVID-19 vaccine, crafted in collaboration with Oxford University, was pivotal during the pandemic, credited with saving over 6 million lives globally within its inaugural year as per independent assessments.
However, AstraZeneca currently faces two high court cases in London related to the vaccine’s side effects. The company is expected to contest these allegations.
The World Health Organization last year affirmed the vaccine’s safety and efficacy for individuals 18 years and older, labelling TTS occurrences as exceptionally rare and characteristically presenting severe blood clots.
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