Health Scan: Drugs at petrol stations? No thanks

'Clothespin' fixes leaky heart valves; nano treatment for chronic wounds.

Pills 311 (photo credit: Courtesy)
Pills 311
(photo credit: Courtesy)
When former Likud MK Dan Naveh was health minister over six years ago, he devoted much effort to a reform he claimed would be a “revolution” in supplying less-expensive over-the-counter (OTC) medications to the public without having to go to a pharmacy. They would be purchased “more accessibly” at petrol stations, supermarkets and other outlets, or displayed along with shampoos and perfumes in pharmacies but not behind the pharmacists’ counter, he maintained. With backing from the Treasury, he pushed through the change, which went into effect in May 2005. The ministry’s pharmaceutical division stipulated physical conditions for storing the drugs and sent inspectors to outlets that asked to be included.
Critics charged that lobbyists from these outlets were behind the move, not because they wanted to sell paracetamol, aspirin or nasal sprays but because people would come in to buy them and then be tempted to buy other (more expensive) goods. Ministry experts quietly opposed the initiative, arguing that it was better for pharmacists to advise patients about OTCs, as even aspirin or Acamol can be deadly if given in high doses or if they conflicted with existing drugs or conditions.
Now a team from the Health Ministry, the Gertner Institute for Epidemiology at Sheba Medical Center and Tel Aviv University’s School of Public Health, have called Naveh’s policy a failure rejected by the vast majority of the public. Naveh didn’t last long enough in the ministry to see the results of his initiative and is now a businessman.
Writing in the latest issue issue of Harefuah of the Israel Medical Association, the authors conducted surveys before the reform was implemented and two years after it began. Seventy percent of those queried said they buy OTC drugs, while an equal percentage knew of the reform. But three-quarters of them continued to buy their OTC medications from a pharmacist rather than a shopkeeper or in parts of a pharmacy where no pharmacist was on duty because they preferred to get expert advice. OTC drugs sold on ordinary shelves turned out to be more expensive than those dispensed by a pharmacist.
Perhaps consumers will one day think supermarkets and petrol stations are convenient places to buy OTC drugs and change their shopping habits. But given the already high accessibility of private and health-fund pharmacies, and the fact that the number of outlets that apply to the ministry for permission to sell such dugs is small, it does not look very likely. The majority of Israelis feel safer consulting a pharmacist.
Leakage of the mitral valve in the heart is a very common condition, especially in elderly patients, but some of those who need repairs cannot survive open-heart surgery. Since a US team developed a technique to perform such repairs using a catheter and a type of miniature clothespin, some 2,300 of the minimally invasive procedures have been performed around the world. Now doctors at Jerusalem’s Shaare Zedek Medical Center have performed the lifesaving MitraClip procedure on two patients, who were discharged in excellent condition within 72 hours. The procedure took a little over 90 minutes. Shaare Zedek catheterization expert Dr. David Meerkin, along with colleagues Prof. Yaron Almagor and Dr. Adi Butenaru, had gone to Belgium and Holland to learn the technique; Sheba Medical Center has sent experts to Brussels, and in the future are expected to do it on their patients.
“It’s a variation of other things that I previously did,” Meerkin told The Jerusalem Post recently. The system was developed by the US-based international company Abbott Vascular. The “clothespin” is attached to the end of a catheter and pushed through a vein in an extremity into the heart. This patches together two parts of the valve and significantly minimizes the leak, which was caused by an organic, traumatic, degenerative or congenital problem.
“Both patients had severe mitral regurgitation of blood,” recalled Meerkin. “I believe this is a major advance in treatment that we can offer our patients, particularly those with severe left ventricular dysfunction and what we call functional mitral incompetence. These patients are usually too high-risk for surgery, and cardiac cripples due to previous heart attacks or stretched valves or heart muscles; their mitral valve parts don’t meet properly. Often, they suffer from pulmonary edema and are admitted several times to the hospital; “they can’t walk more than a few steps. But the two patients who underwent the procedure felt immediate improvement without a postsurgical recuperation period.”
Meerkin notes that the single-use equipment is very expensive and not yet included in the basket of health services. But he recommended inclusion, as the whole procedure costs no more than open-heart valve surgery, and the length of hospitalization is much reduced. Recovery is immediate, as the blood courses right away through the heart, lungs and the rest of the body as needed,” Meerkin concluded.
A low-cost, nanometer-sized drug to treat chronic wounds such as diabetic foot ulcers or burns has been developed by a group of scientists from the Hebrew University of Jerusalem, Harvard Medical School and others in the US and Japan.
Diabetes is a rapidly growing medical problem affecting close to three percent of the world’s population; poor blood circulation arising from diabetes often results in skin wounds that do not heal, causing pain, infection and at times limb amputation.
Several proteins,called growth factors, have been found to speed up the healing process, but purifying them is very expensive, and they do not last long on the injury.
The multinational team, who published their findings recently in Proceedings of the [US] National Academy of Sciences (PNAS), have used genetic engineering to produce a “robotic” growth factor protein that responds to temperature. Raising the temperature causes dozens of these proteins to fold together into a nanoparticle that is more than 200 times smaller than a single hair. This greatly simplifies protein purification, making it very inexpensive to produce, they wrote. It also enables the growth factor to be confined and remain at the burn or wound site. The scientists, including Dr. Yaakov Nahmias, director of the HU Center for Bioengineering in the Service of Humanity, refer to their discovery as robotic, since just as robots are machines that respond to their environment by carrying out a specific activity, so too this protein they responds and reacts to heat. The experimental drug, which has been developed by the research group as a topical ointment, is patented and so far – used to treat chronic wounds in diabetic mice – dramatically increasing the healing rate. The team aim to go to clinical trials after future tests and refinements.