A news item the other day caught my eye: “Obese South African wins reprieve from deportation”. Evidently, the gentleman in the story was threatened with deportation from New Zealand due to his weight, the potential health care costs that might result, and the reluctance of the government to pay for any publicly-funded care that might result from his obesity. This is Mr. Buitenhui (he reportedly now weighs 130 kilograms, down from 160 kilograms a year or so ago). I hope he remains healthy and in whatever country he desires to live within.

picture of Albert Buitenhui

Albert Buitenhui
Photo courtesy of www.dailytelegraph.com

Anyway, after better understanding how obesity became related to someone’s potential deportation, I saw this article: “Bacteria from Lean Mice Prevent Obesity in Peers”. The study, “Gut Microbiota from Twins Discordant for Obesity Modulate Metabolism in Mice” reported in Science, details how overweight mice became thinner after exposure to human gut bacteria from lean humans.  The mental leap I made (pretty easy leap) was that all that might be needed is for my thin neighbor to provide me with some of his skinny bacteria and I’d lose some weight. Although the details of how the right skinny bacteria get from one’s person’s intestinal tract into mine by an acceptable method haven’t been worked out, time and money will resolve the issues.
So this seemingly inexpensive (how much could bacteria cost to make?) and simple answer to obesity led me to wonder how much money might be available to make people thinner. Since money typically follows large populations with health issues, a review of the wealth of information from the American Heart Association’s 2013 Statistical Heart Disease and Stroke Statistics—2013 Update A Report From the American Heart Association provided the answer: “68% of US adults were overweight or obese (73% of men and 64% of women)”

Wow! I mean almost 7 out of 10 Americans are either overweight or obese? When did this all happen? Looking at the data from the AHA’s 2013 report shows a gradual increase from 1962 on:

Prevalence of Obesity in the US 1960-2010

So, there are plenty of overweight and obese people in the US who would benefit from weight reduction.  Further, projected health care costs attributable to cardiovascular disease (one of the undesirable outcomes of obesity) lead the list of top 20 diagnoses for health care spending:
Projected Direct Costs of Cardiovascular Disease

The increase can partially be explained by the extent of the population with risk factors like obesity and being overweight coupled with the aging of the US population. [see “Demographics – Hold on, the ball is already rolling downhill!” for more on US demographics]

The area of microbiota is fascinating to me. If you want to dive a bit deeper into the subject a great place to start would be a special supplement in Nature devoted to microbiota.  Their description: “The human body is colonized by a vast number of microbes, collectively referred to as the human microbiota. The link between these microbes and our health is the focus of a growing number of research initiatives, and new insights are emerging rapidly, some of which we are proud to present in this special collection.”The biopharma world is looking for innovation; I think positively exploiting microbiota is one way to creatively innovate.

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In a September 2013 JAMA Internal Medicine article, Health Care–Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System, the authors provide estimates of the costs associated with what they termed “significant and targetable” healthcare acquired infections (HAIs).

What they determined regarding the infections they studied (catheter-associated urinary tract infections; Clostridium difficile infections; central line–associated bloodstream infections;  surgical site infections; ventilator-associated pneumonias) were 440,000 infections costing an estimated $9.8 billion.

photomicrograph of mrsa

A simplistic calculation: $9.8 billion divided by the estimated 440,000 infected comes out to $22,300 per infected patient.  That value should be high enough to pay for preventative methods I’d think.

A quick look at the methicillin-resistant Staphylococcus aureus data (MRSA kills more than 11,400 Americans a year) shows some 30,055 people infected at a cost of $1.38 billion or $45,900 per infected patient.

Dividing the population at risk for MRSA infection (39.7 million) into the $1.38 billion gives $35.  So, theoretically, a vaccine and/or other preventative service/process costing less than $35 would be cost effective. It could be argued (by some quarters) that a prevention cost greater than $35 would be justified due to reduction of quality of life impact by those who avoided being MRSA infected.

Similar calculations could be performed for the Clostridium difficile infections (C. difficile causes diarrhea and is linked to 14,000 American deaths each year).  The calculations for C. difficile are $43 per patient at risk and $11,285 per infected patient.

Those these calculations are overly simplistic they provide directional insight into the scope of the problem and the costs of the issue and related solutions. There are multiple methods possible to reduce both the number of patients infected and those who die from the infections. Basic steps such as improved hand-washing, wound and catheter care, and room sanitation methods are key. Adherence to established protocols would likely have a significant positive effect and could be achieved with little investment.

A significant improvement could come from the availability of vaccines to prevent infections. Vaccines are in development for MRSA (GSK Phase I, NovaDigm Phase I) and for C. difficile. Click on the hyperlinks for information on Sanofi Pasteur’s vaccine trial (Cdiffense) and Valneva’s Phase I program.

Photos courtesy of CDC – Div. of Healthcare Quality Promotion (DHQP); Control of Clostridium difficile-Associated Disease (CDAD); Janice Carr and CDC – Div. of Healthcare Quality Promotion (DHQP); CDC/ Janice Haney Carr/ Jeff Hageman, M.H.S.

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Great news needs to be shared! It is so nice to see such dramatic and positive benefits from a treatment. The beauty of vaccines lies in their typical cost-effective and dramatic efficacy.

In the June 19, 2013 Journal of Infectious Disease, a study report, “Reduction in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010”, describes the measured decrease in vaccine type HPV prevalence among a nationally representative sample of females 14–19 years old in the vaccine era (2007–2010) compared with the pre-vaccine era (2003–2006). HPV prevalence in cervicovaginal swabs was performed in the National Health and Nutrition Examination Survey (NHANES) in 2002. The article reports the national HPV prevalence among females in the pre-vaccine era (NHANES 2003–2006) and the vaccine era (NHANES 2007–2010) and estimates vaccine effectiveness.

The bottom line: the incidence of HPV infections by the strains included in Merck’s Gardasil and GlaxoSmithKline’s Cervarix fell by 56% among 14- to 19-year olds in the vaccine era. Measured 82% effectiveness with at least one dose. Somewhat surprisingly, measures of the HPV prevalence show decreases of those HPV strains covered and those not covered by the vaccines:
chart of hpv-prevalence data

The authors stated: “The decline in vaccine type prevalence is higher than expected and could be due to herd immunity from vaccination, vaccine effectiveness of a series involving <3 doses, and/or changes in sexual behavior that we did not measure. This decline is encouraging, given the substantial health and economic burden of HPV-associated disease.”.

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