As gene-editing becomes a more feasible part of healthcare across the planet, a new technique is being trialled for the first time in China.
This can be seen as indicative of the increasingly prominent role which China is playing on the world stage, as the world’s most populous nation becomes a major player in world affairs.
The groundbreaking gene-editing technique will be tested on humans for the first time, with Chinese oncologists trialling the innovation on lung cancer patients.
It is hoped that the new technique will enable a larger proportion of lung cancer sufferers to make a full recovery from the debilitating condition.
The team involved in the study hails from Sichuan University’s West China hospital in Chengdu, China, and intends to begin tests in August, according to the scientific journal Nature.
Lung cancer is a particularly big killer in China, with a two-pronged assault on public health having a massive impact.
Firstly, due to the rapid industrialisation of the Chinese nation, the levels of air pollution in some regions of the country are extremely dangerous.
Researchers estimate China endured 2.8 million cancer deaths during 2015 and 4.3 million new cancer cases, with lung cancer the most common of all.
“Cancer incidence and mortality have been increasing in China, making cancer the leading cause of death since 2010 and a major public health problem in the country,” researchers noted.
Secondly, China is the world’s largest consumer of tobacco, with 350 million people in China smoking regularly, and the country producing nearly half of all the world’s tobacco products.
It is this climate which has caused scientists and clinicians in China to seek new and innovative ways to treat lung cancer in particular.
Known as Crispr, the technique entails finding, removing and replacing specific parts of the DNA of individuals.
Those selected for the trial will already have received chemotherapy and radiotherapy, with these proving ineffective.
The Crispr technique adds a new genetic sequence, which is designed to help the patient’s immune system destroy the cancer.
Naturally this is a very technical undertaking, and the effectiveness of the approach and ultimate results are very much cloudy at the current time.
There are also moral concerns about gene-editing, despite the fact that Crispr could see the creation of pest-resistant crops and new cures for serious diseases such a signal-cell anaemia.
Supporters of gene-editing suggest that it differs significantly from genetic modification by not being hereditary.
Naturally everyone involved in the study will have volunteered, and also it must be said that their chances of survival otherwise are basically zero.
Healthcare campaigners and researchers in the UK will be observing the Chinese experiment particularly closely, as the Human Fertilisation & Embryology Authority in Britain approved an application from the Francis Crick Institute to use gene-editing on embryos earlier this year.
This research has yet to receive ethical approval, as the debate over gene-editing continues.
Medical gadgets have been a notable and increasingly prominent addition to the health landscape in the last few years.
Yet despite the benefits of such technology there is currently a distinct lack of legislation and regulation related to them.
In the United States, legislators are currently tackling this issue, with the Obama administration addressing the paucity of guidance for manufacturers of such devices.
It is well known among American government experts that the federal patient privacy law known as HIPAA (Health Insurance Portability and Accountability Act of 1996) has not kept pace with wearable fitness trackers, mobile health apps and online patient communities.
This was noted in a recent damning and delayed government report, which was actually supposed to have been compiled by the end of 2010.
Yet the US Department of Health and Human Services has frustrated many observers of both the technology and healthcare industries in the United States by failing to provide specific recommendations, despite being asked for them by the federal government.
The existing Health Insurance Portability and Accountability Act, the landmark 1996 patient-privacy law, only covers patient information kept by health providers, insurers and data clearinghouses, as well as their business partners.
Technology such as Fitbit falls outside of this legislation, yet enables users to store a huge amount of personal health information and data.
The new report has been compiled by the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology, in conjunction with other agencies, and notes that there is a legislative gap related to health devices.
“Health privacy and security law experts have a reasonably clear idea of where HIPAA protections end, but the layperson likely does not. Moreover, even entrepreneurs, particularly those outside the health care industry…may not have a clear understanding of where HIPAA oversight begins and ends,” the report observes.
But the authors of the report nonetheless suggest that it is an important milestone in the regulation of this industry, stating that readers can ultimately draw their own conclusions from the findings outlined in the text.
“At the end of the day, it’s a very complicated environment that we find ourselves in,” Lucia Savage, chief privacy officer at the Office of the National Coordinator for Health Information Technology, which took the lead on the report, suggested. “We believe we’re fulfilling our duties. If Congress has concerns about that, I’m sure that we will hear about them.”
A study conducted in 2014 assessed 600 of the most popular used health apps, and discovered that less than one-third have explicit privacy policies.
And policies on Apple and Google mobile phone platforms “may be inconsistent, not articulated to individuals, or simply ignored by web developers skirting the rules that operating system developers attempt to impose on them,” according to the recently published report.
This can be considered of particular concern to the UK healthcare system, considering the recent public-private partnership between Google and the NHS.
The new US report can be seen as a stepping stone to the safeguarding of this crucial area of technology.
Over 50 hospitals in England have been granted permission to ignore key waiting time targets owing to their extreme financial difficulties.
The decision is part of an overall package of measures which have been taken by NHS bosses following the £2.5 billion deficit accumulated by NHS trusts during the previous financial year.
Fines for missing targets in A&E, cancer and routine operations have been scrapped altogether as part of the initiative.
The decision to relax targets has already been strongly criticised by the Patients Association.
The chief executive of the organisation, Katherine Murphy, suggested that the initiative would ultimately have a negative impact on the efficacy of NHS operations.
“This is the slippery slope back to the bad old days of never-ending waiting times and uncertainty – with patients left endlessly on A&E trolleys and waiting for life-changing operations. Where is it all going to end?”
But regulators have set up what is described as a ‘failure regime’, with the most incompetent trusts in the country entered into this programme.
The government will place senior managers in hospitals struggling to deliver adequate service, in order to help produce plans to improve the situation.
Five trusts – Barts Health in London, Croydon Health Services, Maidstone and Tunbridge Wells, Norfolk and Norwich Hospitals and North Bristol – have already been informed that they will be parachuted into this system.
And another 13 trusts across the country are threatened with the same prospect if they fail to demonstrate significant and rapid improvement.
Commenting on the issue, NHS England chief executive Simon Stevens indicated his belief that the current period is a critical one for the future of the NHS, and one at that will effectively make or break the health service.
“Precisely because the pressures across the NHS are real and growing, we need to use this year both to stabilise finances and kickstart the wider changes everyone can see are needed.”
But Nigel Edwards, of the Nuffield Trust think tank, believes that the measures taken will be rather trivial in and of themselves, and that more must be done in order to ensure that the health service is placed back on the appropriate footing.
“My big worry is what happens next. I fear that in order for hospitals to virtually eradicate their deficits the next steps could be a series of brutal service reductions and bed closures – which will shock an unprepared public.”
Many trusts and hospitals have been struggling to meet targets related to some of the most critical aspects of the healthcare process, and will welcome this decision.
Although it will inevitably draw some criticism, equally many healthcare experts have suggested that government targets have been too stringent.
Two studies presented at the UK Breast Cancer Research Symposium suggest that research into oestrogen receptors may be critical in treating breast cancer.
It is believed that understanding this may be key to explaining why some forms of breast cancer do not respond adequately to treatment.
The research has already been praised by healthcare experts as groundbreaking, and it is hoped that it will significantly inform the scientific response to the disease going forward.
In the first study, scientists at the University of Pittsburgh analysed non-inherited mutations in the ESRI gene across 122 samples of breast cancer tumours.
Researchers discovered that there are significantly more mutations in secondary samples when this process is conducted.
While it is early to draw firm conclusions on the subject, this nonetheless suggests that primary breast cancers containing ESRI mutations could be an early indication that tumours are resistant to common cancer treatments.
Although scientists are still working to understand the issue, it is hoped eventually that this breakthrough could help doctors understand whether patients will be resistant to certain treatments before cancers become unresponsive to medication.
Further trials are planned to develop this technique still further.
Dr Steffi Oesterreich, who led the research, was enthusiastic about the potential of the study, and explained the results and their significance.
“The ESR1 gene has a very important role in the process by which cancers spread from the breast to elsewhere in the body. Research on the way this gene mutates will help us to identify the cancers which will relapse, and also those which will not respond to our current treatment. It shows how, in the future, new extremely sensitive technologies could give us an ever more detailed picture of what is going on inside a patient’s breast cancer and how the cancer is responding to treatment.”
A second study analysed genetic changes in more than 120,000 women.
Researchers were able to identify five distinctive genetic alterations which could influence the risk of women developing particular forms of breast cancer.
Commenting on the research, Dr Alison Dunning, who led the study, was positive about the potential for treatment that the results indicated.
“All five of the genetic variants we have found near the ESR1 gene affect the levels of oestrogen receptors in breast cells. This seems to indicate that if there are too few or too many oestrogen receptors then the breast cells are more likely to become cancerous.”
The University of Cambridge study discovered that genetic changes in oestrogen receptors can help inform clinicians of the risk of developing breast cancer, and even potentially aid prevention and treatment.
The charity Breast Cancer Now was effusive in its praise for the research, considering the results to be groundbreaking in the understanding and treatment of the debilitating condition.
“Both discoveries relating to the ESR1 gene show great potential to tailor treatment for patients and reveal more about the genetics of breast cancer risk. It is work such as this that will lead to steady improvement in the prevention, diagnosis and treatment of breast cancer in coming years,” chief executive of Breast Cancer Now, Delyth Morgan, commented.
London’s Great Ormond Street Hospital has suggested that the exit of Britain from the European Union could reduce medical research funding and ultimately cost lives of vulnerable children.
The infamous organisation claims that leaving the European Union permanently will pose a serious risk to research funding going forward.
Great Ormond Street also believes that it will lose staff from the Eurozone and that established partnerships with healthcare institutions in Europe will be diluted.
But not all experts agree with the verdict of great Ormond Street, with one leading cancer specialist describing the claims of the hospital as hysterical.
Angus Dalgleish, professor of oncology at St George’s, University of London, who also represents Brexit movement Scientists for Britain, asserted that the claims made by great Ormond Street were a “gross overreaction and rather hysterical”.
Dalgleish went on to discuss what he deems to be a climate of fear.
“There are a lot of scare stories about people not wanting to come because we’re leaving the EU. I don’t think that will happen. There are a lot of us trying to make sure that when Brexit comes, that all the good bits will be left in place. It’s not going to be a break.”
Supporting the statements of Dalgleish, the universities and science minister, Jo Johnson, indicated the commitment of the government to scientific pursuits, stating that the Conservative party wants the UK to remain “a science powerhouse”.
Johnson stated that the government is fully committed to maintaining that position and “limiting some of the risks which the sector has identified.”
“We are more open and outward looking than ever before. We want to forge international collaborations with European partners and countries beyond the EU,” Johnson added.
The Department for Business Innovation and Skills has also indicated that there will be no immediate change to the funding of the Department of Science in the UK, and that this eventuality is not likely to materialise in the remainder of the decade.
Nonetheless, there will be a discussion about the access of Britain to European research and innovation funding.
In what could be described as an uncertain climate, Great Ormond Street Hospital has urged the government to secure a deal with Europe which protects research as soon as possible.
The hospital is also concerned about a potential brain drain as an ultimate result of Brexit.
Great Ormond Street has received £25 million in research funding from European Union sources since 2010, which the hospital divulges is equal to approximately 10% of its overall research budgets.
The chief executive of Great Ormond Street Hospital, Dr Peter Steet, suggested that the current situation with funding is critical, commenting that “for the vulnerable, very ill children we care for, every day counts.”
The hierarchy of the NHS in England has been accused by MPs of failing to be strict enough on an important area affecting mental health.
NHS bosses have been slack in tackling delays regarding medically fit patients being discharged from hospital, according to the Public Accounts Committee.
Commenting on the subject, the committee indicated that NHS England must make more effort to support hospitals in this critical area of patient well-being.
MPs suggested that officials are too ready to rely on excuses regarding care services run by councils, and indicated that there is considerable room for improvement in the way that this system operates.
And the politicians overseeing the issue also promised extra funding in order to address the issue.
Reporting from the committee comes hot on the heels of delays in discharges reaching record levels according to official figures.
It is often the case that community support services such as district nursing, carers or care home places, cannot be found for vulnerable patients.
The elderly have been particularly badly affected by this issue.
A recent report released by the National Audit Office estimated that delays are costing the NHS over £800 million annually, following a rise in the number of delays by over one-third in the past two years.
To put the figure into perspective, it is estimated that care in the community for such patients would cost under £200 million.
This is particularly detrimental for patients, the risk of infection escalates in older people affected by such delays during extended stays.
And the National Audit Office has even suggested that the worrying figures should be considered an underestimate, owing to the fact that the NHS measures delays only from the point patients are deemed ready for discharge.
The report instead indicates that delays waiting for this figure to be recorded, or in other procedures during stays in hospital, could extend delays further still.
This cross-party report urges NHS England is to do more to address the situation, suggesting that the organisation has shown what the MPs described as a “striking poverty of ambition”.
Meg Hillier, who chairs the committee, asserted that “blaming local circumstances for poor performance short-changes patients and is an unacceptable cop-out.”
In response to the report, a spokesman for the Department of Health outlined some of the investments in these services which have already been agreed and set aside.
“Local authorities will have more money – up to £3.5bn extra – for adult social care by 2019-20 and by 2020 we will be investing an extra £10bn a year so the NHS can introduce its own plan for the future and help fewer people go to hospital in the first place.”
As numerous rows about the future of the NHS continue to unfold, new evidence suggests that patients are increasingly being denied major surgery as healthcare is effectively rationed.
Evidence in The Guardian newspaper indicates that patients are frequently denied such critical services as mental healthcare, hip and knee replacement operations, and vital medicinal drugs.
The NHS is seemingly resorting to every conceivable approach in order to overcome its growing cash crisis.
Indeed, the situation is so serious that it is not at all unreasonable to describe the existing policy as one of rationing healthcare.
When doctors in the NHS where surveyed recently, over 75 per cent indicated that they had experienced care being rationed in their particular region of the NHS over the last 12 months.
Treatments rationed included speech therapy, operations to remove varicose veins, Botox to help children with cerebral palsy move more freely, and even potentially life-saving stem cell transplant surgery.
Commenting on these worrying figures, Dr Mark Porter, leader of the British Medical Association, commented: “The NHS is being forced to choose between which patients to treat, with some facing delays in treatment and others being denied some treatments entirely. This survey lays bare the extreme pressure across the system and the distress caused to patients as a result.”
The survey, conducted by Binley’s OnMedica, a healthcare data and intelligence provider, painted a picture of massive problems across the health service as organisers and frontline workers attempt to cope with an increasing convergence of massive infrastructure problems.
Following this survey, debate about the future of the NHS will only intensify.
The Conservative government has attempted to defend its position, and suggest that the health service itself must spend money more efficiently and effectively.
And the findings from the survey prompted comment from the Parliamentary Under-Secretary of State for Health in the House of Lords, David Prior.
Prior even suggested that NHS organisations may be breaching the law by rationing healthcare.
“Treatment decisions should only be made by doctors based on a patient’s individual clinical needs. Local health bodies have a legal responsibility to provide services meeting the needs of their local population, and we expect NHS England to act if there is any evidence of inappropriate rationing of care,” Prior commented.
The NHS is facing numerous problems, with staffing related to junior doctors proving to be a particular issue.
Meanwhile, the health service also faces a deficit of around £30 billion between now and the end of the decade, while also being expected to make serious efficiency savings.
Add in the fact that the Conservative government has opined that the NHS must switch to a true seven-day culture, and the existing situation is pretty much a perfect storm.
There are huge demographic problems for both the NHS and the government to address in the coming years, and it is clear that the time of writing that these are not being tackled satisfactorily.
New data indicates that the number of patients waiting for lengthy periods in Accident and Emergency has increased massively.
A report from the Royal College of Emergency Medicine indicates that there has been a 1,000 per cent increase in the number of patients waiting for more than 12 hours in A&E.
This rather startling figure is indicative of the extent to which the NHS is struggling with organisational difficulties.
It also successfully illustrates the importance of the debates currently taking place regarding the future of the health service, and indeed why these have been so contentious.
Above all else, the problem of extended waiting times indicates the extent to which the NHS is seriously underfunded.
But it also calls into question the plans of the government to expand the NHS into what it describes as a seven-day service.
When combined with the massive issue of junior doctors pay, and a serious lack of social care provision, it is clear that frontline services are currently struggling and suffering in the health service ahead of the busiest period of the year.
And this is not the first issue related to Accident and Emergency departments that has emerged in recent weeks.
It was also revealed recently that the critical first line of defence in the NHS was also suffering from an issue related to patients waiting on trolleys.
The number of patients waiting for longer than 12 hours in this situation had grown substantially over the same three-year period.
When one considers that A&E departments all over the country were besieged with patients last year, and to some extent crumbled under the pressure, it is clear that there could be massive issues this year as well.
Yet government policy now dictates that Accident and Emergency departments in the NHS are placed under increasing pressure to deal with patients.
The current target for A&E departments is to see 95 per cent of patients within four hours of arriving in the emergency department.
Yet official data indicated that the number of patients waiting at least four hours had nearly trebled, with some 304,276 cases seen in 2014/15.
The issue at least partly originates from an increase in the number of social care patients.
Not only is there a lack of provision for home care, but there is also a significant number of hospital beds unavailable, leading to a significant amount of bed blocking.
Indeed, the report from the Royal College of Emergency Medicine documented a 61 per cent increase in the number of patients taking up beds despite being well enough to leave hospital.
Head of the Royal College of Emergency Medicine, Dr Clifford Mann, commented on the issue, offering his opinion that this is an extremely serious situation.
“This is the minimum time they have been waiting – some of these waits could go on for days. These are vulnerable people, mainly elderly. The A&E department is not where they should be – they have a far greater chance of deteriorating there, suffering delirium, and an increased chance of death. No civilized society should be leaving people on trolleys for 12 hours or more. These figures are moving rapidly in the wrong direction – this is not something we can tolerate.”
Considering the extent of the issues related to Accident and Emergency, it seems absolutely inevitable that the NHS will once again experience a crisis over the winter months.
The National Audit Office (NAO) has documented the failure of the NHS to collect appropriate data on the cancer treatment outcome of a large raft of NHS patients related to the Cancer Drugs Fund.
In total, the National Health Service provided drugs to 74,000 cancer patients of whom the medicines regulator has no idea whether or not their lives were extended, according to the NAO.
This naturally indicates significant negligence on the behalf of the NHS, but also renders the statistical data related to cancer considerably less accurate.
According to Meg Hillier, chair of the public accounts committee, the failure to collect this wide variety of data simply makes no sense.
Furthermore, Hillier, who is a Labour MP, indicated that the oversight ensured that it is impossible to judge if the fund has indeed succeeded in extending the survival of patients, due to the gap in data.
In total, the NHS has funded in the region of £1 billion, providing cancer drugs for these 74,000 patients.
And in a report on the matter, the NAO was strongly critical of the NHS and Department of Health’s failure to collate adequate data.
The NAO describes the failure to collect information on the outcomes experienced by patients helped by the Cancer Drugs Fund as a major weakness of NHS operations.
In addition, an investigation by the public spending watchdog found that budgets for other NHS services have suffered as a result of spending on the fund.
The Cancer Drugs Fund attracts an annual budget of £416 million, since being set up by the coalition government back in 2010.
A plus point is that the fund has significantly improved access to 40 cancer drugs that are not usually readily available on the NHS.
This could enhance cancer survival rates regardless of the poor collection of data, with most recipients involved with Cancer Drug Fund requisition suffering from a terminal form of the disease.
Another notable success of the fund is that it underspent on its budget by 20 per cent overall.
However, this trend is unlikely to continue, as it is noted that spending has significantly increased in the last fiscal year.
Thus, the fund is anticipated to spend in the region of £70 million in 2015-16, according to NAO data.
“Taking 2013-14 and 2014-15 together, NHS England overspent the allocated budget for the fund by 35%. The overspend meant that less money was available for other services,” the NAO’s report on the fund states,
Commenting on the fund, the aforementioned Hillier indicated that a rethink was necessary owing to funding difficulties.
“At a time of increased pressures on NHS funding, the cancer drugs fund is not sustainable in its current form. There needs to be much better control of costs and proper assessment of whether these drugs are making a difference to the health of patients,” Hillier observed.
NHS England has already been forced to remove 28 drugs from the list of approved medicines that the fund is willing to pay for.
Cancer charities have warned that the withdrawals would mean the death of some patients awaiting medication, but NHS England has argued that inflated cost makes this decision inevitable.
Jeremy Corbyn has been elected the new leader of the Labour Party after a landslide victory.
After an election campaign which saw the rank outsider gain a huge amount of momentum, Corbyn is now faced with the task of readying the parliamentary party for a serious assault on Downing Street in 2020.
But what does the election of Corbyn mean for the National Health Service? Healthcare professionals are naturally interested in what Corbyn has to say about the NHS, and prospects would certainly seem to be good for the service based on Corbyn’s public statements.
Before examining Corbyn’s stated policy on the NHS in more detail, it is firstly important to emphasise that Corbyn faces a series challenge to ever win a general election.
Aside from the fact that Corbyn will unquestionably be subjected to attacks from the primarily right-leaning media, the Labour Party also faces massive logistical issues in the existing electoral system.
It is generally considered that the dominance of the Scottish National party in its native land will make it extremely difficult for the Labour Party to ever achieve a majority.
This is indeed reflected in the bookmakers’ odds for the next general election, with the Conservative Party considered heavy odds-on favourites.
Failing any meaningful electoral reform, one would have to say that the likelihood of Corbyn becoming prime minister is a slim one.
Nonetheless, the support of Corbyn for the NHS will at least put pressure on the Conservative government to retain the service in its existing form, and offer explicit public support as well.
Corbyn states on his personal website that the National Health Service is the best asset of the UK, and pledges the following:
“More money for hospitals, doctors and nurses; increased support for mental health, and an improvement in public health all happened under the previous Labour government.”
Corbyn in fact makes the argument that the NHS is enshrined in the post-Second World War culture of the UK, and should be protected at all costs.
“After World War II, Aneurin Bevan, the great socialist and Minister for Health, started the publicly owned and publicly funded National Health Service to provide a good level of healthcare to everybody, regardless of their wealth, status or nationality. This principle of universal healthcare which is free at the point of use is something that we all deserve and should be absolutely protected.”
Corbyn clearly believes that removing any element of privatisation from the NHS should be considered a priority. Corbyn stated publicly that he wants to ensure that the NHS is “completely publicly run and publicly accountable”.
In addition, Corbyn has also criticised the extent to which Private Finance initiatives (BFI) have been utilised in order to build NHS infrastructure. “Labour has a duty to remove the PFI burden from the NHS – this really was our mess, and we have to clear it up,” Corbyn has written previously in a Guardian article.
In summary, it seems that the election of Corbyn to the position of Labour leader should have positive benefits for the future of the NHS, even if his political legacy remains unclear at the time of writing.