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An unprecedented constellation of experts—leading cancer doctors, policymakers, cutting-edge researchers, national advocates, and more—explore the legacy and the shortcomings from the fifty-year war on cancer and look ahead to the future. The longest war in the modern era, longer than the Cold War, has been the war on cancer. Cancer is a complex, evasive enemy, and there was no quick victory in the fight against it. But the battle has been a monumental test of medical and scientific research and fundraising acumen, as well as a moral and ethical challenge to the entire system of medicine. In A New Deal for Cancer, some of today’s leading thinkers, activists, and medical visionaries describe the many successes in the long war and the ways in which our deeper failings as a society have held us back from a more complete success. Together they present an unrivaled and nearly complete map of the battlefield across dimensions of science, government, equity, business, the patient provider experience, and more, documenting our emerging understanding of cancer’s many unique dimensions and offering bold new plans to enable the American health care system to deliver progress and hope to all patients.
A look at the realities of free-market medicine in America. A Yale-trained psychiatrist, Dora Calott Wang explores the seismic shifts that have shaken the entire medical profession. Through the prism of her own research and experience, readers watch as she struggles to maintain her professional standards as health care's priorities veer away from the compassionate care of patients toward improving the bottom line. And the stories of some of her patients reveal an oft-ignored human side of our besieged system. As the medical landscape changes beneath Wang, she confronts depression and exhaustion, and fights to find the balance between work and home as it becomes ever clearer that she cannot untangle the uncertain futures of her patients from her own.
A new release in the Quality Chasm Series, Priority Areas for National Action recommends a set of 20 priority areas that the U.S. Department of Health and Human Services and other groups in the public and private sectors should focus on to improve the quality of health care delivered to all Americans. The priority areas selected represent the entire spectrum of health care from preventive care to end of life care. They also touch on all age groups, health care settings and health care providers. Collective action in these areas could help transform the entire health care system. In addition, the report identifies criteria and delineates a process that DHHS may adopt to determine future priority areas.
Historically, the first observation of a transmissible lytic agent that is specifically active against a bacterium (Bacillus anthracis) was by a Russian microbiologist Nikolay Gamaleya in 1898. At that time, however, it was too early to make a connection to another discovery made by Dmitri Ivanovsky in 1892 and Martinus Beijerinck in 1898 on a non-bacterial pathogen infecting tobacco plants. Thus the viral world was discovered in two of the three domains of life, and our current understanding is that viruses represent the most abundant biological entities on the planet. The potential of bacteriophages for infection treatment have been recognized after the discoveries by Frederick Twort and Felix d’Hérelle in 1915 and 1917. Subsequent phage therapy developments, however, have been overshadowed by the remarkable success of antibiotics in infection control and treatment, and phage therapy research and development persisted mostly in the former Soviet Union countries, Russia and Georgia, as well as in France and Poland. The dramatic rise of antibiotic resistance and especially of multi-drug resistance among human and animal bacterial pathogens, however, challenged the position of antibiotics as a single most important pillar for infection control and treatment. Thus there is a renewed interest in phage therapy as a possible additive/alternative therapy, especially for the infections that resist routine antibiotic treatment. The basis for the revival of phage therapy is affected by a number of issues that need to be resolved before it can enter the arena, which is traditionally reserved for antibiotics. Probably the most important is the regulatory issue: How should phage therapy be regulated? Similarly to drugs? Then the co-evolving nature of phage-bacterial host relationship will be a major hurdle for the production of consistent phage formulae. Or should we resort to the phage products such as lysins and the corresponding engineered versions in order to have accurate and consistent delivery doses? We still have very limited knowledge about the pharmacodynamics of phage therapy. More data, obtained in animal models, are necessary to evaluate the phage therapy efficiency compared, for example, to antibiotics. Another aspect is the safety of phage therapy. How do phages interact with the immune system and to what costs, or benefits? What are the risks, in the course of phage therapy, of transduction of undesirable properties such as virulence or antibiotic resistance genes? How frequent is the development of bacterial host resistance during phage therapy? Understanding these and many other aspects of phage therapy, basic and applied, is the main subject of this Topic.