The Nobel Prize in Physiology or Medicine 2015 was divided, one half jointly to William C. Campbell and Satoshi Ōmura "for their discoveries concerning a novel therapy against infections caused by roundworm parasites" and the other half to Youyou Tu "for her discoveries concerning a novel therapy against Malaria".
Announcement of the 2015 Nobel Prize in Physiology or Medicine by Professor Urban Lendahl, Secretary of the Nobel Committee for Physiology or Medicine, on 6 October 2015.
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Interview
Following the announcement, Professor Juleen Zierath, Chair of the Nobel Committee for Physiology or Medicine, was interviewed by freelance journalist Lotta Fredholm about the 2015 Nobel Prize in Physiology or Medicine.
How does an emergency department (ED) go from the 6thto the 99thpercentile in patient satisfaction, while improving dramatically in virtually every performance and efficiency category? If it were a Toyota vehicle-manufacturing plant, a key enabler would be a rope strung along each production line above team members, the Andon Cord. The cord can be pulled by anyone encountering a quality problem or needing assistance from the team leader. When the Andon Cord is pulled, music and lights alert the team leader, and everyone’s attention is turned to collaborate and solve the problem.
In 2009, we pulled the Andon Cord.
We provided care for 57,532 patients that year, and our quality and safety metrics were excellent. Our patients, though, on average, had to endure a wait of more than one hour to see a physician. More than 3 percent of our patients simply walked out, reasonable by academic medical center standards, but by no account desirable. Although patients rated the quality of care by physicians and nurses as very high on standardized surveys, overall patient satisfaction with our emergency department experience ranged between the 6th and 40thpercentile when compared to similar sized academic emergency departments.
We were also overcrowded. A 2007 analysis showed that for the volume of patients we served, our physical footprint was undersized by nearly 50%. Patients deemed sick enough to be admitted to the hospital spent hours in the emergency department “boarding,” or awaiting transfer to an inpatient bed that was already occupied, further burdening already insufficient resources.
A planned doubling of our square footage was derailed by the financial crash, which depleted capital, but in some ways this turned out to be a blessing in disguise. With funding available for only few additional beds, it was clear that we couldn’t just get bigger; we had to get better. And to achieve our aim of “VIP care for every patient, every time,” we not only had to re-engineer our processes; we had to fundamentally change our culture.
Rethinking the time-honored processes upon which our daily operations depended would require overcoming the complacency that pervades many large academic medical centers. To foster a common sense of urgency, every member of our leadership team was provided a copy of John Kotter’s “Our Iceberg is Melting.” By the time we got to work, no one was under the illusion that we could continue on with business as usual.
We enlisted experts in operational effectiveness and service excellence, and both leaders and front line staff were trained on the principles of lean manufacturing. Initially described by John Krafcik at MIT in the late 1980s, lean principles build upon the quality improvement processes of the Toyota Production System (TPS). Healthcare institutions began to experiment with lean in the early 2000s, and some emergency departments were among the early adopters.
Over the next 18 months, our team embraced lean principles, looking to improve value and reduce waste at every step along the patient journey, from arrival to ultimate disposition. We identified key stakeholders: front line staff including physicians, nurses, resident physicians, physician assistants, technicians, and administrative personnel, who formed “work out” teams dedicated to process redesign. Teams were supported by analysts, who provided detailed analysis of arrival rates, process times, census, and staffing. We found, for example, that at key times of day nursing triage was a significant bottleneck to patient flow, even when beds were available in our patient-care areas. But by adopting an “any-patient-to-any-bed” approach we were able to largely eliminate the need for traditional triage, except during periods of substantial patient surge.
During rapid-improvement events, teams mapped processes and designedIshikawa diagrams to aid in identifying cause and effects of waste. Teams conducted dozens of tabletop and live walk through trials of new pathways and innovations. Ideas succeeded and failed in equal numbers; the bar for success was high and immovable. Standard work processes designed to ensure reproducible, predictable outcomes and minimize variation were defined collaboratively. We painstakingly studied, measured and learned from each trial. Then we did it again.
Streamlining our front-end processes and reducing “door to bed” time allowed us to cannibalize much of our waiting room and triage area for badly needed patient care space. Combining this with the modest additional space provided by the hospital created a new patient care unit with 12 beds.
We began to see improvements almost immediately, and the results have been largely sustained. From a baseline of 65 minutes in FY09, the average “door to bed” time has declined to 22 minutes in FY13, with more than half of our patients in a bed within 9 minutes of arrival. Walkouts have declined by more than 50%, from an average of 3.3% per month to less than 1.5%. Our patient satisfaction scores have risen from the lowest quartile to as high as the 99th percentile, and have remained at or above the 90th percentile for 7 of the past 9 quarters. Patient comments confirmed that we were hitting our targets. “Best experience I ever had in the ER. Keep doing what you’re doing!” “I was surprised at how fast I was examined & treated“, “Excellent care – was always kept informed of what was happening, why all decisions made…No delays.” In the interim, our volume has increased to over 60,000 visits annually. One area where we have yet to see improvement: inpatient boarding hours have also increased, an ongoing stress test for our new systems.
In the current healthcare climate, we face increased numbers of complex or seriously ill patients, an aging population, greater costs, declining reimbursement and waning resources. Looking at our care through the eyes of our patients compelled us to pull our Andon Cord. Will you?
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There is no right or wrong way to feel when you hear bad news about your condition. You might feel numb at first, and unable to take in the news, or strangely calm and matter-of-fact. As time passes, you may experience a range of emotions. It’s normal to feel some or all of the following:
shock
fear
anger
resentment
denial
helplessness
sadness
frustration
relief
acceptance
You may also feel isolated and alone, even if you have family and friends around you.
You might not experience all of these feelings, and if you do they will not necessarily come in any particular order. Whatever you feel, you do not have to go through it alone.
When you hear the news
Hearing that your illness cannot be cured can be a frightening experience. Many people will be unable to take everything in. If you are alone in the consultation, ask if you can bring a relative or friend in to hear everything the doctor has to say. This may involve asking for a follow-up appointment so that someone can be with you.
Ask the doctor what support is available to you. They may refer you for additional specialist palliative care alongside the care you are already receiving.
Your GP will also know of any local sources of support. Get in touch with your GP to explain what has happened and ask what help is available near you. This may include information services about your illness, financial benefits you may be entitled to, support groups and counselling.
Not everyone wants to talk about what they are going through. Some people might not want to talk about it at all at first, and this is normal.
However, a terminal (sometimes called life-limiting) diagnosis can bring up worries and fears, and it can help to talk about these so that they do not start to feel impossible to deal with.
You might want to talk to your partner, family, or friends, or to a doctor, nurse, counsellor, or chaplain.
People close to you will be dealing with their own feelings about your diagnosis. If you or they are finding it hard to talk about it, you might want to talk to someone less close to you. Your doctor or nurse can help you to find a counsellor, or you can search for counselling services in your area.
You may also want to talk to other people who are in a similar situation. This can help if you are feeling alone or confused about how others deal with the news that they are dying.
You can ask your doctor or nurse about local support groups for people who are living with a life-limiting illness, or for people who have the same condition as you. You can also look on the internet. Many specialist charities offer support through local groups, email contact, phone lines and web forums. For example, Marie Curie has an online community.
Some people keep a blog or online diary about living with a terminal illness. Dr Kate Granger's blog talks about her life as both a doctor and terminal cancer patient.
It can also be useful to have someone to talk to at night time. Liz Bryan, nurse practitioner at St Christopher’s Hospice, London, says: “The night time can be particularly hard, lying in the dark and thinking about what it will be like to die. Make sure you have someone you can ring, but also don’t make yourself lie in the dark. Turn on the light, read a book, recognise that you don’t have to keep on trying to sleep.”
Living with uncertainty
Knowing that you have a life-limiting condition inevitably leaves you living with uncertainty. You will probably have questions to which there are no definite answers, such as how and when your body is going to change, the effect this will have on your independence and your relationships, what will happen at work, and exactly how much time you have left.
Not knowing exactly what is going to happen to you can feel overwhelming and upsetting. It is normal to feel like this, and it is OK to talk to people about how you are feeling.
It might also be helpful to talk about this with others who are in a similar situation, and to hear how they cope with these feelings.
If you think you are depressed
Everyone is unique and you will react in your own way to news that your condition is life-limiting. It is normal to feel shock, sadness, anger and helplessness.
However, for some people, the feeling that they are not able to cope with their situation does not go away, and they feel too low to be able to do any of the things they want to. If this happens to you and these feelings persist, it may be helpful to talk to your doctor.
Read more about money issues and what you and your carers may qualify for.
Living with your diagnosis
Penny Hansford, director of nursing at St Christopher’s Hospice, offers the following suggestions, which you might find helpful.
One step at a time
What you are dealing with can feel overwhelming, but you may be able to make it feel less so by thinking about it as smaller "pieces".
“It’s an old saying, but take one step at a time,” says Penny. “Try to put life into bite-sized chunks, so take one day at a time, or one week at a time.” Decide on some small, achievable goals, so that you gain confidence. This could be something like putting family photos into an album, or visiting a friend.
You can still think about bigger issues, such as where you would like to receive your care in the future, but don’t feel that you have to tackle everything at once.
Write down your worries
Some people feel helpless and that everything is out of control. Writing down worries and questions can begin a process of deciding what is important to you and how to tackle it.
Penny says: “Start by thinking about what the important issues are for you, what things you want to do, what your feelings and worries are. Making that a bit more concrete by writing it down can help you put some structure around what may feel unmanageable and chaotic.”
If you want, you can use what you have written to help you talk about things with your family, friends and carers.
Look after yourself
Try to take some time to do things you enjoy. This is particularly important when you are feeling tired and weak.
Complementary therapies, such as massage and aromatherapy, may help you feel better. You will probably have many concerns about the people close to you and it will help them if they know you are looking after yourself. There may be things that you can do together.
If friends and family offer help, try to accept this and give specific examples of support you need and would like. For example, someone might be able to help by taking you shopping, bringing you some meals to put in the freezer, or driving you to appointments.
In today's modern world, it is common to hear about diseases that you'd never heard a decade ago. A number of these newly discovered diseases are well understood and treated, but many others are still incurable. Some of them are lethal, while others are not. Still, they've been affecting the way people live today. Here's a bit more about some horrible and even life-threatening diseases.
Horrible Yet Incurable Diseases
1
Schizophrenia
Schizophrenia is an intriguing mental disorder in which patient fail to differentiate between fantasy and reality.
Considered one of the most puzzling disorders, there are no effective medical tests available for diagnosis. Its symptoms usually include hallucinations, delusions, and non-coherence of speech and thoughts. The patient will also lose the ability to recognize the real world people.
2
Ebola
Among all the incurable diseases, Ebola is now known by the whole world. It is a virus and belongs to the family of Filoviridae. It takes its name from the Ebola River in the central Africa where it was first recorded in 1976. It is usually caused by 4 viruses from the genius Ebolavirus, including Sudan Virus, Bundibugyo virus, Tai Forest virus, and Ebola virus.
Some of the most common symptoms include severe headache, fever, weakness, fatigue, muscle pain, vomiting, diarrhea, unexplained hemorrhage, and abdominal pain. These symptoms usually appear between 2 and 21 days of being exposed to Ebola.
3
Polio
Polio, or poliomyelitis, is also known as infantile paralysis because more than half of all polio cases occur in children under 5 years of age. This acute viral infection disease affects the nervous system and may transfer from one person to another through fecal matter. Drinking contaminated water can cause polio.
It usually begins with rather common symptoms such as headache, fever, fatigue, nausea, and muscle pains and spasms, but sometimes, it turns into a more serious paralysis of muscles in several limps, including the throat and the chest.
4
Creutzfeldt-Jakob Disease
It is quite rare, affecting one in a million, but is a fatal degenerative disease that cripples your nervous system. This transmissible spongiform encephalopathy is usually caused by an abnormal version of a protein called a "prion", which often affects biological processes.
The most common symptoms include personality changes, depression, anxiety, impaired thinking, memory loss, insomnia, blurred vision, difficulty swallowing, difficulty speaking and jerky movements.
5
Diabetes
It's a disorder of carbohydrate metabolism and impairs body's ability to produce or respond to insulin. It could be Type I diabetes – an autoimmune disorder in which certain antibodies destroy insulin-producing cells. It could also be Type II diabetes, a condition caused by slow pancreatic secretion of insulin or insufficient responsiveness in target cells to produce insulin.
Some of the most common diabetes symptoms include extreme thirst, frequent urination, hunger pangs, extreme fatigue, bruises with slow healing and blurry vision. You will lose weight if it's Type I diabetes and notice pain, tingling, and numbness in feet and hands if it's Type II diabetes.
6
AIDS
Acquired Immunodeficiency Syndrome or AIDS refers to progressive failure of the immune system, which means your body would no longer be able to fight off life-threatening cancers and infections. The Human Immunodeficiency Virus (HIV) is responsible for this condition, and the HIV infection occurs by the transfer of semen, blood, pre-ejaculate, vaginal fluid, and breast milk.
Most symptoms appear within 2-4 weeks of being exposed to HIV, and they may include swollen glands, fever, sore throat, fatigue, rash, headache, muscle and joint aches and body pain. If you already have HIV infection and aren't taking medication, you may experience other symptoms like rapid weight loss, pneumonia, sores of genitals, depression and memory loss.
7
Asthma
It is the chronic disorder of the lungs in which your airways get inflamed and make breathing difficult. You may develop asthma due to allergy, environmental factors, genetics, tobacco use, etc.
Some of the most common symptoms include coughing, wheezing, shortness of breath and chest tightness. The symptoms could become worse at night or in response to cold air or exercise.
8
Cancer
Cancer is a heterogeneous class of disease – it refers to a group of over 100 distinct diseases in which cells display uncontrolled growth. The disease affects 1 in 3 persons in developed countries and is one of the major causes of death in the world.
You may notice different symptoms depending on the type of cancer you've developed. A lump in your breast is usually a sign of breast cancer. You may notice severe, persistent coughing, breathlessness and chest pain if you've developed lung cancer. Change in bowel habits, blood in urine, blood when you cough, moles with irregular shapes and unexplained weight loss may well be symptoms of cancer.
9
Progeria
Also known as Hutchison-Gilford syndrome, Progeria is a rare, progressive genetic disorder. It affects children in the first couple of years of their lives and makes them age rapidly. This abnormal aging process is caused by a single gene, called lamin A (LMA), mutation, which is responsible for making a protein to hold the center of a cell together.
People with Progeria may experience symptoms like slowed growth with below-average weight and height; narrowed face with thin lips and small lower jawbone; large head as compared to the face; loss of hair, including eyebrows and eyelashes; spotty, thinning, wrinkled skin; and incomplete closure of the eyelids.
Other Incurable Diseases
The list of incurable illnesses is quite long, here are some other incurable diseases you may or may not have heard of.
Common Cold: The virus causing common cold transmits through exposure to nasal secretions or saliva of an infected person. The most common symptoms may include runny nose, sore throat, cough, nasal congestion, muscle aches, headaches, fatigue, loss of appetite and shivering. （BTW, it seems strange that cold cannot be cured, right? But it’s true, just google it.）
Spinocerebellar Ataxia: This genetic disease has many different types, but certain drugs are now available to help alleviate its symptoms like tremors and loss of muscle control.
Cerebral Amyloid Angiopathy: This neurological condition makes a protein, called amyloid, to build up on the walls of nervous system's blood vessels. It can cause bleeding into your brain and produce symptoms like headache, drowsiness and speech changes.
What's Behind The Skyrocketing Costs of Lifesaving Drugs?2:57
At least half a dozen drugs, including colon cancer treatments Cyramza, from Eli Lilly & Co, and Stivarga, sold by Bayer AG, aren't worth prices that can exceed $100,000 a year, top cancer specialists said in interviews with Reuters.
If specialists do start considering a drug's cost in their prescribing habits, such decisions could dent the multibillion-dollar cancer drug business of companies from Roche Holding AG to Celgene Corp. Worldwide spending on cancer medicines reached $100 billion in 2014, a year-over-year jump of more than 10 percent.
Doctors are unimpressed with so-called "me too" drugs developed by companies looking to grab market share from a more established product. They are also less likely to use a drug outside of its approved indication for patients who have exhausted other types of treatment.
"There are drugs that don't make much sense given how much they cost, given their small benefits," said Dr. Peter Bach, director of Memorial Sloan Kettering's Center for Health Policy and Outcomes in New York. "There are drugs that can cost up to $10,000 a month that provide, at the median, a few weeks or less than a month of additional life, but with substantial toxicity."
More than one-quarter of spending by Medicare, the federal health insurance plan for seniors, is for services provided to beneficiaries in their last year of life, according to the Kaiser Family Foundation.
Doctors say that, even with harsh side effects, a few more weeks of life may be well worth the price to some patients. For others, the potential benefits may not outweigh the costs.
Lilly's Cyramza was approved by U.S. regulators in April to treat advanced colorectal cancer in combination with chemotherapy. It works similarly to Roche Holding AG's much older drug Avastin and to Sanofi SA's Zaltrap.
"Lilly got it on the market in stomach cancer (in 2014), which was a very nice strategy since it was one of the few indications where Avastin missed," said Dr. Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering. But when Lilly put it on the market for colon cancer, where it does compete with Avastin, they kept its price at double the rate of the Roche drug.
"In colon cancer, I don't know anyone who is using it," Saltz said of Cyramza. Even Avastin, which extends colon cancer survival by about 1.4 months compared to chemotherapy alone, is "massively overused and massively overpriced," he said.
Dr. Lowell Schnipper, chief of hematology-oncology at Beth Israel Deaconess Medical Center in Boston, also described Cyramza as providing limited benefit at a cost of $7,000 to $9,000 a month.
Lilly said in an emailed statement that Cyramza addresses a high unmet medical need, while Bayer said that Stivarga is an important, and competitively priced, treatment option. Genentech, the U.S. biotechnology unit of Roche, said it limits the annual cost of Avastin to about $69,400 for its approved uses.
U.S. patients are paying a larger portion of their own health costs, in the form of higher deductibles, co-payments and premiums. Some insurance plans require patients pay up to 30 percent of the cost of cancer drugs, although most also put a cap on those expenses. Under President Barack Obama's Affordable Care Act, insurance policies have total out-of-pocket limits of $6,600 for individual consumers and $13,200 for families.
Major medical groups including the National Comprehensive Cancer Network and the American Society of Clinical Oncology are developing ways to consider a drug's affordability in their treatment decisions. But as they wait for firmer guidelines, some cancer doctors are making what they view as some obvious changes.
"In the past, the cost implications of care were not on our radar until the patient brought it up ... now we are much more sensitized to the issue," said Dr. Neal Meropol, chief of hematology and oncology at University Hospitals Seidman Cancer Center in Cleveland.
Showing how inefficient the current pricing system is, even when a drug is less effective than a competitor, it doesn't necessarily cost less. Of 51 cancer drugs approved between 2009 and 2013, 21 treatments classified as "novel" had a median annual price of $116,100, while the 30 deemed "next-in-class" had a median price of $119,765, according to a recent study in the Journal of the American Medical Association Oncology.
At the same time, the cost of treatment is rising steadily. In 1995 oncology patients and their insurers paid $54,100 for an additional year of life, but by 2013 the price had jumped to $207,000, according to a study sponsored by the National Bureau of Economic Research.
Saltz at Memorial Sloan Kettering said Cyramza for colon cancer is a clear example of "a drug that costs much more and does absolutely nothing," but said doctors may find it harder to decide on a drug that "costs a lot and does very, very little."
He views Stivarga in that category.
"It costs around $12,000 to $13,000 a month and makes people feel tired, causes skin rash on hands and feet," he said. Insurers cover it, but require patients pay a substantial amount up front. "I used it a fair amount when it first came out, but noticed that people didn't feel too good. I now discuss it with patients and most decide not to use it."
Anthem Inc, the second largest U.S. health insurer, has a program to steer oncologists toward effective treatments deemed to offer the best value, paying them a monthly fee for adhering to a recommended treatment regimen. Anthem cited drugs like Avastin and Celgene's Abraxane as overused relative to their value.
"Abraxane is a newer version of an older (generic) drug called paclitaxel - they basically do the same thing," said Dr. Jennifer Malin, medical director for oncology at Anthem and an attending physician at the Veterans Affairs Greater Los Angeles Health Care System.
One advantage of Abraxane is that it is less likely to cause numbness. But Malin notes that a doctor can use paclitaxel first and only switch to the more expensive drug if the patient experiences that side effect.
Paclitaxel costs around $200 per dose compared with $10,000 for Abraxane, she said. Celgene, which makes Abraxane, said it believes the drug is a valuable treatment option.
Following the announcement, Professor Juleen Zierath, Chair of the Nobel Committee for Physiology or Medicine, was interviewed by freelance journalist Lotta Fredholm about the 2015 Nobel Prize in Physiology or Medicine.
