Quote of the Day

Ezekiel Emanual (U Penn) wrote an Editorial in this weeks JAMA titled "Where are the Health Care Cost Savings?" where he suggests that there are not enough aggregate savings in targeting malpractice costs, insurance profits, drug costs, and the "million dollar babies" to make a significant impact in US medical expenditures.

Where does he think the savings are:

"One estimate suggested that as much as 22% of all health care expenditures is related to potentially avoidable complications...reducing avoidable complications by 10% could save more than $40 billion per year."

The reference for the 22% estimate is a 2009 article by François de Brantes et al in the NEJM. What was the preventable complication example in the 2009 article? A readmission for a harvest site SSI post-CABG.

Video of the day

Here's a short video from a great organization, Clean the World. They collect leftover soap and shampoo from hotels, recycle it, and take it to those who need it in the developing world.

Chart of the day

The graph here shows the yearly number of publications found via a PubMed search using the terms "MRSA" and "active surveillance." What this means is open to interpretation, but I do sense that some of the fervor for this practice may be waning.

Death of the Mid-Career Investigator

Now that we Iowans have failed to select a candidate in the GOP caucuses, we can turn our attention to other political pursuits.  There is an important article just released in PLoS ONE by Kristin Matthews and colleagues at Rice University that describes the aging of the biomedical-research community in the US and its potential impact. 

The authors report that the average age of an NIH investigator rose from 39 to 51 between 1980 and 2008, while the average age of a new (first time) investigator rose from 36 to 42 during the same period. They also make some interesting comparisons to the average age of Nobel Laureates to determine if the rising age barriers at NIH could impact future innovative ideas and research. They found that during the same period, 96 scientists won a Nobel Prize in medicine or chemistry for biomedical research at an average age during the awarded research of 41 and 78% completed their research before age 51. They suggest that scientists do great work early in their careers but now those early careers won't be funded.

They conclude that "if nothing is done to reverse the rising age of PIs and first-time grantees, the scientific community could lose a generation of researchers, leading to an unsustainable biomedical research infrastructure and a dearth of talent participating in NIH-funded projects in the near future." I think a similar problem exists in infectious diseases and infection prevention research.

A world filled with only postdocs  (source Matthews et al PloS ONE)

Thus, there appears to be little funding or opportunity in the early and particularly mid-career period. This results in many fine and well-trained investigators leaving biomedical research in their 40's and never returning. Sure, a few lucky people will survive this pyramid scheme, but there won't be enough senior investigators in 10-20 years to mentor the next generation.

I'm not sure what the solution is or even the exact problem.  Is it ageism in scientific review committees or the lack of tenure-track faculty positions at the University level?  I suspect both of those issues are intertwined.

Source: Matthews et al. PLoS ONE 12/28/2011

Hospital epidemiologists are killing pharma

Photo: 2old2play. com

A new report shows that the hospital acquired bacterial infections market for the time period 2010 through 2017 is expected to decline by a negative CAGR of 3.4% (click here if, like me, you need help understanding a CAGR). One of the major reasons cited for this decline in the market for these antibacterial drugs is a reduction in healthcare associated infections.

If you are interested in learning more about what's in this report, click here and submit your credit card information. For only $3,500 (about the same price as a course of fidaxomicin), the report can be yours.  

Happy New Year from #Iowa #Nice

I think infection control was also invented in Iowa...

Treatment as prevention; or, the best defense is a good offense

The journal Science has selected this paper as their “breakthrough of the year”. As you know, the HIV Prevention Trials Network study 052 demonstrated that early antiretroviral therapy reduced heterosexual HIV transmission by 96%. The concept is intuitively obvious, but often we compartmentalize “prevention” and “treatment” without recognizing how crucial prompt and effective therapy can be to preventing pathogen transmission (and/or to preventing emergence of antimicrobial resistance). I suspect we can and will put together some excellent sessions on “treatment as prevention” at the inaugural ID Week in 2012.

Oh, and Happy January 2012 from this humble blog.