MPH Master pieces

Treatment outcomes - mental health

The interest in this paper is not so much the findings as the fact that it was possible at all. We famously collect a lot of routine data on what has been done to patients but never what difference that treatment actually made. This seems to be an exception. 

It's interesting how the tribes have different cultures - haematologists enter everyone into trials, surgeons just get on with it, and clinical psychologists are deeply wedded to questionnaire instruments. Not sure what the tribal characteristic is for public health. 

Developing a vaccine

I was at a meeting last week hearing the latest on Type 1 diabetes. It's clearly an autoimmune disease with an unknown trigger and some strong genetic predictors; the modern and expanding range of immune modulating drugs are hugely promising as treatments which avoid the need for obsessional use of insulin. Clear benefits for not-so-obsessional teenagers who are diabetic. 

But actually that's not what I wanted to say. One wry comment from the lecturer noted that insulin was discovered in April 1921; commercial production was under way by July 1921. That's three months. Nowadays the regulatory path from discovery to commercial use is typically 14 years. Progress?

Here's an account of the first stages in developing a vaccine against Zika. Looks set to beat the 14 year norm; massive resources and a global problem help. 

Meanwhile I always used to think of cholera vaccine as being a bit useless but I was wrong. Not much use as a general prophylactic for travellers, perhaps, but highly effective in outbreak control, as this report from Zambia shows. 

Heart failure epidemiology

Heart failure is common, increasing and burdensome. This is simple epidemiology, but it's well executed. 

Ebola - stats vs people

Public health is a matter of statistics and aggregates, but we must never forget the real individuals who compose those aggregates and constitute those statistics. This paper sets out graphically the human cost of Ebola in Sierra Leone, while also provoking thought about the true cause of the epidemic (and it's not the virus).