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The Hitchhiker’s Guide to the Healthcare Galaxy

What do people do when they get the first indication that they might be seriously ill? What do they do next? Where do they go from there?

Such questions are increasingly being asked by public health scholars, ethnographers, and medical anthropologists who are studying the so-called “therapeutic itineraries” of everyone from malaria sufferers in Gambia to diabetics in Brazil.

Nearly all the research, so far, has been done the old-fashioned way: by interviewing people. When three researchers asked 12 breast cancer patients from central Mexico, for instance, what each did right after discovering a lump in her breast, the women’s answers revealed a dozen different health care routes—paths that led, in some cases, to markedly different outcomes. Some women got their definitive cancer diagnosis within three months of discovering a suspicious lump, others not until 18 months later.

Therapeutic itineraries can help pinpoint the weak joints in a given healthcare system, the barriers and bottlenecks that delay care or limit access to it. They can also reveal failures in communication that, if corrected, might dramatically improve outcomes.

Consider the case of malaria. Despite significant progress made against the disease over the past decade, it remains endemic in much of Africa. One still-unsolved problem is that infected individuals who come late to treatment can serve as a reservoir for new infections. And a recent study of therapeutic itineraries of infected individuals in rural Gambia, led by Sarah O’Neill of the Institute of Tropical Medicine in Antwerp, shows at least one reason it’s often hard to find and treat them earlier.

In some West African traditions, the graver symptoms of severe malaria—disorientation, fainting, convulsions—are thought to be caused by non-human spirits, and so a common first stop is to a traditional healer rather than a modern health clinic. Even the term “malaria,” O’Neill and her colleagues explain, is “considered to be a ‘toubab’ (meaning ‘white man’) word.” The underlying sickness is described differently by the Mandinka people and the Fula, and by the Soninke and the Wolof—and in ways that don’t always translate to either the same disease or the same urgent message: “Go to the clinic right away.”

Healthcare activities are social responses organized to face diseases and can be understood as a cultural system,” write two itinerary trackers from Brazil. That system includes not just the providers of modern medicine—the people and institutions we mostly focus on—but also our families, friends, social networks, search engines, online communities, and more.

Think about that a minute: Healthcare activities are inherently social—informed by social rules and customs.

And what that means, dear Daily readers, is that any broad-based public health intervention that doesn’t address that component isn’t likely to succeed.

Happy Friday.

Clifton Leaf
@CliftonLeaf
clifton.leaf@fortune.com

DIGITAL HEALTH

Diabetes reversed in mice with assist from rat-grown pancreases. Researchers at Stanford University and the University of Tokyo were able to successfully reverse diabetes in mice by growing pancreases in rat embryos. The embryos, which were genetically modified to prevent them from growing their own pancreases, were injected with mouse pluripotent stem cells that formed into a pancreas. (The reason for growing the organ within a rat rather than a mouse was that the scientists needed to produce enough insulin-producing cells to reverse diabetes’ effects in mice.) Then, taking just a small number of “islets,” or distinct tissue clusters that form insulin, and inserting them into the mice was able to successfully reverse the diabetes. The new tissue wasn’t rejected since they stemmed from the mice’s cells in the first place. “We found that the diabetic mice were able to normalize their blood glucose levels for over a year after the transplantation of as few as 100 of these islets,” said Dr. Hiromitsu Nakauchi, a professor of genetics at Stanford, in a statement. “Furthermore, the recipient animals only needed treatment with immunosuppressive drugs for five days after transplantation, rather than the ongoing immunosuppression that would be needed for unmatched organs.” Now for the inevitable caveat: there’s still a lot of work to be done before this type of technique could be applied to larger animals like pigs, sheep, and (potentially), one day, humans. (FierceBiotech)

Trump nixes Obamacare advertising in final days of open enrollment. The Obama administration had already paid for a last-minute television and digital advertising spree to cover the final weeks of open enrollment for Obamacare. But the Trump administration has put the kibosh on that plan, withdrawing $5 million in ad funding less than a week before the signup deadline. This could be especially harmful to the stability of the statewide individual insurance marketplaces because enrollment tends to surge just ahead of the January 31 cutoff, especially among younger people who put the task off until the last minute. “We know that more young people enroll during the final days of open enrollment, but they need to be reminded of the Jan. 31 deadline,” said former Healthcare.gov CEO Kevin Counihan, who called the decision “outrageous.” Obamacare signups have surged since Trump’s election, with 11.5 million Americans signing up through December 24. (Fortune)

INDICATIONS

Biogen issues a mixed bag earnings update. Biotech giant Biogen is scaling back its 2017 earnings guidance after a Q4 2016 which missed revenue expectations by about $65 million. Biogen is now projecting that it will pull in revenue of $11.1 billion to $11.4 billion in 2017. And much of the company’s fate will rest on Spinraza, a new muscular atrophy drug that comes at a steep list price of $750,000 for the first year of treatment. The company’s 2016 revenues totaled $11.4 billion. One of its flagship treatments, the multiple sclerosis therapy Tecfidera, saw a nice 9% spike in 2016 sales – but this was at least partially due to a price increase on the drug.

Novartis’ biosimilar of Amgen best-seller Enbrel won’t hit the market until 2018. Novartis generics unit Sandoz scored a major victory when the FDA approved its biosimilar version of Amgen’s Enbrel, which brings in nearly $5 billion in yearly sales in the U.S. alone. The copycat therapy, Erelzi, won’t be able to hit the market for at least another year thanks to the ongoing patent spat between Novartis and Amgen over the drug (Amgen claims that Enbrel has IP protection through 2029). “[The legal fight] won’t really reach a conclusion until 2018,” said Sandoz head Richard Francis in an interview with Reuters. “That’s the frustration sometimes of the legal situation, but the way I look at that, we’re carving the landscape out as we go.” There are still a number of unresolved legal issues surrounding biosimilars, which have only been around in the U.S. since 2015. Novartis and Amgen are actually key players in this battle, with a separate legal case over when biosimilar makers must give their branded counterparts a six-month notice heading to the Supreme Court. (Reuters)

THE BIG PICTURE

The NFL’s concussion problem isn’t getting a whole lot better. Just ahead of this weekend’s Pro Bowl matchup between the runners up of the NFC and AFC football conferences, the NFL has revealed that player concussions remain a major problem despite recent rule changes attempting to protect players’ health and safety. The league announced that there were 244 concussions in 2016. That’s a dip from the 275 such injuries logged in 2015 but a far cry from the 206 and 229 concussions in 2014 and 2013, respectively. Repeated head injuries such as these concussions have been linked to eventual brain damage – a fact that the NFL only publicly admitted last year. But at least one rule change appears to have improved the numbers: touchbacks have only resulted in 17 to 20 concussions over the last several years, about half the injuries compared with pre-2011 seasons when that play moved the ball to the 20-yard rather than 25-yard line. (Wall Street Journal)

Trump’s border wall import tax would hit medical supplies. President Donald Trump’s administration floated a rather controversial idea on Thursday for how to pay for his infamous border wall with Mexico: a 20% tax on Mexican imports. But such a broad and steep tax would hit key industries, including the medical supplies sector. As Modern Healthcare notes, the U.S. imports more medical, surgical, dental, and veterinarian instruments from Mexico than it does from any other country, with more than $5.4 billion worth of these supplies coming in from the nation between January and November of 2016 alone. White House Press Secretary Sean Spicer has said that the import tax is not an official policy proposal, but rather an example of how Mexico could be forced to pay for the wall. (Modern Healthcare)

REQUIRED READING

How Amazon’s Success With Echo Threatens Apple’s Smart Home Strategyby Reuters

Stanford’s Artificial Intelligence Is Nearly As Good As Your Dermatologistby Sy Mukherjee

Companies Issue More Stock Options When They’re Committing Fraudby David Z. Morris

Trump Urges GOP Congress to Move Swiftly On His Agendaby Reuters

Produced by Sy Mukherjee
@the_sy_guy
sayak.mukherjee@fortune.com

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