from the when-it-really-does-make-sense-to-"think-of-the-children" dept.
Surgery For Saving Babies From 'Water On The Brain' Developed in Uganda
Traditionally doctors treat hydrocelphalus in the U.S. with what's called a shunt: They place a long tube in the baby's brain, which allows the liquid to drain into the child's stomach. But a third of the time, these shunts fail within two years, says Dr. Jay Riva-Cambrin, a neurosurgeon at the University of Calgary. "Imagine buying a car and having the dealer tell you, 'By the way, there's a 40 percent chance the car won't be on the road in two years.' You'd be like 'No way.' "
That failure rate is tolerable here in the U.S. because children can be rushed quickly to a hospital for emergency surgery to fix the shunt, says Dr. Benjamin Warf, a neurosurgeon at Harvard Medical School, who led the development of the new method at a clinic in Mbale, Uganda. "Some kids wind up having dozens of these shunt operations over over[sic] the years," he says. But for many kids in rural Uganda — and other poor countries — emergency neurosurgery isn't an option. "They're going to die from a shunt malfunction," Warf says. "I can't put a shunt in a baby and then send them back to a rural village in western Uganda or southern Sudan because it would take days to return to the clinic."
So Warf and his colleagues decided to innovate. They took a technique that works in adults and then tweaked it a bit so that it would have a better chance of working with babies. In the new method, doctors basically poke a hole in the brain's chambers so they can drain. They also prevented the chambers from filling back up by partially damaging the region of the brain that produces spinal fluid.
The team knew the procedure fixed the hydrocephalus. They could see that the babies' brains stopped swelling. But the big question was whether or not the method could prevent brain damage as effectively as shunting does. After 15 years of testing and optimizing, he and his team can finally say that their approach — at least in the short term — appears to be just as effective as the procedure commonly used here in the U.S. In the study, Warf and his colleagues tested the two methods on about 100 children in Uganda. After 12 months, the doctors couldn't detect a difference in the children's brain volume or cognitive skills.
Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda (open, DOI: 10.1056/NEJMoa1707568) (DX)
(Score: 1, Insightful) by Anonymous Coward on Sunday December 24 2017, @05:06PM (13 children)
Because the patients can't sue if something goes wrong from the surgeons hacking around?
(Score: 5, Informative) by JoeMerchant on Sunday December 24 2017, @05:31PM (8 children)
Because Ugandan surgeons aren't incentivized to do expensive, shoddy work that leads to expensive life-or-death followup surgeries.
Expect 20+ years before this procedure is even considered for replacing the current shunt cash cow.
BTW, they don't only fail in the first 2 years - had a friend who had a diving accident at 18, needed a shunt, got a shunt - worked great, until she was 28. Through her 30s she averaged over 1 surgery a year attempting to get a replacement shunt working. Over a dozen surgeries for a single patient, a cool $500K in reimbursements to the doctors and hospitals.
🌻🌻 [google.com]
(Score: 2) by JoeMerchant on Sunday December 24 2017, @05:33PM
Top search result jives with my off-the-cuff recollections:
https://www.ncbi.nlm.nih.gov/pubmed/15617596 [nih.gov]
🌻🌻 [google.com]
(Score: 3, Insightful) by eravnrekaree on Sunday December 24 2017, @07:33PM (3 children)
It may have to also do with how risk averse they are in the USA to try something new, for fear of massive malpractice lawsuits if it didn't work. So, they tried it in some third world country without all of the red tape and expensive litigation. Maybe thats the trick to getting this stuff proven and approved faster.
(Score: 3, Interesting) by JoeMerchant on Sunday December 24 2017, @08:29PM (2 children)
This is the legal shrine of "the standard of care." As long as you are using "accepted best practices" while delivering "standard of care" for the accepted diagnosis, everything flows smoothly on the money side of things. Does f-all for actual patient care and outcomes, but mountains of data can't be argued against in a court case, so that's what out physicians do, not think, not practice, diagnose as best they can, then follow the data to get a lawsuit protected paycheck.
Thus: 20 years (from now) before a clearly superior Ugandan procedure collects enough data to start to swing the needle in US practices. Mind you, they've already got 15 years of Ugandan data, but that's just enough to get a mention in the US press, not enough to start US trials.
🌻🌻 [google.com]
(Score: 2) by jimshatt on Monday December 25 2017, @01:10AM (1 child)
We're not talking about switching to another programming language for your website.
(Score: 3, Interesting) by JoeMerchant on Monday December 25 2017, @02:18AM
Transparency, not oversight, but available insight and review of decisions made.
The real problem with this is that it terrifies everyone because they cover so much bad decision making over with the shroud of "patient privacy" and general lack of access to the data. I'm o.k. with the fact that human beings screw up, I'm o.k. with the fact that it happens all the time, what I want is to be able to shine a light on the decisions that my doc has made and compare them to the decisions that other docs have made in similar cases and compare outcomes.
I had a Thenar flap procedure done in ~2012... according to literature I found from the 1970s, this used to be a local anesthesia procedure with a projected recovery time of ~2 weeks. I had general anesthesia, a clearly visible bone-chip left in the wound on the morning-after X-ray, and 6 weeks later, I'm still in therapy, the crap is not getting better, and nobody is letting on like this is anything unusual at all... That's what I really want to stop, the: "oh, he's the greatest doc, you're doing fine, you're getting the best possible care" B.S. when I'm presently faring in the bottom 5% of expected outcomes, and 15% of Mr. Wonderful's patients are right down there with me getting a 6 week course of IV antibiotics for a case of osteomyelitis that should never have happened in the first place.
What I want is a realistic picture, clear data showing expected outcomes before making a treatment decision, and accurate performance data tracking after the fact.
🌻🌻 [google.com]
(Score: 2) by frojack on Sunday December 24 2017, @09:33PM (2 children)
Odd this story is followed immediately by the "Black Hole" of Accountability for Drug Trials Flouting FDA Oversight? story. (or maybe it was Takyon balancing the scales).
Still, your friend "had a diving accident". That means trauma damage, which is totally different from a birth condition.
She may have qualified for the method mentioned in this story which was already used on adults.
I'll take your testimony and your copious medical degrees as sufficient proof that her doctors were buffoons. Clearly any fool can see her doctors should have just poked a hole in the brain's chambers so they can drain and damaged the region of the brain that produces spinal fluid.
No, you are mistaken. I've always had this sig.
(Score: 2) by JoeMerchant on Sunday December 24 2017, @10:03PM
The diving accident was around 1990, so predating all of this - not calling her doctors buffoons, though one has to wonder after the 10th revision surgery... OTOH the orthopedist who knowingly left a bone-chip in me only to have it start spouting green pus 6 weeks later (a completely predictable outcome) - were I inclined to lawsuits, he was ripe.
My point in both of these anecdotes is: the system rewards the continuation of practices that are highly reimbursed, like multiple shunt revision surgeries, or going back in to get rid of the bone chip that was clearly visible on the first post-op X-ray. These MDs in Uganda have different motives (like, not killing their patients), and have found a different way that works, but it will be a long time before the US medical community picks up on the idea that this is a good thing.
Makes me think of the film about the Ketogenic diet... another non-compensated treatment option that is usually rejected by the establishment - to the point of intimidating patients and their caregivers into destructive lobe-ectomies before even trying the diet.
🌻🌻 [google.com]
(Score: 2) by takyon on Monday December 25 2017, @12:13AM
I had no specific agenda other than "hey Uganda is pioneering a medical technique" and "hey another article about Peter Thiel lol". And the second was on STAT News [statnews.com], a feed with some good content amid a sea of paywalled stories. 💉💊💀
[SIG] 10/28/2017: Soylent Upgrade v14 [soylentnews.org]
(Score: 3, Interesting) by Runaway1956 on Sunday December 24 2017, @07:57PM (1 child)
Uganda? One doesn't think of medical innovations coming from Uganda. TRIGGER WARNING, LMAO!! I don't even think of medical innovations coming from most of the African continent. South Africa, maybe, or Egypt, but not most of the continent.
But, why not? All it takes is one bright individual, or a small group of intelligent people. It seems that they could presume the baby's chances of survival were low anyway. Why not try something that just might work?
(Score: 2) by frojack on Sunday December 24 2017, @09:36PM
Uganda? One doesn't think of medical innovations coming from Uganda.
No, you are mistaken. I've always had this sig.
(Score: 0) by Anonymous Coward on Sunday December 24 2017, @09:19PM (1 child)
Hospitals in the US have no incentive to make permanent solutions when they can make more money on temporary fixes.
In for profit healthcare profit comes first.
(Score: 0) by Anonymous Coward on Sunday December 24 2017, @11:24PM
How could anyone possibly make money by having more effective solutions than the competition?/sarcasm
Please point me to some evidence that shows hospitals colluding to provide temporary fixes instead of permanent ones.
(Score: 2) by requerdanos on Sunday December 24 2017, @11:27PM
I know that the proverbial car analogies are often helpful, and slightly humorous.
But "Dead Baby Car Analogies" -- I am not sure I can get behind a thing like that.
---
* I've bought several cars whose two-year life expectancies were questionable. All depends on where you are in life. I did not think of them as "Dead babies" at the time.
(Score: 3, Interesting) by BK on Monday December 25 2017, @03:29AM
Just to be clear here, the doctors in this case are causing deliberate brain damage. Now admittedly, it's that or death (due to shunt failure) in most cases, so the moral case for their actions is pretty unambiguous, but it's not hard to understand why this hasn't been adopted everywhere.
...but you HAVE heard of me.