Every loaf of bread is political - Reflections on collective care responses to Covid-19 in Cape Town

Feminist perspectives on care have demonstrated how capitalism undervalues care work. The Covid-19 pandemic highlighted this further, as systems of production and social reproduction became destabilized globally. In many countries, the formal pandemic response fell short of attending to the daily, fundamental care needs of people living through the crisis, especially those compromised by the socio-economic effects of the pandemic. These needs were often attended to at the community level. This article explores a community-led network of care, known as CANs, that emerged in response to the pandemic in Cape Town. It makes three overarching observations. The first is that community-led responses were characterised by a push towards the collectivisation of care work. The second is that this enabled emergent strategies and relational practices of care, centring notions of solidarity, inter-dependence and horizontal exchange of resources and knowledge. Finally, we observed that, although the devaluation of care work limited the recognition and material support extended to CANs, opportunities to re-politicise care work as resistance work emerged. These represent a prefigurative moment in which alternative logics and strategies can transform the vision of our health and care systems, and the notion of community participation in and ownership of those systems.

Intersectional insights into racism and health: not just a question of identity

Intersectionality is a useful tool to address health inequalities, by helping us understand and respond to the individual and group effects of converging systems of power. Intersectionality rejects the notion of inequalities being the result of single, distinct factors, and instead focuses on the relationships between overlapping processes that create inequities. In this Series paper, we use an intersectional approach to highlight the intersections of racism, xenophobia, and discrimination with other systems of oppression, how this affects health, and what can be done about it. We present five case studies from different global locations that outline different dimensions of discrimination based on caste, ethnicity and migration status, Indigeneity, religion, and skin colour. Although experiences are diverse, the case studies show commonalities in how discrimination operates to affect health and wellbeing: how historical factors and coloniality shape contemporary experiences of race and racism; how racism leads to separation and hierarchies across shifting lines of identity and privilege; how racism and discrimination are institutionalised at a systems level and are embedded in laws, regulations, practices, and health systems; how discrimination, minoritisation, and exclusion are racialised processes, influenced by visible factors and tacit knowledge; and how racism is a form of structural violence. These insights allow us to begin to articulate starting points for justice-based action that addresses root causes, engages beyond the health sector, and encourages transnational solidarity.

POS1577-PARE WHAT PATIENTS VALUE AND NEED FROM HEALTHCARE IN THE DIAGNOSIS AND MANAGEMENT OF AXIAL SPONDYLOARTHRITIS

Background

The clinician’s understanding of what constitutes good quality care for axial spondyloarthritis (axial SpA) has been explored (1) and used to define quality standards (2,3). However, research into the patient perspective on what constitutes good quality care was lacking. The UK’s National Axial Spondyloarthritis Society (NASS) commissioned Headstrong Thinking, and its research partner, Community Research, to investigate this issue.

Objectives

The objectives of the research included: to explore the lived experience of those with an axial SpA diagnosis, to identify all the stages (domains) and milestones they identify and describe in their journey; to identify tangible person-centred indicators of “quality” in each of those stages, covering clinical care, patient care (non-clinical) and support for their mental health needs; to capture the everyday language used to articulate their values and needs around “quality”; and to understand possible differences between individual/subgroup experiences.

Methods

The project will use both qualitative and quantitative methods sequentially.

This paper reports only on the qualitative stage of the project, which comprised twelve individual depth interviews, conducted online, across a broad spectrum of people living with axial SpA in the UK, allowing for variation in age, sex, socioeconomic status, presence of children, length of time since diagnosis, physical symptoms and comorbidities.

Findings from the qualitative stage will inform the questionnaire for the quantitative stage (target n=1,500), which will seek to validate and refine initial hypotheses and quantify differences between sub-groups.

Results

This paper presents a rich understanding of the impacts on mental, emotional, cognitive and practical aspects of life with axial SpA. A detailed picture of a wide range of clinical, psychological and practical adverse impacts around delayed diagnosis is described.

Further, the qualitative research found that, from the perspective of people with axial SpA, quality care consists of three elements, defined by patients as: to be seen, heard and believed; to experience a purposeful, consistent pathway of care, underpinned by effective administration and communication (rather than a series of care “snapshots”); and to be helped to know what they can do to help themselves, including making a care plan that evolves as needs change.

Individuals with multiple or complex comorbidities were less likely to report having experienced good quality care, as they defined it, in part due to the challenges of accessing a joined-up patient journey and their greater reliance on an effective cross- disciplinary (NHS) healthcare system.

Conclusion

Patients define quality care in the diagnosis and management of axial SpA differently to clinicians. Professionals involved in the diagnosis and care of people living with axial SpA (including rheumatologists, but also those involved in the wider care of people living with axial Spa, such as physiotherapists and even mental health professionals) would benefit from a greater understanding of the patient perspective.

The individual stories uncovered in this qualitative phase underline the importance of collecting and analysing quantitative data by demographics, life stage and by discrete phases in the diagnostic /ongoing patient (self) management journey.

References

[1]Kiltz U, Landewé RBM, van der Heijde D, et al Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis Annals of the Rheumatic Diseases 2020;79:193-201.

[2]ibid

[3]National Institute for Health and Care Excellence (2018) Spondyloarthritis Quality Standard

Disclosure of Interests

None declared

The Multiple Lenses on the Community Health System: Implications for Policy, Practice and Research

Community health systems (CHSs) have historically been approached from multiple perspectives, with different purposes and methodological and disciplinary orientations. The terrain is, on the one hand, vast and diverse. On the other hand, under the banner of universal health coverage (UHC) and the Sustainable Development Goals (SDGs), a streamlined version of ‘community health’ is increasingly being consolidated in global health and donor communities. With the view to informing debate and practice, this paper seeks to synthesise approaches to the CHS into a set of ‘lenses,’ drawing on the collective and multi-disciplinary knowledge (both formal and experiential) of the authors, a collaborative network of 23 researchers from seven institutions across six countries (spanning low, middle and high income). With a common view of the CHS as a complex adaptive system, we propose four key lenses, referred to as programmatic, relational, collective action and critical lenses. The lenses represent different positionalities in community health, encompassing macro-level policy-maker, front-line and community vantage points, and purposes ranging from social justice to instrumental goals. We define and describe the main elements of each lens and their implications for thinking about policy, practice and research. Distilling a set of key lenses offers a way to make sense of a complex terrain, but also counters what may emerge as a dominant, single narrative on the CHS in global health. By making explicit and bringing together different lenses on the CHS, the limits and possibilities of each may be better appreciated, while promoting integrative, systems thinking in policy, practice and research.

Collective sensemaking for action: researchers and decision makers working collaboratively to strengthen health systems

Lucy Gilson and colleagues draw on experiences from Kenya and South Africa to consider the practice, benefits, and challenges of research co-production for strengthening health systems

Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa

This paper reports a study from Cape Town, South Africa, that tested an existing framework of everyday health system resilience (EHSR) in examining how a local health system responded to the chronic stress of large-scale organizational change. Over two years (2017–18), through cycles of action-learning involving local managers and researchers, the authorial team tracked the stress experienced, the response strategies implemented and their consequences. The paper considers how a set of micro-governance interventions and mid-level leadership practices supported responses to stress whilst nurturing organizational resilience capacities. Data collection involved observation, in-depth interviews and analysis of meeting minutes and secondary data. Data analysis included iterative synthesis and validation processes. The paper offers five sets of insights that add to the limited empirical health system resilience literature: 1) resilience is a process not an end-state; 2) resilience strategies are deployed in combination rather than linearly, after each other; 3) three sets of organizational resilience capacities work together to support collective problem-solving and action entailed in EHSR; 4) these capacities can be nurtured by mid-level managers’ leadership practices and simple adaptations of routine organizational processes, such as meetings; 5) central level actions must nurture EHSR by enabling the leadership practices and micro-governance processes entailed in everyday decision-making.

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Resilience to chronic stress will prepare health systems to face acute shocks.

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Collective problem-solving and sensemaking enable everyday resilience.

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Distributed leadership, feeling safe and reflective practice are key processes.

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New forms of health system strengthening are needed to nurture resilience.

What Is COVID-19 Teaching Us About Community Health Systems? A Reflection From a Rapid Community-Led Mutual Aid Response in Cape Town, South Africa

The coronavirus disease 2019 (COVID-19) pandemic has exposed the wide gaps in South Africa’s formal social safety net, with the country’s high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self-organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community-based response to COVID-19 and the ensuing epidemiological and social challenges it has wrought. This article describes and explains the organising principles that inform this community response, with the view to reflect on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.

Paramedics, poetry, and film: health policy and systems research at the intersection of theory, art, and practice

Violence is a public health issue. It is the consequence of a complex set of interacting political, social, and economic factors firmly rooted in past and current injustice. South Africa remains one of the most unequal countries in the world, and in some areas, the rates of violence are comparable to a country that is at war. Increasingly, paramedics working in high-risk areas of Cape Town are being caught in the crossfire, and in 2018, there was an attack on a paramedic crew nearly every week. These attacks are a symptom of much deeper, complex societal issues. Clearly, we require new approaches to better understand the complexity as we collectively find a way forward. It is in this context that we are collaborating with paramedics, poets, and filmmakers to tell human stories from the frontline thereby bringing the lived experiences of healthcare workers into policy making processes. In this commentary, we share a series of poems and a poetry-film that form part of a larger body of work focused on the safety of paramedics, to catalyze discussion about the possibilities that arts-based methods offer us as we seek to better understand and engage with complex social issues that have a direct impact on the health system.

Novel heterozygous mutations in the PGAM2 gene with negative exercise testing

Pathogenic variants in the PGAM2 gene are associated with glycogen storage disease type X (GSDX) and is characterized by exercise induced muscle cramping, weakness, myoglobinuria, and often tubular aggregates in skeletal muscle. We report here a patient diagnosed with GSDX at 52 years of age with a normal increase in post-exercise lactate with both anaerobic and aerobic exercise. Genetic testing found two novel PGAM2 variants (c.426C > A, p.Tyr142Ter and c.533delG, p.Gly178Alafs*31).

Whole-exome sequencing is a valuable diagnostic tool for inherited peripheral neuropathies: Outcomes from a cohort of 50 families

The inherited peripheral neuropathies (IPNs) are characterized by marked clinical and genetic heterogeneity and include relatively frequent presentations such as Charcot-Marie-Tooth disease and hereditary motor neuropathy, as well as more rare conditions where peripheral neuropathy is associated with additional features. There are over 250 genes known to cause IPN-related disorders but it is estimated that in approximately 50% of affected individuals a molecular diagnosis is not achieved. In this study, we examine the diagnostic utility of whole-exome sequencing (WES) in a cohort of 50 families with 1 or more affected individuals with a molecularly undiagnosed IPN with or without additional features. Pathogenic or likely pathogenic variants in genes known to cause IPN were identified in 24% (12/50) of the families. A further 22% (11/50) of families carried sequence variants in IPN genes in which the significance remains unclear. An additional 12% (6/50) of families had variants in novel IPN candidate genes, 3 of which have been published thus far as novel discoveries (KIF1A, TBCK, and MCM3AP). This study highlights the use of WES in the molecular diagnostic approach of highly heterogeneous disorders, such as IPNs, places it in context of other published neuropathy cohorts, while further highlighting associated benefits for discovery.

N-linked glycan truncation causes enhanced clearance of plasma-derived von Willebrand factor

Essentials von Willebrands factor (VWF) glycosylation plays a key role in modulating in vivo clearance. VWF glycoforms were used to examine the role of specific glycan moieties in regulating clearance. Reduction in sialylation resulted in enhanced VWF clearance through asialoglycoprotein receptor. Progressive VWF N-linked glycan trimming resulted in increased macrophage-mediated clearance. Click to hear Dr Denis discuss clearance of von Willebrand factor in a free presentation from the ISTH Academy SUMMARY: Background Enhanced von Willebrand factor (VWF) clearance is important in the etiology of both type 1 and type 2 von Willebrand disease (VWD). In addition, previous studies have demonstrated that VWF glycans play a key role in regulating in vivo clearance. However, the molecular mechanisms underlying VWF clearance remain poorly understood. Objective To define the molecular mechanisms through which VWF N-linked glycan structures influence in vivo clearance. Methods By use of a series of exoglycosidases, different plasma-derived VWF (pd-VWF) glycoforms were generated. In vivo clearance of these glycoforms was then assessed in VWF-/- mice in the presence or absence of inhibitors of asialoglycoprotein receptor (ASGPR), or following clodronate-induced macrophage depletion. Results Reduced amounts of N-linked and O-linked sialylation resulted in enhanced pd-VWF clearance modulated via ASGPR. In addition to this role of terminal sialylation, we further observed that progressive N-linked glycan trimming also resulted in markedly enhanced VWF clearance. Furthermore, these additional N-linked glycan effects on clearance were ASGPR-independent, and instead involved enhanced macrophage clearance that was mediated, at least in part, through LDL receptor-related protein 1. Conclusion The carbohydrate determinants expressed on VWF regulate susceptibility to proteolysis by ADAMTS-13. In addition, our findings now further demonstrate that non-sialic acid carbohydrate determinants expressed on VWF also play an unexpectedly important role in modulating in vivo clearance through both hepatic ASGPR-dependent and macrophage-dependent pathways. In addition, these data further support the hypothesis that variation in VWF glycosylation may be important in the pathophysiology underlying type 1C VWD.

Proximal myopathy with focal depletion of mitochondria and megaconial congenital muscular dystrophy are allelic conditions caused by mutations in CHKB

We recently evaluated two of the original three patients (siblings) diagnosed with Proximal Myopathy with Focal Depletion of Mitochondria. The condition was named for the distinctive pattern of enlarged mitochondria around the periphery of muscle fibres with a complete absence in the middle. These siblings, aged 37 and 40, are cognitively normal with mild non-progressive muscle weakness and a susceptibility to rhabdomyolysis. Both were shown to be compound heterozygotes for novel mutations (c.263C>T + c.950T>A) in CHKB, the gene currently associated with Megaconial Congenital Muscular Dystrophy. Individuals with this condition have early-onset muscle weakness and profound intellectual disability but share the same unique pattern on muscle biopsy as was noted in Proximal Myopathy with Focal Depletion of Mitochondria; focal depletion of mitochondria was surrounded by abnormally large "megaconial" mitochondria. Thus the phenotypic spectrum of CHKB mutations ranges from a congenital muscular dystrophy with intellectual disability to a later-onset non-progressive muscular weakness with normal cognition.

Characterization of patients referred for non-specific intellectual disability testing: the importance of autosomal genes for diagnosis

Genetic testing for non-specific intellectual disability (ID) presents challenges in daily clinical practice. Historically, the focus of the genetic elucidation of non-specific ID has been on genes on the X chromosome, and recent research has brought attention to the growing contribution of autosomal genes. In addition, next-generation sequencing (NGS) has greatly improved the ability to simultaneously analyze multiple genetic loci, making large panel testing a practical approach to testing for non-specific ID. We performed NGS analysis of a total of 90 genes implicated in non-specific ID. The 90 genes included 56 X-linked genes and 34 autosomal genes. Pathogenic variants were identified in 11 of 52 (21%) patient samples. Nine of the eleven cases harbored mutations in autosomal genes including AP4B1, STXB1, SYNGAP1, TCF4 and UBE3A. Our mutation-positive cases provide further evidence supporting the prevalence of autosomal mutations in patients referred for non-specific ID testing and the utility of their inclusion in multi-gene panel analysis.

Perceived insomnia, anxiety, and depression among older Russian immigrants

There are few data on the relationships of anxiety and depression to insomnia among immigrants in the United States. Observations of high rates of symptoms of these associated conditions among older Russians indicate the need to focus clinical attention on this population. Relationships of self-reported depression and anxiety to insomnia complaints were investigated in a community-based sample of older Russian immigrants. Volunteers (N=307) were urban community-residing Russians (ages 50 to 95 years; 54% women). Surveys were conducted in a semistructured environment by bilingual educators in various community centers. 93% reported a major health problem, 83% experienced pain, and 62% had problems engaging in daily activities. Of the sample, 61% reported an insomnia complaint, and 43% considered depression and/or anxiety to be a major impairment. Logistic regression analysis showed that insomnia was the most important predictor of perceived anxiety and depression; the corresponding multivariate-adjusted odds ratio was 4.37. Insomnia complaints and perceptions of depression and anxiety among older Russians may have a synergistic effect. Both patients and primary-care physicians should be better educated regarding the recognition of barriers limiting access to adequate health care among older Russians.

An evaluation of prototype VR medical training environment: applied surgical anatomy training for malignant breast disease

This paper presents an enquiry into the suitability of Virtual Reality (VR) technology as the principal training method for applied surgical anatomy. In this work we present the development of a prototype VR medical training environment and the evaluation results of preliminary trials aiming to identify the effectiveness of the system in the subject domains of anatomy teaching and surgical rehearsal, whilst acknowledging current training requirements.

NGF receptor TrkAd5: therapeutic agent and drug design target

Biochemical studies have shown that domain 5 of the TrkA (tropomyosin receptor kinase A) receptor is involved in the binding of NGF (nerve growth factor). Crystallographic studies have confirmed this, demonstrating that one homodimer of NGF binds to two TrkAd5 molecules. TrkAd5 has been made recombinantly in Escherichia coli, purified and shown to bind NGF with picomolar affinity. We have used the co-ordinates of the crystal structure of the NGF-TrkAd5 complex to screen approximately two million compounds in silico for the identification of small molecule agonists/antagonists. Selected hits were shown to be active in an in vitro ligand-binding assay; structure-activity relationships are now being investigated. In addition, TrkAd5 has been shown to be efficacious in preclinical models of inflammatory pain and asthma by the sequestration of excess levels of endogenous NGF, and therefore represents a novel therapeutic agent.

Surface analysis and depth profiling of corrosion products formed in lead pipes used to supply low alkalinity drinking water

Modern analytical techniques have been applied to investigate the nature of lead pipe corrosion products formed in pH adjusted, orthophosphate-treated, low alkalinity water, under supply conditions. Depth profiling and surface analysis have been carried out on pipe samples obtained from the water distribution system in Glasgow, Scotland, UK. X-ray diffraction spectrometry identified basic lead carbonate, lead oxide and lead phosphate as the principal components. Scanning electron microscopy/energy-dispersive x-ray spectrometry revealed the crystalline structure within the corrosion product and also showed spatial correlations existed between calcium, iron, lead, oxygen and phosphorus. Elemental profiling, conducted by means of secondary ion mass spectrometry (SIMS) and secondary neutrals mass spectrometry (SNMS) indicated that the corrosion product was not uniform with depth. However, no clear stratification was apparent. Indeed, counts obtained for carbonate, phosphate and oxide were well correlated within the depth range probed by SIMS. SNMS showed relationships existed between carbon, calcium, iron, and phosphorus within the bulk of the scale, as well as at the surface. SIMS imaging confirmed the relationship between calcium and lead and suggested there might also be an association between chloride and phosphorus.

Variable response to exogenous Lactobacillus acidophilus NCFM consumed in different delivery vehicles

AIMS

To study the effects of the delivery vehicle for Lactobacillus acidophilus on the human faecal microbiota. Our hypotheses were that (i) the delivery vehicle would influence faecal lactobacilli numbers and (ii) consumption of Lact. acidophilus would influence the populations of Bifidobacterium and hydrogen sulphide-producing bacteria.

METHODS AND RESULTS

Ten subjects each received Lact. acidophilus with skim milk or water. Lactobacillus, Bifidobacterium and hydrogen sulphide-producing bacterial populations were analysed before, during and after each treatment. Regardless of the vehicle, faecal lactobacilli populations changed during treatment. Bifidobacteria and the hydrogen sulphide-producing bacteria underwent no statistically significant population changes. Intra- and intersubject variability was observed.

CONCLUSIONS

The vehicle in which Lact. acidophilus was delivered did not influence faecal lactobacilli numbers. Consumption of Lact. acidophilus did not influence the populations of Bifidobacterium and hydrogen sulphide-producing bacteria. The lactobacilli populations of subjects were variable. The fed lactobacilli did not appear to colonize the gastrointestinal tract.

SIGNIFICANCE AND IMPACT OF THE STUDY

We provide evidence that (i) there was no collective advantage to using skim milk as a delivery vehicle vs water; (ii) exogenous Lact. acidophilus did not affect endogenous bifidobacteria or hydrogen sulphide-producing bacteria; (iii) data should be carefully examined before pooling for analysis and (iv) continuous feeding was required to maintain an elevated lactobacilli population.

16S ribosomal DNA analysis of the faecal lactobacilli composition of human subjects consuming a probiotic strain Lactobacillus acidophilus NCFM

AIMS

The aims of this study were to evaluate the ability of exogenous Lactobacillus acidophilus strain NCFM to survive through the human gastro-intestinal (GI) tract, and to evaluate the selectivity of Rogosa SL medium for faecal lactobacilli.

METHODS AND RESULTS

The composition of the faecal lactobacilli of 10 healthy subjects was monitored for two weeks prior to, two weeks during and two weeks after the administration of the Lact. acidophilus strain NCFM consumed with skim milk (daily dose 10(10) viable cells). Fresh faecal samples were collected, processed and cultured on Rogosa SL selective medium for lactobacilli enumeration. Colonies demonstrating various morphologies were identified and purified for 16S ribosomal DNA sequence analysis for speciation of colonial genotype. The species composition of cultivable faecal lactobacilli changed considerably during consumption of the strain NCFM.

CONCLUSIONS

The probiotic Lact. acidophilus strain NCFM can survive through the human GI tract, but cannot colonize itself during the two-week consumption. Rogosa SL medium is selective for faecal lactobacilli. However, genetic analysis is required for colony speciation.

SIGNIFICANCE AND IMPACT OF THE STUDY

It is demonstrated that continuous consumption is necessary to maintain a high population of the probiotic strain, and that the Rogosa SL medium is reliable.

What does receiving the care programme approach mean for service users?

OBJECTIVE

To explore what receiving the Care Programme Approach means for service users.

DESIGN

A qualitative study based on peer group discussion, the transcript being subjected to issues analysis to generate key themes.

SETTING

Ayrshire and Arran, West of Scotland.

SUBJECTS

Six people with severe and enduring mental illness who were receiving the Care Programme Approach. The size of the group was restricted to allow service users time to express their views. (A representative response was not being sought.)

RESULTS

Four major themes emerged from the service users: the power of user involvement, how receiving CPA can help to avert potential problems, the rights of service users, and the benefits of advocacy. These service users felt that CPA had made a real difference to their lives.

CONCLUSION

As user involvement is an integral part of CPA, it is important that we develop strategies that allow their views to shape, in a genuine way, the services being put in place to meet their needs. In Ayrshire they seem to have learned that their participation mattered.

Risk factors for chronic rejection after pediatric liver transplantation

BACKGROUND

Chronic rejection is a major cause of graft failure and a frequent reason for retransplantation after pediatric liver transplantation. Identification of risk factors for chronic rejection in pediatric transplant recipients is vital to understanding the pathogenesis of chronic rejection and may help prevent further graft loss.

METHODS

The study population consisted of 285 children with 385 liver transplants performed at University of Chicago between 1991 and 1999. Logistic regression analysis was used to evaluate risk factors for chronic rejection, including age, sex, race, type of graft (living related vs. cadaveric), native liver disease, acute rejection episodes, cytomegalovirus (CMV) infection, and posttransplant lymphoproliferative disease (PTLD).

RESULTS

The chronic rejection rate was significantly lower in recipients of living-related grafts than in recipients of cadaveric grafts (4% vs. 16%, P=0.001). African-American recipients had a significantly higher rate of chronic rejection than did Caucasian recipients (26% vs. 8%, P<0.001). Numbers of acute rejection episodes, transplantation for autoimmune disease, occurrence of PTLD, and CMV infection were also significant risk factors for chronic rejection. However, recipient age, gender, donor-recipient gender mismatch, and donor-recipient ethnicity mismatch were not associated with higher incidence of chronic rejection

CONCLUSION

We have identified a number of risk factors for chronic rejection in a large group of pediatric liver allograft recipients. We believe that donor-recipient matching for gender or race is not likely to reduce the incidence of chronic rejection. The elucidation of the mechanisms by which living-related liver transplantation affords protection against chronic rejection may provide insight into the immunogenetics of chronic rejection and help prevent further graft loss.

Neuroimaging consortium workshop: development of novel PET and SPECT ligands for brain imaging

It was clear from the levels of participation in this panel discussion and from the levels of interest expressed in the upcoming NIMH tracer Consortium Workshop that there is a great deal of potential benefit to public health from the development of new PET and SPECT (and, perhaps, MRI?) tracers. For extramural NIH programs, the tool guidelines for grantees are in fact only that--guidelines--but they could become specific regulations if unacceptable threats to basic research are perceived. This is because the benefits of collaboration among basic scientists are considered essential for the success of research programs. On the other hand, intramural programs at NIH are considered by some to be the "beta test site" for emerging issues and policies, regardless of the specific scientific topic. This may well be true for research tools and presents an opportunity to find new ways of working. As for the industry, threats to intellectual property arise from myriad sources. The magnitude of these threats can only be appreciated from the perspective of long-term investment in research-based industries with significant regulation. In particular, the pharmaceutical industry enjoys only a relatively short period of time during which investments in the last medicament can be recouped to support the development of the next. A great deal of commitment and sophistication will be required if the United States shall succeed in finding new ways of translating basic into applied science for the practical benefit of currently underserved patient populations.