Both Presidential candidates’ health-care plans come under scrutiny in the Sept 16 issue of Health Affairs, and both are found to have serious flaws.

Right now, people who receive employer-subsidised health insurance do not have to pay taxes on it. In their analysis of John McCain’s proposals, authors Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz state that this not only lowers each employee’s tax burden; it also strengthens risk pools by including younger, healthier people who take advantage of the tax break to obtain coverage. Under McCain’s plan, employer-subsidised health insurance would be considered income and become subject to federal income taxes. However, families would receive tax rebates of US $2500 to $5000 to offset the cost of those policies. 

On the assumption that, stripped of the tax benefit of employer-based coverage, many people would then buy policies on the open market, the McCain plan would eliminate current restrictions against crossing state lines when shopping for policies. Many states now require insurance companies to cover certain services, such as mammograms, even in their barest-bones policies; under the McCain programme, people in one state could buy a less-expensive policy in another state that required less generous coverage.

All in all, the authors estimate that 20 million of the 160 million Americans now covered through employer health plans would lose that insurance under the McCain plan in its current form. His proposal to deregulate the market ultimately would raise prices for consumers and leave them with fewer protections and more limited coverage. Read the rest of this entry »

The following will apppear in the Sept 20 issue of The Lancet:

Suicide watch Statistics released by the US Department of Veteran Affairs (VA) show that suicide rates in young men who served in the Iraq and Afghanistan wars are increasing. There were 46 suicides per 100 000 veteran men aged 18-29 years who used VA services in 2006 compared with 27 the year before.

Biomedical funding In a new joint initiative, the Wellcome Trust and the Government of India’s Department of Biotechnology will aim to provide postdoctoral funding for Indian biomedical researchers. Many talented researchers are forced to find work outside India and few return, but £80 million over 5 years will provide 40 fellowships for researchers early in their career, 20 for those with intermediate experience, and 15 senior researchers every year.

Antibiotic resistance In the run-up to its annual conference, the UK’s Health Protection Agency has drawn attention to the continued need for new antibiotic development. There are now more options for the effective treatment of gram-positive bacteria, but more work needs to be done on suppressing gram-negative bacteria, says the agency.

New meningitis vaccine African health ministers are set to introduce a new highly promising meningitis vaccine. Designed to stop deadly periodic epidemics and priced at only US$0·40 per dose, the vaccine offers a higher immune response than those currently available. The governments of 25 African countries aim to immunise 300 million children and adults between 2009 and 2015.

Near death experiences The world’s largest study of near death experiences has been launched by the University of Southampton, UK. The AWARE (AWAreness during REsuscitation) study is an international collaboration of scientists and physicians who aim to study the brain and consciousness during cardiac arrest, and to test the validity of out-of-body experiences. A successful pilot was done in hospitals in the UK, and the study will now include the rest of Europe and North America.

Human trafficking The International Organisation for Migration (IOM) and the South African Government are holding several workshops in the country to aid and encourage the media to raise public awareness about human trafficking. The IOM estimates that the global trade of people is now worth between US$7 million and $12 billion each year.

2008 Lasker awards On Sept 13 the 2008 Lasker Awards were announced. The award for clinical medical research went to Akira Endo from Japan, who worked on the first statin. Victor Ambros from the USA has been honoured with the basic medical research award for his discovery of small nuclear RNAs, including microRNAs. Read the rest of this entry »

 Sept 12, 2008, marks the 30th anniversary of the Alma-Ata Declaration -a huge milestone for international health. This week’s issue of The Lancet marks the anniversary with a comprehensive series of articles about what Alma-Ata stood for back in 1978, where we have come in ‘putting the ‘Health’ into Public Health’, and what future priorities are for accessible and equitable health care worldwide. Listen to Alma-Ata series co-ordinator Joy Lawn discuss Alma Ata in a podcast. And take part in our Alma-Ata poll…

Much has been made of the fact that the Republican Vice-Presidential candidate, Alaska Governor Sarah Palin, has a 5-month-old baby boy with Down syndrome. While a good deal of the discussion has generated far more heat than light, Palin’s personal situation does raise the question of whether she will be a disability-rights advocate if elected.

During her acceptance speech at the Republican National Convention, Palin underscored her connection to families with special-needs children. They would, she said, have “a friend and advocate in the White House”.

But Palin’s-and the Republicans’-stand on some issues could complicate her ability to advocate for the disabled. She is opposed (unlike her running mate) to embryonic stem-cell research, a position highlighted by her Democratic counterpart, Senator Joe Biden. On Sept 9, Biden asked why, if Palin plans to help parents of disabled children, she doesn’t support stem-cell research. The McCain campaign called Biden’s remarks part of “an offensive debate over who cares more about special-needs children”. Neither campaign appears to have addressed the issue of whether stem-cell research holds any promise for conditions like Down syndrome.

Like John McCain, Palin also supports a voucher system that would enable parents to choose which schools their children attend. School choice is usually appealing to voters in principle, since it gives parents the right to remove children from failing or dangerous public (ie, state-supported, free) schools, and vouchers theoretically broaden the availability of educational venues beyond the public system to private or charter (fee-supported) schools. In practice, though, US schools are basically run by state, local, and private authorities, not by the federal government. Those local policies may dictate which children can enroll in specific schools, and not all schools (in particular, private ones) will accommodate special-needs children. Read the rest of this entry »

If the US presidential race can be described as theatre, last week’s Democratic National Convention would have been a Broadway hit, with its star candidate Barack Obama and his adorable family in the leading role, and a supporting cast that included the veteran politician and vice-presidential pick Senator Joe Biden. The performance went off without a hitch.With his own nominating convention this week, Republican candidate John McCain hoped to capture at least some of the fanfare from the Obama Show. Instead, he has had to overcome distractions that threatened to spoil the opening act. First, McCain surprised everyone by announcing his vice presidential running mate is Sarah Palin, a previously unknown Alaska governor with little political experience. Then Hurricane Gustav took the stage, narrowly missing an evacuated New Orleans and causing Republicans to delay the start of their convention by a day.

That should have been enough drama for one convention. But the McCain-Palin ticket hit another bump in the political road. And it stems not from the merits of either candidate, but rather from a situation involving Palin’s pregnant and unmarried teenage daughter.

The story dominated the airwaves for the first two days of the convention, although both candidates and a cast of experts pointed out that such personal issues have no place in politics.

Nevertheless, the announcement of Palin’s soon-to-be grandchild is politically relevant, and here’s why: Palin is touted by Republican insiders for her socially conservative credentials, including a strong anti-abortion record. In addition to opposing abortion, on a 2006 questionnaire submitted to gubernatorial candidates, Palin refused support for “explicit sex-education programs”, according to CNN. Read the rest of this entry »

The following will be published in the Sept 6 issue of The Lancet:

Macular degeneration Ranibizumab, a sight-saving drug for patients with wet age-related macular degeneration, will become accessible to patients in the UK. In a dose-capping scheme, the National Health Service has agreed to fund the first 14 injections for each eye. The manufacturer will meet any additional costs.

Poverty report The World Bank has assessed that 1·4 billion people in the developing world lived in poverty in 2005; this is substantially more than its 2004 estimate of 985 mil­lion people. The figure is based on a newly drawn poverty line of US$1·25, which for the first time is ad­justed for inflation. Although the global poverty rate has fallen from 50% to 25% over the past 25 years, poor people in sub-Saharan Africa have almost doubled in number, to 380 mil­lion, and still make up half the population.

Fake sick notes on the internet A website is selling notes and medical certificates that purport to be from real doctors at NHS medical centres in any part of the UK. The site advertises the notes at £25 for two, with 48 h delivery. The NHS fraud squad has said that anyone who uses a fraudulent document risks prosecution, but that selling the notes is not illegal.

Post-traumatic stress disorder Since the war in Iraq began, post-traumatic stress disorders have become en­demic, and other stress-related mental illnesses are also com­mon. How­ever, psychiatric services have deteriorated. Baghdad’s Central Paediatric Teaching Hospital has now been funded to open a clinic for chil­dren with psychological disorders.

HIV in New York City 72 in every 100 000 people in New York con­tracted HIV in 2006, more than three times the US average of 23 per 100 000. Since re­searchers used new technology to identify recent infections, and a novel statistical model to estimate inci­dence at a population level, these results cannot be used to assess change over time. However, even a rough estimate of incidence will help to understand and combat the spread of HIV.

Read the rest of this entry »

Back in March, we covered the launch of a 3-week global dialogue on the development of a code of practice for the international recruitment of health workers. This culminated in a draft code. Today sees the beginning of the next stage in the process of developing the final document: a web-based public hearing (the “fully legal” bit), which will result in a revised draft to be discussed by WHO’s Executive Board when it meets in January next year.

Anyone can take part, and contributions should be submitted by Sept 30, 2008, via the dedicated WHO website. Now is your chance!

Zoë Mullan

Several news and comment items on the abortion issue:

• The Mexican Supreme Court has upheld a Mexico City law that makes legal abortion in the first trimester of pregnancy.
• Kenya is also debating a new abortion law.
• John McCain, the presumptive US presidential nominee for the Republicans, has chosen an abortion-rights opponent for his running mate. Some background about Sarah Palin here.

The just-released WHO report on social determinants of health is getting lots of coverage. Check out persepctives from the Voice of America, the Guardian, Time magazine, and the Economist.

All eyes this week were on Denver and the glitz and glamour of the Democratic National Convention, which many commentators likened to a Hollywood production with an emphasis on personalities rather than issues.

Media coverage made a political soap opera out of Bill and Hillary Clinton supposedly vying for the limelight one last time before the party formally throws its support behind its nominee Barack Obama, who will address the convention today.

In a speech on Tuesday night, Hillary Clinton urged her backers to get behind Obama to prevent a John McCain presidency, the Chicago Sun-Times reported. “I can’t wait to watch Barack Obama sign a health-care plan into law that covers every single American”, she said, reminding the convention floor that health reform was a key issue for her supporters.

Clinton also attacked McCain, who will be formally endorsed as the Republican nominee at his party’s convention next week. “John McCain says the economy is fundamentally sound. John McCain doesn’t think that 47 million people without health insurance is a crisis.” She repeated the Democratic message that a McCain presidency would be a continuation of George W Bush’s policies. Read the rest of this entry »

The following will be published in the Aug 30 issue of The Lancet:

Rising floods WHO reports that flooding caused by heavy rain across west Africa poses major health risks. Malaria, yellow fever, and diarrhoea are among the potential diseases, and tens of thousands of people have been displaced. Damage to bridges, roads, and railway lines is making aid access difficult. Futhermore, the loss of food crops will exacerbate the food crisis in this malnourished region.

American measles The US Centers for Disease Control and Prevention (CDC) is concerned about an upsurge in measles—131 cases across 16 US states were reported between January and July, 2008. This incidence is the highest since 1996. Of 95 patients who were eligible for vaccination, 63 were unvaccinated because of philosophical or religious beliefs. The CDC aims to educate parents on the dangers of measles and the importance of vaccination.

Safer medicines Iraq has pledged to stop the import of illegal medicines by Sept 1, 2008. The Ministry of Health has concluded that 70% of all Iraq’s medicines are either illegally imported or have expired. These drugs can cause adverse effects such as internal bleeding. Medicines can now only be imported at six border points, where strict checks are in place to ensure their authenticity.

Neuroscience centre University College London (UCL), UK, is expected to host a research centre to investigate the role of neural circuits in behaviour. The £140 million centre will be jointly funded by the Wellcome Trust and the Gatsby Charitable Foundation. The strength of the neuroscience centre at UCL might have led to its selection as the preferred host university, but a final decision is yet to be made. Read the rest of this entry »