Taking back control of opioid prescription drugs

IStock_000030516224XXXLarge

Addiction is, by its very nature, about loss of control. The more I’ve been in this job and the longer I’ve lived, the more substances seem to be added to the addictive list. 

In the past few weeks, my early morning news on the radio has featured addiction to alcohol, to food, to gambling, to smart phones, to illegal psychoactive substances, and, the inspiration for this blog, to opioid prescription painkillers. Sadly yet more deaths and lives destroyed. 

Continue reading

Accurate and timely communication is key to stopping transmission of Ebola

Ebola on TDB
Ebolavirus: coverpage for CABI's print journal Tropical Diseases Bulletin

Ebola brings out the worst and the best in mankind.

Global coverage of the Ebola outbreak in West Africa began with (the best) courageous foreign health care workers (HCWs) being flown home by their governments in a desperate attempt to save their lives, and rapidly moved on to the sheer panic amongst the local populations experiencing the outbreak: riots, health care workers and government officials abandoning their posts (the worst). Somewhere imbetween mention was made, usually by the foreign HCWS, of their local colleagues left behind who struggled on without resources and personal protection (the best).

Medicin Sans Frontiers highlighted the slow response of the international community.

Misinformation, public panic and stigma

Ebola haemorrhagic fever (caused by different ebola virus strains) has been around since 1976, with regular self-limiting outbreaks, usually in remote areas of one country. Index cases always involve some contact with animal reservoirs (bushmeat (wild animal meat), bats, rodents, monkeys), and its then spread by person-to-person transmission through contact with bodily secretions or with objects contaminated with secretions. It’s infamous for its high case-fatality rate and the ease with which it spreads among contacts of the diseased.

What makes this time different is the Zaire strain has now reached West Africa: there  it has spread from remote regions into highly populated urban areas, and it has crossed borders so that there are escalating outbreaks in 3 adjacent countries (Guinea, Sierra Leone and Liberia), with no end in sight. The epidemic (for that is what it is now), has resulted from sustained person-to-person transmission.

Cases have also been reported in Nigeria and Senegal but these countries seem to have contained the transmission of the virus. DR Congo  has an outbreak.   An up-to-date Ebola Healthmap can be found here.

Ignorance and fear, drivers of disease

Misinformation among health workers and the public fuelled panic and contributed to the spread of Ebola-zaire over the last 6 months.  HCWs abandoned their posts or were the source of rumours that created riots, government officials got out whilst they could. [The index case for Nigeria, was an official who left Liberia, who knowingly had had contact with an Ebola victim].

Fear has not just caused civil breakdown.  It is masking the magnitude of the outbreak, especially in Liberia and Sierra Leone. Families fear stigma so hide sick relatives or consider the hospitals as death sentences (breaking relatives out!) or indeed consider them the cause of the illness in the first place. Cases being cared for outside hospitals do not enter the statistics.   

Unlike the “Black Death” in medieval Europe, it’s not lack of real clinical knowledge that’s the problem but:

  1. Weak health systems, lacking skilled HCWs and resources
  2. Lack of knowledge amongst the general public
  3. Lack of community involvement & mistrust of government
  4. Misinformation among health workers, ministries of health and the public
  5. Lack of effective drugs and vaccines…supportive therapy only is current medical response.

Continue reading

Epigenetics: epi what?

Pity the poor editor on BBC’s news programme  “Breakfast” (11 jan 2011) subtitling, as Professor Robert Winston and others discussed the possibility of gender selection to "complete your family in the way you desire" i.e. to finally achieve that longed for girl or boy.

Throughout the discussion the text editor had kept up admirably, coping with explanations of these gender selection techniques:

  • at fertilisation (by enriching for male sperm)
  • pre-implantation (by removing a cell from a fertilised embryo to check the sex.

 (Both techniques are tried and tested. Sperm enrichment is used for cattle breeding and pre-implantation tests are used to select healthy embryos without a gender-linked genetic defect)

 In vivo fertilisation was rendered accurately too, which just shows how much the public has come to know and understand about IVF since it was first introduced all those years ago.

Then Professor Winston mentioned in passing “epigenetic influences” which was transcribed rapidly onto my TV screen as “EDGE THE GENETIC”!

Clearly the editor hadn’t a clue. So I’ve decided to define (& explain) for you the term “epigenetic” so that you will.  Along the way, I hope, you emerge fascinated…

 

Continue reading

Death by CAP

Butter_mountains_3

How EU economists are ‘killing Europeans through CHD’

Surprisingly, it’s not the acronyms that are at the root of the World Health Organization’s damning accusation, it’s our old friends, saturated fats.

The common agricultural policy (CAP) was put in place by the powers that be in Europe, not just to confuse any non-economist who has tried to understand it, but, according to the World Health Organisation, it is ‘a system designed to kill Europeans through CHD’ (or, for the acronym-intolerant, coronary heart disease).

The Common Agricultural Policy was dreamed up in the days when Europe was emerging from war, rationing and widespread starvation. Many deficiency diseases that we no longer see today were rife. But agriculture had just caught the wave of plenty – industrialisation was leading to what was essentially a farming revolution. The future was bright. Applying subsidies to farmers to grow food and grow it in abundance and create a common market for all this produce was going to solve all of Europe’s problems, prevent another war and buffer the continent from the pressures of world free market capitalism. No-one said anything about heart disease.

Continue reading