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This week in medicine

Wednesday, June 23rd, 2010

The following will be published in the June 26 issue of The Lancet:

Resistance alert The Center for Global Development has released a report on the threat of global drug resistance. According to the report, careless practices in drug supply are raising costs and making future generations vulnerable to dis­eases such as malaria. The report offers recommendations including strengthening national drug regulatory authorities.

Collaboration for health The US In­stitute of Medicine (IOM) has issued a report on the need for collaboration in the US health-care system. The report is the result of a workshop with multiple stakeholders to discuss strategies to improve efficiency by encouraging the frag­mented network of individuals and organisations to work cooperatively towards a com­mon goal: improving patients’ health.

Aid suspended The Global Fund has suspended payments to Zam­bia’s Ministry of Health after an investigation into suspected fraud and corruption. The money that supports the country’s AIDS, tuberculosis, and malaria programmes will be redirected via the UN Development Programme to allow the continued treatment of patients, irrespective of this action.

Gun warnings Doctors in Britain have agreed to breach confidentiality and flag the medical files of mentally ill patients who own firearms to give police warning that they could be a threat to themselves or others. The discussions already taking place be­tween the British Medical Association and the Association of Chief Police Officers gained more notice after a man shot dead 12 people earlier this month.

Immunisation success The GAVI Alli­ance, formed to make life-saving vaccines available to the world’s poorest children, marked its first decade by releasing a report high­lighting the 5·4 million deaths prevented and the 250 million children vaccinated by its efforts. It also notes that the financial commitment of developing countries to immunisation is at the highest level ever.

Refugee return In its 2009 Global Trends Report, the UN Refugee Agency has deemed 2009 the worst year for voluntary repatriation since the mid-1990s. Last year, 43·3 million people were forced to leave their homes by conflict, many of whom may not be able to return for years. Only 251 000 refugees were repatriated in 2009, compared with an average of about 1 million in previous years.

Child soldiers Six central African nations including Chad, Sudan, and Nigeria signed the binding N’Djamena Declaration earlier this month, which obliges nations to end the use of child soldiers and help reintegrate exploited children back into their communities. UNICEF Executive Director Andrew Lake praised the move, noting that it built on progress already made in central Africa.

Vitamin D danger The US Food and Drug Administration has issued a warning about the dangers of giving infants more than 400 IU of liquid vitamin D. Many droppers in supplement bottles are not clearly marked with the correct amount and can hold more than necessary. Overdoses can cause vomiting, constipation, muscle weak­ness, and kidney damage.

Polio eradication Last week saw the formal launch of the Global Polio Eradication Initiative’s new strat­egic plan for 2010–12. The plan introduces district-specific strategies to target remaining areas of poliovirus, uses the bivalent oral polio vaccine, and addresses health-system weaknesses. But efforts are threatened by a serious budget shortfall of US$1·3 billion.

Female genital mutilation Human Rights Watch demanded last week that authorities in the autonomous Iraqi region of Kurdistan ban the practice of female genital mutilation. The group released a report noting that the practice was common in the region and extremely damaging to the emotional and physical health of young girls and women. It also urged the Kurdistan Regional Government to establish awareness campaigns.

Women’s health Chinese women might be increasing their risk of car­diovascular disease because they are unaware of the risk factors. A survey by Opinion Health on behalf of the World Heart Federation showed that 90% of such women do not know that heart disease and stroke are the top causes of death among their peers, and about a third do not believe that smoking or lack of exercise increase their risk.

Vuvuzela volumes The UK’s Royal National Institute for Deaf People has warned fans attending the 2010 South Africa World Cup about the potential hearing loss caused by the popular vuvuzela horns. The horns can emit a noise of 127 dB, equivalent to a jet airliner taking off. Such volumes can cause hearing damage in less than 15 min.

This week in medicine

Wednesday, June 16th, 2010

The following will be published in the June 19 issue of The Lancet:

Bhopal sentences 26 years after the Bhopal disaster in India, seven men have been sentenced to 2 years in prison for criminal negligence. Up to 25 000 people are thought to have died and around 500 000 are estimated to have been harmed by the clouds of lethal gas that escaped from the chemical plant run by Union Carbide in 1984.

Pfizer warning The US Food and Drug Administration (FDA) has issued a warning to Pfizer for repeatedly failing to report promptly adverse effects of post-marketed drugs. Such drugs include Pfizer’s top-selling Viagra (sildenafil) and Lipitor (atorvastatin). According to FDA director Ronald Pace, Pfizer inspectors found system-wide lapses during their inspections.

Water hunting Geologists are using magnetic resonance sounding to locate ground­water in Chad. Serious water shortages caused by insufficient rainfall and rapid population growth, including the arrival of refugees from neighbouring Sudan and Central African Republic, have forced the use of this method, which is expensive but more accurate than standard geophysical techniques.

Torture tests Physicians for Human Rights released a report last week alleging that US doctors working for the Central Intelligence Agency during the Bush Administration participated in illegal experiments on detainees with the aim to improve torture techniques, such as waterboarding. US Government officials rejected the study, asserting that no such research occurred.

Polio protection WHO has vaccinated more than 1·2 million children against poliomyelitis in Afghanistan after an outbreak of the disease near the Afghan border in neighbouring Tajikistan. To ensure that all Afghan children were vaccinated, WHO set up immunisation posts at the border, as well as doing house visits, setting up mobile clinics, and having hospital immunisation teams.

Media and health The Brunei Ministry of Health has held a seminar with the country’s most influential radio and television broadcasters to encourage listeners to lead healthier lifestyles and educate participants on health-related issues, such as diet. According to Deputy Minister of Health Pehin Abdullah, the media is crucial to the positive promotion and spread of health information to the public.

Telemedical abortions Doctors in Iowa, USA, are providing medical abortions to women in remote areas via video link. A clinic nurse examines the woman and provides counselling and follow-up care. A doctor “arrives” via video conference and issues the necessary drugs by clicking a button that releases a drawer in the clinic. Opponents charge that the scheme makes abortion easier.

Mental disorders At least 30 million young people in China have mental disorders or behavioural problems, according to estimates reported at the 19th World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions. China’s rapid urbanisation and industrialisation and greater societal competition are thought to be part of the problem.

Contaminated water Lead poisoning of water reserves in northwestern Nigeria, probably caused by illegal gold mining, has left more than 160 people dead, many of them children. The US Centers for Disease Control and Prevention called the contamination “unprecedented”, and the Nigerian Government has set up emergency clinics in conjunction with several aid agencies to help treat those affected.

Stem-cell tourism Costa Rica’s health ministry has shut down the largest stem-cell clinic in the country. The clinic had treated thousands of foreigners because it was cheaper or more accessible than those in other coun­tries. The Ministry’s chief said that the treatments were unproven, and the centre’s owner admitted that they were not approved by the Food and Drug Administration.

HIV disclosure Uganda has drafted a new policy to allow HIV-positive children to be informed of their status by the age of 10 years to try to im­prove their adherence to antiretroviral therapy. The previous policy required parental consent to inform children by age 12 years, but the new policy allows health workers to do so earlier (with parental support) after assessment of the child’s ability to understand.

Loud and clear Telecommunications company Geemarc has developed a mobile phone with a 100 dB ringtone. Although the Clearsound CL8200 was developed for people with hearing loss, its simplicity and enlarged button and screen size were also designed to appeal to older people frustrated with the tendency of modern phones to be both overly complex and tiny.

This week in medicine

Wednesday, June 9th, 2010

The following will be published in the June 12 issue of The Lancet:

AIDS summit The first White House summit on HIV/AIDS in African-American men on June 2 heard that the prevalence of the virus is increasing in this group. According to Shannon Hader, Director of the District of Columbia HIV/AIDS Administration, part of the problem is stigma in black communities. The summit was part of an ongoing plan to create a national HIV/AIDS strategy.

Marriage laws As a means to curb underage marriages, Saudi Arabia has mandated that marriage contracts must declare the age of the bride. Human rights advocates such as the National Society for Human Rights praised the move by the kingdom, which currently has no laws preventing child marriage, stating that it was necessary to protect young girls from harm.

Cardiovascular disease A report by the Australia Institute of Health and Welfare (AIHW) summarises the high health burden and economic cost of cardiovascular disease in the nation’s women. An AIHW spokesperson emphasised the fact that, although it is seen as a “man’s disease”, cardiovascular disease is the leading cause of death in Australian women.

Tetanus milestone Maternal and neonatal tetanus has been eliminated from Burma, an international expert team made up of WHO and UNICEF has confirmed. This development is the result of years of government-led systematic efforts, including the vaccination of pregnant women. Burma is the second country in east Asia after Vietnam to achieve elimination status.

World Cup criticism Football govern­ing body FIFA came under scrutiny last week from the World Cancer Research Fund for accepting sponsorship from companies such as McDonald’s, Coca-Cola, and Budweiser for the South Africa 2010 World Cup. The charity stated that the event should be used to encourage healthy lifestyles and that such advertisements could negatively affect children.

Infection rates released Weekly rates of nosocomial infections with meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile are to be made publicly available for all English hospitals. The aim of publishing the data is to allow the public to compare hospitals and health-care organisations. Rates of MRSA and C difficile infection are currently the lowest ever recorded.

Forced sterilisation The Namibian state is being sued for the sterilisation, allegedly without consent, of three HIV-positive women. The women are represented by the Legal Assistance Centre (LAC), which has recorded 15 similar cases in Namibian hospitals since 2008. An LAC spokesman said that HIV-positive women are some­times advised to undergo sterilisation without being properly informed.

Drug withdrawals Two Danish phar­maceutical companies, Leo Pharma and Novo Nordisk, pulled several drugs off the market in Greece last week in objection to the government’s 25% reduction in medicine prices instituted in response to the debt crisis. The move prompted fears that additional companies could follow suit, resulting in a shortage of medical supplies.

Prison health The Howard League, a UK penal reform charity, has reported that less than 10% of allegations of serious assault and only a quarter of allegations of sexual assault in UK prisons were investigated in 2008. An inspectorate report into Brinsford prison also concluded that the prison system is failing to protect teenagers from assault.

Aflatoxin scare The Kenyan Govern­ment has announced that 2·3 million bags of maize have been contaminated with a fungus that produces lethal aflatoxins. One child was killed by the toxins, and several cases of maize-related poisoning have been reported. The fungal contamination is the result of inappropriate storage facilities. The government has pledged to buy and destroy the affected maize.

Guilty of defamation? The National Academy of Science of Peru has issued a declaration in support of Ernesto Bustamante, a molecular biologist facing prison for criticising a study published in a newspaper. A Peruvian court found the defendant guilty of character defamation. Scientists and institutions worldwide are also lending their support via a petition asking for the right of scientific critique.

Casual sex A report by the Centers for Disease Control and Prevention released last Wednesday on sexual attitudes in US teenagers found that, although condom use had increased, young people were becoming less afraid of pregnancy, particularly outside marriage. The study also noted an increase in teenage girls who were using the rhythm method, up to 17% from 11% in 2002.

This week in medicine

Wednesday, June 2nd, 2010

The following will be published in the June 5 issue of The Lancet:

Health Bill The health plans of the UK’s new coalition Government were announced by Queen Elizabeth II on May 25. The Conservative/Liberal Democrat coalition will set up an independent National Health Service (NHS) board, focus on public health and reducing health inequalities, cut health-service quangos, and aim to give health professionals and patients more say over NHS decision making.

iPhone poisonings As excitement mounted about the release of Apple’s iPhone 4G, it was revealed that at least 62 people in Jiangsu Province, China, had been admitted to hospital after working on the product. The factory concerned was reportedly making employees use the toxic chemical n-hexane to clean the screens. It has now stopped using it, and paid the medical expenses of the workers.

Spanish smoking ban The Spanish Government had hoped to tighten smoking restrictions in 2010, but according to Spanish health minister, Trinidad Jimenez, such rules on smoking in public places are unlikely to be approved until 2011. Despite clear public health benefits, opposition comes from Spain’s Hotel and Catering Federation, who worry what effect a full ban could have on their industry.

Immunisation campaign The Zim­babwean Government, with financial support from WHO and UNICEF, has started an immunisation campaign against measles and six other major killer diseases, targeting 5 million children younger than 15 years. Since late last year, nearly 400 deaths from measles have been reported in Zimbabwe.

Fracture warning The US Food and Drug Administration has announced plans to add a warning to the labels of proton-pump inhibitors (PPIs) indicating an increased risk of bone fractures after chronic use or high doses. The agency recommends that both doctors and patients consider whether the benefits of PPIs outweigh the risks.

Rabies vaccine withdrawn A batch of human rabies vaccine produced by the Wuhan Institute of Biological Products has been recalled in China over concerns for consumer safety. The substandard vaccine contained an excessive amount of bacterial endotoxin, which can cause fever. A statement released by the State Food and Drug Administration confirmed that there have been no reports of adverse side-effects.

Taking the strain The UK’s National Institute for Health and Clinical Excellence has issued a guidance docu­ment on management of idiopathic constipation in children. Up to 30% of children are affected by constipation, which can commonly require referral to secondary care. The guideline advises treatment with laxatives and behavioural interventions rather than dietary modification alone.

Last rites 2000 test tubes of blood are to be returned to the Yanomami tribe of South America, 43 years after they were taken by anthropologists. The samples are currently stored in five US research institutions. The return of the blood will allow the descendants of  people who donated the samples to complete the traditional funeral rites for their relatives.

Physical activity The US Centers for Disease Control and Prevention has released a report aimed at increasing Americans’ physical activity. Key strategies are creating or enhancing access to places for physical activity, enhancing physical education and activity in schools and in child-care settings, supporting urban design and land use, and transportation policies.

Rape victim victory Mexico’s Supreme Court has upheld a federal directive that all rape victims should be provided with emergency contraception or abortion by public hospitals. The ruling came in response to a challenge by the state of Jalisco that health workers should not have to offer these services. Human Rights Watch claimed the decision a victory for women’s rights to health and life.

New TB/HIV centre Tuberculosis researcher William Bishai has been named as the head of the KwaZulu-Natal Research Institute for Tuber­culosis and HIV (K-RITH) in Durban, South Africa. K-RITH is a partnership between the University of KwaZulu-Natal and the Howard Hughes Medical Institute, MD, USA, which aims to boost research into tuberculosis and HIV co-infection.

Taliban first aid The Red Cross in Afghanistan is giving basic first-aid training and first-aid kits to members of the Taliban. The International Committee of the Red Cross, which aims to remain neutral in the conflict, has said that people in the affected areas need training since their access to hospitals is often hindered by fighting, landmines, and roadblocks.

This week in medicine

Wednesday, May 26th, 2010

The following will be published in the May 29 issue of The Lancet:

Born HIV Free The Global Fund has launched a campaign to enlist public support for the prevention of mother-to-child transmission of HIV. The goal of Born HIV Free is to ensure that, by 2015, no more mother-to-child transmission occurs anywhere in the world. In high-income countries, this route has already been wiped out, but in developing countries, 430 000 chil­dren are born with HIV every year.

Electronic records Tororo Hospital in Kampala, Uganda, has computerised its medical records in a bid to improve mortality rates and the efficiency of medical services. The electronic Health Management System is part of a Ministry of Health initiative to compile a uniform patient database, allowing histories, birth details, and medical data to be easily accessible within any Ugandan health facility.

Patent blow A key patent on Glaxo­SmithKline’s (GSK’s) inhaled lung drug Advair (fluticasone plus salmeterol) has been deemed invalid by a court in Germany. The ruling opens the way for sales of generic versions of the drug, which netted GSK £5 billion (US$7 billion) and accounted for 18% of sales last year. The company is considering an appeal.

Smallpox statue On May 17, a statue was unveiled at the WHO headquarters in Geneva, Switzerland, to com­mem­orate the 30th anniversary of the eradication of smallpox on May 8, 1980. The strategy for eradication was mass vaccination combined with disease prevention by surveillance and containment. The success has been described as one of the greatest achievements in public health.

Virtual exercise The American Heart Association (AHA) and Nintendo are joining forces to promote healthier living. AHA President Clyde Yancy praised the company for demon­strating “clear leadership in active-play video games”. The partnership aims to inform and educate consumers as well as provide physical experiences. Nearly 70% of Americans are not doing the recommended amount of exercise.

Suicides in Japan According to Japan’s National Police Agency, nearly 33 000 people committed suicide in the country in 2009. Men accounted for nearly 72% of deaths, with depres­sion and economic struggles cited as contributing factors. Japan will allocate 12·4 billion yen (US$133 million) in the current fiscal year to March, 2011, in a bid to curb suicide rates.

Metronidazole recall Sagent Pharma­ceuticals, in conjunction with the US Food and Drug Administration, has voluntarily recalled all lots of 5 g/L metronidazole injections in the USA, owing to the discovery of non-sterility in two batches of the drug. The company stated that non-sterility can result in infections and could be fatal, especially in patients who are immunocompromised.

End-of-life care The UK’s General Medical Council has released a guidance document on good practice in treatment and care towards the end of life. The guidance offers advice and instruction on how to respond to patients’ advance care requests, how to involve family and carers, end-of-life treatment and care for neonates and infants, and how to respond to patients’ wishes for care after death.

Work for food The UN World Food Programme has launched an initiative in Iraq to help internally displaced people and other vulnerable groups earn enough money to buy food. Many such people still rely on food assistance and government aid. Under the new scheme, people will be paid in cash to take part in efforts to improve water and sanitation systems and revive damaged farmlands.

Health incentives The UK’s Nation­al Institute for Health and Clinical Excellence (NICE) held a public consultation last week on the use of financial incentives to encourage healthier lifestyles—eg, for losing weight, taking medicines properly, or abstaining from illegal drug use. The findings will be made available for further public comment before they are put to the NICE Board.

Food security The European Union has donated €4 million (US$5 million) to the UN Food and Agriculture Organisation to support Lesotho in its effort to ease undernutrition. In a country where 500 000 of the 2 million inhabitants are short of food, and where most of the population relies on farming for its livelihood, the money will go towards seeds and instruments to improve food security.

New at NCI Harold Varmus has been unveiled as the new Director of the US National Cancer Institute (NCI). Nobel laureate and latterly President of Memorial Sloan-Kettering Cancer Center, Varmus also had an effective spell as Director of the National Institutes of Health under the Clinton regime, which could bode well for the NCI in straitened financial times.