There are several reasons why the United States is so attractive to so-called medical tourists – patients travelling from other countries to the United States to seek medical treatment. Foremost is the advanced treatment they can expect to receive, particularly for complex cases. Such treatments are often not available in their home countries. Secondly, leading hospitals in the US employ some of the world’s most advanced specialists in their fields and as such can be trusted to provide the best medical expertise available in the world.
Third, leading hospitals in the United States house some of the world’s most advanced medical technology. It is this combination of expertise and advanced MedTech that helps ensure patients receive an accurate diagnosis and the best treatment outcomes.
Fourth, the amount of funding given over to biomedical research is phenomenal, both from the private sector and the public sector. The National Institutes of Health is the largest public funder of bio- medical research in the world, investing more than US$32 billion a year.
For example, the NIH Director’s Awards totaling approximately $285 million was announced in October. The High-Risk, High-Reward Research program, supported by the Common Fund at the National Institutes of Health awarded 103 new research grants to support highly innovative scientists who propose visionary and broadly impactful biomedical re- search projects. Awards this year include, among others, the impact exposure to fracking might have on pregnancy and conception; how brain mechanisms influence memory performance; tissue regeneration using the uterus as a model; and a new model organism to lead in the development of an HIV vaccine.
The NIH explains that the High-Risk, High-Reward Research program supports investigators at each career stage who propose innovative research that, due to their inherent risk, may struggle to raise support in the traditional NIH peer-review process despite their transformative potential. Investigators seeking program support are encouraged to think beyond traditional bounds and to pursue trailblazing ideas in any area of research relevant to the NIH’s mission to advance knowledge and enhance health.
It is inspiring to see how many of these research projects regularly come to fruition. Looking at the sheer number of research projects achieving results – the NIH announces the publication of several of these completed and published studies each week – it is clear how rapidly innovation in healthcare is evolving in the United States.
Bionic pancreas
For example – and there are many examples – a new NIH-funded multicenter clinical trial has found that a bionic pancreas, which uses next-generation technology to automatically deliver insulin, was more effective at maintaining blood glucose levels within the normal range compared to standard-of-care management among people with type 1 diabetes.
Compared to other available artificial pancreas technologies, the iLET bionic pancreas requires less user input and provides more automation because the device’s algorithms continually adjust insulin doses automatically based on users’ needs. Users initialize the bionic pancreas by entering their body weight into the device’s dosing software at the time of first use. Users of the bionic pancreas also do not have to count carbohydrates, nor initiate doses of insulin to correct for high blood glucose. In addition, healthcare providers do not need to make periodic adjustments to the settings of the device.
Four type 2 diabetes drugs compared
In another NIH-funded and recently published study <https://doi.org/10.1056/NEJMoa2200433 > researchers directly compared four drugs commonly used to treat type 2 diabetes. The researchers note that while there is general agreement among healthcare professionals that metformin combined with diet and exercise is the best early approach in diabetes care, there is no consensus on what to do next to best keep high blood glucose in check.
Launched in 2013, the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study was conducted at 36 US study centers. It was designed to compare four major medications approved by the FDA at the time GRADE started to treat diabetes in combination with metformin. The study found that participants taking metformin plus liraglutide or insulin glargine achieved and maintained their target blood levels for the longest time compared to sitagliptin or glimepiride. This translated into approximately six months more time with blood glucose levels in the target range compared with sitagliptin, which was the least effective in maintaining target levels. The study also looked at the treatments’ effects on developing diabetes-related cardiovascular disease. Researchers found that participants in the liraglutide group were least likely to experience any cardiovascular disease overall compared to the other groups.
Sleep and the immune system
Another recently published study <https://doi.org/10.1084/jem.20220081> funded by the NIH looks at the importance of sleep and found that it supports normal production and programming of hematopoietic stem cells, a building block of the body’s innate immune system. In other words, getting a good night’s sleep supports the body’s immune function. The study authors note that what they are learning is that sleep modulates the production of cells that are the protagonists of inflammation and that good, quality sleep reduces that inflammatory burden.
Umbilical cord milking
NIH-funded research is astoundingly prolific. Yet another recently completed study <https://doi.org/10.1016/j.ajog.2022.08.015> suggests that a treatment to move blood from the umbilical cord into an infant’s body may improve the overall health of newborns classified as non-vigorous – limp, pale and with minimal breathing. The procedure, known as umbilical cord milking, involves gently squeezing the cord between the thumb and forefinger and slowly pushing the blood into the abdomen. Compared to non-vigorous infants receiving the standard treatment of immediate umbilical cord clamping, infants who underwent cord milking were less likely to need heart and respiratory support, less likely to have a low level of oxygen in the brain, and more likely to have higher levels of hemoglobin.
Biomedical research is imperative to advancing healthcare and when this is carried over into clinical practice it is the patients who benefit with the best treatment outcomes. The United States is clearly a world leader in this regard, and this is evidenced in the exceptionally high standard of clinical practice provided by leading hospitals in the United States.
