Street Medicine; Folic Acid for Suicidality; and Malaria Vaccines

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Street Medicine Reaches People Where They Live

Doctors across the country have carved out a new specialty in order to treat people who are homeless: street medicine. It is difficult to fund and almost impossible to bill for the care that is given — there is no Medicaid line for “on the street” — but it is also the best way to reach and treat the unsheltered as both patients and people.

By the numbers: More than half a million people in the US are homeless, often with mental illness. They struggle with substance abuse and have limited or no access to medical care. In one estimate, the number of deaths among homeless people for 2018 was between 17,500 and 46,500: a margin greater than the potential death count. By another study’s account, people who are homeless are 10 times more likely to die than their same-age counterparts.

Potential funding: Street medicine groups got together to petition the Centers for Medicare & Medicaid Services to amend an existing code or add a new one that will allow providers to bill for care in the streets. There has been no answer.


Folic Acid Tied to a Reduction in Suicide Attempts

Prescription folic acid may reduce suicidal ideation, according to results from a large-scale pharmaco-epidemiologic study, resulting in a dramatic 44% reduction in suicide events. The analysis, if borne out by further research, could, quite literally, save lives.

One fourth the national rate: The study followed 866,586 adults who filled a folic acid prescription over 24 months. During the study period, the overall suicide event rate was 133 per 100,000 population — one fourth the national rate reported by the National Institutes of Health.

Prior evidence: Previous research has hinted at a link between folic acid and suicidality, but the evidence was thin. However, its use has been long acknowledged by the psychiatric field. Foliate deficiency is associated with lower response to SSRIs, and folic acid, a synthetic form of vitamin B9, has been prescribed to augment antidepressants.


At Long Last, Can Malaria Be Eradicated?

It’s an exciting time to be fighting malaria, according to experts in the field. The Mosquirix vaccine was approved by the WHO last year and may be available next year. Another malaria vaccine, R21, showed 80% efficacy in recent clinical trials. New monoclonal antibodies protected 88% of participants in a recent study. And bed nets treated with a new kind of insecticide cut cases in half in a trial in Tanzania.

A battle of two vaccines: But eradicating malaria is always a complicated problem. To develop Mosquirix took 35 years and $200 million. As the first vaccine against any parasite, it’s a technological achievement. But R21 is roughly twice as effective as Mosquirix, and it appears to be cheaper and easier to produce. It’s also more effective after fewer doses. It’s unclear where funding and distribution efforts should be directed.

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