Tag: 11/9/26

Categories : Healthcare Politics and RegulationsTags : Leave a comment

Can SA’s New Director-General for Health Turn Around a Struggling Department?

On By ModernMedia
Dr Thembisile Xulu is the newly-appointed Director General of the National Department of Health. (Photo: Denvor de Wee/Spotlight)

By Marcus Low

Dr Thembisile Xulu is South Africa’s sixth permanent Director-General of health since the dawn of democracy. How will she measure up against her predecessors?

In recent months, we’ve been keeping an especially close eye on the media statements following the twice-monthly meetings of South Africa’s cabinet. Then last week, we finally spotted the line we had been waiting for – the announcement of South Africa’s new Director-General (DG) for Health. 

The name of the country’s sixth permanent DG since 1994 was a familiar one. Back in 2020, Spotlight interviewed Dr Thembisile Xulu when she was appointed CEO of the South African National AIDS Council (SANAC) – the national body established by Cabinet to coordinate South Africa’s response to HIV, Tuberculosis, and Sexually Transmitted Infections. 

In moving from the job of SANAC CEO to health DG, Xulu follows in the footsteps of Dr Sandile Buthelezi, who was CEO of SANAC from 2017 to 2020 and DG for Health from 2020 to early 2026, when he was suspended along with two other senior officials in the department. 

Prior to her time at SANAC, Xulu worked at the non-profit Right to Care for around a decade and a half. She is a medical doctor and has a master’s degree in public health. As far as we can tell, she is well liked in healthcare circles.

A huge task

The job facing Xulu is a daunting one. 

First, she will have to sort out problems within the department itself. As we pointed out in an editorial published in April, the department hasn’t gotten a clean audit in any of the last five years. The Digital Vibes scandal and the suspension of several senior officials earlier this year relating to another matter paints a bleak picture. While we know there are several committed and capable people working in the department, organisationally it seems to be exhibiting all the classic signs of chronic dysfunction and a lack of effective leadership. 

Maybe the most urgent task facing Xulu then is simply to turn the health department into a more professional organisation. This will require strong leadership and management skills, but it will also require her to more effectively protect the department from whatever the political whims of the day may be. Ultimately, a DG that always says, “yes Minister”, isn’t actually doing the Minister, or the public, any favours. 

But it won’t be easy. When the DG job was advertised back in March, the advert did not open by referencing the Constitution or the National Health Act, as one might expect, but by stating that the DG will be responsible for implementing the Presidential Social Compact for transformation of the health sector. The last health compact, signed in 2024, was a controversial document that did not get buy-in from several key business and healthcare worker organisations. That the job advert starts by referencing the compact rather than the relevant laws, seems an ominous sign for the DG’s chances of building a more capable, less politicised, department. 

Second, getting the department’s house in better order will help with what is of course Xulu’s main job – helping to address the country’s many health challenges. Top of the list is the chronic shortages of healthcare workers in the public sector. We have seen an important policy document and some extra funds for healthcare workers, but the incisive leadership and sustained commitment and planning needed to really get on top of the problem has been absent. 

There is a worrying pattern whereby government looks into a problem, maybe a committee of some sort is set up, the intentions are all good, but then everything stalls once some implementation challenge or political complication arises. We need a DG who does not allow important health issues to drift in this way, but who has the focus and determination to find workable solutions and to see them through. 

And then there is NHI

The NHI Act might currently be tangled up in a thicket of litigation, but whatever happens in the courts, NHI will be a big part of the DG’s work in the coming years (DGs are appointed for five years at a time). This may take the form of implementing some elements of the current NHI Act, or working with a revised Act, we just don’t know at this stage. 

But there will be many other bread and butter issues besides NHI demanding Xulu’s attention. In our analysis, the department has badly dropped the ball on urgent issues such as healthcare worker shortages, the regulation of private healthcare, and improving the quality of public healthcare services in areas such as mental health, diabetes, and hypertension. Hopefully under the new DG, the department will find ways of better addressing these issues in parallel with its work on NHI. 

A chance at renewal

There is some reason for optimism. With the appointment of Xulu as DG, and that of Dr Nonhlanhla Ndlovu before that as the department’s HIV czar, new people are now in two of the most important positions in the department. Such leadership changes offer a unique opportunity for organisational renewal. 

Spotlight has requested an interview with Xulu and we hope to get some time with her once she’s been in the job for a few weeks. We will ask her the tough questions, but we will also be fair and give her time. After all, we all want to see a health department and a health system that works. 

– Low is editor of Spotlight

This article was first published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.

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Study Identifies Potentially Harmful Drug Combinations Prescribed to Older Adults

On By ModernMedia
Photo by Kampus Production

A new Ontario-wide study reveals that common medications, from statins to iron supplements, are quietly setting off prescribing cascades that leave older adults unknowingly taking drugs to treat side effects of other drugs.

The research, published in BMJ and led by Paula Rochon, a clinician scientist at Sinai Health and professor of medicine at the University of Toronto’s Temerty Faculty of Medicine, has revealed that certain drug combinations are a common but unrecognised contributor to drug related harm at the population level and add unnecessary costs to the healthcare system. 

A potentially inappropriate prescribing cascade (PIPC) happens when a medication’s side effect gets mistaken for a new health problem, leading to another prescription that may not have been needed in the first place. One common example flagged in the study involves non-steroidal anti-inflammatory drugs (NSAIDs). Commonly prescribed for pain, these drugs are associated with a rise in blood pressure, which can lead to a new prescription for high blood pressure, rather than a second look at the original pain medication. Older adults are especially vulnerable to this pattern because they’re more likely to be on multiple medications at once, due to having multiple conditions, making it harder for both patients and clinicians to trace a new symptom back to an existing drug.

“These sequences of events are common but often missed in clinical practice,” says Rochon, who serves as the director of research at the Weston and O’Born Centre for Mature Women’s Health at Sinai Health. “Knowing what medications you are taking, when they were started and for what indication is important in order to identify possible prescribing cascades that may be problematic.”

The study brought together an interdisciplinary, international team of collaborators and leaders in drug prescribing and geriatric medicine research from the United States, Belgium, Italy, Israel and Ireland, along with Sinai Health researchers and U of T professors Vasily Giannakeas and Nathan Stall, geriatrician Christina Reppas-Rindlisbacher and research staff Wei Wu and Joyce Li.

With the expertise of 12 international panellists specialising in internal medicine, geriatric medicine and clinical pharmacology, the research team previously created a list of 65 PIPCs. Using this list and population-level prescription data from ICES, Ontario’s health data institute, the researchers examined each PIPC against three factors: how common the initial drug was in the population, how often it was followed by the second drug, and how strong the link was between the two. That analysis allowed them to pinpoint the 24 potentially inappropriate prescribing cascades most commonly seen in the population and with a potential to cause harm.

Seeing the pattern behind every prescription 

For Rochon, the findings highlight a gap that opens quietly, one prescription at a time. “Our concern is that so often these conversations between the health care prescriber and the patient are being missed, so people don’t recognise the sequences of events and that they are connected to one another,” she said.

Closing that gap means physicians need to think about medication history at every visit, not just what a patient is currently taking, but why each drug was started in the first place, and whether the next one was really needed.

The work also carries a particular weight for mature women, as they tend to live with more chronic conditions than men over their lifetime. Mature women are prescribed more drug therapies, and experience more adverse drug events. By being on multiple medications at once, they are more exposed to the risk that a drug’s side effect gets mistaken for a new diagnosis rather than traced back to its source.

The team’s findings point to promising next steps.

The first involves technology. Automated clinical decision support tools could flag a prescribing cascade in real time and prompt a second look before a new prescription is added. This information could be leveraged in one of several automated ways to help clinicians be aware of these potentially inappropriate prescribing cascades at the point of care. 

Next is optimising the role of pharmacists as part of the care team and more directly integrating them into the prescribing process alongside physicians. Their expertise can help identify these potentially inappropriate prescribing cascades for further evaluation.

Original written by Jayda Ayriss

Source: University of Ontario

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Novel Immunotherapy Leads to Complete Regression of Liver Cancer in a Child

On By ModernMedia
Photo by CDC on Unsplash

A new report in the New England Journal of Medicine by researchers at Baylor College of Medicine, Texas Children’s Hospital and Seattle Children’s describes a complete regression of hepatoblastoma, the most common paediatric liver cancer, in a 3-year-old treated with a novel immunotherapy. The patient is enrolled in the CARE study (NCT04715191), a first-in-human, Phase 1 trial evaluating glypican-3-specific chimeric antigen receptor (GPC3-CAR) T cells armed with interleukin-15 and -21 (IL15 and IL21).

The child initially presented with a large primary liver tumour and metastases in the lungs. Prior to enrolment in the CARE study, the patient was treated with three lines of chemotherapy and underwent complete resection of the primary liver tumour and two lung metastases. His cancer was no longer responsive to chemotherapy, and a new lung metastasis recurred after surgery when he was enrolled on the CARE study.

The immunotherapy was engineered from the patient’s own cells at the Good Manufacturing Practices laboratories at the Center for Cell and Gene Therapy using two vectors: one encoding the second-generation GPC3-CAR and the second encoding IL15, IL21 and the inducible caspase 9 safety switch, which Center for Cell and Gene Therapy investigators previously showed controlled CAR T expansion.

Two infusions were administered eight weeks apart in the outpatient setting. A partial response was observed after the first infusion, and imaging showed complete resolution of the metastatic disease after the second infusion. No dose-limiting toxicities or cytokine release syndrome occurred. Complete regression continues one year after treatment.

“This case demonstrates that a durable complete response in a chemotherapy-resistant solid tumour can be achieved entirely in the outpatient setting without systemic toxicity,” said first author Dr David Steffin, associate chief of cellular therapy and bone marrow transplant at Texas Children’s and associate professor of paediatrics – haematology and oncology in the Center for Cell and Gene Therapy at Baylor.

“This study provides evidence that these novel CAR T cells may be a safe and effective modality for hepatoblastoma and highlights the need for further assessment in patients with GPC3+ solid tumors,” said corresponding author Dr Andras Heczey, principal investigator at Seattle Children’s and professor of pediatrics in hematology-oncology at the University of Washington School of Medicine. Heczey was at Baylor and Texas Children’s at the time of research.

Source: Baylor College of Medicine

Categories : NeurologyTags : Leave a comment

Trial Testing Out-of-Body Experiences Produces Unexpected Twist

On By ModernMedia
Photo by Bruce Christianson on Unsplash

A test to determine if people who report out-of-body experiences could identify objects in another room produced results no better than chance, but afterward something strange happened: Two participants described, unprompted, researchers’ locations and activities behind closed doors.

The participants’ unexpected observations were not part of the trial’s predefined outcome measures and therefore can’t be considered evidence for out-of-body experiences, or OBEs, UVA Health investigators say. But the unexplained results may help researchers design better, more effective ways to evaluate the potential validity of a phenomenon that has been reported for decades.

“I hope this study encourages researchers to think creatively about how we test these experiences. The unexpected findings give us a potentially useful new direction, but they also need to be tested prospectively and under rigorous conditions before we can know what they mean,” said researcher Marina Weiler, PhD, of the University of Virginia School of Medicine’s Division of Perceptual Studies. “For me, the most important takeaway is that unexpected findings can sometimes help us ask better questions. We now have a specific idea that can be tested in future experiments, and that is exactly what science should do.”

Understanding Out-of-Body Experiences

In the recent trial, conducted in Brazil, 21 participants attempted to identify a random object on a laptop screen in another room. Of the 21, 10 reported having an out-of-body experience, and 13 provided target descriptions. (The 13 included participants who had not reported leaving their bodies but said they could see images on an internal “mental screen” or the like.)

The descriptions the participants gave of the objects on the laptop screen did not prove statistically more accurate than what could be expected from guessing. But during interviews afterward, one participant described how a researcher in another room, behind closed doors, had been seated on the left looking at a laptop screen while another researcher was farther back reading a book. Another participant described how a researcher had been seated on the right, taking notes, while a second was sitting on the left at the computer.

Trial records confirmed both descriptions were correct at the time of the participants’ sessions. Further, there was no way the participants could have seen the researchers, according to the trial organizers.

That has prompted Weiler and her collaborators to propose that the targets provided during OBE trials may play important roles in determining outcomes. It’s possible, they suggest, that memorable, distinctive or emotionally engaging targets may be easier for participants to visualise. Researchers conducting future trials may want to supplement the traditional targets with other unseen details that participants might notice, such as having a researcher wear a distinctive or colorful item of clothing while behind closed doors. 

If participants could recall such items without seeing or being told about them, that might bolster the case for out-of-body remote viewing.

“I hope these findings encourage us to think more deeply about what they might mean for our understanding of consciousness and, ultimately, the nature of reality. If studies demonstrate that people can obtain accurate information that they could not have accessed through their ordinary senses, we would have to reconsider some of our assumptions about the relationship between consciousness, perception and the physical world,” Weiler said. “At its deepest level, this research is not only asking whether out-of-body experiences are real. It is asking what we mean by ‘real’ in the first place, and whether our current understanding of reality is broad enough to account for everything human consciousness can experience.”

Findings Published

The researchers have published their findings in the peer-reviewed journal Explore. The research team consisted of Weiler, Damon Abraham, David J.P. Acunzo and Niffe Hermansson. The researchers have no financial interest in the work.

Source: University of Virginia Health