Your cells die every day. Don’t worry, your body is protecting itself. In a process known as apoptosis or programmed cell death, cells that are no longer needed commit suicide. Some cells are only required for a short time, they maybe infected by a virus or develop harmful cancerous mutations. Cell death is also an essential part of development from an embryo. For example mouse paws begin as spade-like structures and only form the individual digits as the cells in between die . During apoptosis the cells fragment into smaller apoptotic bodies, and their cell surface is flipped open to display lipid molecules called phosphatidylserines, which act as an “eat me” signal to recruit cells called macrophages to engulf them, before their contents spill out and damage the surrounding tissue. This is a process known as efferocytosis.
However cell death is not always so orderly. Some cells suffer premature death known as necrosis, where they burst open for various reasons such as infection, physical trauma or extreme temperatures. However as the cell’s contents are released into the open, an inflammatory response is triggered, so the macrophages sent to engulf these cells release substances that can damage the surrounding tissue, resulting in a build-up of dead cells.
It is this damaging chain of events that often occurs in atherosclerosis; the build-up of fatty plaques which can block arteries or trigger blood clots leading to heart attacks, strokes or tissue death, known as ischaemia. As fatty lipid molecules (primarily LDL or ‘bad’ cholesterol) build up in arteries, they act like damage signals. Macrophages recognise these damage signals as if it is phosphatidylserine, and engulf the lipids to become what is known as a foam cell; a cell full of lipid. A healthy macrophage can repackage the LDL into larger HDL cholesterol, which is released back into the bloodstream to be excreted by the liver. The foam cell can also leave the atherosclerotic plaque to be disposed of via lymphatic vessels, thus shrinking the plaque.
However, foam cells can be overwhelmed by engulfing excess cholesterol, increasing harmful inflammatory signals, stress and apoptosis. But all is not lost here. If other macrophages clear the dying foam cells, less harm will be done. The problem is the increased inflammation renders efferocytosis defective, resulting in a process called secondary necrosis. Here apoptotic bodies swell and burst open, as they haven’t been cleared in time. As a result, a large amount of cell debris builds up inside the atherosclerotic plaque, creating what is referred to as a necrotic core. The core is pro-thrombotic when it is exposed to clotting factors in the bloodstream.
Re-organising the world's largest public health service could not only damage healthcare provision but also medical innovation
In March 2012, the Conservative and Liberal Democrat coalition government (also cynically known as the Con-Demned coalition) passed the Health and Social Care Act through parliament. The Act permits radical re-organisation of England’s world-renowned National Health Service (NHS). The scale of re-organisation, perhaps a misnomer for extensive privatisation, has raised serious concerns about the level of healthcare that will remain freely available to taxpayers. One concern that has not been discussed in great detail is how NHS privatisation will affect the future of medicine i.e. training future doctors and advancing medical innovation.
The Labour party founded the NHS in 1948, pledging to deliver high quality healthcare to all citizens regardless of wealth, and funded entirely by taxpayers . The NHS has since expanded into the largest publicly funded health service in the world featuring world-renowned hospitals, and allowing patients to benefit from various health services they could not otherwise afford, ranging from dentists to open-heart surgery. As a result, the NHS is most beloved in the UK with consistently high levels of satisfaction expressed by patients. The majority of today’s population was born with the aid of NHS services, and many rely on state-funded healthcare during their lifetime. The UK’s life expectancy has also continued to rise since the NHS was founded. The UK was recently rated as having the best health service amongst 12 developed countries, including the US, Australia and Germany . A vibrant health organisation placing skilled health professionals and scientists under one roof has fostered numerous medical discoveries, revolutionising healthcare not only within the NHS, but throughout the world. Examples include: the link between smoking and lung cancer, the UK’s first ever heart transplant, and the world’s first ‘test tube’ baby born as a result of in vitro fertilisation (IVF) .
So how will the re-organisation permitted by the Health and Social Act affect the ability of the NHS to deliver medical innovation? Squeezing of the NHS budget and increasing staff workloads in recent years already prompted a large migration of doctors to countries like Australia, in the hunt for reasonable salaries and a more manageable work-life balance. The loss of such valuable talent has harmed medical training and clinical research in the NHS. The transfer of services and facilities from the state to the private sector inevitably means profit is valued more than patient welfare. As a result we have already witnessed a multitude of hospital closures and staff redundancies, and this will aggravate existing problems. Unite the Union argues that the private sector may ‘cherry-pick’ more profitable services and surgical procedures causing a loss of low-demand but still vital services for some patients, and further opportunities to train junior doctors and medical students .
Most hospitals collaborate with academic research laboratories providing patient samples for research experiments. Hospital mergers and closures will drastically cut the number of collaborations and the pool of samples available for such research, thus limiting the rate at which progress can be made towards the next medical therapy. The private sector may even decide to charge for medical training and access to patient samples and clinical research facilities, elevating costs for medical students and researchers (generally funded by the taxpayer or charities) respectively.
On the contrary, the government states that the private sector will play a greater role in medical research through an increase in academic-industry collaborations . Such a move would be advantageous in obtaining funding for medical research, as private companies tend to offer more funding than research councils and charities. But naturally private investors will expect something in return. We are well aware that pharmaceutical companies have failed to invest in research on diseases plaguing developing counties, due to the lack of financial return . Pharmaceutical companies often spend millions of pounds investing in the development of one drug, aiming to earn the money back from sales of the drug, which developing states cannot afford to pay for. Hence a similar trend could occur in the UK, where pharmaceutical and medical device companies may refuse to invest in research to develop treatments for rare diseases due to low prospects in profiting, or they may develop treatments but charge colossal amounts unaffordable for patients. With strengthening of academic-industry collaborations also comes the probability that more state and charity funding of academic research will result in discoveries that subsequently rely on industry to produce the treatment, and ultimately reap the profits.
Of course these possibilities are hypothetical, but we have already seen evidence both within the NHS and in other scenarios that these negative consequences are unfolding and could severely jeopardise standards of healthcare delivery and the future of medical innovation, not only in the UK but worldwide. Are these consequences we want to live with? And in case you are wondering what is motivating this large-scale privatisation of the NHS, take a look at this: http://socialinvestigations.blogspot.co.uk/2012/02/nhs-privatisation-compilation-of.html
Please join the People's March for the NHS, further details here: http://999callfornhs.org.uk
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 Book by Ben Goldacre (2012) Bad Pharma: How Medicine is Broken, and How We Can Fix It, Fourth Estate, UK.
Dr. Anusha Seneviratne
My research is funded by the British Heart Foundation. To donate click sponsor me below.
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