Author Archives: RWJF Blog Team

Visualizing the Threat Posed by Antibiotic Resistance

Mar 3, 2011, 12:05 AM, Posted by RWJF Blog Team

By JOHN LUMPKIN AND RAMANAN LAXMINARAYAN

How reimagining data – and reframing a problem – can help avert a looming public health crisis

 For the first time, researchers and policymakers can visually track the rise in “superbug” infections over time and identify regions of the country with rapidly spreading rates of resistance.

Researchers at Extending the Cure, a nonprofit project funded by the Robert Wood Johnson Foundation’s Pioneer Portfolio, have developed ResistanceMap—an online tool that tracks changes in resistance levels. These maps show us how the problem of antibiotic resistance has gotten worse, with some regions of the country experiencing a significant and worrying increase in drug-resistant microbes.

Infections like those caused by MRSA (methicillin-resistant Staphylococcus aureus) kill an estimated 100,000 people in the United States each year. Progress toward solving this emerging public health crisis has been slow, an important reason why the Robert Wood Johnson Foundation has funded this research through its Pioneer Portfolio. We share a common view that the best way to prevent an epidemic from occurring may lie in dramatically reframing how we approach the problem.

This is exactly what Extending the Cure has done with ResistanceMap, a web tool that presents scientific data in a user-friendly way, allowing policymakers and researchers to quickly identify regions in urgent need of better infection control, enhanced surveillance, more vigilant antibiotic stewardship, and comprehensive methods to curtail the spread of resistant microbes.

At the core of these maps are data on more than 5 million individual patient samples tested for resistance, or the ability to survive a treatment course with an antibiotic. The resulting maps show that resistance has risen sharply during the first decade of the 21st century.

They also highlight additional significant trends. Each year, tens of thousands of people are killed by Acinetobacter baumannii, which causes pneumonia and other health problems. This microbe now has the ability to evade a last-resort class of antibiotics called carbapenems. The map shows resistance rates in the U.S. have risen from under 5 percent in 2000 to nearly 40 percent in 2009, an eight-fold increase. In some cases, infections caused by this superbug are unstoppable.

That’s why tackling a superbug like Acinetobacter requires new thinking on an old problem. The Extending the Cure project started with a 2008 report that examined antibiotic resistance in a fundamentally different light. By approaching the problem as a natural resources economist might, the report argued that we could help turn the tide on superbugs by optimizing the effectiveness of a scarce societal good (antibiotics).  Taking such a perspective leads researchers to look upstream from the point of antibiotic use and consider issues related to the development, production, regulation and management of these drugs.  This is a dramatic break from usual approaches to drug resistance which emphasize infection control and greater government investment in new antibiotics to replace older, ineffective ones without altering incentives for how antibiotics are utilized.

At the time, this concept was well outside the established research paradigm. And, in fact, the concept emerged from a completely different field of study. However, through its Pioneer Portfolio, the Robert Wood Johnson Foundation serves as an incubator for ideas – like ResistanceMap — that have the ability to drive lasting change in health and health care.

With the launch of ResistanceMap, we have the ability not just to study the past but to peer into the future of resistance, accelerating our progress against superbugs—a crucial step if we are to stave off a major public health crisis.

John Lumpkin, M.D., M.P.H., is senior vice president and director of the Health Care Group at the Robert Wood Johnson Foundation in Princeton, N.J.

Ramanan Laxminarayan, Ph.D., is the director of Extending the Cure, a project that studies the growing problem of antibiotic resistance. Extending the Cure is funded in part by the Robert Wood Johnson Foundation’s Pioneer Portfolio.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Defining and Understanding Violent Video Games

Oct 26, 2010, 12:12 PM, Posted by RWJF Blog Team

Guest blogger Maria Chesley Fisk, Ph.D., is Deputy Director of Health Games Research, a national program of the Robert Wood Johnson Foundation’s Pioneer Portfolio, which funds research to advance the innovation and effectiveness of digital games and game technologies intended to improve health.

On November the 2rd, the U.S. Supreme Court will hear the case of Schwarzenegger v. Entertainment Software Association.  The court will hear arguments for and against the state of California’s yet-to-be-enacted law banning the sale of violent video games to youth under the age of 18. Under the law, violent video games would be labeled 18 and those who sell them to minors could be fined up to $1000. Games used as examples include Resident Evil 4 and Tom Clancy Rainbow Six 3. The California law defines “violent video game” in 150 words as, in part, as “a video game in which the range of options available to a player includes killing, maiming, dismembering, or sexually assaulting an image of a human being.”

On October 22, at the Meaningful Play conference at Michigan State University, I facilitated a lively and thoughtful discussion about this case and its implications. A couple of themes emerged, and I will surely flavor them with my own opinion as I describe them here.  One theme was that whether there is an enacted law or not, parents should monitor their children’s gameplay (play with them even!) and teach their children positive strategies for handling conflict and frustration.  In short, parents should proactively take responsibility. 

A second theme of the discussion was that video games are powerful teachers. They teach whether they are designed for education, change, or entertainment and whether the teaching is intentional or unintentional. In other words, video games have effects on players. We as a society would benefit from honest, informative conversations about the nature and extent of those effects, as well as from more research that informs those conversations. 

A third theme was that parents should take into account the ratings assigned to games by the ESRB rating system in addition to their own evaluations of the appropriateness.  At least some participants wished we could use the resources consumed by the court cases that led to the Supreme Court case differently— informing parents about the rating system and the potential positive and negative consequences of playing games.  Game reviews from organizations like Common Sense Media are other tools that can help. 

I support a simple definition of violent video games:  Violent video games are those that represent violence as the best or only way to resolve conflict.  And I wholeheartedly agree with the discussants that parents are in the best position to monitor and help children process the messages they get from video games and other media.  Processing messages from media involves noticing them, evaluating them, and considering alternatives. In the case of violent games, an alternative is a peaceful approach to resolving differences. I hope the upcoming Supreme Court case will raise our country’s awareness and fuel productive, healthy conversations about the implications, responsibilities, and opportunities associated with children’s use of media.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

The Potential Effect of Health Courts: Another Insight

May 17, 2007, 5:06 AM, Posted by RWJF Blog Team

The Washington Post reported recently on a study published this month in the Michigan Law Review by University of Missouri law professor Philip G. Peters, Jr., on who fares better in jury trials for malpractice lawsuits: defendants or plaintiffs. Evidently, defendant doctors do: the Post says Peters found that "Doctors win about half of the cases that independent experts who review them believe should result in a plaintiff's victory."

The Post goes on to comment

"One proposed solution -- to turn cases over to specialized health courts -- might result in less-favorable results for physicians, he (Peters) suggests. Studies have consistently found that malpractice plaintiffs fared better in front of judges than in front of juries."

The blog Kevin, MD has been hosting quite a discussion on Peters' findings, including comments on the likely implications of and for the health courts model.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Health Wonk Review Highlights Health Courts Series

May 16, 2007, 3:07 AM, Posted by RWJF Blog Team

Health Wonk Review is a biweekly compendium of the best health policy writing in blogs.  The most recent edition praises Pioneering Ideas' series on health courts.  Our thanks to the Review's host, Robert Laszewski, of the blog Health Care Policy and Marketplace Review. 

Lots of other interesting posts described in the Review as well.  We urge you to visit.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Terms of Use

Aug 25, 2006, 11:58 AM, Posted by RWJF Blog Team

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Updated November 1, 2007

This commentary originally appeared on the RWJF Pioneering Ideas blog.