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Letters to the Editor Issue 240

by Letters(more info)

listed in letters to the editor, originally published in issue 240 - August 2017

Complementary Medicine in Switzerland now a Mandatory Health Insurance Service

The Swiss Federal Government announces that specific medical services using complementary medicine are to be covered by mandatory health insurance (basic insurance). The Swiss Umbrella Association for Complementary Medicine and the Union of Associations of Swiss Physicians for Complementary Medicine welcome this decision. It implements one of the key demands of the constitutional referendum held on 17 May 2009. With this decision, the Swiss Federal Council is acknowledging that complementary medicine in Switzerland meets statutory regulations when it comes to effectiveness, guaranteeing high quality and safety.

At the 17 May 2009 constitutional referendum, the Swiss people voted in favour of complementary medicine being included in public healthcare by a two-thirds majority. A key requirement of the new constitutional article 118a on complementary medicine is that mandatory health insurance (basic insurance) also has to cover specific services using complementary medicine.

It is now decided that the following disciplines of complementary medicine will be fully covered by mandatory health insurance (basic insurance) as of 1 August 2017:

  • Anthroposophical medicine;
  • Classical homoeopathy;
  • Traditional Chinese medicine;
  • Herbal medicine.

This is provided that these are practised by conventional medical practitioners who have an additional qualification in one of the four disciplines as recognised by the Swiss Medical Association (FMH).

The Swiss Federal Health Insurance Act (HIA 1996) together with constitutional article 118a provide everyone with access to complementary medical services (according to the solidarity principle). Despite these regulations, the implementation was followed by several years of controversy about how to cover the costs of complementary medical services. Scientific programmes commissioned by the government were abused for political ends, meaning that, for a while, such services were no longer covered.

With today’s decision, the Swiss Federal Government is finally acknowledging that complementary medicine meets the regulations of the HIA when it comes to effectiveness, guaranteeing high quality and safety. By law, only those services that are effective, appropriate and cost-effective (art. 32 of the requirements of the Federal Act on Health Insurance) can be covered.

The government’s decision is important for any person or family that cannot afford private supplementary insurance and for people with indications for which the only available options in conventional medicine carry a higher potential risk.

The Swiss Umbrella Association for Complementary Medicine and the Union of Associations of Swiss Physicians for Complementary Medicine are pleased with the Federal Council's policy decision to strengthen support for complementary medicine in basic medical care.

Contact

Dr Hansueli Albonico, former Chairman of the Union of Associations of Swiss Physicians for Complementary Medicine: Tel: +41 79 595 79 48;  hu.albonico@hotmail.com

Dr Gisela Etter, Chairwoman of the Union of Associations of Swiss Physicians for Complementary Medicine, member of the Board of Directors of the Swiss Umbrella Association for Complementary Medicine: Tel: +41 79 312 64 42; etter.praxis@bluewin.ch  

Walter Stüdeli, Head of Policy and Media of the Swiss Umbrella Association for Complementary Medicine: Tel: +41 79 330 23 46; walter.stuedeli@dakomed.ch

Further Information

The Swiss Umbrella Association for Complementary Medicine

The Swiss Umbrella Association for Complementary Medicine campaigns for the recognition of complementary medicine within the Swiss healthcare industry. The association was set up in 2009 to implement the core requirements associated with constitutional article 118a:

  • To promote integrative medicine (cooperation between conventional and complementary medicine);
  • To include complementary medicine disciplines as practised by physicians in basic insurance and other forms of social insurance (Suva accident insurance, military and disability insurance);
  • To promote teaching and research;
  • To establish national qualifications and cantonal professional licensing for non-medical therapists;
  • To ensure the availability of a variety of therapeutic products.

The founding members include associations of physicians and therapists, hospitals, schools, health organizations, the Swiss druggists’ association and the manufacturers’ association for complementary medical products and therapeutic products of plant origin.

The Union of Associations of Swiss Physicians for Complementary Medicine

The Union has been successfully campaigning for complementary medicine as practised by physicians to be recognised within the healthcare industry since 1996 and calls for complementary medicine to be afforded equal status in practice, teaching and research. It is committed to making complementary medicine a fundamental part of basic medical healthcare and promotes cooperation between the affiliated associations of physicians.

 

 

Tel Aviv University Develops New DNA Technology against Drug-Resistant Bacteria

Antimicrobial resistance is one of the biggest threats to global health, affecting anyone, at any age, in any country, according to the World Health Organization. Currently, 700,000 deaths each year are attributed to antimicrobial resistance, a figure which could increase to 10 million a year by 2050 save further intervention.

New breakthrough technology from Tel Aviv University facilitates DNA delivery into drug-resistant bacterial pathogens, enabling their manipulation. The research expands the range of bacteriophages, which are the primary tool for introducing DNA into pathogenic bacteria to neutralize their lethal activity. A single type of bacteriophage can be adapted to a wide range of bacteria, an innovation which will likely accelerate the development of potential drugs based on this principle.

Prof. Udi Qimron of the Department of Clinical Microbiology and Immunology at TAU's Sackler Faculty of Medicine led the research team, which also included Dr Ido Yosef, Dr. Moran Goren, Rea Globus and Shahar Molshanski, all of Prof. Qimron's lab. The study was recently published in Molecular Cell and featured on its cover.

For the research, the team genetically engineered bacteriophages to contain the desired DNA rather than their own genome. They also designed combinations of nanoparticles from different bacteriophages, resulting in hybrids that are able to recognize new bacteria, including pathogenic bacteria. The researchers further used directed evolution to select hybrid particles able to transfer DNA with optimal efficiency.

"DNA manipulation of pathogens includes sensitization to antibiotics, killing of pathogens, disabling pathogens' virulence factors and more," Prof. Qimron said. "We've developed a technology that significantly expands DNA delivery into bacterial pathogens. This may indeed be a milestone, because it opens up many opportunities for DNA manipulations of bacteria that were impossible to accomplish before.

"This could pave the way to changing the human microbiome - the combined genetic material of the microorganisms in humans - by replacing virulent bacteria with a-virulent bacteria and replacing antibiotic-resistant bacteria with antibiotic-sensitive bacteria, as well as changing environmental pathogens," Prof. Qimron continued.

"We have applied for a patent on this technology and are developing products that would use this technology to deliver DNA into bacterial pathogens, rendering them a-virulent and sensitive to antibiotics," Prof. Qimron said.

The research has been granted $700,000 from the Momentum Fund, a unique $24,000,000 fund established by Ramot, Tel Aviv University's business engagement center. This funding enables the advanced development of this technology within TAU laboratories. The Momentum Fund invests in promising breakthrough technologies in a wide range of fields, including pharmaceuticals, healthcare, high-tech and the physical sciences. Tata Group is the lead investor of the Momentum Fund. Singapore-based Temaske is another key investor.

Further Information

www.aftau.org/weblog-medicine--health?=&storyid4704=2337&ncs4704=3&erid=6571456 

www.cell.com/molecular-cell/fulltext/S1097-2765(17)30310-6?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1097276517303106%3Fshowall%3Dtrue 

Source

"George Hunka, American Friends of Tel Aviv University" ghunka@aftau.org 

 

 

Outcomes Following Metal-On-Metal Hip Revision have Improved but could Improve More

A new study[1] has found that outcomes following metal-on-metal hip revision surgery performed for abnormal reactions to metal have improved since the initial reports were published over five years ago, and are now similar to the outcomes in patients with other types of hip replacement undergoing revision surgery. The observed differences are in part due to increased surgical experience, researchers at the University of Oxford have suggested. However, the researchers proposed that surgeons had the potential to improve outcomes even further.

Approximately 1.5 million patients worldwide have received metal-on-metal hip replacements for painful arthritis. Abnormal reactions to metal can develop which may cause surrounding tissue damage. Many patients with these reactions require further operations, known as revision surgery. This is concerning as most patients who received this type of hip replacement are young and active. Therefore, poor results after these further operations would have a significant impact on a patient’s quality of life.

The biggest study in the world of its kind, published 3 July 2017, used National Joint Registry [NJR] data on 2,535 metal-on-metal hip replacement patients undergoing revision surgery performed for abnormal reactions to metal (also known as adverse reactions to metal debris - ARMD). The study, funded by Arthritis Research UK and the Orthopaedics Trust, was carried out by researchers based at the University of Oxford.

The research team also identified some factors that the surgeon can modify during revision surgery, which could potentially improve the outcomes for patients further. These factors specifically related to which of the original metal-on-metal hip components were removed by the surgeon, and which material the surgeon used for the articulation at the revision procedure. These latest findings are important as surgeons have currently received very little guidance about how best to treat these patients.

On the study’s findings, one of the authors, Mr Gulraj Matharu, commented:

“Early studies in this area highlighted catastrophic short-term outcomes for patients undergoing revision for abnormal reactions to metal, with up to one third of patients requiring further surgery known as re-revision. Therefore, it is encouraging to observe substantially improved outcomes following hip revision surgery performed for abnormal reactions to metal.  This is positive news as there are still many patients who have metal-on-metal hip replacements that may require revision surgery in the future.

“It is important that surgeons have robust information concerning the expected outcomes of this type of surgery in order to appropriately discuss potential risks with patients.  The findings from our study should help support this dialogue between surgeons and patients.

“Additionally, our findings identified risk factors associated with a poor outcome but which surgeons could actually modify during the revision procedure. Surgeons should therefore be mindful of these when making decisions regarding the type of hip reconstruction to perform. Doing so may help to further reduce the rate of subsequent failure following ARMD revision, which would be beneficial to our patients.”

Dr Stephen Simpson, director of research and programmes at Arthritis Research UK; comments:

“This study will be welcome news to the 56,000 people living with metal-on-metal hip replacements in the UK.  This research could help the small percentage of those patients who may need to undergo revision surgery, by not only assisting in decision making but also by improving the outcomes of the surgery through advice for surgeons.

“There would seem to be real value in reviewing and carefully considering the recommendations made within this study by healthcare professionals.”

The findings have been published in the Bone and Joint Journal. The study was also selected as part of a prestigious ‘Game Changers’ session at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting earlier this year.

Reference Published article 

1. Mr Gulraj Matharu, Associate Professor Andrew Judge, Professor Hemant Pandit, and Professor David Murray. ‘Which factors influence the rate of failure following metal-on-metal hip arthroplasty revision surgery performed for adverse reactions to metal debris? An analysis from the National Joint Registry for England and Wales’. The Bone and Joint Journal (In Press - accepted 21 February 2017).

Contact and Further Information

Enquiries via the University of Oxford Press Office - Tel: 01865 280528; news.office@admin.ox.ac.uk 

For more information about the NJR, please contact James Ludley on Tel: 020 7997 7390;  james.ludley@hqip.org.uk .

About the National Joint Registry for England, Wales, Northern Ireland and the Isle Of Man: 

Established in 2002, the NJR monitors the performance of hip, knee, ankle, elbow and shoulder joint replacements to improve clinical outcomes for the benefit of patients, clinicians and industry. The registry collects relevant, high quality data in order to provide quality, robust evidence to support decision-making in regard to patient safety, standards in quality of care and overall cost effectiveness in joint replacement surgery. It also supports and enables research to maximise the value of the information it holds, now with over 2 million records, and collaborates internationally to foster greater knowledge and understanding.

About Arthritis Research UK 

Arthritis Research UK invests in breakthrough treatments, the best information and vital support for everyone affected by arthritis. For more information, please visit www.arthritisresearchuk.org .

 

 

Cardiac Stem Cells from Heart Disease Patients May Be Harmful

Tel Aviv University researchers discover molecular pathway involved in toxic interaction between host cells and immune system. Patients with severe and end-stage heart failure have few treatment options available to them apart from transplants and ‘miraculous’ stem cell therapy. But a new Tel Aviv University study finds that stem cell therapy may, in fact, harm heart disease patients.

The research, led by Prof. Jonathan Leor of TAU's Sackler Faculty of Medicine and Sheba Medical Center and conducted by TAU's Dr Nili Naftali-Shani, explores the current practice of using cells from the host patient to repair tissue - and contends that this can prove deleterious or toxic for patients. The study was recently published in the journal Circulation.[1]

"We found that, contrary to popular belief, tissue stem cells derived from sick hearts do not contribute to heart healing after injury," said Prof. Leor. "Furthermore, we found that these cells are affected by the inflammatory environment and develop inflammatory properties. The affected stem cells may even exacerbate damage to the already diseased heart muscle."

Tissue or adult stem cells - ‘blank’ cells that can act as a repair kit for the body by replacing damaged tissue - encourage the regeneration of blood vessel cells and new heart muscle tissue. Faced with a worse survival rate than many cancers, many heart failure patients have turned to stem cell therapy as a last resort.

"But our findings suggest that stem cells, like any drug, can have adverse effects," said Prof. Leor. "We concluded that stem cells used in cardiac therapy should be drawn from healthy donors or be better genetically engineered for the patient."

Hope for Improved Cardiac Stem Cell Therapy

In addition, the researchers also discovered the molecular pathway involved in the negative interaction between stem cells and the immune system as they isolated stem cells in mouse models of heart disease. After exploring the molecular pathway in mice, the researchers focused on cardiac stem cells in patients with heart disease.

The results could help improve the use of autologous stem cells - those drawn from the patients themselves - in cardiac therapy, Prof. Leor said.

"We showed that the deletion of the gene responsible for this pathway can restore the original therapeutic function of the cells," said Prof. Leor. "Our findings determine the potential negative effects of inflammation on stem cell function as they're currently used. The use of autologous stem cells from patients with heart disease should be modified. Only stem cells from healthy donors or genetically engineered cells should be used in treating cardiac conditions."

The researchers are currently testing a gene editing technique (CRISPER) to inhibit the gene responsible for the negative inflammatory properties of the cardiac stem cells of heart disease patients. "We hope our engineered stem cells will be resistant to the negative effects of the immune system," said Prof. Leor.

Reference

1. Nili Naftali-Shani, La-Paz Levin-Kotler, Dahlia Palevski, Uri Amit, David Kain, Natalie Landa, Edith Hochhauser, Jonathan Leor. Left Ventricular Dysfunction Switches Mesenchymal Stromal Cells Toward an Inflammatory Phenotype and Impairs Their Reparative Properties Via Toll-Like Receptor-4Clinical Perspective. Circulation 135 (23): 2271 DOI: 10.1161/CIRCULATIONAHA.116.023527. 2017.

Further Information

https://www.aftau.org/weblog-medicine--health?=&storyid4704=2336&ncs4704=3&erid=6557112

Source

George Hunka, American Friends of Tel Aviv University" ghunka@aftau.org

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