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Brainstorm Health Daily: May 23, 2017

May 23, 2017

Greetings. This is Laura Entis, filling in for Sy (who is on a well-deserved tropical vacation.)

This afternoon, World Health Organization members from 194 nations will vote to elect the agency’s next leader, putting an end to what has been a high-profile, political, and at times, ugly campaign. The race, which is believed to be a toss-up, is between Tedros Adhanom Ghebreyesus of Ethiopia, David Nabarro of the United Kingdom, and Sania Nishtar of Pakistan. Later today, each will briefly address the assembly, gathered in Geneva, before ballots are cast.

The winner will shape the organization’s efforts to improve global health, an enormous challenge. Issues on the table include: preparing for health emergencies (from the next Zika and Ebola to a potential globe-spanning influenza outbreak), antimicrobial resistance, access to medicines and vaccines, adolescent health, chemicals management, and climate change. And that’s far from an exhaustive list.

He or she will also take the reins of a cash-strapped agency embroiled in controversy. Earlier this week, the Associated Press placed the WHO’s annual travel budget at around $200 million (a sum that includes business class tickets and five-star hotel bookings), which is more than the agency spends on combatting AIDS, hepatitis, malaria, and tuberculosis, combined.

The position is an hugely important one, and the spotlight can be (appropriately) glaring.

Here are the candidates:

Tedros Adhanom Ghebreyesus of Ethiopia. While the race is expected to be close, Tedros might have an edge as he’s unanimously backed by the African Union (which will cast 54 votes). The former health minister of Ethiopia is also backed by ex-CDC director Tom Frieden.

Tedros’ campaign hasn’t been without controversy, however. Earlier this month, the New York Times published an article detailing accusations that, as Ethiopia's health minister, Tedros covered up multiple cholera outbreaks by labeling them “acute watery diarrhea.” The charges reportedly originated from backers of David Nabarro—who also happens to be running for the director-general position. Tedros lashed back at these accusations, telling the Times that Nabarro’s supporters have a “typical colonial mind-set aimed at winning at any cost and discrediting a candidate from a developing country.” (Frieden has since come to Tedros’ defense.)

David Nabarro of the United Kingdom. Despite the controversy above, Nabarro is a well-respected and long-time public health specialist, who is closely associated with the UN, where he has worked to address multiple crises, including the 2014-16 Ebola outbreak in West Africa and the ever-present threat of influenza.

Sania Nishtar of Pakistan. A cardiologist and specialist in noncommunicable diseases, Nishtar is also the founder of Heartfile, a non-profit NGO that works to bring sophisticated cardiovascular treatment to third-world countries. She has promised to run only for a single term, according to the Chicago Tribune, as a precaution against politicking. Considered a long-shot—her candidacy is opposed by China and India—she could prove the upset victor if neither of her opponents is able to secure enough votes to win in a single round.

More news below.

DIGITAL HEALTH

Researchers uncover 40 genes connected to human intelligence. Identified via a large-scale study involving 60,000 adults and 20,000 children, the discovery means scientists have now identified 52 genes that play a role in intelligence. To be clear, this is just the tip of the iceberg -- hundreds, possibly thousands, of genes are believed to shape IQ, and genetics are just have the equation (Previous research on twins indicate environmental factors account for the rest.) (Guardian).

INDICATIONS

Puma Biotechnology’s stock is up. Shares surged after the FDA released the briefing documents it will use to review the company’s breast cancer drug, neratinib. They reveal promising results: in a clinical trial, the drug reduced the recurrence of breast cancer within two years from 8.1% to 5.8%. But the documents also highlight concerns, including side effects (diarrhea, in 95% of patients) and, more seriously, whether modifications made to the clinical trial rendered the results statistically invalid. (Forbes)

THE BIG PICTURE

The president’s budget draft slashes medical and health funding. The cuts are many, and they are deep. The proposal would cut Medicaid spending by $800 billion, and food stamp spending by $192 million over the next decade. For 2018 specifically, cuts includes: $4.8 billion from the National Institutes of Health (including $1 billion from the National Cancer Institute), $222 million from the CDC’s chronic disease prevention program, $82 million from the agency that works on vaccines for respiratory diseases, and $850 million from the FDA (although the proposal states this loss will be offset by $1.3 billion collected in fees from drug and device makers in exchange for product approval.) (The Washington Post. The New York Times.)

Trump asks an appeals court to delay a major decision on health care. The administration, along with congress, filed a motion to delay a court hearing that would whether the government will continue to cover health subsidies for low-income people, payments that help offset costs incurred by insurers. Without them, experts predict premiums could rise by 15% to 20%.(The New York Times)

Lawyers and venture capitalists take on depression. Both professions -- high stakes, all-consuming, often dependent on maintaining an image of mental toughness -- have long resisted discussing the mental health issues roiling beneath the surface. But there are subtle signs this is changing. As the Wall Street Journal reports, some law firms in the U.S. are offering on-site psychologists in an attempt to destigmatize depression, addiction, and anxiety (lawyers are significantly more likely to experience signs of depression than the general population.) Similarly, a number of high-profile entrepreneurs and venture capitalists, both professions that require an outward projection of confidence, are opening up. Chief among this group is Techstars co-founder Brad Feld, who has repeatedly -- and candidly -- shared his experiences with depression and anxiety. On Thursday, Feld is holding an AMA on the topic in honor of mental health awareness month. (Wall Street Journal)

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