Japan could become one of the first countries in the world to end the HIV epidemic, says the president of Gilead Sciences Japan, Kennet Brysting. The idea for now could seem a little too ambitious, but it is not entirely unrealistic, given that the availability of medicines that can prevent transmission of HIV. Drugs are not the cure, but control over the spread of virus to the point where the disease is no longer a major public health threat.

What Is The Role Of Preventative HIV Medicines?

Gilead's have two key drugs, Truvada and lenacapavir. These two are playing a crucial role in prevention. Truvada is taken as a daily pill, while lenacapavir requires two injections per year. It can make the virus undetectable in infected individuals and prevent transmission to those who are not infected yet. In trials, lenacapavir showed 100% efficacy in preventing HIV infections. This is why it is describe as "almost a vaccine".

In 2024, Japan also approved Truvada for HIV prevention, but the country has yet to approve lenacapavir for the same. Until now, people in Japan had been importing generic versions of Truvada or purchasing it from clinics that source it from overseas.

HIV In Japan

Up until now, Japan reported around 25,000 HIV infections, whereas 669 new cases were reported in 2023. For seven consecutive years, the number of new infections remained under 1,000. The downward trend thus shows that the virus has been controlled, however, getting to zero new infections remains the ultimate goal.

Brysting too acknowledged that simply having effective drug is not enough. What is important is to have a proper implementation, access and healthcare support to make sure that these treatments are widely available and effective.

What Are The Challenges In Implementation?

The biggest challenges is testing rates. There is a need to increase testing rates. At this very moment, around 86% people infective with Japan have been tested, but the goal is to increase it up to 95%, with an ideal goal of 100%. Without widespread testing, many infected people may not even know that they are infected and it could transmit the virus.

Another measure issue is the cost of preventative medication. While Japan's health insurance covers treatments for diseases, it does not cover preventative drugs. Those who purchase Truvada for prevention, pay around $470 per month. Some clinics in Tokyo offer generic alternatives too, which is cheaper, but they are not ideal.

Better Healthcare Support

Brysting expressed concern that individuals importing medications might not be consulting doctors regularly, which is essential for monitoring HIV status and overall health. Truvada users need to be tested for HIV initially and every three months, along with screenings for other infections and kidney function checks. Without proper medical supervision, there is a risk of misuse and inadequate protection.

Gilead is in discussions with Japanese authorities to improve access and insurance coverage for Truvada, and progress is being made. Japan has shown efficiency in approving critical medicines, as seen during the COVID-19 pandemic when Gilead’s remdesivir was approved in just three days.

What Is The Way Ahead?

Gilead at this moment is not only focused on HIV and hepatitis C, but also expanding into oncology with innovative treatments like CAR-T cell therapy, which strengthens a patient's immune system to fight cancer.

However, Japan’s strict approval processes can slow down drug availability. Phase 3 clinical trials often need to be conducted within the country, and Japan tends to approve medicines much later than other regions. For instance, Truvada was approved for prevention in Japan 12 years after the U.S. and nearly 20 years after its approval for treatment. inancial factors also play a role. The Japanese government adjusts drug prices annually, often reducing them, which can make long-term investment challenging for pharmaceutical companies.

US President Donald Trump has nominated White House policy aide Heidi Overton to serve as commissioner of the Food and Drug Administration (FDA), according to media reports.

Overton, who currently serves as deputy director of the White House Domestic Policy Council, is awaiting Senate approval, Bloomberg News reported.

If confirmed, she will succeed Marty Makary, who resigned in May after 13 months in the role following clashes with senior White House and health advisers and scrutiny over a series of controversial agency decisions. Kyle Diamantas has been serving as acting FDA commissioner since May.

Who Is Heidi Overton?

Overton previously worked at the conservative think tank America First Policy Institute, where she ultimately oversaw its Health Policy Center.

A physician by training, Overton received her medical degree from the University of New Mexico. She completed general surgery training at Johns Hopkins and pursued clinical investigation research training at the Johns Hopkins Bloomberg School of Public Health.

She also served during the first Trump administration before joining the America First Policy Institute.

Her work also involved overseeing signature health policy efforts, including the HHS administration’s push to redesign the food pyramid, overhaul the childhood vaccine schedule and work out pricing deals with pharmaceutical companies.

Overton’s Role in Vaccine Policy

Overton appeared alongside President Trump last week when he signed an executive order calling for an overhaul of the childhood vaccine schedule. The order called for reducing the number of federally recommended shots and separating the measles, mumps and rubella (MMR) vaccine into three separate shots.

“We do still recommend the measles vaccine for all children, but we want parents to be informed about the timing and to have the option to separate them out,” Overton said at the event.

She also said the order could help states identify “gold standard” recommendations and take steps to limit vaccines required for school entry.

“We are going to be working directly with states so that we’re not reliant on the court case to resolve,” Overton said, referring to ongoing litigation over pared-down vaccine recommendations. “We are doing it right away so that parents get the benefit from state laws changing.”

Criticism Over Overton’s FDA Appointment

Overton’s reported nomination has already drawn criticism from some health policy experts.

Raymond James analyst and former Trump health official Chris Meekins told Axios that Overton has degrees but “seemingly no real experience running anything.”

He also described her as a former Makary protégé who had moved further toward what he characterised as “anti-science and anti-vaccine messaging” within elements of the MAHA movement.

“Industry will view this pick as extremely troublesome and FDA career staff will continue to flee the agency,” Meekins said. “Any progress made since Makary’s departure is likely to be immediately reversed if she is confirmed.”

CDC Leadership Update

Earlier this month, the US Senate confirmed Dr. Erica Schwartz as director of the Centers for Disease Control and Prevention (CDC), making her the public health agency’s first permanent leader in nearly a year after months of uncertainty.

The Senate approved her nomination in a 51-44 vote on August 5.

Flying thousands of metres above the ground comes with a form of exposure most passengers rarely think about: cosmic radiation. A new study has found that pilots and flight attendants have the highest and second-highest number of deaths from radiation-linked cancers among more than 500 occupations in the US.

The findings pose questions about whether repeated exposure to radiation at cruising altitude could have serious consequences for aircrew health years later.

The study, published August 17 in JAMA Internal Medicine, analysed more than 12.7 million US deaths between 2020 and 2024, covering 503 occupations. Researchers examined deaths from cancers known to have associations with ionising radiation, including breast cancer, melanoma, prostate cancer, thyroid cancer, leukemia, lymphoma and multiple myeloma.

What Did The Study Find?

About 6.9% of deaths among flight attendants and 6.7% among pilots were from the radiation-associated cancers examined.

That was higher than the proportion seen in other occupations, including workers with more conventional occupational radiation exposure. Nuclear technologists, for example, ranked 12th in the analysis.

The researchers also found significantly higher mortality among aircrew from several individual cancers, including breast cancer, central nervous system cancers, melanoma and prostate cancer. Pilots additionally had higher mortality from leukemia.

But this study does not prove that cosmic radiation caused these deaths. The researchers did not have individual radiation-dose measurements for each worker, and factors such as lifestyle, work schedules and other occupational exposures could also contribute.

Also read: Groundbreaking Experimental Vaccine May Prevent Pancreatic Cancer From Spreading, Early Trial Finds

Why Are Pilots And Flight Attendants Exposed To Radiation?

At ground level, Earth's atmosphere and magnetic field provide substantial protection from cosmic radiation arriving from space. At commercial flight altitudes, there is less shielding.

Aircrew therefore receive more ionising radiation during their working lives than most other occupational groups. JAMA notes that aircrew members receive the largest mean annual effective dose of ionising radiation of any occupational group in the US, primarily because of cosmic rays encountered at commercial flight altitudes.

The amount varies depending on altitude, latitude, flight duration and solar activity. And unlike a passenger who flies occasionally, pilots and cabin crew can accumulate exposure repeatedly over years of employment.

Also read: Does Sunscreen Really Raise Skin Cancer Risk? What The 470,000-Person Study Found

How Can Cosmic Radiation Cause Cancer?

This is why radiation exposure has long been considered an occupational health concern for aircrew. Previous research has also found higher rates of melanoma among pilots and cabin crew, although researchers have debated how much of that risk can be attributed to radiation versus other factors.

Does This Include Frequent Flyers?

The study focuses on occupational exposure accumulated by people who fly regularly for their jobs. A person taking a few flights a year does not receive the same cumulative exposure as someone spending hundreds of hours in the air annually.

Harvard Medical School senior author Anupam Jena and colleagues said the findings support considering occupational radiation protections for US aircrew that are appropriate for their level of exposure.

The US Department of Health and Human Services (HHS) has accused more than 200 hospitals and healthcare providers of using improper insurance billing codes to obtain coverage for gender-related medical treatments provided to minors.

The allegations are part of a new HHS report, Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine”, released this month. The report examines insurance coding, financial incentives and the provision of what the agency calls “sex-rejecting procedures” to children.

According to HHS, its review identified nearly $120 million in insurance claims since 2019 involving treatments like puberty blockers and hormone therapy.

The agency alleges that some providers used diagnostic codes unrelated to gender dysphoria, including codes for conditions like early puberty or unspecified hormonal disorders, to secure insurance reimbursement.

Allegations By HHS

At the centre of the report is medical billing, rather than simply whether a particular treatment was provided. HHS alleges that some hospitals coded gender-related treatments under diagnoses that could make the procedures eligible for insurance coverage.

The department argues that this amounted to fraudulent or improper billing because the codes allegedly did not accurately describe why the treatment was being provided.

The report names several major healthcare institutions, including Mount Sinai Hospital and Boston Children's Hospital, according to Reuters.

HHS says the review covered procedures including puberty blockers, cross-sex hormones and surgeries. The report estimates that nearly $120 million in insurance charges were associated with the treatments examined since 2019. HHS argues that financial incentives helped drive the expansion of pediatric gender-related services.

The agency's report also claims that hospitals and physicians could benefit financially from establishing long-term treatment relationships with patients.

However, an allegation in an HHS report is not the same as a finding of fraud by a court or a final determination by an insurer. Individual billing and claims would need to be investigated to establish whether fraud actually occurred.

Also read: What Trump’s Childhood Vaccine Order Means: When Will It Take Effect?

Part Of Trump's Broader Effort To Restrict Gender-Related Treatments

The report is part of the Trump administration's broader effort to restrict gender-related medical interventions for minors.

The administration has already taken steps affecting federal funding. Earlier this month, the Centers for Medicare & Medicaid Services finalized a rule ending federal Medicaid and CHIP funding for certain gender-related procedures for children and young people.

HHS Secretary Robert F. Kennedy Jr.'s department has framed the issue as one involving both patient safety and the use of public and private healthcare funds.

Also read: Kennedy Announces Food Policy Reforms Under Trump’s MAHA Agenda: What Has Been Proposed?

Hospitals And Gender-Affirming Care Supporters React

Supporters of gender-affirming care argue that treatments such as puberty blockers and hormones can be medically appropriate for some adolescents with gender dysphoria and that access to such care can be important for mental health and wellbeing.

Reuters reported that supporters of the treatments dispute the HHS's characterization of the care. Boston Children's Hospital said it was reviewing the findings, while the American Hospital Association did not provide a comment to the news agency.

The allegations could lead to further scrutiny of hospitals' billing records and potential investigations into whether insurers or government health programmes were improperly charged.