The Changing Economics of Medical Technology


Book Description

Americans praise medical technology for saving lives and improving health. Yet, new technology is often cited as a key factor in skyrocketing medical costs. This volume, second in the Medical Innovation at the Crossroads series, examines how economic incentives for innovation are changing and what that means for the future of health care. Up-to-date with a wide variety of examples and case studies, this book explores how payment, patent, and regulatory policiesâ€"as well as the involvement of numerous government agenciesâ€"affect the introduction and use of new pharmaceuticals, medical devices, and surgical procedures. The volume also includes detailed comparisons of policies and patterns of technological innovation in Western Europe and Japan. This fact-filled and practical book will be of interest to economists, policymakers, health administrators, health care practitioners, and the concerned public.




Comparative Oncology


Book Description




Transforming Clinical Research in the United States


Book Description

An ideal health care system relies on efficiently generating timely, accurate evidence to deliver on its promise of diminishing the divide between clinical practice and research. There are growing indications, however, that the current health care system and the clinical research that guides medical decisions in the United States falls far short of this vision. The process of generating medical evidence through clinical trials in the United States is expensive and lengthy, includes a number of regulatory hurdles, and is based on a limited infrastructure. The link between clinical research and medical progress is also frequently misunderstood or unsupported by both patients and providers. The focus of clinical research changes as diseases emerge and new treatments create cures for old conditions. As diseases evolve, the ultimate goal remains to speed new and improved medical treatments to patients throughout the world. To keep pace with rapidly changing health care demands, clinical research resources need to be organized and on hand to address the numerous health care questions that continually emerge. Improving the overall capacity of the clinical research enterprise will depend on ensuring that there is an adequate infrastructure in place to support the investigators who conduct research, the patients with real diseases who volunteer to participate in experimental research, and the institutions that organize and carry out the trials. To address these issues and better understand the current state of clinical research in the United States, the Institute of Medicine's (IOM) Forum on Drug Discovery, Development, and Translation held a 2-day workshop entitled Transforming Clinical Research in the United States. The workshop, summarized in this volume, laid the foundation for a broader initiative of the Forum addressing different aspects of clinical research. Future Forum plans include further examining regulatory, administrative, and structural barriers to the effective conduct of clinical research; developing a vision for a stable, continuously funded clinical research infrastructure in the United States; and considering strategies and collaborative activities to facilitate more robust public engagement in the clinical research enterprise.




The Prevention and Treatment of Missing Data in Clinical Trials


Book Description

Randomized clinical trials are the primary tool for evaluating new medical interventions. Randomization provides for a fair comparison between treatment and control groups, balancing out, on average, distributions of known and unknown factors among the participants. Unfortunately, these studies often lack a substantial percentage of data. This missing data reduces the benefit provided by the randomization and introduces potential biases in the comparison of the treatment groups. Missing data can arise for a variety of reasons, including the inability or unwillingness of participants to meet appointments for evaluation. And in some studies, some or all of data collection ceases when participants discontinue study treatment. Existing guidelines for the design and conduct of clinical trials, and the analysis of the resulting data, provide only limited advice on how to handle missing data. Thus, approaches to the analysis of data with an appreciable amount of missing values tend to be ad hoc and variable. The Prevention and Treatment of Missing Data in Clinical Trials concludes that a more principled approach to design and analysis in the presence of missing data is both needed and possible. Such an approach needs to focus on two critical elements: (1) careful design and conduct to limit the amount and impact of missing data and (2) analysis that makes full use of information on all randomized participants and is based on careful attention to the assumptions about the nature of the missing data underlying estimates of treatment effects. In addition to the highest priority recommendations, the book offers more detailed recommendations on the conduct of clinical trials and techniques for analysis of trial data.




Metronomic Chemotherapy


Book Description

This book analyzes all aspects of metronomic chemotherapy, a new approach involving low-dose, long-term, and frequently administered therapy that has preclinical and clinical activity in various tumors. After an opening section on the pharmacological bases of metronomic chemotherapy, including its antiangiogenic effects and impact on immunity, preclinical studies on various classes of drug are discussed. Clinical applications of metronomic chemotherapy in a wide variety of tumors are then addressed in detail, with description of the results of all published studies. The clinical pharmacology of metronomic chemotherapy is also considered in depth, encompassing pharmacokinetics, pharmacogenetics, pharmacoeconomics, and adverse drug reactions. The book closes by describing the role of this therapy in the veterinarian clinic.




Advanced Drug Delivery Systems in the Management of Cancer


Book Description

Advanced Drug Delivery Systems in the Management of Cancer discusses recent developments in nanomedicine and nano-based drug delivery systems used in the treatment of cancers affecting the blood, lungs, brain, and kidneys. The research presented in this book includes international collaborations in the area of novel drug delivery for the treatment of cancer. Cancer therapy remains one of the greatest challenges in modern medicine, as successful treatment requires the elimination of malignant cells that are closely related to normal cells within the body. Advanced drug delivery systems are carriers for a wide range of pharmacotherapies used in many applications, including cancer treatment. The use of such carrier systems in cancer treatment is growing rapidly as they help overcome the limitations associated with conventional drug delivery systems. Some of the conventional limitations that these advanced drug delivery systems help overcome include nonspecific targeting, systemic toxicity, poor oral bioavailability, reduced efficacy, and low therapeutic index. This book begins with a brief introduction to cancer biology. This is followed by an overview of the current landscape in pharmacotherapy for the cancer management. The need for advanced drug delivery systems in oncology and cancer treatment is established, and the systems that can be used for several specific cancers are discussed. Several chapters of the book are devoted to discussing the latest technologies and advances in nanotechnology. These include practical solutions on how to design a more effective nanocarrier for the drugs used in cancer therapeutics. Each chapter is written with the goal of informing readers about the latest advancements in drug delivery system technologies while reinforcing understanding through various detailed tables, figures, and illustrations. Advanced Drug Delivery Systems in the Management of Cancer is a valuable resource for anyone working in the fields of cancer biology and drug delivery, whether in academia, research, or industry. The book will be especially useful for researchers in drug formulation and drug delivery as well as for biological and translational researchers working in the field of cancer. - Presents an overview of the recent perspectives and challenges within the management and diagnosis of cancer - Provides insights into how advanced drug delivery systems can effectively be used in the management of a wide range of cancers - Includes up-to-date information on diagnostic methods and treatment strategies using controlled drug delivery systems




Multi-Drug Resistance in Cancer


Book Description

Chemotherapy is one of the major treatment options for cancer patients; however, the efficacy of chemotherapeutic management of cancer is severely limited by multidrug resistance, in that cancer cells become simultaneously resistant to many structurally and mechanistically unrelated drugs. In the past three decades, a number of mechanisms by which cancer cells acquire multidrug resistance have been discovered. In addition, the development of agents or strategies to overcome resistance has been the subject of intense study. This book contains comprehensive and up-to-date reviews of multidrug resistance mechanisms, from over-expression of ATP-binding cassette drug transporters such as P-glycoprotein, multidrug resistance-associated proteins, and breast cancer resistance p- tein to the drug ratio-dependent antagonism and the paradigm of cancer stem cells. The book also includes strategies to overcome multidrug resistance, from the development of compounds that inhibit drug transporter function to the modulation of transporter expression. In addition, this book contains techniques for the detection and imaging of drug transporters, methods for the investigation of drug resistance in animal models, and strategies to evaluate the efficacy of resistance reversal agents. The book intends to provide a state-of-the-art collection of reviews and methods for both basic and clinician investigators who are interested in cancer multidrug resistance mechanisms and reversal strategies. Tianjin, China Jun Zhou v Contents Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix 1 Multidrug Resistance in Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Bruce C. Baguley 2 Multidrug Resistance in Oncology and Beyond: From Imaging of Drug Efflux Pumps to Cellular Drug Targets . . . . . . . . . . . . . . . . . . . . . . . . . .




Optimal Control of Drug Administration in Cancer Chemotherapy


Book Description

This monograph is a study of optimal control applied to cancer chemotherapy, the treatment of cancer using drugs that kill cancer cells. The aim is to determine whether current methods for the administration of chemotherapy are optimal, and if alternative regimens should be considered.The research utilizes the mathematical theory of optimal control, an active research area for many mathematicians, scientists, and engineers. It is of multidisciplinary nature, having been applied to areas ranging from engineering to biomedicine. The aim in optimal control is to achieve a given objective at minimum cost. A set of differential equations is used to describe the evolution in time of the process being modelled, and constraints limit the policies that can be used to attain the objective.In this monograph, mathematical models are used to construct optimal drug schedules. These are treatment guidelines specifying which drug to deliver, when, and at what dose. Many current drug schedules have been derived empirically, based upon ?rules of thumb?.The monograph has been structured so that most of the high-level mathematics is introduced in a special appendix. In this way, a scientist can skip the more subtle aspects of the theory and still understand the biomedical applications that follow. However, the text is self-contained so that a deeper understanding of the mathematics of optimal control can be gained from the mathematical appendix.The mathematical models in this book and the associated computer simulations show that low intensity chemotherapy is a better choice of treatment than high intensity chemotherapy, under certain conditions.




Advances in Cancer Treatment


Book Description

This work covers the pathophysiology of cancer, exploring the difficulty of optimal treatment due to the complexity and diversity of cancer types. The search for distinctive molecular biology characteristics of tumor cells is especially relevant in the identification of overexpressed receptors and proteins that can be used as a target for cancer treatment. We highlight the main therapeutic modalities, particularly conventional systemic chemotherapy, addressing its mechanisms of action, therapeutic classes and even the toxic effects. We also describe the main tumor markers, their importance in the diagnosis and treatment of cancer, and the specificity of tumor cells. The first chapters serve as an introduction to the central topic of this book, targeted therapy. Key aspects of target therapy, such as classes of drugs, immunotherapy, monoclonal antibodies, checkpoint inhibitors, cancer vaccines and tyrosine kinase inhibitors are presented, and, for each one, the benefits, as well as the adverse effects are reported. Chapter 6 compares conventional systemic chemotherapy and targeted therapy, identifies the risks and benefits and also the eligibility criteria for patient care. The possibility of targeted therapy replacing conventional chemotherapy is discussed while reviewing studies that demonstrate the benefits of combining both types of treatment. Finally, the introduction of pharmaceutical nanotechnology to improve antineoplastic agents is addressed in the last chapter and sets the direction for future research in cancer treatment. This is a valuable resource for many health professionals including physicians, pharmacists, nurses, researchers and students interested in the field of oncology.