Testing times The UK’s General Medi­cal Council has launched a public consultation on the long-discussed proposal for a new licensing procedure for doctors. The process, known as revalidation, would involve a yearly appraisal of a doctor’s fitness to practise, supported by feedback from colleagues and patients. The consultation closes on June 4.

Doctors come home Authorities in Wasit Province, central Iraq, are offer­ing financial incentives, a car, and housing allowances to specialists such as anaesthetists, cardiologists, and gynaecologists to try to get them to return to local health facilities. Many doctors have fled to the more peaceful northern parts of Iraq or abroad because of violent conflict and crime.

Nutrition claim slap Ahead of plans to tighten up the labelling of foods, the US Food and Drug Administration has made public dozens of stiff warning letters that it issued recently to several foodmakers with respect to “unauthorized nutrient content claims” on product labels and websites. Some claims about health benefits were so extreme as to count some products as drugs.

Ecuadorian achievement Ecuador has become the second nation in the Americas to stop the transmission of onchocerciasis, according to the country’s Ministry of Health and the Onchocerciasis Elimination Program in the Americas (OEPA). Colombia interrupted transmission in 2008, and now only four nations in the region—Brazil, Guatemala, Mexico, and Venezuela—remain endemic. The OEPA seeks to stop transmission in these countries by 2012.

Mongolia winter crisis As heavy snow and temperatures of –50°C con­tinue to affect Mongolia, aid efforts have been redoubled. UNICEF and the government have airlifted emergency and edu­cational supplies to schoolchildren, while mobile medi­cal teams supported by WHO and UN agencies have been delivering support to pregnant women and newborn babies in remote areas.

Migrant health How to improve access to health care for hundreds of millions of international and inter­nal migrants was addressed last week at a meeting in Madrid, Spain. Convened by WHO, the International Organization for Migration, and the Spanish Govern­ment, the meeting called for more partnerships across sectors and be­tween countries affected by migration.

Child marriage UNICEF is supporting a new movement against child mar­riage, launched by children in West Bengal, India. Amar Shaishab Amar Adhikar (My Childhood, My Right), has released a manifesto, which for the first time collected children’s views on child marriage and suggested points of action for parents, teachers, and communities.

Prostate cancer screening In the wake of controversy about the benefit of screening strategies in reducing the burden of prostate cancer, the American Cancer Society’s new guide­lines, released on March 3, emphasise the importance of involving men in the decision to be tested. The guidelines suggest starting the screening discussion at different ages, dependent on the man’s risk.

Mudslide deaths Mudslides in eastern Uganda have left 80 people dead; hundreds more are missing after several days of torrential rains. The UN Office for the Coordination of Humanitarian Affairs, which has dispatched two teams to assess the situation, stated that immediate health needs include first aid and support in accessing medical facilities.

Environmental health European government ministers met in Parma, Italy, this week to discuss emerging environmental health challenges, with a focus on children. Four general areas—water and sanitation, physical activity, air quality, and protection from chemicals—were discussed in the broader context of socioeconomic and gender inequalities, extreme weather events, and the financial downturn.

Kenya health insurance Social health insurance in Kenya could be reality this year after the National Economic and Social Council accepted a proposal to transform the National Hospital Insurance Fund into a National Social Health Insurance Scheme for outpatient treatment. This reform could help millions of Kenyans who are currently only covered for in-patient treatment costs.

Pill power Could a glowing pill-bottle lid be a solution to the problem of  non-compliance? One such product is about to be tested in a small trial. When it is time to take a tablet, the top of the bottle glows orange. Pro­crastinate, and it will beep with in­creasing urgency. Ignore, and a wireless transmitter could inform your doctor.

Earthquake hits Chile One of the biggest earthquakes in a century, measuring 8·8 on the Richter scale, hit Chile last week, killing at least 708 people, destroying buildings, and triggering a tsunami that threatened Pacific coastlines. President Michelle Bachelet estimated that the economic damage could be up to US$30 billion, equivalent to about 15% of Chile’s gross domestic product.

Road safety On March 2, the UN General Assembly met to discuss a new resolution on road safety. A proposed plan of action called on member states to tackle rising trends in road traffic deaths and injuries worldwide by increasing resources for road safety, targeting the most common causes of road traffic crashes, and setting targets for reduction of fatalities.

Prescription placebos The formal licensing and government fund­ing of homoeopathic treatments has been denounced by the UK’s Science and Technology Committee. Lack of evidence of the efficacy of homoeopathic treatments means that they should not be labelled as medicines, the Committee declared. Such actions “lend a spurious medical legitimacy to homeopathic products”.

India’s health budget In its 2010–11 budget, the Indian Government has earmarked US$4·82 billion for health (an increase of 8·3% from 2009). An annual health survey will be done to map the district health profile of the rural population. AIDS control, mental health programmes, prevention of diabetes and heart disease, and the shortage of health-care workers were all allocated increased funds.

Science lessons A report by the UK’s Science and Learning Expert Group has called for school science lessons to be made more exciting by adding more experiments to the classrooms. The report, commissioned by ministers, also advises the government to increase the salaries of science and mathematics teachers to attract more specialists into teaching.

Child poverty The number of Egypt­ian children living in poverty is increasing, according to UNICEF and the Egyptian Govern­ment. The country’s economic growth is failing to keep up with the rapidly rising population, leaving 23% of children younger than 15 years with less than US$1 per day. The report calls on Egypt to invest in education and to introduce special laws for the protection of children.

Misuse control Misuse of prescription drugs is on the increase, according to the International Narcotics Con­trol Board. Public ignorance about the risks associated with misuse of pain medication, and the distribution of drugs via illegal internet pharmacies, were highlighted. However, the danger that patients could be denied legitimate pain relief by overly rigorous policies was also recognised.

Drug R&D in Africa African policy makers were urged to improve drug research, production, and access to essential medicines at the African Expert Meeting on Pharmaceutical Innovation in Africa, which took place in South Africa on Feb 18–20. Although around 120 proposals for research and development are in place, initiatives are uncoordinated and long-term plans are scarce.

Going too far? A series of sexually suggestive anti­smoking posters by pressure group Les Droits des Non-fumeurs has sparked controversy in France. The posters, which have been circulated to the press, depict teen­agers in sub­missive sexual positions, and bear the slogan “Smoking is to be a slave to tobacco”. Smoking in 13–15-year-olds increased by 66% in France during 2004–08.

Dengue alert At least 20 years after its last registered case of dengue fever, Queensland, Australia, has announced its first locally acquired case. In an effort to contain the disease within one town, a team of mosquito controllers has been called and the population has been advised to thoroughly clean in and around their homes to reduce mosquito breeding sites.

Lobbying rules The Danish pharma­ceutical industry association, Lif, has issued a new code of conduct for its members to follow when lobbying decision makers such as health technology appraisal bodies. Stakeholders will be encouraged to learn that Lif members must not provide incorrect or misleading infor­mation nor use personal issues to exert pressure.

Round hole, square peg? The Ameri­can Academy of Pediatrics has recom­mended a redesign of the humble hot dog. The fast food results in the choking-related treatment of 15 000 youngsters in the USA every year. Experts say square-shaped hot dogs could save lives. But other foods, such as grapes, also pose a risk, according to the Academy. Sadly, their redesign might prove more difficult.

More broken promises Last week the Organisation for Economic Co-operation and Development released a review of aid performance of its member countries for 2010. Although overall aid will reach a record high of US$107·4 billion, it is $21 billion short of the amount originally pledged in 2004. Countries not reaching their projected goals include France, Germany, Austria, Italy, Greece, and Portugal.

Organ awareness In an attempt to overcome the shortage of compatible donors in the UK, a campaign to raise awareness about organ donation in black and south Asian communities has been launched by NHS Blood and Transplant. Currently, black and south Asian patients wait nearly twice as long as does a white person for a compatible organ.

Niger famine 5 years ago, an extreme famine in Niger was largely ignored by the international community (despite pleas from aid agencies) until the media got involved. Worryingly, 7·8 million people—two-thirds of Niger’s population—are now facing extreme food insecurity. This time, pleas for international help should not be ignored.

Syrian seizure Syria has shut down a group of counterfeit drug manu­facturers and traders operating in the country and exporting fake drugs to Iraq, Turkey, Lebanon, Iran, and Egypt. Syrian officials also seized fake medicines and equipment used to produce the counterfeits. 65 people, including smugglers and pharmacists, have been arrested in connection with the case and await trial.

Waste disposal The UN Industrial Development Organization (UNIDO) and the Government of India have teamed up to help to improve disposal of hazardous medical waste in India. The 5-year, US$40-million project will use environmentally friendly methods such as microwave and autoclave to reduce persistent organic pollutants. UNIDO’s Director-General also appealed to the private sector to reduce the burden on hospitals.

Info or ad? An opinion from an Advocate General of the European Court of Justice might mean that the Information to Patients strand of the EC’s Pharmaceutical Package (which some have regarded as direct-to-consumer drug advertising by another name) might now become law. But the ruling is vague, relying on the “deliberate and direct intention” of drug companies to give information versus advertising.

Extreme poverty A joint report by the UN Economic and Social Commission for Asia and the Pacific and the UN Development Programme states that the global economic downturn could push 21 million people in the Asia-Pacific region into extreme poverty.  Asia has weaker social protection programmes in place than do other regions such as Latin America and eastern Europe.

Patent care The US Patent and Trademark office has upheld a previous decision that an element of Pfizer’s Viagra (sildenafil) is not a new invention and so cannot be patented. Seemingly sildenafil works in a similar way to the Chinese herb yin yang huo, otherwise known as horny goat weed, which is sold via the internet.

Pay for performance The World Bank has released the results of a study on the use of pay-for-performance (P4P) medicine in low-income countries. The study examined the effect of P4P on maternal and child health services such as facility-based childbirth and scheduled vaccination in Rwanda, and concluded that financial performance incentives are capable of improving both the quantity and quality of health services.

Nurse prescribing Finnish nurses could soon be able to prescribe drugs for the specific medical conditions in which they have been trained, with authorisation from a supervising doctor. The bill, currently being con­sidered by the Finnish Parliament, is expected to improve the efficiency of services in health centres and to slow down the increasing demand for physicians.

New drug registration A report by the Drugs for Neglected Diseases Initiative outlines recommendations to improve registration of new drugs in Africa. These include closer collaboration between high-income and low-income countries, further involvement of WHO, and the establishment of regional centres of excellence to assess the safety, efficacy, and quality of new drugs for the specific populations most affected by neglected diseases.

Medical drama Canadian researchers have revealed the shocking fact that medical dramas on television are not the best source of information about first aid, especially when it comes to seizures. The researchers spent many a gruelling hour watching episodes of House MD, ER, Grey’s Anatomy, and Private Practice, and found that 46% of depictions of seizure care involved inappropriate actions such as putting something into the patient’s mouth.

Typhoon Ketsana, the massive storm that wreaked havoc in the Philippines, continues to have consequences. But for a group of 43 community health workers, nurses, and doctors now languishing in a military prison, the consequences were way beyond their worst nightmares.

The group was taking part in a week-long training seminar organised by the Community Medicine Foundation, to build first-responders capacity at provincial level, so the effects of disasters like Ketsana could be mitigated.

Participants had come from all parts of the Philippines to a farm in Rizal, east of Manila, owned by Melecia Velmonte, a leading infectious diseases specialist who regularly lends her farm to medical organisations for conferences, training sessions, and meetings.

But the Armed Forces of the Philippines, viewed the seminar as something entirely different. They insist that what was going on was a terrorist training camp where participants were being trained to make explosives. At first light on Feb 6 they swooped on the farm to achieve what they described as their biggest-ever mass arrest of insurgents.

“Around 6.15 am, 300 heavily armed elements of the military and police forced their way into the farm”, says a report released by the human rights Karapatan (whose deputy general secretary is married to one of the doctors arrested during the raid).

“At gunpoint, the military forced the caretaker to open the gates. Inside, the soldiers fanned out to different directions. They also kicked the main door to get into the building.”

“When Dr Velmonte and her son, Bob demanded for a search warrant, they were merely brushed aside by the military. All medical practitioners and health workers, were ordered to line up at the garage, frisked, and handcuffed…The male victims were then blindfolded with old shirts brought in by the soldiers and secured with packaging tape. All of the personal belongings of the victims were also taken by the military.”

While the medical workers waited outside, cuffed and blindfolded, wondering what would happen next, the soldiers searched their sleeping quarters. There they found, according to an official announcement made later that day, C4 (composition 4) explosives, a gun with seven bullets, and three hand grenades. One of the grenades was allegedly found under someone’s pillow.

“Would you hide a grenade under your pillow?” asked Roneo Clamor, husband of one of the detainees, Mary Mia-Clamor, during a press conference held by relatives and friends to demand that the 43 individuals be freed immediately.

Their demands fell on deaf ears. The health workers remain locked up in a military camp in Rizal—the women all in one room, the men in smaller cells in ones and twos. Relatives who have been able to see them for short periods say they have been tortured, and subjected to lengthy interrogation, sleep deprivation, and, in some instances, sexual abuse.

Their military captors say the interrogations have yielded evidence that some were involved in attempts to abduct senior commanders involved in counter-insurgency operations. However, this has yet to be tested legally. The Philippines’ supreme court issued a writ of habeas corpus commanding the military to produce the 43 in court on Feb 12, but they did not, citing a “lack of resources”. They eventually produced the health workers in court on Feb 15.

To outsiders the two versions—a disaster medicine training seminar and a terrorist training camp—are so far apart, the arrests seem absurd. But those familiar with the extrajudicial arrests, detentions, and killings often done in the name of counter-insurgency by a powerful, well funded military poorly controlled by the judiciary or the elected government, are not surprised.

Doctors who choose to become community health specialists and work with poor people in the provinces, are automatically considered leftists and targeted. “It’s sending a really bad message—not only to the health sector…we already have problems with our health-care delivery and now doctors are frightened of going to the provinces”, said Gene Nisperos of the Health Alliance for Democracy.

Margaret Harris Cheng

Late last year, the Times of India ran an advertorial on behalf of the asbestos industry. Entitled “Blast those Myths about Asbestos”, it began by asserting “asbestos is a naturally occurring material”. Readers were assured that “only safe white fibre is used in manufacturing of asbestos cement products in India”; and that the “problems” other countries have encountered “are not relevant in the Indian context”.

India’s surging consumption of asbestos, the industry’s hefty political and economic clout—of which the Times advertorial was one manifestation—and the country’s poor record of worker protection, has alarmed experts. A sizeable burden of asbestos-related disease is inevitable. But if current trends continue unabated, the public health consequences will be felt into the next century.

Worldwide, at least 90 000 people die every year from illnesses resulting from occupational exposure to asbestos. However, this number only takes into account workers and ex-workers who have been identified with asbestos-related lung cancer, mesothelioma, and asbestosis. But asbestos has also been linked to laryngeal and ovarian cancer. Factor in asbestos-related illness among individuals whose work history has not been recorded, the family members of those who work with asbestos, and people living near asbestos factories and mines, and the death toll is much higher.

The lengthy latency period of asbestos-related malignant diseases—in some cases more than 40 years—means that even in countries that no longer use the material, the disease burden continues to rise. The UK, for example, banned all forms of asbestos in 1999 but at least 3500 people die from asbestos-related illnesses every year, and this figure is expected to increase to about 5000 in the coming years.

Chrysotile (or white asbestos) is the only form of asbestos still being mined—it constitutes more than 90% of all asbestos used throughout history. Canada—from where India sources much of its asbestos—is home to the Chrysotile Institute; an influential organisation funded by the Canadian Government, which lobbies internationally on behalf of the material, often hosting events in Canadian embassies. Indeed, Canada has been instrumental in stymieing efforts to have chrysotile listed in the Rotterdam Convention, a UN registry of hazardous materials, which requires “prior informed consent” before they can be exported.

The Chrysotile Institute distinguishes between chrysotile and amphibole forms of asbestos, contending that the former is not so dangerous and can be safely used. Crucially, the Chrysotile Institute maintains that “there is no evidence of increased cancer risk” if worker exposure to chrysotile is less than 1 fibre/cm3; an assertion denied by health experts. “WHO’s position is very, very clear”, says Maria Neira, director of public health and environment at WHO, “all types of asbestos are carcinogenic”. The organisation’s guidelines state: “increased cancer risks have been observed in populations exposed to very low levels.”

All of which has prompted more than 40 countries—including all member states of the European Union—to ban chrysotile. The World Bank has determined not to use it in any new development projects; and WHO has noted that “the most efficient way to eliminate asbestos-related disease is to stop using all types of asbestos”.

Nevertheless, about 125 million people across the globe are exposed to chrysotile in their working environment. Worldwide production remains at roughly the same level as in 1960: nearly 2·2 million metric tonnes per year. Vast development projects in Asia are largely responsible for maintaining the market. In particular, India’s asbestos industry is burgeoning.

From 2000—07, India’s use of asbestos rose from roughly 125 000 metric tonnes to about 300 000. Nearly all of India’s asbestos is mixed with cement to form roofing sheets. Bolstered by asbestos import tariffs that have been reduced from 78% in the mid-1990s to 15% by 2004, the country’s asbestos-cement industry is increasing by roughly 10% every year, employing in excess of 100 000 people. Since 2003, companies no longer require a special licence to import chrysotile.

Since 1960, India has incorporated about 7 million tonnes of asbestos into its buildings. The health consequences are already apparent, but the scale of the problem is not clear. “The Government of India has a very poor, almost non-existent, system to record death and disease”, explains Arthur Frank from Drexel University, Philadelphia, PA, USA. Besides, cancer is not a notifiable disease. Frank cites a hospital in Mumbai which sees a dozen cases of mesothelioma every year. Studies have shown high rates of asbestosis among workers in the industry, including in those whose exposure to the material has spanned less than 5 years. “But I suspect that there has been no real assessment of [asbestos-related disease] to the point that you can get accurate figures”, Frank concedes.

It is not simply a case of data collection. Of India’s 300 or so medical schools, only one has a training programme in occupational health. 55 million Indians are covered under the Employee State Insurance Corporation. “They have 6500 physicians”, points out Frank, “yet virtually none of them have had training in occupational health”. Consequently, asbestosis is frequently misdiagnosed as tuberculosis or bronchitis. Besides, “doctors do not have access to the standard ILO [International Labour Office] radiological plate which is needed to diagnose asbestosis”, V Murlidhar from the Occupational Health and Safety Centre, Mumbai, India, told The Lancet.

Asbestos-cement is durable, fireproof, and easily secured, unlike thatched roofs. It does not clatter in the monsoon or rust, unlike metal roofs; and it will not gust in the wind, unlike a sheet of tarpaulin. Its proponents claim it is vital for sustainable development. Alternatives such as polyvinyl chloride and ductile iron might have to be imported, whereas most countries have access to cement. But, says Frank, “there are many substitutes for asbestos which don’t carry the same health risk”.

The Chrysotile Institute claims that chrysotile can be used safely as long as employers follow basic precautions. This is just not feasible, answers Pat Martin, Canadian member of parliament and former asbestos miner. “If we in the developed world haven’t found a way to handle chrysotile safely, how can we expect them to do so in developing nations?” he asks.

Vessels laden with asbestos are deposited in Indian ports, to be dismantled by some of the country’s 60 000 or so ship breakers. For these individuals, and for most workers in the asbestos-cement industry, the outlook seems bleak. “Most workers are not protected at all”, notes Madhumita Dutta from Ban Asbestos Network of India based in Chennai. “Health and safety standards in the asbestos industry in India are negligible”, agrees Martin, he talks of factories covered in carcinogenic dust and workers using bits of cloth as rudimentary masks. “There is very low awareness of the adverse effects of asbestos amongst workers”, adds Dutta. Many Indians smoke, a factor which massively increases the risk of lung cancer when taken in combination with exposure to asbestos.

The difficulties do not end there. Intact, asbestos-cement locks in harmful fibres. But it does not always remain intact. Indian consumers are unlikely to know that as asbestos-cement erodes and crumbles, dangerous fibres are released; that you must never use power saws on asbestos-cement, nor cut the product dry.

“Every time you put a piece of asbestos-cement in place, you’re putting in place the seeds of a potential future problem”, Frank stated. Even if building materials are kept in pristine condition and future generations are made aware of the building’s contents, there is no legislation for man-made disasters. The 2001 Gujarat earthquake destroyed almost 400 000 homes. In the USA, after the World Trade Centre collapsed, some dust samples showed asbestos concentrations of 4%.

Hopes for India’s immediate future are muted. “We can expect a lot more death and disease, that’s no secret”, Frank told The Lancet. “There is no champion for the working person, or for the elimination or reduction in the use of asbestos, that I can see in the central Indian Government”, he added. Dutta points out that several parliamentarians have major holdings in asbestos companies, and there are asbestos manufacturing plants in state ownership. “The asbestos industry in India is a very powerful force”, agrees Barry Castleman, an environmental consultant who has advised the World Bank and WHO on asbestos. Both he and Frank asserted that the industry has even affected government agency studies into asbestos, providing funding and helping to design questionnaires.

At a minimum, those workers who are already ill must be compensated, says Murlidhar. As things stand only a handful have received compensation—India’s intricate labour laws make it difficult to hold negligent employers to account. The final aim, however distant, is an outright ban. “The health hazards of asbestos don’t warrant its use”, Martin says simply.

Talha Burki

Health advocates for the poverty-stricken Mississippi Delta in southern USA have spent millions of dollars over the years attempting to address seemingly intractable health issues disproportionately affecting the region’s African-American population. Now a group is turning to an unlikely source for a model of primary care provision: the health house programme of rural Iran.

Established in the early 1980s, the model uses community health workers to track villagers’ health, and provide basic care and health education. Trusted workers chosen from the community help patients connect with appropriate high-level services when needed. The programme has bolstered the health status of Iran’s rural population and garnered high praise internationally.

Continuous monitoring and support, and a community-based link to the fragmented US health-care system is just what the Delta needs as well, say health house advocates. The present system has failed the rural region for decades. Saddled with a long history of discrimination and unemployment, more than 20% of the population is uninsured, and rates of diabetes, hypertension, obesity, and infant mortality are among the highest in the country. Many residents have no access to regular care and turn to the hospital emergency room when they need attention.

Aaron Shirley is a long-time champion of health care for the Delta and chair of the Jackson Medical Mall Foundation, supporting a facility that attends to Mississippi’s underserved population. He is leader of the health houses initiative. Critical to its success, he said, is community involvement in both designing the programme and implementing it. “You’ve got to know the Mississippi Delta. There’s a distrust factor. But this [programme] is from the ground up”, says Shirley. “You’d be surprised at the response that we’re getting starting with the people and saying ‘here’s an idea, what do you think about it’ rather than going in and saying ‘here’s what we’re going to do’”, he added. “They’ve had a lot of that.”

Delta health houses, like those in Iran, will employ members of the community to serve as health workers. They will bridge the divide between public health and clinical medicine, tracking individual household’s health status and serving as advocates to improve living conditions including water quality and access to healthy food. They will help patients to negotiate the complex medical system, and follow physician instructions. The group initially will train workers with at least a high school education using the equivalent of nursing assistant certification, but hopes to develop an expanded curriculum with increased focus on community issues and even disaster preparedness.

Shirley and others are seeking US$30 million to begin supporting up to 15 health houses in the Delta region. With tight budgets in Washington, and reticence to adopt a model from a country in extreme disfavour in the USA, funding is an uphill battle. But the group is moving ahead with a pilot project in a donated building in Greenwood, MS. In addition to serving as a headquarters for the health workers, James Miller, another advocate for the project and managing director of Oxford International Development Group in Oxford, MS, says the building will be a meeting place for healthy activities, and will house exercise equipment and blood pressure monitors.

With health reform faltering in Congress, provision of community-based primary care for underserved populations will be paramount in the USA, both to improve access and cut costs. The use of community health workers like those in the Delta project, long a staple in global health programmes, is becoming more widely recognised and supported in the USA. According to Carl Rush, a community health expert based in San Antonio, TX, more states, insurers, hospitals, and the federal government are realising the value of the workers. They enhance disease prevention, ensure adequate prenatal care to prevent low birthweights, and encourage patient follow-up to reduce hospital readmissions.

Advocates hope turning to Iran as an unlikely ally in the promotion of rural primary health will finally start to meet the needs of the Delta population. “This is a human disaster that’s been hitting here for decades”, says Miller.

Nellie Bristol

Radiation protection The US Food and Drug Administration has an­nounced an initiative to reduce high radiation exposure from CT, nuclear medicine studies, and fluoroscopy. It will hold a meeting next month to solicit input about the requirements for manufacturers to incorporate safeguards in the development of technologies and provision of appropriate training for practitioners.

Dubious drugs A third of anti­malarial drugs available in three African nations are substandard, according to the USAID-funded Promoting Quality of Medicines pro­­gramme. Researchers sampled 491 antimalarials (artemisinin-based com­bination therapy and sulfadoxine-pyrimethamine) in Madagascar, Sene­gal, and Uganda. The results are part of a larger ten-country project.

Technology for health Pharmaceutical companies are turning to non-traditional partners, such as telecoms and information technology, to meet the needs of their customers. Ernst & Young’s report—Progressions, Pharma 3.0—discusses the need for innovative approaches, such as iPhone applications for glucose monitoring, to improve clinical outcomes.

Yemen law Yemen could introduce a complete ban on female genital muti­lation within 4 years if new evidence shows that the practice is continuing unabated 9 years after a ban on health workers doing the practice came into force. Women’s rights groups say that although the practice may have stopped in hospitals, it is now done at home where the tools are less clean.

Stem cells for stroke? The first clinical trial of stem cell therapy for strokes has been granted approval. If successful, the 2-year trial of 12 patients with ischaemic stroke could provide a promising treatment option for stroke survivors, with the potential to provide some recovery of function to people left disabled. Extensive animal tests lend support to the use of neural stem cells for brain tissue repair.

Haiti aid Only 6% of post-earthquake assistance funds have been allocated to nutritional aid for women and children in Haiti. UNICEF has warned that high levels of acute malnutrition will result if insufficient provision for these vul­nerable groups continues. The target beneficiaries are 2·4 million women of childbearing age, 240 000 pregnant women, and 600 000 children younger than 5 years.

Pharmacovigilance Experts gathered in Brussels, Belgium, late last month to discuss the European Commission’s proposals for strengthening pharma­covigilance in the European Union. Delegates welcomed direct reporting of adverse drug reactions by patients to health authorities, but were wary of a shift in responsibilities to the pharmaceutical industry. The draft legislation will be voted on in the European Parliament later this year.

Cholera outbreak Papua New Guinea is struggling to contain its cholera outbreak, which has spread to 2000 people. The waterborne disease has killed at least 40 people since July, 2009, and is spreading to new areas, owing to poor sanitation in the country. WHO officials have urged the government to ensure people’s access to clean water.

Don’t forget Pakistan The UN has urged donors not to neglect Pakistan as Haiti’s plight dominates headlines. The organisation has appealed for US$538 million to assist the estimated 1 million Pakistani nationals who remain displaced by fighting between the army and the Taliban. Many are living with host families, but tens of thousands are in camps where food is desperately needed.

Cigarette tax hike A report by the US Campaign for Tobacco-Free Kids, the American Heart Association, and others projects that adding a tax of US$1 per pack to cigarettes in the USA would raise more than $9 billion in new revenue per year, and save $52·8 bil­lion in immediate and long-term health-care costs; it also would prompt 1·2 million adult smokers to quit.

Deadly heatwave An unprecedented heatwave that began last month is continuing to cause deaths in Latin America. Those affected are mostly older people and those with existing medical disorders. With temperatures as high as 40°C in Paraguay and 43·9°C in Brazil, medical staff have launched campaigns to inform people of the dangers of dehydration, and the need to drink regularly.

Lost in space Global positioning systems (GPS), used in emergency services and disaster relief, might soon have their usual accuracy of 3 m decreased to 10 m as the sun wakes up from low activity. The speed of GPS signals entering the ionosphere is affected by the sun’s radiation. The Newton-Raphson equation for position might well need another dimension.