A look at Skin & Derm + some expert tips on dental health & hygiene
This fortnight's updates!
Dear Friend of Global Health Conversations,
I always approach writing to you on these Sunday evenings with joy. I sometimes feel nervous, because I want to be sure that I am continuing to improve gradually - and make this worth your while. But I am always thrilled to write you this letter.
As I write, I sit at a lovely little spot in Geneva over a great big pot of fondue; enjoying a romantic supper for one. Last fondue of the season and I couldn’t be enjoying it more. For the most part, I spent my weekend meeting friends and thinking deeply about cell-lines, protein signalling and Master Cell banks.
Nevertheless, my skin has been doing well recently: seasonal acne gently abating, exfoliating weekly, doing well with sunscreen except on the odd busy day and having recently resolved to drink a litre of water a day. (Baby steps) But there’s so much more to skin & derm than our poreless aspirations. The skin is the body’s largest organ and the very first line of defence in protecting our fascia, tissue and organs.
There are certainly more important, ongoing concerns in the worlds of Global Health & Pharma than those related to skin & derm. Perhaps it is for this reason that I was not aware that the most ancient and Biblical of conditions, Leprosy, is still prevalent enough to affect hundreds of thousands of patients annually, and has recently experienced a resurgence in the US. (And in other regions, so have scabies and yaws.) I discuss this briefly in the Fortnight in Resources.
In more other news, this week I rediscovered scrabble on mobile 🔥. Ever since, I have been hoping for an opportunity to use Scabble’s legendary, highest-scoring, accepted word: Oxyphenbutazone. It’s a now lesser used non-steroidal anti-inflammatory drug (NSAID), similar to many of the analgesics we commonly use today like Ibuprofen, to treat musculoskeletal pain. It served to me as a reminder that, in many ways, drugs are truly part of our daily lives. Part of ensuring longer, healthier life for all: in treatment, prophylaxis and management of symptoms. And that we ought not to forget the extent to which these gains have ensured fewer DALYs and QALYs - improving quality of life for so many.
Until next fortnight, Friend
C
OUT NOW: Latest Episode
Dental Dialogue: Prioritising Oral Health in Public Health (ft. Ema Prohić) - Part 1
Ema and I continue our conversation discussing proper teeth brushing, baby root canals, systemic issues in dental care and continue on the theme of the true cost of oral health. I have no doubt that this will be as informative of a listen as it was to record.
1. Cholera outbreaks have been on the rise in recent years and countries have been fighting back. Now an international coalition are joining that fight.
In the largest-ever global initiative to combat cholera, over 1.2 million rapid diagnostic tests are set to be distributed to 14 high-risk countries, with Malawi receiving the initial shipment. This global deployment, orchestrated by Gavi in partnership with WHO, UNICEF, FIND, and other entities, marks a significant enhancement in the timely detection and monitoring of cholera outbreaks and the effectiveness of vaccination campaigns.
The program aims to expedite the identification of cholera cases through improved surveillance and testing, thereby facilitating rapid and precise outbreak response and supporting the strategic application of preventive vaccinations. The countries selected for these initial distributions, including Ethiopia, Somalia, Syria, and Zambia, are currently grappling with severe cholera outbreaks. These tests have previously been utilized in outbreak responses and are now being integrated into regular cholera surveillance activities.
Cholera's global surge since 2021 has intensified the need for such diagnostic tools. The disease, primarily transmitted through contaminated water, continues to pose severe public health challenges, exacerbated by inadequate water and sanitation infrastructure, especially in regions affected by climate change, conflict, and displacement.
Gavi has committed significant resources, not only for cholera but also for other infectious diseases like yellow fever and meningitis, aiming to bolster disease surveillance and response mechanisms globally. This initiative reflects a strategic shift towards systematic cholera testing, aligning with updated guidelines from the Global Task Force on Cholera Control, which advocate for routine and expanded use of RDTs to enhance surveillance and inform public health interventions effectively.
(Read more: GAVI)
2. Persistent Challenge of Leprosy and Skin-Related Neglected Tropical Diseases
Neglected tropical diseases, including skin-related conditions like leprosy, scabies, and yaws, (and not excluding mpox - not highlighted here) persist as public health issues. They are debilitating and highly stigmatizing, often leading to severe social and psychological consequences for the affected individuals.
Leprosy, one of the oldest known diseases, continues to be a major concern, with cases frequently reported in parts of Africa and Asia amounts to about 200 000 annual cases according to WHO. Despite being curable, the social stigma attached to leprosy results in discrimination and isolation of patients, exacerbating their suffering. The disease primarily affects the skin, nerves, and mucous membranes, with symptoms that can be managed with early diagnosis and treatment.
Scabies and yaws are other prevalent skin NTDs. Scabies, caused by mites that burrow into the skin, leads to intense itching and secondary infections. Yaws, a bacterial infection, affects the skin, bones, and cartilage. It can cause chronic disfigurement if not treated properly with antibiotics.
Efforts to combat these diseases are ongoing. Togo has become the first country to eliminate four NTDs, including Guinea worm disease and trachoma. Achievements like this result from strong policy, planning, comprehensive, health economic approaches involving mass drug administrations, improved diagnostics, investing in strengthening surveillance systems and substantial community engagement. Nigeria has also made significant progress - eradicating Guinea worm disease.
Despite these successes, challenges remain. The need for strengthened healthcare infrastructure, more dermatologists alongside infectious diseases specialists in affected regions, and ongoing financial and political support is critical.
While there is hope and measurable progress, the fight against leprosy and other skin-related neglected tropical diseases is far from over. Enhanced global support and local actions are imperative to achieve the eradication of these diseases. Sadly, infectious diseases seem to become neglected diseases based on the populations that they affect. For this reason, it is heartening to see countries prioritising some of their most vulnerable citizens in costly public health campaigns that will definitely pay off in the long run in terms of the reduction of DALYs and QALYs, increase in life expectancy and economic productivity gains. Above all, every life is valuable and outside of calculations, I alway feel that saving and improving a life is an activity so noble as to be without cost.
(Read more here)
In other, unrelated news - finally credited with discovering one of the first treatments for Leprosy. Alice Ball was honoured this fortnight. Here is a video from 2022 when her contribution was first officially recognized.
In other, unrelated news, here is a study about rising AMR in dermatology. The study highlights the escalating crisis of antimicrobial resistance in dermatology, particularly against dermatologically significant bacteria like MRSA and Pseudomonas aeruginosa. Overuse and misuse of antibiotics, especially in outpatient settings, are exacerbating resistance issues, which now surpass deaths from HIV/AIDS and malaria globally. Urgent calls for enhanced antibiotic stewardship are emphasized to mitigate this public health threat.
Behind the scenes:
It has been a busy and fun-filled fortnight on my end - despite battling a little bit of insomnia. The original intention was to rest. But I ended up studying, enjoying the gorgeous weather, attending a wonderful painting workshop, re-reading portions of my favourite novels of Mohsin Hamid (both of which are uniquely written in the second person - highly recommended), attending pilates classes but leaving early for meetings (🚩), relishing these lovely postcards from friends and finally, this very evening, filling my little lactose intolerant belly with a wonderful pot of fondue.
I’m always curious as to when you read this newsletter. Do you read it before bed? On Monday morning? I love to hear from you and also get some analytics to try to improve. I’m always contactable in response to this e-mail. Postcard below. From my happy heart to yours.
Recent Episodes: In case you missed them! 💃🏾
Episode 17: Dental Dialogue: Prioritising Oral Health in Public Health (ft. Ema Prohić) - Part 1
Ema and I discuss oral health as a public health issue. Discussing system challenges, incentivisation and disincentivasation, dental caries as the most common infectious disease, bacteria and the use of antibiotics. We also discuss a public health project that I led back in 2020 with the Ministry of Health Qatar and PHCC wherein she focussed on integrating oral health into a primary care program. Ema is a doctor of dental medicine from Croatia, currently undertaking her specialization in orthodontics and facial orthopedics in Barcelona as well as working in the UK in several dental practices as an NHS and private practitioner.
Episode 16: Tackling Cervical Cancer: Health Equity in Focus (International Women's Day Special)
This episode is in recognition of International Women's Day. We talk about cervical cancer and discuss its significance as a symbol of global health disparities and gender inequality. Cervical cancer incidence is exacerbated by socio-economic factors and disproportionately affects women in poverty. We discuss the importance of HPV vaccination, regular screening, and innovative prevention strategies like diagnostic tools to enable self-sampling. And the incredible toll of the devastating disease.
Episode 15: Why do Americans pay (so much) more for healthcare?
In this solocast we discussed the cost of medical care. Particularly, I attempted to answer the question: Why do Americans pay (so much) more for healthcare? With my health economist hat on - I looked into transparency, drug prices and administrative costs. But are these only reasons that the US has the world’s third highest out of pocket health expenditure? And, moreover, how does this affect patients and patient outcomes?
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Yours,
C