The impact of education on Global Health - Riad Dabaja

I grew up in a country where healthcare was not given as much priority as there is the developed countries with excellent facilities to incorporate the importance of well being and preventative measures. There was uncertainty about the sickness of kids and most of the time we did not understand the intensity of a child/parent being sick. There was a lot of closeness between people living in a community and people shared personal objects freely,

I was always eager to understand how and why members of my neighborhood got sick and how the chain continued from one child being sick to a whole community of kids who played together, being extremely sick. It was a common theme that everyone in one household got sick at the same time and recovered at the same time. Unknown to us, was the fact that there was a viral/bacterial infection that spread to make people extremely unwell. It made me wonder that maybe we can find the cause of all these illnesses and stop this from happening even before it started.

There have been many campaigns and goals set up by the WHO and the UNICEF to help spread awareness amongst people about diseases and the advantages of preventative measures. A lot of these campaigns stem off from the fact that vaccinations are vital for all, especially closely knit communities. Herd immunity is one of the greatest things that we have received by vaccinating individuals, second only to complete eradication of certain virus that caused smallpox. Awareness is the first step that is required for the poor, the uneducated and for people who simply  do not understand the mechanisms and science behind viral infections. There are millions of people around the world, especially in developing countries who do not have access to the internet to research about vaccinations; more than that, some people can not even read about these topics and that’s where we need to make a difference.

 The reason why awareness is sometimes very difficult to spread is because people in rural areas of certain countries, such as Pakistan and Nigeria, are completely oblivious of to the fact that vaccinations are preventative and not a cure. Some people from these countries also argue their religious and spiritual beliefs and indoctrinate their communities about the dangers and fatalities caused by vaccinations. These are poverty ridden places that are extremely lacking in resources to understand basic scientific principles. Recently, there have been initiatives, such as the Millennium Development Goals that helped instill a hope worldwide to feature the basic healthcare system. This involved eradication of hunger, empowerment of women and a new goal to eradicate malaria and HIV/ AIDS.

 Child mortality is a common theme in developing countries especially one inflicted with malaria. About 35% of people who lose their life because of malaria are children. There were countless measures that have tried and failed at stopping malaria and it is an extremely heartbreaking situation to witness and hear about. Recently, rates of malaria have come down drastically due to awareness of the common population in African countries and by the innovation of safety nets and medications/ screenings in the earliest stages of the transmission of the malarial parasite. According to UNICEF, rates of malaria have fallen by over 60% due to preventative methods and saved countless lives. Even if there isn’t a clear cut cure to diseases such as malaria and polio, just acting on prevention is enough to reduce mortality rates.

By starting some of the global health goals and initiatives, there is sense of community in developing countries and more often that not, people come together for one purpose to better their life quality. It is much more important to bring the help and equipment to those who are in need and use any kind of media that can help them better understand why vaccinations and preventions do not just help them, but everyone around them are safeguarded by their choices. We understand that communicable diseases and infections such as measles and tuberculosis are supposed to remain confined but there are millions of people who do not realize the seriousness of this situation until and unless they are exposed to the truth by means of compassion and conveying of the message. 

In summary ,making my home in the United States and having a constant exposure to preventative healthcare because of my Biology/ Pharmaceutical expertise has blessed me and my family to understand things we never realized before. It is much more important for us to first know the basics of preventions and vaccinations so we can communicate these messages to people who are in dire need of help, who live in countries that are struck with deadly illnesses and face life threatening situations in their everyday routine. Just observing serious viruses, such as ebola in the recent past should be an eye opener that hidden viruses are waiting to be exposed and pass on from one person to another, one continent to the another and can strike anyone at any time. With the advent of vaccinations and the discoveries of brilliant scientists around the world, we can take it one step at a time and play our role, in any way to convey the importance of prevention and immunization to the countries where it needed the most. 

Contradictions

Your dad, your teacher, your professor, your religious father figure or your politician, what do they preach to you as you grow up till this day? Be compassionate, be innovative, help others, be true to yourself, don’t be ordinary and the list goes on…

But is that really where we are going as humans and as Americans?  Let’s look at healthcare, are we compassionate in how we deal with the problems we face as a nation?  Are we trying to be innovative in how we face the growing cost of healthcare or to address the problems that come with implementing any form of healthcare plan? Are we truly thinking of how to help others that may be less fortunate or do not have the resources that we have, financially, educationally or culturally? Are we true to ourselves, do we apply what our values call for?

Solving the healthcare problems is actually simpler than politicians want us to believe; there are a large number of systems out there that are very successful.  We should be able to adapt any number of these experiences to our needs and unique communities.  There are many expert opinions regarding how to go about reducing healthcare cost or developing a universal healthcare system that fits our society.  The reason it seems complex is that it has become a partisan issue rather than a human issue. 

This problem extends beyond healthcare.  We don’t value science as much as we did in the past, but talk about innovations and want the latest technology at the lowest price.  We will cut NASA’s budget and NIH funding, while increasing military budgets and provide tax cuts for those who really don’t need it and in some cases are opposed to it.  We used to be proud of landing on the moon or exploring what is beyond.  Now its seen by many as an unnecessary luxury.

More to come...Possibly.

Why People Don’t Trust Science - Andrew Dodson

Vaccines. Climate change. Big Bang Theory. Evolution. These are the Big 4 when it comes to controversy in the United States. This begs the question: why, if there is such widespread consensus among scientists, do people still reject these ideas? It is not a small faction who reject these either. According to an AP poll, 40% of Americans do not believe in evolution, more than half reject the Big Bang theory, 40% do not see humans as the driving force in climate change, and 15% are against vaccines. Why is there such widespread rejection of scientific evidence?

Much of it comes down to beliefs; mostly religion and politics. Why don’t people believe in the Big Bang theory and evolution? Because it directly contradicts the Creation story held by the major Abrahamic religions that dominate the United States. Since religion is taught from birth and most children are not introduced to science until age 8, there is a very strong paradigm set that science then has to uproot. Climate change is a heavily politicized issue that fell along party lines and was discussed, not as a scientific issue, but as an economic one. The idea that humans are the cause of climate change is extremely detrimental to many industries (i.e. the oil industry).

Vaccines are a bit trickier. There does not seem to be any direct correlation between some belief system and vaccine rejection. This comes down to what is called “confirmation bias” which essentially says that people are more likely to believe opinions that are congruent with their previously held views. For example, if someone is already distrustful of science, it makes them more likely to distrust any further scientific evidence while latching onto anything that portrays science in a bad light. Or, if they are distrustful of the government, they will reject governmental studies that prove vaccine safety and efficacy.

When it comes to mistrust of science, there are 5 common “hallmark” moves by pseudoscientists:

1.       They say scientific consensus is nothing more than a conspiracy to suppress dissention.

2.       They produce fake experts to challenge common scientific knowledge, even though these “experts” have a spotty scientific background (at best).

3.       They cherry-pick data to both discredit the current view and propagate their views.

4.       They use “false analogies” or other logical fallacies.

5.       They set unrealistic expectations of research that science can never fulfill (i.e. the “missing link”).

In a 2011 poll, 69% of Americans believe that scientists falsified climate change data. Once there is mistrust that scientists will create data to promote an agenda, all bets are off and all science is open for debate. So what are we as scientists supposed to do? I believe we need to respond to disbelief at its source. Science needs to be depoliticized so that the argument becomes about science and not about money. Additionally, we need stronger science education. I remember reading a story about a teacher who was faced with a student who did not want to do a project because his family did not believe in global warming. Instead of dismissing the student’s views and forcing him to do the project, the teacher offered that the student should build his own theory and support it with evidence. At the end of the project, the student said that he understood why people believe in global warming, but that he also believed that there is a better explanation. This led to a view that I think is key in scientific exploration. Wide-accepted views stand up to inspection. If somebody has a different idea about something, encourage that they investigate it. Nobody is required to accept the foremost theory and that they are only responsible to investigate their own beliefs earnestly.

“Well-accepted theories are well-accepted for a reason: they stand up to inspection. As long as we encourage and empower students to earnestly inspect, the proof will take care of itself.”—David Joyner

https://www.nature.com/scitable/blog/scibytes/unbelievable

http://www.newyorker.com/news/news-desk/the-mistrust-of-science

http://www.realclearscience.com/blog/2016/08/the_public_should_mistrust_science.html

https://www.reddit.com/r/AskReddit/comments/62x5m7/teachers_whove_had_a_student_that_stubbornly/dfpsh0u/

Still Tough: Birth Control Pills In CA Without A Prescription

Even though legislation SB493 was passed in January of 2013, a law that allows pharmacists to deal out hormonal birth control without a prescription from a doctor, it is still a struggle for women to find pharmacists who will distribute the medicine in California. It was supposed to be in effect in April 2016, but it took an additional 18 months for some pharmacy chains to establish regulations. And even then, there are still some pharmacies who have not rolled out the law yet. The law itself allows pharmacists to prescribe pills, patches, injections, and vaginal rings; if the device has to be inserted (like IUDs), it has to be done by a doctor.

So why the long wait time? Politics. Just kidding, not really. Most pharmacy chains said that they weren’t ready, some pharmacists said they still needed to undergo the state-mandated training and their stores were still trying to figure out how they want to implement the services. There’s also confusion among the pharmacies as well. It is estimated that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing these types of nonprescription birth control to patients. Walgreens and Rite Aid both confirmed that they are not yet providing birth control pills or a contraceptive patch without a prescription. Walgreens operates about 629 pharmacies in California, and their spokesperson said they are ‘currently assessing" the law's requirements and plan to test the service in a small number of pharmacies. While CVS said they’re testing this service in some locations in LA to feel customer demand.

In addition to California, states like Oregon, Washington, and most recently, New Jersey have their own legislation with varying modifications that allow pharmacists to prescribe birth control. States such as New Mexico, South Carolina, Hawaii, Missouri, and Tennessee are in the middle of discussion about this type of law. Some of the variations lie in age requirements and the level of birth products being able to be prescribed, but what is universal is that pharmacists must get the patients’ relevant medical history, pregnancy status, perform a blood pressure screening via a 1 page questionnaire, similar to those used in immunizations. After a birth control product is chosen, the pharmacist will counsel the patient, explain things such as how the medication works, side effects, warnings on limitations of its protection against STDs, remind them of the importance of health screenings such as cervical cancer, and then finally end with a fact sheet on birth control.

“Pharmacists who wish to participate in these practices must first complete the necessary training seminars mandated by their state” The Board of Pharmacy have developed a protocol for pharmacists; they first have to be trained to do a short consultation with patients, to help them select the appropriate birth control option and identify red flags in a patient’s medical history such as a history of blood clots or uncontrolled high blood pressure.  Currently, there are online classes available for practicing pharmacist and pharmacy students in CA now get this training as part of their curriculum.

There are still concerns about this topic. Some, like the CA medical association, think that if pharmacists are able to prescribe birth control, there will be less visits to the doctor for necessary checkups, i.e. pap smears (something to be checked for every 3-5 years for women at certain ages). But pharmacists will check to see if the patient has had a checkup with their doctor and if their birth control prescription was prescribed within the last 2 years; this ensures women are doing recommended screenings.

Pharmacists can perform this service that was once reserved for the doctor’s office, but it might not be celebrated by all. Not only do they have a checklist of duties in a fast-paced work environment they have to get through, but they also have this new hormonal contraceptive service, something, they won’t get sufficiently reimbursed for their time and counseling if their respective states don’t have provider status. The law does not compel insurance companies or Medi-Cal to reimburse pharmacists for these services.  Currently pharmacists in California gets reimbursed up to $10 per prescription. The only hope is that they will be able to bill insurance in the future, just as a physician would. In the long run, the law could ultimate decrease health care spending, because reimbursement rates for pharmacists will most likely be lower than what doctors charge.

The prescribing of contraceptives is just the beginning of this movement of pharmacists prescribing power. Pharmacists have long been an underutilized resource in our health care system. With increased prescribing authority, they can improve an individual’s access to care, patient adherence, and ultimately, be the solution to the shortage of primary care physicians.

http://www.latimes.com/local/lanow/la-me-ln-birth-control-law-20160408-story.htmlhttp://www.npr.org/sections/health-shots/2016/05/26/478878991/its-still-hard-to-get-birth-control-pills-in-california-without-a-prescriptionhttp://www.pharmacytimes.com/publications/issue/2016/november2016/pharmacists-prescribing-birth-control-improving-access-and-advancing-the-profession
http://www.npr.org/sections/health-shots/2015/06/05/412226430/california-women-can-soon-go-right-to-the-pharmacist-for-birth-control

America is Overdosing: Combating the Opioid Epidemic

We have all heard of the newest epidemic sweeping the nation: opioid abuse. Day after day we hear of people overdosing on products like oxycodone, heroin, and even new illegally synthesized fentanyl. It is estimated that every day about 46 people die from an overdose of opioids. However, opioids have been around for centuries and have been used in many pharmaceutical preparations. How did this epidemic rise and who is to blame for all these deaths?

Results from the National Survey on Drug Use and Health showed that almost 2 million Americans, 12 years or older, misused or abused opioid pain relievers in 2013. Since then there has been an upward trend in the number of patients abusing their prescriptions. There are many factors that have contributed to the increased access to opioid prescriptions and the potential for abuse. The rise in deaths can be attributed to poor prescribing habits, the 300% increase in prescription opioid sales since the year 1999 and the improper disposal of medications leading to diversion. The next natural approach to combat the opioid epidemic is to crack down on prescribing habits. Opioids that became harder to obtain by prescription had people who became addicted turn to the streets for their next fix. Data indicates that misuse of prescription opioids was a significant risk factor for heroin use. Heroin use has become much more common. As a result, there was a rise in HIV and hep C infections in many areas across the country. Health care professionals are stepping up to recognize the signs of misuse and get patients the help that they need.

How can we as future pharmacists combat this rise in opioid and illicit drug use? Educating patients is the best place to start! We can use our great communications skills to educate our patients about opioid misuse, proper disposal of unused medications, and be able to recognize addiction and help patients get the treatment they need. More importantly, those who have prescriptions for opioids commonly get naloxone to reverse the effects of an opioid overdose in the case of an emergency. Pharmacists can work together with the patients family members or caregivers to make sure that they can recognize a drug overdose and properly administer the drug. Additionally, checking statewide databases such as MAPS can be an effective tool in identifying patients who may doctor shop or fill at many pharmacies which may be signals of drug abuse or diversion. Pharmacists are major players in the fight to combat the opioid epidemic.


http://www.pharmacytimes.com/publications/health-system-edition/2016/may2016/opioid-addiction-and-overdose-new-legislation-and-how-pharmacists-play-a-critical-role-in-the-epidemic

http://www.pharmacytimes.com/conferences/ashp-midyear-2016/ashp-midyear-pharmacists-can-take-lead-on-addressing-opioid-crisis

https://www.cdc.gov/drugoverdose/epidemic/

Dr. Pharmacist: Saving the World from Drugs

A middle aged woman came up to my pharmacy counter and asked for my supervisor.  She wanted to report the nurse practitioner who works in the Minute Clinic adjacent to my pharmacy for not prescribing her antibiotics.  According to the customer, this was the second time she had been to the clinic in one week with complaints of a persistent cough.  Both times, the nurse practitioner followed protocol and deduced that the patient did not have a bacterial infection, and therefore did not need antibiotics.  The patient, already having her mind set on receiving antibiotics, stormed to a nearby urgent care clinic that is notorious for corralling patients in and out with a Cipro prescription, and came back about an hour later to pick up her antibiotics.  According to the urgent care, the patient had walking pneumonia, which they had determined without doing a chest x-ray, blood test, sputum test, or any kind of diagnostic measures to tell if the patient even had a bacterial infection, let alone which kind of bacteria.

As the patient continued to complain to my pharmacist while we filled her prescription, it was obvious that the pharmacist doubted the validity of the diagnosis as she informed the patient that the antibiotics were probably not necessary, and that a treatment for cough would likely do the trick.  My pharmacist, being the treatment expert, knew the exact requirements for diagnosis and treatment of walking pneumonia, yet dispensed the prescription anyway because that's what pharmacists do.

In this instance, had the pharmacist had more discretion over the situation, the patient would not have received the unnecessary antibiotics, and that would have been one less person contributing to antibiotic resistance and putting herself at risk for secondary complications and readmittance to a clinic.  There are countless other cases where a pharmacist's knowledge has the potential to prevent a patient from receiving an unnecessary or harmful drug, and in most institutions, especially in the outpatient or community setting, pharmacists simply do not have the power to intervene with or override the decisions of a doctor.  This is why the full potential of a pharmacist needs to be recognized, accepted, and implemented in all pharmacy practice, The push for provider status is at least a legal step closer to this, but I believe that an additional component needs to be considered; that is that the clinical knowledge and drug expertise of pharmacists should be regarded as equal to that of a medical doctor, and that community pharmacists should have the power to refuse to dispense any prescription that they believe is not in the best interests of the patient without first having a thorough, logical discussion with the prescriber and the patient.

This partly is a challenge due to the legal implications of a dispensing pharmacist's duties, but is also largely related to a pharmacist's own perceptive on his or her job, and the unfortunate business and corporate need to use community pharmacies purely as a revenue-generating resource.  Individually, community pharmacists should realize that their value as a health care provider is much more than someone to simply bag and sell prescriptions (after all, are we really going through four years of pharmacy school just to count pills and follow alerts on a screen?).  With this realized, a pharmacist can use his/her clinical knowledge to the extent that a doctor does, and could truly make an impact of treatment choices as a double check for the doctor.  From the corporate vantage point, more large businesses should shift their focus from the money involved with prescription counts to the importance of time and energy spent on patient care.  Companies need to allow their pharmacists time to really analyze each prescription in order to determine its appropriateness and safety, rather than just automatically verifying each one to be sold.

Medicine is a powerful field.  With great power, though, comes great responsibility, and in the community setting, I believe that pharmacists and health care companies have a responsibility to dedicate time and knowledge to each patient in order to get the right drugs to the right patients for the right reasons, and to know when to intervene and not dispense a prescription as well.

Defunding Planned Parenthood; Defunding Public Health

“Communities and countries and ultimately the world are only as strong as the health of their women”, (Michelle Obama). Women power half of the United States population. Yet, it is still astounding how little they represent in their opinions, ideas, and beliefs when it comes to public health. Today’s world is populated by the thought of a few that affects many, whom have little say in these effects. Planned Parenthood is a nonprofit organization founded on the belief that all members of society should have legal and political protection of reproductive rights.1 They provide numerous reproductive health services to create a network of support for these individuals. Some services they provide include birth control, long-acting reversible contraception, emergency contraception, cancer screenings, pregnancy testing, sex education, vasectomies, and many other services. However, there exists a strong opposition to this organization on the basis of minute aspects.

Opposition stems from the fact that Planned Parenthood provides abortions, a popular topic that many do not support. Some view abortions as a truly unethical procedure that infringes on life itself. This has driven public demonstrations and governmental policies to attempt to halt any and all federal funding to Planned Parenthood. This, however, is still a baffling reality that comes from a single action that is done by this organization. It has been stated that they are the most significant provider for this procedure, but it is only a subset of their services.3

Out of all the clinics, only half of Planned Parenthood perform this service, and it is also a very small part of their operations. Many people who oppose planned parenthood oppose the fact that one can take a life away through this procedure, yet this force of opposition against abortions is actually taking away the life of two. The woman that has come to terms, through careful thought, that this is the best course of action may now not be able to have this procedure. First of all, there must be a strong reason to have considered this last resort option: may it be it was a truly unwanted, accidental pregnancy or simply a child that the mother is unable to take care of. I have always had the mindset of do what I want and let others do what they want if it’s to their best intentions. Another person’s beliefs and views should not obstruct others in obtaining something that could save their lives. This is not the only case where two lives are affected, both the mother and potential child. In defunding Planned Parenthood, access is restricted to healthcare that may be essential to some women. Contraceptives, clinical testing, and education are among the most helpful resources that are provided. Studies have shown that in areas where funding has been restricted at a local level, pregnancies and births increased and the use of contraceptives decreased.2 It seems so wrong to pry away these beneficial services that allow for a better quality of life and outcome in public health, yet so many people are blindsided by a very small portion of what Planned Parenthood can do.

Restriction of access will be detrimental to many others in the population as well. With fewer women using contraception in addition to less sexual education provided by Planned Parenthood, there can be a higher incidence of STIs, which can spread to many members of the community. Additionally, there can also be an increased amount of dangerous abortions occurring. Limiting the safe access to this procedure will only promote the search for an alternative and much more risky alternative. As such, the defunding of Planned Parenthood with the aim of reducing the incidence of a single aspect of the organization will spiral into a multitude of other problems. Although I may not need these services, and some others may not as well, it is not my place, nor anyone else’s to say that they should not have access to it, especially if their life depended on it. The fixation and the desire to eliminate abortions allows one to justify this rash decision, one that will ultimately cost the public its health.

1. Lawrence, Jason. "Legislators, Planned Parenthood debate abortion". The Galveston County Daily News. Archived from the original on May 12, 2011. Retrieved February 14, 2011.
2. Stevenson, A., Flores-Vazquez, I., Allgeyer, R., Schenkkan, P., Potter, J. “Effect of Removal of Planned Parenthood from the Texas Women’s Health Program”. N Engl J Med. 2016; 374: 853-860.
3. http://www.npr.org/sections/health-shots/2017/01/15/509662288/that-vow-to-defund-planned-parenthood-easy-to-say-hard-to-do