When it comes to public health, there are bad ideas that seemingly can't be stopped and smart ones that don't get their due.
Often, the real trick to improving health is getting both patients and doctors to hear the right message and then do something about it.
So what's the best way to get the word out about a decades-old generic drug that could save the lives of critically injured patients?
Make a comic book.
That's what Dr. Ian Roberts, a British epidemiologist, did, anyway. Roberts believes a cheap, readily available drug called tranexamic acid, or TXA, could prevent tens of thousands of trauma patients from bleeding to death each year, if doctors only knew how well it worked and used it correctly.
TXA improves blood clotting. The drug, first synthesized in Japan in the 1960s by a husband-and-wife team, is widely used in Asia and Europe by women with heavy periods, as well as by dentists performing tooth extractions.
Its cost ranges from about $17 per course of treatment in the developing world to $30 or so in places like the U.K.
Roberts wondered if TXA could save lives in the emergency room. More than a million people around the world die in car accidents each year, he says. Ninety percent of trauma deaths occur in less developed countries. In a third of cases, hemorrhage is to blame. An inexpensive clotting drug like TXA could have a big effect in poor places with dangerous roads and primitive hospitals, he figured.
In 2005, Roberts launched a big study, called CRASH-2, to test the idea. More than 20,000 trauma patients in 40 countries, rich and poor, took part. Half were given TXA within three hours of their injury. The other half were given a placebo. The results were published in The Lancet in 2010, with another analysis published the following year.
The findings showed that people who got the drug were significantly less likely to bleed to death, especially if they received TXA early.
But medical practice wasn't immediately transformed.
"You can find something that's true, publish it in The Lancet, wash your hands of it, and say, 'Well that's that,' " Roberts tells Shots. "But that doesn't seem very responsible. Getting research into practice takes a long time."
He points to the introduction of clot-buster drugs, which are now given routinely to heart attack patients. "After the confirmatory clinical trials," he says, "it took about ten years for those to get into practice. In the meantime, that's a small massacre. That's a lot of people dying unnecessarily."
Roberts turned to an unconventional medium to communicate his message, commissioning Emma Vieceli, a British comic book artist, to write and draw a graphic novella that showed ER doctors treating trauma patients with TXA.
"Science is very good at finding the answer to whether a treatment works," Roberts says. "But it's very bad at helping you to remember that that treatment is effective. What people remember are stories — emotional stories."
Roberts' comic book begins with a bomb blast and follows three rather well-chiseled emergency doctors as they make their rounds, triaging casualties and treating wounds.
In between asides that convey TXA's correct dosing and contraindications, there is time for both a stabbing and a budding departmental romance. "We also tried to make doctors giving tranexamic acid look sexier than doctors not," Roberts adds, laughing. "I don't know if you noticed that one."
One of TXA's earliest adopters, even before the comic, was the military. "The British army started using it straightaway," Roberts says, particularly on the battlefield in Afghanistan. The U.S. Army was skeptical at first, so it conducted its own study, comparing the outcomes of wounded soldiers in Afghanistan treated by British surgeons — and hence with TXA — with those treated by American doctors, no TXA.
The data showed that soldiers treated with the drug were less likely to die, despite often grievous injuries, and the American army soon started using it as well.
Roberts hopes that TXA can now make the jump from the battlefield to the home front. He points out that there are far more shooting deaths in American cities each night than in Afghan ones.
But then, it's not just ER doctors that need winning over. "One of the advantages of tranexamic acid is also a disadvantage," Robert says. "It's a generic drug and it's really cheap. It's one of the cheapest ways to save a life that currently exists. The disadvantage is, no pharmaceutical company is going to make a lot of money out of it. So they don't have a huge marketing team working on it."
Roberts has a message and his medium. All he needs now are some comic book fans in the right places.