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Welcome to The Lancet Global Health Network. As a leading independent journal of global medicine, The Lancet is committed to advancing health for all people around the world. We publish research aimed at changing medical practice and adding informed analysis and opinion to scientific and policy debates. The aim of this site is to bring together international scientific and public health experts. The network will synthesise evidence, conduct new analyses, devise programmatic recommendations, and formulate proposals for action in international health and development.

July 2nd 2009

This week in medicine

The following will appear in the July 4 issue of The Lancet:

The price of eggs After a year of deliberation, the Empire State Stem Cell Board has agreed to compensate women financially for donating eggs for stem-cell research. The decision, which makes New York state the first to pay for egg donation for purposes other than reproduction, has caused controversy among some who cite the risk of exploitation and the danger this procedure can represent.

Cooperation on cancer The Ministry of Health in Chile and the US National Cancer Institute are forming a partnership to speed up progress on tackling cancer in Hispanic populations in the USA and Latin America. The alliance aims to cooperate on several mutual interests including basic research, technology transfer, sharing of expertise, enhancement of cancer registries, and early-phase clinical trials that are culturally sensitive.

Violence against men Figures for 2007 from the New South Wales Bureau of Crime Statistics show an increase of 159% since 1999 in the number of women charged with violence against their male partners. Abused men face prejudice and lack legal and practical means of leaving violent relationships. The Men’s Rights Agency is calling for action to provide more gender-neutral help to victims of domestic violence.

Homecoming At a conference hosted by the Ministry of Science and Technology in Baghdad, the Government of Iraq has appealed for Iraqi scientists living abroad to return home and help rebuild the economy. During the years of conflict, thousands of professionals and academics fled Iraq because of safety concerns.

New at the top Tom Blundell has been appointed the new Chair of the Biotechnology and Biological Sciences Research Council (BBSRC)—the UK funding body for research in the life sciences. Blundell, a Cambridge professor of biochemistry and the founding Chief Executive of BBSRC, returned on July 1, succeeding Peter Ringrose. He will remain for 4 years.

Afghan family planning Although family-planning services are provided by 90% of health-care facilities in Afghanistan, only 15% of rural women use them, according to the country’s Ministry of Public Health. Low uptake might be due to the perception of contraception as taboo. Afghanistan has the highest fertility rate in Asia, and if this is sustained the population is set to reach 56 million by 2050.

Research priorities On June 30, the US Institute of Medicine released its final report on the 100 health topics for which research into the comparative effectiveness of different approaches to care is most urgent. The top 25 areas range from treatment of atrial fibrillation and hearing loss, to prevention of falls and hospital-acquired infections, to management of prostate cancer and dementia.

H1N1 update As of June 29, there had been almost 71 000 cases of influenza A (H1N1) infection and 311 deaths worldwide. Since it was officially termed a pandemic on June 11, the disease has penetrated previously unaffected areas including Morocco, Algeria, Ethiopia, South Africa, Saudi Arabia, Iran, and Papua New Guinea. Bearing the brunt are Mexico, the USA, Canada, Chile, the UK, and Australia.

Children’s rights The Obama administration is considering its position on the nation’s failure so far to ratify the UN Convention on the Rights of the Child. The USA is the only country in the world, save Somalia, not to have signed up to the treaty, which took effect in 1990. When quizzed last week about the reasons for the continued dissent, US ambassador to the UN, Susan Rice, said: “It’s a long story”.

Disaster texts Two mobile-phone operators in Bangladesh have agreed to provide state-generated text messages that warn people in the most vulnerable areas of impending natural disasters. Bangladesh is regularly battered by floods and cyclones, the most recent being cyclone Aila, which struck on May 25, leaving 167 dead and more than 7000 injured.

Insulin and cancer The European Association for the Study of Diabetes (EASD) has called for more research after studies from Germany, Sweden, and the UK revealed a possible link between the use of insulin glargine (an insulin analogue) and increased risk of cancer. The studies are not conclusive, and EASD stresses that patients should continue using insulin until more evidence from other countries becomes available.

Sex education In an attempt to learn more about sex, many Chinese people have turned to the internet, leading to concerns by the government about access to inappropriate material. Now health websites that link to sex-related research will only be accessible by health professionals. The move is part of a wider effort to improve the quality of information on health-related websites.

June 24th 2009

This week in medicine

The following will appear in the June 27 issue of The Lancet:

Australian child health Australian children are “doing well” but “could do better” according to the latest in a series of national statistical reports. Death rates continue to fall, as do rates of teenage pregnancy, and immunisation rates are going up. However, the rise in the incidence of diabetes and obesity, and the disparity between white and indigenous children, are areas of concern.

Teaching CDI Senior university officials from 12 African nations have agreed to introduce the teaching of community-directed intervention (CDI) into their departments of medicine. The draft curriculum is modelled on WHO’s highly successful African Programme for Onchocerciasis Control, which has been empowering communities to fight the disease in their own villages for nearly 14 years.

Latvia loses minister Latvia’s health minister, Ivars Eglitis, resigned last week after refusing to slash spending in the health sector—a measure called for by the government in response to the country’s economic crisis. The Baltic state is facing a 20% economic decline and is cutting wages by 20% in the state sector to try to meet the terms of an international bailout.

Somali conflict Armed conflict between Islamist guerrillas and Somali and UN-backed forces is having a disproportionate effect on women and children, according to UNICEF. The looting of the agency’s main humanitarian supply centre last month has “seriously affected” UNICEF’s ability to assist the most vulnerable, it said.

Malaria funding Despite global commitment to the fight against malaria, funding is falling short, with an estimated US$5·3 billion needed in 2009 and $6·2 billion in 2010. A report by the European Alliance Against Malaria says that although the EU is cumulatively the largest global contributor, more funds are needed to ensure sustainability of prevention and control programmes.

World Refugee Day On June 20, the world paid tribute to people who are forced to leave their homes as a result of conflict and persecution. 42 million people were thus affected in 2008, according to a UNHCR report. Although the figure is lower than the previous year, recent crises in Sri Lanka, Pakistan, and Somalia have already “more than offset” this decline, according to the report.

Lost in conversion According to the UK’s National Patient Safety Agency, 60 000 children younger than 18 years were subject to national health service “safety alerts” in England and Wales during 2007-08. 10 000 of these alerts resulted from medication errors, mainly incorrectly calculated drug doses. The findings raise the importance of packaging drugs with precalculated paediatric doses.

Trials in India The Government of India has made it obligatory for all trials done in the country to be registered in the Indian registry. All trials starting after June 15 must comply. This step will ensure accurate records of objectives, provide avail-ability of all results, help inform participants, and discourage unethical conduct.

World Drug Report The UN Office on Drugs and Crime launched its World Drug Report 2009 on June 24, 2 days before World Drug Day. The report provides evidence about the trends in world drug markets, and contains a chapter about the effect of drug-related organised crime and what should be done about it.

Migrants and HIV The laws and policies of many countries prevent or restrict the treatment of HIV-positive migrants, according to a report by Human Rights Watch. The organisation is calling for countries to repeal all HIV-related restrictions on entry, stay, and residence; to ensure that treatment provision is not affected by origin or citizenship; and to refrain from deporting HIV-positive people to countries where treatment is unavailable.

Bubonic plague An outbreak of bubonic plague near the town of Tubruq, eastern Libya, seems to be under control after the instigation of a WHO-supervised programme. One death due to plague had been reported and 13 other cases confirmed before provision of antibiotics and efforts to control rat populations quelled the outbreak.

Cold comfort On June 16, the US Food and Drug Administration (FDA) advised consumers against using three intranasal common-cold remedies containing zinc. The FDA has received more than 130 reports of anosmia after use of the three popular Zicam products. The manufacturer, Matrixx Initiatives, has been issued with a formal warning letter stating that these products cannot be marketed without permission from the FDA.

June 17th 2009

This week in medicine

The following will appear in the June 20 issue of The Lancet:

Obama addresses AMA US President Barack Obama spoke to sceptical physicians about his proposals for health-care reform at the annual meeting of the American Medical Association (AMA) on Monday. Although still clearly unconvinced by the public insurance option, AMA President Nancy Nielsen said she was pleased Obama had recognised doctors’ litigation worries.

Rotavirus vaccine WHO has issued a recommendation that the vaccine for rotavirus—the main cause of severe and fatal diarrhoea and dehydration in children younger than 5 years—be established in national immunisation programmes globally, particularly in Africa and Asia. 1600 children younger than 5 years die from severe gastroenteritis every day in the developing world.

Kidney care According to the National Confidential Enquiry into Patient Outcome and Death, half the 564 hospitalised patients who died from acute kidney injury in England, Wales, and Northern Ireland during the first 3 months of 2007, received substandard care. Among the report’s recommendations is that all patients should have electrolytes measured on admission.

Prison feeding programme The International Committee of the Red Cross is providing more than 6000 prison inmates in Zimbabwe with food after a television documentary aired in South Africa showed shocking images of emaciated prisoners. According to a report by the Zimbabwean Association for Crime Prevention and Rehabilitation of the Offender, 20 inmates are dying daily.

FDA and tobacco The US Senate has given the Food and Drug Administration the go-ahead to regulate tobacco products. The government will now be able to control factors such as the amount of nicotine in cigarettes and the marketing of tobacco products, including health warnings for packaging.

HIV in South Africa The third national HIV survey in South Africa shows encouraging progress: prevalence has stabilised at 11% overall, and has fallen for children and teenagers. Condom use and exposure to HIV/AIDS prevention programmes is increasing, except in older people. Prevalence continues to show significant regional disparity, however.

NHS faces financial crisis A report by the NHS Confederation, Dealing with the downturn, has predicted a £15 billion shortfall in resources available to the UK’s national health service between 2011 and 2016. The economic crisis and rising costs are to blame, with experts concerned that the lack of funds will lead to longer waiting lists for tests and treatment, and poorer training of staff.

Up in smoke? India’s efforts to introduce graphic health warnings on tobacco products have stalled, again. The images were meant to appear in November last year but were delayed after fierce lobbying from the tobacco industry. The Supreme Court then set a cut-off date of May 31, after which it would be mandatory for all tobacco products to carry the warnings. But, 3 weeks on, the images have yet to materialise.

G7 drags its heels By the end of 2008, the G7 nations had delivered only a third of the aid they promised African countries at the 2005 Gleneagles summit, according to the DATA Report. The remaining two-thirds is unlikely to appear by the due date of 2010, owing mainly to the poor performance of France and the “utter failure” of Italy. Meanwhile the USA, Canada, and Japan have surpassed their commitments.

Afghan food hygiene Diarrhoea is one of the preventable diseases that results in 50000 child deaths per year in Afghanistan, and contaminated food and water is thought to have a key role. In an attempt to improve food hygiene, the Health Ministry in Kabul has announced 4 days of spot checks on restaurants, bakeries, and street-based food and drink vendors.

Fake-drug peddler jailed A British man has been jailed for 2 years for operating an illegal online pharmacy. The business, which turned over more than £6 million between 2003 and 2007, sold unlicensed or counterfeit drugs for erectile dysfunction in the UK and elsewhere. Once thought to affect only developing countries, fake drugs now make up an estimated 1% of all medicines in developed nations.

Sickle cell day June 19 marks the first annual Sickle Cell Disease World Awareness Day. Launched at the UN headquarters in New York, the event is one of the outcomes of a UN resolution set out last year to recognise the disease as a major public health problem, to raise awareness internationally, and to eliminate prejudices. Sickle cell disease affects 1 in 5000 people in the USA, most of whom are African-American.

June 10th 2009

This week in medicine

The following will appear in the June 13 issue of The Lancet:

FDA food fees The US Food and Drug Administration (FDA) has announced new plans to enforce fees of US$1000 per year on all food companies, to fund more frequent inspections of food facilities. The fees are expected to raise an extra $375 million per year, which the FDA says is needed to help avoid further scandals such as the contaminated spinach and peanut outbreaks of recent years.

Congo malnutrition A quarter of children in the Republic of Congo are chronically or acutely malnourished, according to a UNICEF survey. A joint statement from UNICEF and the government attributed the situation to poor feeding practices, in particular low levels of exclusive breastfeeding and diets deficient in vitamin A. Limited access to maternal health services was also blamed.

ASCO news The big news from the American Society of Clinical Oncology’s annual meeting last week was the advent of poly ADP-ribose polymerase inhibitors, a new class of drugs for hard-to-treat breast cancer. Phase II results were promising and phase III trials are now underway in women with triple-negative breast cancer and those with BRCA mutations.

Human rights reported Amnesty International has released its annual report detailing the state of human rights around the world. Shocking human rights abuses are present on every continent. The global financial crisis has forced many people into poverty, making them more vulnerable to human rights violations. The report is reviewed in depth in The Lancet Student.

Compulsory MMR vaccination? Former chairman of the British Medical Association Sandy Macara proposed last week that children in the UK should not be allowed to go to school unless they have had the measles, mumps, and rubella (MMR) vaccine. His call was prompted by a recent drop in MMR vaccination rates and a substantial rise in measles cases.

STIs in children The number of children diagnosed with sexually transmitted infections (STIs) in Scotland is on the increase. In 2004, 249 children aged 10-15 years were diagnosed with chlamydia, compared with 318 in 2008. The number of cases of gonorrhoea and genital warts also increased in the same period.

Road safety On June 15, WHO will release its Global Status Report on Road Safety. Funded by a US$9 million grant from Bloomberg Philanthropies, the report is a scorecard aimed at showing what individual countries have achieved, and the gaps that remain, in relation to WHO’s 2004 world report on prevention of road traffic injuries. Such injuries are predicted to become the eighth leading cause of death by 2030.

H1N1 update As of June 8, 25 288 cases of influenza A (H1N1) infection have been officially reported across 73 countries, including the first African country, Egypt. There have been 139 deaths worldwide so far. WHO has still not raised the alert level to 6, despite the criteria being met (sustained community-level outbreaks in two or more countries in one WHO region, and at least one other country in another WHO region).

No refuge Zimbabweans fleeing to South Africa from the ongoing disaster in their home country continue to endure “intolerable suffering” once they get to their destination, according to a report from Médecins Sans Frontières. The organisation is calling on the South African Government and UN agencies to address urgently the basic needs of these vulnerable people.

Homoeopathy plea Members of the Voice of Young Science network have written to Akpan Etukudo of WHO’s African region calling for WHO to condemn the promotion of homoeopathy for killer diseases such as HIV/AIDS, malaria, and tuberculosis. Homoeopathy clinics thrive in many African countries, where some claim to provide “affordable natural medicine for the people of Africa”.

Women in disasters The Bangladesh Red Crescent Society has launched a project aimed at teaching women disaster preparedness. Women attend community-based training sessions and are then encouraged to relate the information gleaned to their neighbours. Bangladesh is regularly hit by natural disasters, the latest being cyclone Aila, which struck the country in late May.

From the hip Across the USA, increasing numbers of high-profile sports stars and junior athletes are developing hip injuries. A focus on training to prevent knee injuries might be to blame for placing stress on hip joints and leading to torn cartilage. 34 major league baseball players were unable to play because of hip injuries in 2008,  compared with 20 in 2007.

June 3rd 2009

This week in medicine

The following will appear in the June 6 issue of The Lancet:

Addiction accounts The USA’s National Center on Addiction and Substance Abuse has released a report on the cost of substance misuse. US$468 billion was spent in 2005—more than a tenth of total government expenditure. In what the report calls “a reckless misallocation of public funds”, only 2% of these funds were spent on prevention, treatment, and research; the rest went on dealing with the consequences of abuse.

Zambia corruption The Netherlands and Sweden have suspended aid for health projects in Zambia, pending an investigation by the country’s Anti-Corruption Commission into allegations of inappropriate use of funds by government officials. With foreign aid constituting 55% of Zambia’s budget for health, this decision will no doubt have serious implications.

Child health ambassador Ex-Minister of Health and current Minister in Presidency for South Africa, Manto Tshabalala-Msimang, has been made the African Union’s Goodwill Ambassador for the improvement of maternal and child health in Africa. Health activists in the region have mobilised against the controversial minister’s appointment, since her AIDS policies have failed to reduce maternal and child mortality in the past.

US family planning The US Institute of Medicine has released its assessment of the Title X Family Planning Program, the national resource for family planning. The programme aims to provide reproductive health care for low-income individuals. The report acknowledges the success of the programme in achieving this aim, but also highlights failures in its chosen goals and structure.

Acupuncture for backs The UK’s National Institute for Health and Clinical Excellence (NICE) has given its seal of approval to the use of acupuncture, exercise classes, and massage as part of the routine treatment of patients with persistent non-specific lower back pain. NICE recommends the use of such therapies over the current practices of radiographs and spinal injections.

Yellow fever risk Stockpiles of yellow fever vaccine are at risk of running out by 2010 if funding for vaccine production is not achieved. Togo, Mali, Senegal, Burkina Faso, and Cameroon have successfully completed vaccination campaigns and eliminated the threat of outbreak, but in a further seven African countries, 150 million people are still at risk.

H1N1 vaccine A vaccine against swine-origin influenza came another step closer last week with the development of a candidate vaccine virus by the UK National Institute for Biological Standards and Control. The recombinant strain, produced by reverse genetics, joins another candidate produced in the USA by classical reassortment earlier last month, and is being made available to vaccine manufacturers.

Cholera in Zimbabwe The Red Cross has warned that the threat of cholera in Zimbabwe is still very real. An estimated 100 000 people have been infected with cholera, and, at the time of writing, 4300 have died. These figures have greatly surpassed the worst-case scenario predictions from WHO.

Australian Debt2Health Australia has negotiated a debt swap agreement with Indonesia as part of the Debt2Health initiative set up by the Global Fund. Indonesia will have to use the AU$75 million it owes Australia to fund domestic tuberculosis programmes for this commercial debt to be written off. Debt2Health allows conversion of old government debt into a funding resource for tackling HIV/AIDS, tuberculosis, and malaria.

EU aids food security The UN World Food Programme has received €39 million from the European Union to improve food security in Bangladesh, Pakistan, and Sierra Leone. The projects will allow small-scale farmers, mostly women, to improve their food production and overcome the growing problem of food insecurity in the regions.

Charity crunch England’s Association of Medical Research Charities has warned that many medical research charities will struggle for funding in the current economic climate. A quarter of its 117 members said that they would have to cut their funding this year, affecting grants for medical research.

Poverty in Iraq A quarter of Iraqi people live below the poverty line, according to a government survey. Poverty, defined as living on US$2·20 per day, was most prevalent in the rural south, where rates of up to 50% were found for some provinces. The government blamed unemployment, poor infrastructure, and corruption for the high rates, but claimed they were better than expected.

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