Let prevention be my cure!

Thursday, 27 February 2014 00:56 -     - {{hitsCtrl.values.hits}}

Our expenditure on medical services is becoming quite significant and when considering the fact that much of it is sourced from overseas, from tablets to syrups to instruments, being healthy surely means a wealthy nation. This is of course by allowing people to have more disposable income to be spent on other things. ‘Prevention is better than cure’ is an oft-quoted statement and this is true from healthcare to environmental management. The philosophical aspect of this statement can be extended to many other areas. ‘A penny saved is a penny earned’ quantifies the philosophy of this statement – however, quite often quoted when observing events and practices we appear to be adhering to anything but that. However, for some action-oriented personnel with limited analytical power, issues should be present for their self worth to be shown and today we do have a society where the importance of prevention brought through the ability to analyse, understand, plan and then execute activities has become limited. ‘Fools rush in where angels fear to tread’ and we have many a situation where zeroes try to be heroes, first by creating a situation and then trying to show their self worth by designing solutions. Sadly, the majority of the populace may understand problem solving capability when demonstrated in this manner. Pollution prevention Pollution prevention pays became a big hit when 3M, a US corporate giant, identified its environmental strategy based on that mantra and the acronym 3P is well known today.  Dr. Joseph Ling VP of 3M achieved fame and is today considered the father of pollution prevention for his pioneering efforts in this area having initiated 3P – Pollution Prevention Pays. The global environmental movement as a result shifted from pollution control to pollution prevention strategies. You prevent what you can and then treat what you cannot became the fashionable way forward within the West’s environmental movement which started in the early 1970s. End-of-pipe treatment (what is happening when you only install a wastewater treatment plant to the end of the pipe carrying all your wastewater or sewage) to process integrated waste minimisation was a big and a profitable way forward. American aid organisations too were quick to roll out the strategy through their donor programs and Sri Lanka witnessed the push in this direction in the mid 1990s. Vaccination The value of pollution prevention is unquestionable. Similarly, the value of a vaccine over an antibiotic is equally unquestionable. How vaccination has supported global health strategy is well-known and the singular objective of vaccination is allowing prevention to be my cure. The emergence of vaccination had its heroes, ‘true heroes’ in this situation, as the first to understand and pursue vaccination, Edward Jenner, actually injected his own son in search of the vaccine which he eventually gifted to the world. He also self-funded his work. Today multiple layers of administrative, technical and ethical related steps have come in when carrying out medical research with human subjects as greed on potential has entered the medical and commerce arena. Vaccine to prevent heart attacks It is indeed interesting to hear the recent news that came out of the life science research in India recently. Bangalore’s Thrombosis Research Institute is said to be in a position to roll out a candidate vaccine – yes, a vaccine – to prevent heart attacks within a period of three years. This is a research project started out by Prof. Vijay V. Kakkar in 1999 and is known as the Atherovac Project. Prof. Kakkar is not an unknown in medicine as his work on blood clots and blood thinners has won international accolade. "Considering that cardio vascular diseases are becoming almost the No. 1 issue in non-communicable diseases, this research should be fantastic news to many. Imagine being able to vaccinate yourself against potential heart disease. The news further states that the vaccine should be equally effective in preventing strokes too. Vaccine availability means a leading cause of mortality becoming a non-event" This is research that is happening in three places from Bangalore to London to the University of Szeged in Hungary. Prof. Kakkar originally started the Thrombosis Research Institute in London in 1989 with the objective of developing cost effective preventive solutions. There is always an original idea and some eureka moments in an endeavour of this nature. A vascular surgeon, Prof. Kakkar knew that inflammation is an important factor of heart disease. The exact nature and the linkage are still debated but studies have gradually pointed to infection to play a role. Once a hypothesis is formed, the research started in earnest. It is stated that during the past decade many research papers by several groups, i.e. in Sweden, Netherlands, etc., have been published indicating the connectivity between the immune system acting against the body’s own constituents and heart attack and stroke. Then the possibility opens up – how can one control the immune system and then take charge of inflammation, considered to be a leading issue for disease? The emergence of a vaccine may see the last word on this debate and that is the direction Prof. Kakkar has taken with his international team. Fantastic news Considering that cardio vascular diseases are becoming almost the No. 1 issue in non-communicable diseases, this research should be fantastic news to many. Imagine being able to vaccinate yourself against potential heart disease. The news further states that the vaccine should be equally effective in preventing strokes too. Vaccine availability means a leading cause of mortality becoming a non-event. This is indeed research work of the highest relevance and considering the line of thinking the hypothesis on which the work is based on, Prof. Kakkar and his team’s work, if successful, would qualify to Nobel Prize candidate status without any issue. It is also interesting to note the change that the emergence of a vaccine in this area would do in the society at large. The CVD sector in the medicare and medical industry including the insurance sector involves significant investments and current services from an investment point of view generate definite positive returns on investment. The disease patterns have led to the understanding of potential patients in time to come, which forms the basis for investment analysis. All these are likely to change with the emergence of a vaccine. Thus this has the potential to be a disruptive innovation as a paradigm shift in practice has to take place. It is also interesting to consider whether people moving away from lifestyle practices which are promoted from a healthy heart perspective would be made redundant as the vaccine is able to tackle plaque, etc., and what was once quite challenging to address would no longer be the case. Also imagine the situation if an AIDS vaccine was introduced into society and AIDS was no longer an issue! Traditional medicine In Sri Lanka we do have strict demarcations between traditional medicine and Western medicine, unfortunately to our disadvantage. Hospitals and ministries exist separately, catering almost as to support different tastes. This parting of our ways had been quite unfortunate as there is so much to gain by working together and understanding the value of both knowledge systems. Traditional medicine has evolved over many years and there is a substantial body of knowledge within the community of practitioners. Dr. Mashelkar, who spearheaded the Indian research transformation, introduced the concept of traditional medicine, modern medicine and modern science. This is known as the ‘Chitrakoot Declaration’ in India. Lots of insight generated over thousands of years of practice could be subjected to analysis via the modern tools becoming available through modern science. It is not being a heretic to use a microscope to observe a differently healing process. Today there are tools which can visualise the six carbon atoms in a benzene ring and that is some visualisation capability. One can study how reactions happen in real time and one can understand this is quite an achievement when considering that these timescales are much less than a nano second and a nano second is one billionth of a second! That these tools and technique can throw light on many areas of existing knowledge is unquestionable. Modern science has extended the capability of an individual and it is really unfortunate if one turns one’s back on an opportunity. It is again important to consider that while we may be distancing ourselves from our own knowledge systems, the West had been much more accommodating pursuing the knowledge existing elsewhere. We may indeed have a heart-warming development with the possible emergence of a vaccine. The pursuit is also indicating to us few lessons – international cooperation, committed pursuance of a concept, extended support against ‘I want results tomorrow if we are to support concept,’ not-for-profit research, etc. We wish Prof. Kakkar success and hope that society understands the importance of prevention rather than sensing unbridled consumerism as an opportunity due to the emerging possibility of enabling one to be in more control of one’s arteries. (The writer is Professor of Chemical and Process Engineering at the University of Moratuwa, Sri Lanka. With an initial BSc Chemical engineering Honours degree from Moratuwa, he proceeded to the University of Cambridge for his PhD. He is the Project Director of COSTI (Coordinating Secretariat for Science, Technology and Innovation), which is a newly established state entity with the mandate of coordinating and monitoring scientific affairs. He can be reached via email on ajith@cheng.mrt.ac.lk.)

Recent columns