30 Nisan 2014 Çarşamba

Saatchi Bill: Folks energy drives the battle to remedy cancer

Last week, the Department of Health closed the public consultation into the Medical Innovation Bill – a Bill which I first introduced in December 2012, designed to protect patients and their doctors who wish to innovate. And thanks to the Secretary of State, and his legislation team at the Department of Health, it has been a model of a Government listening.


We now have the results. A staggering 18,655 people – including doctors and patients, relatives of the bereaved and soon-to-be bereaved, scientists, lawyers, legislators and the man and woman in the street – have responded wholeheartedly in support of this Bill. Fewer than 100 were against it. Thanks to the Telegraph in particular, which backed the Bill and the consultation from the start, this has been the biggest digital response of its kind to a Department of Health consultation by miles.


In February, we ran the first House of Lords Google Hangout – an online “town hall” meeting. It was a truly democratic way to gather public opinion in the heart of the Palace of Westminster. The social media response was huge – we reached more than 15 million on Twitter alone and this connected patients and doctors to the Bill, which they in turn adopted. Patients told their stories online, inspiring more and more to join, and the whole thing went viral.


The Bill has obviously touched a nerve. Why? Because people know that all cancer deaths are wasted lives. Science does not advance by one centimetre as a result of all these deaths, because the deceased receive only the “standard procedure” – the endless repetition of a failed experiment.


This was no tick-box or postcard consultation. Supporters took the time to write their own stories and reasons for backing the Bill – probably because they have seen first hand the desperation of those failed by conventional practice.


We have heard from doctors whose patients’ lives have been ripped apart, from the children who lost parents, and from children facing terminal illness. They want the answer to the same question: confronted with a prognosis of certain death, they ask, “Has everything been done? Can any more be done? Is there anything else you can do?”


Right now, that is a hard question for doctors to answer. The President of the Royal Society of Medicine, Professor Sir Michael Rawlins, explained in the current British Medical Journal: “…departing from what is regarded as established practice or the standard of care leaves a doctor open to an action for negligence”.


Following the consultation, the Bill that is presented to Parliament in its final form will go further than the Mental Health Act in safeguarding patients. The Mental Health Act requires the authorisation of two doctors before an abortion or sectioning in a mental institution can take place lawfully; the Medical Innovation Bill requires the Multi Disciplinary Team in the hospital to approve the proposed innovation in advance. This is a most severe test, but however severe, it is better than the current position in which any departure from standard procedure can lead to the end of a doctor’s reputation and livelihood.


If the Bill receives Royal Assent after scrutiny in both Houses of Parliament, good doctors will be protected and encouraged by the law. And bad doctors will be deterred from innovation without the support of a responsible group of colleagues. To anyone who wants to preserve the pre-eminence of the status quo this consultation result provides the answer: the people have spoken. The Bill will change the culture to stimulate innovation in medical treatment, which alone might lead to a cure for cancer.


I hope Her Majesty’s pen is full of ink.



Saatchi Bill: Folks energy drives the battle to remedy cancer

States ought to be given accessibility to earnings tax, audit report says

State governments would be given entry to revenue tax and complete duty to supply a host of public providers, such as schooling and health, underneath a radical reworking of federal-state relations proposed by the Commission of Audit.


The commission’s tax reform proposal is that Canberra ought to permit state governments to entry the federal income tax base. This would give them with a trustworthy income stream when their very own revenue raising choices are limited.


In idea, the reform works like this:



  1. Canberra would lessen by ten percentage factors the current individual tax price of 32.five% – to 22.5%.

  2. The state would then apply its personal surcharge of 10%, delivering a new source of revenue of up to $ 25bn yearly.

  3. Provided the state would then have the money to manage and deliver public companies, the commonwealth would then abolish the grants it now provides to the states for packages such as colleges and hospitals.


Malcolm Fraser supplied a comparable deal to the states in the 1970s– but the proposal was rebuffed by the premiers on the basis that it was double taxation.


The Commission of Audit envisages a fundamental reworking of commonwealth/state relations and responsibilities at both the philosophical and practical level.


It says government providers – like wellness, schooling, housing and disability – should be delivered by the tier of government closest to the men and women receiving them.


In practice that implies most of the providers now becoming funded and managed in a policy sense by the commonwealth would shift back to the states.


“Underneath the principle of sovereignty, as far as practicable, each degree of government must be sovereign in its personal sphere,” the report says. It adds that allocating the accountability for solutions to one particular level of government, rather than across the federation, will provide “better clarity and accountability”.


The tax proposal would see the federation revert back to a model of competitive rather than collaborative federalism. Every single state would be given scope to fluctuate their very own surcharges, which means states could undercut one particular an additional with their respective tax attractiveness.


The commission also says – of the lengthy-running dispute among state premiers about the carve-up of the GST – that revenue from the consumption tax should be shared on an equal, per capita basis.


This recommendation sides with the large states, so will be controversial in the smaller states. The commission says the revenue shortfalls must be dealt with by supplying further grants to the states which are manufactured worse off by the adjust.



States ought to be given accessibility to earnings tax, audit report says

FDA Cracks Down On Autism Quackery

The US Meals and Drug Administration (FDA) “has warned a variety of businesses that they are dealing with feasible legal action if they carry on to make false or misleading claims about items and therapies claiming to treat or cure autism,” according to a client update from the agency.


About time. Autistic young children have suffered prolonged adequate from the “interventions” that the FDA lists as targets that “carry considerable well being hazards,” like


–Chelation, which the FDA says is hazardous simply because “chelating important minerals essential by the physique can lead to severe and existence-threatening outcomes.”


–Hyperbaric oxygen treatment (HBOT), which the FDA cites as not possessing been cleared for autism. The company issued a buyer warning last August about the off-label employs of HBOT.


–Miracle Mineral Resolution: As I wrote final October:



It stands for Miracle Mineral Resolution, but it’s really bleach. I know because I examined it myself, destroying a completely good cloth napkin in the procedure. Consider a appear at what it does to cotton. Now envision it on the inside of a child’s mouth, esophagus, stomach, or intestines–its peddlers inspire its administration as an enema. Horrorshow. Yet not only do parents consider this bleach as a “treatment” for their children’s autism, but also a significant autism conference truly featured a presenter flogging this things, and the claim that it “recovered” 38 children in 20 months remains on the conference site as I kind this.



Each and every of these happen to be three of the prime 5 scariest autism remedies that I selected to highlight last October. Now the FDA evidently strategies to ultimately do anything about them.




English: An external photo of a 40&quot hyper... 40″ hyperbaric chamber. Bruce McKeeman writer. (Photograph credit: Wikipedia)




The FDA’s prime five also contains “detoxifying clay baths,” which proponents declare will draw out “chemical toxins,” and CocoKefir probiotics merchandise, which “have not been confirmed secure and successful for (the) advertised use” of “recovery” from autism.”


Last but not least, the FDA’s consumer update delivers buyers a listing of red flags that ought to alert to suspicious claims, like claims of treating a broad variety of illnesses, making use of personal testimonial and not scientific proof as a selling stage, providing a quick fix, or calling itself a miracle, breakthrough, or “secret.” For the discerning customer, I provide a far more detailed checklist of queries to ask by yourself here. Let’s just say that none of the “therapies” on my prime five “worst of” listing or the FDA’s would pass the test.



FDA Cracks Down On Autism Quackery

Australian cardiologist regrows monkey hearts with human stem cells

An Australian cardiologist has accomplished what could demonstrate a key breakthrough in treating heart disease, following operating with US scientists to use human stem cells to regenerate the broken hearts of monkeys.


A evidence-of-principle examine, published in Nature, showed that human embryonic stem cells boosted heart regeneration when transplanted into injured macaque hearts.


The findings represent the very first time that scientists have been ready to develop stem cell-derived heart muscle at a scale to treat huge animals. The study was also profitable in displaying that the transplanted cells worked in tandem, rather than towards, host tissue.


Preceding work has shown that the human cardiac stem cells, known as cardiomyocytes, could be utilised on rodents. But the breakthrough with the macaque monkeys exhibits it could be possible to use the same remedy in people, albeit following many much more years of research. A lot more than twenty,000 Australians die from heart failure every single 12 months.


Dr James Chong, a cardiologist at the Westmead Hospital and Sydney University lecturer, authored the study paper in collaboration with a University of Washington group, led by Charles Murry.


The researchers induced a heart attack in eight macaque monkeys by impeding the blood flow into the organ. Two weeks later on, the stem cells had been injected into the heart.


In excess of a time period of 3 months, the hearts had been proven to have regenerated dead tissue by up to forty% and accomplished electromechanical coupling with the unique host heart. Even so, it is unclear from the examine whether a full recovery would be achievable by way of stem cell remedy.


Chong explained the investigation was a “very important advance” in the work to locate much better ways to treating heart failure.


“I feel it is practical to presume that this could be used in humans sooner or later on,” he informed Guardian Australia. “A whole lot of function needs to be accomplished but I don’t believe we’re also far away.


“Heart failure is a increasing issue. We’ve acquired much better at treating heart attacks but it means that a whole lot of people are living longer with damaged heart muscle. This harm gradually spirals out of handle and the drugs we have only slow down the approach.


“The only remedy truly is a heart transplant, which is certainly problematic. The human heart and brain are the least regenerative parts of the physique.”


The researchers are now looking for even more funding to advance the studies so that human clinical trials can eventually be undertaken.



Australian cardiologist regrows monkey hearts with human stem cells

Minimum alcohol price tag not in the public curiosity, says overall health company

Australian drinkers ought to not be forced to pay a minimum cost for alcohol even although the move would almost certainly reduce booze-fuelled harm, the Nationwide Preventive Wellness Agency (NPHA) has stated.


In its long-awaited report, the NPHA concluded a floor value for alcohol was very likely to cut “crime and violence, alcohol-relevant disease and productivity losses”, but stated all round the policy was not in the public interest.


That is primarily simply because a minimal price tag, unlike a tax, would lead to alcohol retailers raking in greater revenue as an alternative of a lot more income going to the government to “be utilised to additional reduce or deal with alcohol-connected harm”, the NPHA said.


“Cost increases in the industry … would movement solely to the private sector under such regulation,” it stated in the report, launched on Thursday.


In the United kingdom, the company explained, it was estimated a minimal alcohol value of 45 pence per standard drink would boost retail earnings by in between €700m ($ 1.05bn) and €2.2bn.


“Hence, the company advises the commonwealth government that a minimum (floor) value for alcohol should not be launched nationally at this time,” the NPHA explained.


The NPHA also said there was robust assistance for alcoholic drinks to be taxed in accordance to alcohol power, not cost, under a “volumetric tax” method.


In addition, the agency urged the government to appear at the wine equalisation tax, which it explained “outcomes in price tag distortions in the alcohol marketplace in certain in favour of inexpensive wine”.


Yet another essential recommendation was for more alcohol data collection, which includes on cider consumption.


The report said a minimum price of about $ one.50 would have the most significant affect on the expense of cask wine, whilst beer and most other types of alcohol would not be affected.


The report has come amid speculation the NPHA is 1 of a quantity of well being agencies marked for abolition in the federal government’s commission of audit.


The audit, due to be unveiled on Thursday, is explained to include 86 suggestions and urge massive cuts to the size of government.


The NPHA was established in 2010 to forestall preventable persistent ailment by targeting well being issues, including obesity, tobacco and alcohol.



Minimum alcohol price tag not in the public curiosity, says overall health company

Reward healthful individuals with tax rebates to save the NHS, urges thinktank

Woman takes a break from jogging

Folks with wholesome lifestyles need to be rewarded for the income they conserve the NHS, according to a thinktank Photograph: Alamy




Britons ought to be rewarded with tax rebates for giving up smoking, staying slim or consuming less as a way of relieving the “thoughts-boggling” increase in demand for NHS care, a thinktank urged on Thursday.


20/twenty Overall health says incentive schemes that reward healthful lifestyles would inspire people to be much more responsible about searching soon after themselves and staying away from damaging habits. They should be obtainable for those who do not become unwell or demonstrate great at managing problems such as diabetes, it suggests.


“We propose ‘payment by results’, a monetary reward for folks who turn into active partners in their wellness, whereby if you, for illustration, hold your blood sugar levels down, quit smoking, hold bodyweight off, [or] consider on more self-care there will be a tax rebate or an finish of yr bonus,” it says in a report on the NHS’s long term.


GPs could check patients’ habits, although the payments family physicians get for carrying out particular checks on or interventions with sufferers and patients’ electronic health care records would also underpin such a technique.


The thinktank cites the example of Tayside in eastern Scotland exactly where the local NHS has because 2007 been offering mothers-to-be weekly grocery vouchers in return for stopping smoking. Girls are offered the £12.50-a-week credits, which can not be utilised to get alcohol or tobacco, all through pregnancy and up to 3 months soon after the baby’s birth.


It is believed that of the 450 ladies who have taken element in the “give it up for little one” and “quit4u” schemes so far, about twenty% are still not smoking – double the accomplishment price achieved by a lot more traditional NHS cease smoking companies.


“Much more funds spent on creating healthy selections rather than pursuing unachievable choices would be the best stewardship of NHS money and taps into our human wish to save money,” say co-authors Julia Manning and Gail Beer.


Manning stated that as GPs already receive monetary incentives for hitting specified targets, individuals with healthful lifestyles must be similarly rewarded.


The Department of Well being stated England’s 211 GP-led clinical commissioning groups, which control neighborhood NHS budgets, had been free of charge to supply rewards if they needed. “The use of incentives is a determination for local public overall health providers. We think that creating certain men and women have the proper data to make selections about their lifestyle is key,” stated a spokeswoman.


NHS England has warned that the service is dealing with a £30bn gap by 2021 amongst the money it has obtainable and the demand for care that ageing and the rise of situations such as diabetes will generate.


The thinktank also proposes ending the present “postcode lottery” in what providers and remedies patients obtain by drawing up a checklist specifying what each and every patient in England need to get irrespective of where they reside, despite the fact that such a move would inevitably involve rationing of particular remedies as as well costly.


The NHS is about to run out of funds and requirements billions of pounds a yr in extra fund to preserve afloat, a new report from the King’s Fund thinktank warns.


With no further funding it will slip into a financial crisis which will damage patient care, in accordance to its evaluation of the NHS’s potential sustainability.


Far more cash is needed to bail out the expanding amount of hospital trusts which are ending up in deficit, and also to keep present hospital-primarily based services going whilst new providers are set up elsewhere – what wellness professionals get in touch with “double working” – which will form the basis of a a lot more patient-centred potential NHS, it says.


Professor John Appleby, the King’s Fund’s chief economist, said that while the NHS could enhance its efficiency, “it is now a query of when, not if, the NHS runs out of funds. With no important further funding, this will lead to growing waiting times, cuts in personnel and deteriorating quality of care.”


Politicians from all parties required to be honest with the public about the scale of the process dealing with the NHS, Appleby stated.


Meanwhile, Heatherwood and Wexham Park Hospitals NHS Foundation Believe in has turn into the latest hospital believe in to be place into special measures since it was located to be providing poor care and getting badly led.


Monitor, an NHS regulator, has told it to produce an action strategy to drive by means of enhancements and has arranged for Frimley Park NHS Basis Trust to “partner” with it to help it increase.




Reward healthful individuals with tax rebates to save the NHS, urges thinktank

Yet another Failed HDL Therapy Trial

In spite of robust epidemiological evidence suggesting that HDL has a sturdy protective result towards cardiovascular disease, there has been no excellent proof showing that HDL-primarily based therapies are helpful. Huge trials of medicines that increase HDL levels, including niacin and CETP-inhibitors, have failed to show enhancements in final result. Some observers gleaned hope from numerous small scientific studies of drugs that mimic HDL activity but these research have been as well modest to supply convincing evidence. Now a new study– the biggest to ever examine an HDL mimetic– has failed to locate even a glimmer of benefit.


Final results of the CHI-SQUARE (Can HDL Infusions Substantially QUicken Atherosclerosis Regression) examine were published on the internet in the European Heart Journal. Within two weeks of having an acute coronary syndrome, 507 patients had been randomized to obtain 6 weekly infusions of either placebo or one of 3 doses of CER-001, an HDL-mimetic from Cerenis Therapeutics.


Benefits of the trial were extensively unfavorable. CER-001 had no substantial impact on atherosclerosis, as assessed by both intravascular ultrasonography (IVUS) and quantitative coronary angiography (QCA). There were also no significant distinctions in the number of individuals who had at least a single significant cardiovascular occasion.


Cerenis was apparently so shocked by the unfavorable finding that it asked for a publish-hoc re-analysis of the IVUS recordings from a separate group. The outcomes, unluckily for them, were no diverse.


I asked several cardiologists who have performed HDL research to comment on the research. They remain remarkably optimistic about the prospects of HDL.


PK Shah sent the following response:



This is a really disappointing study displaying no quick phrase results of rHDL (containing wild kind Apo A-I linked to two phospholipid carriers) infusion at doses of 3, 6, 12 mg /kg on non-culprit coronary lesion size as assessed by IVUS and QCA.


If you are a pessimist and disregard all the biological plausibility information on vascular protective effects of Apo A-I or its mutants such as Apo A-I milano proven in preclinical models and modest clinical research , you could conclude that APo A-I infusions treatment may possibly not understand its guarantee on the other hand if you are an optimist , you could make the arguments that a damaging examine could have been due to:



  1. Not measuring plaque composition which is more very likely to adjust just before plaque dimension modifications i.e not measuring lipid core dimension and irritation that goes with it. IVUS could not be the ideal methodology.

  2. Not deciding on the sort of patient most likely to show a change in plaque, i.e., a patient with a lipid wealthy plaque rather than any plaque without regard to its composition.

  3. Not employing a large ample dose ( Apo Milano review in 2003 utilized 15 and 45 mg/kg /per dose even though as the dose utilised in this study were 3, 6, 12 mg/kg/dose)???

  4. Not using enough infusions to remodel the plaque ???

  5. The compositional attributes of the HDL mimetic utilised in this examine may possibly not be optimum HDL containing APo A-I milano, probably a obtain of perform mutant, may possibly make different final results as suggested by preclinical scientific studies carried out in our laboratory.


As a believer in HDL’s vascular protective results, I stay optimistic that, even though HDL has been a difficult nut to crack, one particular of these days we will get it right making use of the correct formulation, appropriate patient and correct dose investigation in this area need to continue till we get it correct, the simple biology is very compelling.



I asked William Boden, PI of the NIH’s AIM-Substantial trial, if it was time to write the obituary for HDL:



You have to be kidding me! The finish of what? HDL RIP? How about: RIP suboptimal examine style and trial hypotheses? I proceed to be astonished that we see nothing but pejorative commentary and noise about the death knell for the HDL hypothesis and HDL-raising therapy when, time right after time and trial after trial, we see the very same unenlightened examine style perpetuated.


What do ILLUMINATE, Dal-OUTCOMES, HPS-two THRIVE, and this CHI-SQUARE trial all have in frequent? The answer is: an unreasonable review population in which to test HDL-raising treatment. The two CETP inhibitor trials and this 1 incorporated ACS individuals who have been not pre-chosen for a profile of minimal HDL-C cholesterol. In reality, I did not see any baseline lipid worth for CHI-SQUARE. The baseline apo-B values were &lt80 mg/dL in two groups and had been 81 and 86 in the other 2 groups–values that would be considered “optimal” or perfect. The Apo-A1 values of &gt130 mg/dL are likewise typical. Consequently, we can presume that the baseline LDL-C and HDL-C had been regular, or possibly optimum. Why on earth would one assume that a patient with an HDL-C of, say, 50 mg/dL to demonstrate a reduction in coronary atherosclerosis or clinical events when you are producing a regular baseline worth super-typical with an HDL-raising intervention? Since the epidemiology of HDL-C tells us that the danger of incident CV events is both inverse and curvilinear, if the starting up HDL-C is on the flat (typical) component of the event connection, then why would a single count on that raising the HDL-C to 70 or 80 would decrease CV events?


Our latest data (from four separate sources of observational and submit hoc RCTs) recommend that baseline HDL-C &lt30 mg/dL could be the threshold under which one particular requirements to target HDL-Raising therapy. This is the place the event curve steepens inversely and the place one might anticipate to see an HDL-raising therapeutic advantage.


So this trial tells me practically nothing new that I haven’t witnessed in the other above trials. In our submit hoc evaluation of AIM-Substantial (admittedly only “hypothesis-generating”) an HDL-C &lt31 mg/dL was associated with a niacin treatment method result for the primary endpoint. This would really be the 5th information set to present that it is the extremely lower HDL-C subset that we need to target, not these “all-comers” styles where patients have typical or high HDL-C to start.


We have nevertheless to see the right trial design and style. And, of course, since the wonderful bulk of AIM-Substantial and HPS-two individuals have been getting statins for one-5 years, how can you assume, as in HPS-two, to see an incremental HDL-C raising effect when the baseline LDL-C was 63 mg/dL and the baseline HDL-C was ~47 mg/dL? Perhaps we require trials of individuals who are statin naïve, not such well-taken care of patients exactly where danger mitigation possibly cannot be attained.




Yet another Failed HDL Therapy Trial

Fluorescent Green Stem Cells Regenerate Heart Muscle tissue Right after Heart Attacks

Two weeks following possessing heart attacks, three macaque monkeys received injections of a billion heart cells, derived from human embryonic stem cells, to fix their broken muscle. About 40 % of the broken tissue was regenerated n the macaque’s hearts utilizing this strategy, in accordance to a examine published in the journal Nature.


Heart attacks do harm to the cells that make the heart beat, which are named cardiomyocytes. Injury to them makes it more difficult for the heart to pump blood throughout the entire body, which is why several folks usually remain on medication completely right after heart attacks. About one million people in the U.S. have heart attacks each and every yr.




English: A Crab-eating Macaque (Macaca fascicu... English: A Crab-eating Macaque (Macaca fascicularis) Monkey eating peanuts. Pictured in Bangalore, India Français : Un Macaque crabier (Macaca fascicularis) mangeant des cacahuètes, Bangalore, Inde. (Photograph credit score: Wikipedia)




Men and women generally experience heart attacks when a waxy cholesterol plaque breaks open in an artery, triggering a blood clot to form. The clot, if big ample, can absolutely block blood from flowing by way of the heart’s arteries. The muscle ordinarily fed by the blood movement via that artery commences to die. The dead muscles don’t increase back — rather they are replaced by scar tissue, which helps make it harder for the heart to pump blood. Heart attacks can lead to other severe problems, like heart failure, arrhythmias, and death.


The hope of stem cell therapy is changing the tissue broken by the heart attack with new cells that could enable the heart to heal back to one thing like normal perform. Today’s review suggests that may possibly be attainable. The stem-cell derived heart muscle cells matured and started to beat along with the macaque heart cells, and after three months, they were completely integrated. The scientists were in a position to determine this by making confident the human stem cell-derived cells would express a fluorescent green protein, creating them less difficult to spot. Not only had been they fairly standard, new blood vessels had grown to feed the heart cells, the 1st time that is been noticed.


There have been some hiccups. Very first, all the monkeys needed immunosuppressive treatment to stop their bodies from rejecting the human cells. And ultrasound studies of the animals’ hearts showed that the muscle’s capability to pump blood improved in some but not all of the animals. But the most worrisome thing were episodes of irregular heartbeats that occurred shortly after the stem cell injections. These disappeared following two to three weeks following the injection, as the stem cells matured.


But the method, even though employed in only a couple of animals, might one particular day offer support for heart failure individuals, the examine authors wrote. Of program, a lot more analysis wants to be carried out.



Fluorescent Green Stem Cells Regenerate Heart Muscle tissue Right after Heart Attacks

Caesarean part does not decrease fertility

Between minimal-danger first-time mothers, 224,024, or 21.four%, had been delivered by Caesarean part, with fewer than 4% possessing an elective caesarean segment, or a single planned in advance.


All types of caesarean part were connected with a lowered subsequent birth charge, compared with these who had vaginal deliveries, but the dimension of the reduction varied amongst distinct groups of ladies.


The smallest reduction was for an elective caesarean segment for a breech child – one in feet-very first place – where a girl had no other issues for the duration of pregnancy.


The greatest was for ladies possessing an elective caesarean area for health care motives.


Dr Tahir Mahmood, from the workplace for study and clinical audit at the RCOG and co-writer of the paper, which is published in the journal Human Reproduction, explained: “The attainable effect of caesarean segment on subsequent fertility is important as the age of initial-time mothers proceed to rise, along with the charges of caesarean part.


“This is the greatest cohort study to date hunting at the association in between mode of delivery and fertility, and to minimise the chance of bias we focused on minimal-danger pregnancies.


“By carefully distinguishing among different problems of pregnancy, we have found that getting a caesarean segment as a very first-time mom leads to only a quite small result on subsequent fertility.


“The conditions behind the method may have a bigger influence and may possibly explain the reduction in fertility apparent in prior studies.”


Previous research have reported that delivery by Caesarean is linked with fewer subsequent pregnancies and infants, as properly as longer intervals among pregnancies.


A research published in 2004 by researchers from the University of Dundee located that girls who had their first little one by Caesarean have been more very likely to report getting troubles conceiving once more compared to girls who had a vaginal delivery using instruments this kind of as forceps.


Louise Silverton, director for midwifery at the Royal School of Midwives (RCM), mentioned: “The reality that the effects on fertility may possibly be minimal need to go some way to reassure individuals ladies for whom a Caesarean is needed and who might want an additional child in the future.


“Nevertheless, even although there is less result on fertility than was assumed, this does not negate the other unfavorable effects of Caesarean sections. The wider problem right here is to ensure that girls are aware of the consequences that can come up as a end result of having an needless Caesarean part.


“There is escalating evidence about the negative implications for women and their infants of possessing a caesarean segment. This is a major surgical operation that has the prospective for elevated complications each time a woman has the process carried out. A choice to have a caesarean section must not be taken lightly by ladies or physicians.


“As a consequence we ought to carry on to try out to minimize the number of Caesarean sections amongst first-time mothers. We should also carry on to encourage women who can, to take into account a vaginal birth for the next and subsequent pregnancies.


“A single of the methods this can be done is by marketing and providing far more midwife-led care the place lady are significantly less probably to have a caesarean area and other interventions.”



Caesarean part does not decrease fertility

WHO calls for urgent action to preserve energy of antibiotics and make new ones

Pneumonia will again turn out to be a feared killer, surgical procedure risky and diarrhoea fatal if urgent action is not taken to protect the energy of existing antibiotics as properly as build new ones, the Globe Well being Organisation has warned on Wednesday.


In its initial investigation of the extent of antimicrobial resistance across the planet, the WHO said we are dealing with a massive risk to public wellness, which could affect anybody of any age.


No nation is immune, as bacteria and viruses resistant to medication travel the globe with ease.


In the Uk, as elsewhere, there is rising concern about infections from Klebsiella pneumoniae, bacterium carried in the intestines which has turn into resistant to the final line of antibiotics accessible, the carbapanems. In fragile individuals on intensive care wards and newborn babies, these infections can be fatal. Meanwhile, sexually transmitted gonorrhoea is on the improve and is also resistant to the final-resort antibiotics utilised to deal with it.


“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can as soon as yet again destroy,” mentioned Dr Keiji Fukuda, WHO’s assistant director basic for health safety.


“Successful antibiotics have been one particular of the pillars allowing us to dwell longer, reside more healthy, and benefit from modern day medicine. Except if we take important actions to increase efforts to stop infections and also adjust how we make, prescribe and use antibiotics, the globe will lose more and far more of these worldwide public overall health items, and the implications will be devastating.”


Wednesday’s report is the first to gather complete data from the WHO on antibiotic resistance and has info from 114 nations. Even though the information is much more full in some areas than in other folks, it is clear that drug-resistant strains of bacteria and viruses are frequent and that striving to preserve the efficacy of present antibiotics is a shedding battle.


“We know that the pathogens are everywhere. They have been right here prior to humanity,” Dr Carmen Pessoa Da Silva, staff leader on antimicrobial resistance at WHO, advised the Guardian. “It is not a dilemma of a single nation or single region. It is a issue that belongs to the total planet. This is essential. No single country even with the greatest possible policies in spot can deal with this issue alone. We want all countries to get together and examine and put in practice feasible options.”


The report raises worries about drug-resistant tuberculosis, which is spreading and calls for far more than a 12 months of therapy with combinations of antibiotics that are unaffordable in some nations. It also seems at the rise of remedy-resistant strains of HIV, which is common in Europe and north America.


But the report’s principal target is 7 bacteria accountable for typical infections that are now at times life-threatening since of antibiotic resistance. The most worrying findings are the globally drug-resistant K pneumoniae, the therapy failures in gonorrhoea in 10 countries – which includes the United kingdom – and the widespread resistance to fluoroquinolones – a single of the most widely utilized antibacterial medicines for the treatment of urinary tract infections induced by E coli.


New medication are not on the horizon. There have been no new courses of antibiotics for 25 years, mentioned Dr Danilo Lo Fo Wong, senior adviser on antimicrobial resistance to WHO Europe.


Pharmaceutical firms can not cover the costs of research and development, due to the fact new antibiotics have to be used sparingly for fear of resistance developing – and when that begins, they have a brief lifespan. “New antibiotics coming on to the industry are not truly new,” Lo Fo Wong stated. “They are variations of those we previously have.” That means that bacteria are likely to create resistance to them that significantly sooner.


“We see treatment failure and we see people die because they are not handled in time,” he mentioned. “In some elements of the world, it is about availability.” But in other individuals, patients are taken care of with one antibiotic soon after another to attempt to find some thing that functions, escalating the danger to them due to the fact they become more sick and also further driving resistance. Some countries in Europe do not instantly carry out tests to establish what the infection is, particularly if there are added costs to the hospital or patient.


The WHO urges all nations to be more sparing in their use of antibiotics in people and in animals and improve hand hygiene, which has been credited with minimizing the numbers of instances in the United kingdom of the “superbug” MRSA – staphylococcus aureus – that is resistant to the antibiotic methicillin.


The health-related charity Médecins Sans Frontières said a worldwide strategy for the rational use of reasonably priced antibiotics was urgently necessary.


“We see horrendous prices of antibiotic resistance wherever we appear in our discipline operations, including young children admitted to dietary centres in Niger, and individuals in our surgical and trauma units in Jordan,” stated Dr Jennifer Cohn, health-related director of the MSF Access Campaign. “Countries require to improve their surveillance of antimicrobial resistance, as otherwise our actions are just a shot in the dark with out this data, physicians don’t know the extent of the difficulty and can’t consider the correct clinical choices required.


“In the end, WHO’s report ought to be a wake-up phone to governments to introduce incentives for market to develop new, reasonably priced antibiotics that do not rely on patents and high prices and are adapted to the requirements of building countries.”


British experts agreed on the urgency of the problem. “The world demands to respond as it did to the Aids crisis of the 1980s,” mentioned Laura Piddock, professor of microbiology at University of Birmingham and director of the campaigning group Antibiotic Action. “To do this, we need to be ambitious to do well.”


Necessary and funded international surveillance and public training campaigns were important, she additional, “but these are just commencing points. We even now need to have a greater knowing of all elements of resistance as nicely as new discovery, research and improvement of new antibiotics.” Nonetheless, United kingdom government funding for antibiotic investigation had dwindled, Piddock warned.


Prof Martin Adams, president of the Society for Utilized Microbiology, also named for much more investigation into how resistance develops in the two human and animal antibiotic use. “Even if there are new antimicrobial drugs brought to industry, we will even now encounter the spectre of resistance unless we can understand how to minimise or slow its improvement,” he stated.



WHO calls for urgent action to preserve energy of antibiotics and make new ones

The superbugs the WHO warns we need to worry


WHO officials have warned of a crisis that is threatening to turn these widespread infections, which are at present very easily taken care of with a brief program of medicines, into significant killers yet again.




Staphyococcus aureus (MRSA) – skin infections, wound infections, bloodstream infections, arthritis


Streptococcus pneumoniae – skin infections, sore throats, pneumonia, meningitis, bronchitis, conjunctivitis


Nontyphoidal Salmonella - diarrhoea


Shigella species - diarrhoea and dysentry


Neisseria gonorrhoeae – gonorrhoea




The superbugs the WHO warns we need to worry

The superbugs we must all dread


WHO officials have warned of a crisis that is threatening to flip these typical infections, which are at the moment effortlessly handled with a quick program of drugs, into key killers once more.




Staphyococcus aureus (MRSA) – skin infections, wound infections, bloodstream infections, arthritis


Streptococcus pneumoniae – skin infections, sore throats, pneumonia, meningitis, bronchitis, conjunctivitis


Nontyphoidal Salmonella - diarrhoea


Shigella species - diarrhoea and dysentry


Neisseria gonorrhoeae – gonorrhoea




The superbugs we must all dread

Stem cell remedy repairs broken hearts in monkeys

Stem cell heart repair trials

Cardiac cells derived from human stem cells (green) and monkey heart cells (red) in a photo issued by the University of Washington. Photograph: Murry Lab/University of Washington/PA




Scientists have efficiently repaired damaged monkey hearts by injecting new heart cells created from human stem cells, paving the way for a trial in people just before the finish of the decade.


Researchers now hope that the remedy could give individuals a new lease of lifestyle following huge heart attacks that trigger scarring and in the long run heart failure.


“When human embryonic stem cells had been 1st discovered, this is just the type of treatment individuals hoped they would lead to. We are optimistic, but we are also cautious,” stated Charles Murry, who led the crew at the University of Washington in Seattle.


The heart is 1 of the poorest organs in the body at repairing itself when it sustains injury. Right after a heart attack, muscle tissue in the heart dies off, and is replaced a month or so later on with scar tissue. This does not contract like regular heart tissue, so the heart is weakened and struggles to pump blood around the body.


Much more than 100,000 people have heart attacks in Britain every single year, and one particular in three dies prior to reaching hospital. Significant heart attacks are accountable for 750,000 individuals residing with heart failure in the United kingdom. But the productive trial heralds the chance of a new approach: “We believe we can do our first patient in around 4 years in a phase-1 trial,” Murry mentioned. The study is reported in the journal Nature.


Studies in mice and rats have previously proven that injections of stem cells can help to repair damaged heart muscle, but those animals have considerably various physiology and heart rates to people.


Sian Harding, director of the British Heart Basis cardiovascular regenerative medication centre at Imperial School London, called the operate a big phase forward.


“This is as close as you can get to placing these cells into humans. It truly is actually essential, simply because this is searching at a big volume of muscle, and that has not been accomplished prior to. It truly is what you are going to need in humans,” Harding stated. “It shows us you can make the muscle, hold it there, get the blood vessels in, and have it perform even at higher heart rates.”


Murry’s crew examined the process in four pig-tailed macaques and located that the cells assisted to restore heart tissue injury. The researchers induced small heart attacks in the monkeys by blocking a heart blood vessel for 90 minutes.


For the duration of the subsequent two weeks – ahead of scar tissue had time to kind – they injected one billion younger heart cells developed from human embryonic stem cells into and around the damaged heart muscle. The animals have been offered drugs to stop their immune techniques rejecting the cells.


Most of the injected cells – all around 90% – died off. But the remainder grew into fresh heart muscle that commenced to perform with the animals’ remaining healthful heart tissue. The cells formed connections with neighbours for passing electrical signals across, and blood vessels grew into the new tissue to provide it with oxygen and nutrients.


But the procedure did not go fully smoothly. All of the monkeys that acquired human heart cells developed irregular heartbeats, or arrhythmias, which lasted for two to 3 weeks. Though none of the animals died from the arrhythmias, the dilemma will make researchers wary of transplanting the cells into humans.


The cells most likely caused irregular heartbeats simply because they were immature when they had been injected. As the cells matured in the animals, the arrhythmias subsided, Murry advised the Guardian.


“If we did this in individuals there would be a vulnerable period of a handful of weeks and they would stabilise following that, but we would favor to solve the problem prior to we treated individuals,” Murry mentioned.


Murry explained that close to a quarter of the heart muscle groups was damaged in the monkeys his group treated. Had they triggered significantly much more harm the monkeys might have died prior to the scientists had had a chance to inject them with fresh heart cells.


Harding added that rather of injecting the heart cells, one more choice might be to make grafts of heart cells in the lab and transplant them as a sheet of tissue. These could sit in excess of scarred heart tissue, and aid the heart to pump more strongly.


John Martin, professor of cardiovascular medicine at UCL, was cautious about the examine since it failed to present no matter whether the transplanted cells improved the perform of the monkeys’ hearts. The occurrence of arrhythmias was worrying as well, he extra.


Anthony Mathur, director of cardiology at Barts Well being NHS trust, is working with Martin on a trial that will see three,000 heart attack individuals across Europe infused with stem cells taken from their own bone marrow. Whilst the cells do not gather in the heart and make fresh muscle tissue, they do release chemical compounds that lessen damage and possibly assist the heart to recover. A single benefit of the procedure is that individuals do not need to have to get anti-rejection medication, simply because the cells are their own.


Peter Weissberg, health care director at the British Heart Basis, explained: “This analysis brings us 1 step closer to repairing a damaged human heart, but we nevertheless have some way to go until finally we reach our aim.”




Stem cell remedy repairs broken hearts in monkeys

Top quality of life in retirement a lot more critical than typical pension revenue, minister suggests

Mr Webb induced controversy the day soon after the Spending budget when he explained that he was “relaxed” about the thought of pensioners paying their savings on a Lamborghini.


Appearing yesterday before MPs on the Commons Function and Pensions Committee, Mr Webb said that in potential pensions will be ready to have a “mixture” of capital and earnings to enable them to get pleasure from their retirement.


Mr Webb mentioned: “The significance here is that in the previous we’ve thought about what we want in retirement [is] a normal cash flow but actually what you want in retirement is good quality of lifestyle and that may possibly be a mixture of capital and cash flow and it may be different at different factors in retirement.”


He also explained that the changes to pensions will allow elderly individuals to shell out off debts that have been “getting them down”.


Mr Webb explained: “One of the excellent factors about these new freedoms is some folks will spend off debts that have been hanging more than them, that have been obtaining them down, that they wouldn’t have been capable to pay out off. They’ll be capable to do that and they’ll come to feel excellent about it.”


The minister also insisted that his reforms have not dealt a “death blow” to the annuities industry.


He stated that around a hundred,000 to 200,000 annuity revenue could still get area every single yr and explained these goods are likely to become competitive as companies will know that retirees have a better option of choices accessible to them.


Controversy in excess of annuities has been developing amid tumbling costs in current many years and issues that folks are not acquiring the best deal they could by purchasing close to. Up till now, about 400,000 folks a 12 months have bought an annuity.


Mr Webb stated: “I never believe it is a death blow to annuities. Plainly there is a set of men and women, and we can argue and discuss how big that will be, who will not buy annuities now, and estimates, and they are only guesstimates truly, differ significantly.


“But obviously an awful great deal of people even now require an earnings in retirement.”


Mr Webb explained: “It depends who you pay attention to, but it really is still considered a hundred,000, 200,000 annuities a year will be offered… I will not believe that the approach is irredeemable.”



Top quality of life in retirement a lot more critical than typical pension revenue, minister suggests

No Longer King Of The North, Pfizer Seems to be To Recapture Crown

Company is war and practically nothing is much more illustrative of that level than a healthful cycle of M&ampA activity.  Amid a wave of healthcare transactions, Pfizer Pfizer, one of the world’s biggest pharmaceutical companies, announced a $ one hundred billion bid for the British pharmaceutical company AstraZeneca AstraZeneca.


What if this have been the least negative selection for Pfizer in an increasingly challenging organization atmosphere?  Pfizer, like other big pharmaceutical businesses, is struggling. The blockbuster patent cliff has left the firm with greatly diminished income and has endangered earnings per share. In 2010, Pfizer revenue was much more than $ 65 billion while in 2013 income declined to $ 51.6 billion, a lower of far more than 20% in 3 years.


Rather of tactically obtaining vibrant biotech firms with actually mission-oriented cultures or even innovating through good old-fashioned lab function, Pfizer is trying to turn into the world’s greatest pharmaceutical enterprise by means of a complex financial initiative.



So why is Pfizer performing this?  As a $ 200 billion healthcare business, Pfizer can show its relevance in a way that only a key deal can command. This deal also allows Pfizer to compensate for lost income and merchandise exclusivity by acquiring AstraZeneca’s merchandise lines and investigation abilities. Lastly, as most great CPAs will inform you, keeping away from taxes is the subsequent ideal issue to rising income and this acquisition could considerably reduce the company’s tax liability.


But this wouldn’t be the 1st time Pfizer has executed this sort of financial maneuvering.  If background repeats itself, the following precedents must be noted. On January one, 2010, after acquiring Wyeth for $ 68 billion, Pfizer had 116,500 workers. By the finish of 2013, the firm had 77,700 employees, a reduction of more than 38,000 men and women. Also, in 2013 the organization initiated a $ ten billion stock repurchase prepare. In the course of the exact same time period Pfizer increased its earnings per share from $ one.94 to $ three.19.  The result of this kind of tactics had been quick lived, nevertheless, as Pfizer was weakened by a violent downturn in the economy and the realities of the great patent cliff.



AstraZeneca’s R&ampD Web site in Mölndal, Sweden: primary gate (Photo credit: Wikipedia)




By acquiring AstraZeneca, Pfizer could increase its earnings by turning into a British-based mostly corporation with a significantly reduce tax burden than a U.S. firm. Furthermore, for the income portion of any deal, considerably of the income Pfizer would use to acquire AstraZeneca would come from Pfizer’s huge offshore accounts. So Pfizer could obtain a significant asset by making use of money that would have been taxed at a increased fee if they had been ever brought back to the U.S., and Pfizer would conserve substantial taxes on product product sales going forward by getting to be a British-based business and enjoying a significantly reduced tax charge.


All this tends to make ample economic sense for Pfizer, a firm that has lost large amounts of income on its most profitable goods – drugs like Lipitor, Norvasc, Celebrex and Lyrica that now face competition from minimal-value generic brands.  But the proposed acquisition of AstraZeneca would not bolster the combined company’s blockbuster holdings for long. AstraZeneca has and will continue to lose exclusivity of many of its own blockbusters. In 2013, AstraZeneca misplaced exclusivity of Seroquel IR. It will lose exclusivity of Nexium in 2014 and Crestor in 2016. At the exact same time, income of Brilinta/Brilique, which had been anticipated to compensate for losses from other drugs have been disappointing.


As the previous blockbuster cohort declines, there is a new generation of blockbuster medicines, but a lot of have not come from classic huge pharmaceutical businesses. They are now the legacy of the big gamers in biotechnology like Amgen Amgen, Celgene Celgene and Gilead Sciences Gilead Sciences. The irony is that these had been all tiny biotechnology organizations not also long ago. That they are market common-bearers these days demonstrates that mission-oriented R&ampD organizations driven by dynamic cultures can make scientific breakthroughs and accomplish development.


For now the stakes are higher for all the gamers in the healthcare kingdom as an “acquire or be acquired” frenzy reigns.  After this round of mergers and acquisitions comes to an finish, which invariably it have to, it is very likely big pharma will return to business as normal, even though the subsequent logical move ought to be to obtain greater biotechnology organizations ahead of the biotechs grow to be the rulers of the land.



No Longer King Of The North, Pfizer Seems to be To Recapture Crown

The international battle for clean air podcast transcript

HM: Hugh Muir


SB: Simon Birkett


JV: John Vidal


DP: David Pasadas


SB: Sarah Boseley


KLK: Katie Leach-Kemon


AC: Aaron Cohen


SJ: Sam Jones


AP Ana Peñalosa


HM Simon Birkett is on a mission.


SB It’s an extraordinary feeling, whenever I ask people to sign up to the campaign or help – everyone did.


HM He wants to rid his city from air pollution.


SB I wrote a letter to the European commission, and the next thing I was getting calls from Brussels.


HM And there’s quite a few pollutants out there.


SB So we get diesel exhaust, for example, tyre and brake wear; we get construction dust, coal particles, benzene.


HM His campaign group is called Clean Air in London. He says there’s a hidden epidemic.


SB Well it is. I would argue that we are with invisible air pollution where we were 30 years ago with smoking. And I know, actually, that quite a lot of scientists and also media commentators, particularly those who have been following this story for many years, have actually moved their families outside London and now commute in.


HM He’s one of many around the world trying to do something about the air we breathe. With all the fantastic advances we hear about carbon capture, renewable energy, electric cars … why are we still pumping so much pollution into our atmosphere. Today on the Global development podcast we’ll take you to the Philippines, to one of the top three polluted cities in the world. Then to Mexico to hear how their government is tackling the crisis. And we’ll hear from the Guardian’s health editor, Sarah Boseley – she’ll tell us how pollution is affecting all of our lives. This is the Guardian Global development podcast. I’m Hugh Muir, that’s all to come.


First then, to Manila where the Guardian’s environment editor, John Vidal, sent us this report.


JV This is metro Manila, a 12 million strong megalopolis in the Philippines. It’s no different from any number of other major cities in Asia. The smell is awful and the noise makes it almost impossible to talk. In the end, I’ve had to record this back in the studio so that you can hear me properly – that’s how bad it can be. The hospitals here are full of people with respiratory and heart diseases. The latest figures suggest 2 million people in Asia will die prematurely of air pollution this year. The WHO, that’s the World Health Organisation, now thinks that one in eight people in the world dies from air pollution.


Jeepneys are the most popular form of transport for Manila’s poor. But these brightly coloured buses also leave vast plumes of diesel smoke in their wake. David Pasadas has lived in the city for years and is a consultant on urban and green issues.


DP In the Philippines, normally, right now, the law says that all vehicles have to be Euro 2 compliant, new vehicles. But old vehicles, they have a hard time meeting even Euro 1 standards because a lot of the public vehicles are using these rebuilt engines. And so you see a lot of vehicles, when they’re accelerating, like these Jeepneys and these tricycles, you see visible plumes of black smoke or white smoke.


JV Is that also because the fuel they use has been adulterated, has been smuggled in – what’s going on with the fuel?


DP Because we are an archipelago of 7,100 islands, it’s very easy to smuggle in fuel – and there have been reports of that. Aside from that, there’s a lot of contaminants in the fuel, unless you get it from a reputable gas station. And I guess it’s not just in the Philippines but it’s a common pattern in Asia.


JV But you’re a refugee, you now live in a suburb 20km outside the main city. What happened to your health when you moved outside, did it improve?


DP Actually it’s not as bad. It improved, but I was getting a lot of respiratory allergies in the city because you could literally see the pollution coming from the vehicles. You would feel it on your skin and your face after a long day of work taking the public transport. A lot of that is really because a lot of these public transport drivers have a hand-to-mouth existence, meaning the probably earn maybe £15 in a day, after a hard day of work. They don’t religiously maintain their engines. So you see a lot of engines here that are actually already starting to burn oil.


JV You’re young, and many of the people in the Philippines are very young. We get the impression that there’s building up a sort of public health crisis which will show itself in 20-30 years’ time as these respiratory diseases become worse and worse. Is that understood in the Philippines, that air pollution really is a serious problem now?


DP Originally, I thought only the middle class and the upper middle class understood these things because there were paying for like inhalers … and expectorants. But lately I’ve also tried to talk to some of these, for example, these Jeepney drivers. And I was surprised to learn that they are aware of the risks, and it’s like they’re caught in a situation where they want to change but they don’t know how.


JV And because it costs a lot of money to change.


DP It costs money if you’re running a dilapidated surplus engine. Because these public transport conveyances they don’t really get to taste a new engine per se. What they mean by new engine in their case is really a surplus rebuilt engine. So the life of the engine has a limited expectancy. And what they do is to save money they try to prolong it. And that’s where the problem occurs.


JV But you could also say that the life of the human who’s driving some of these cars is pretty limited as well.


DP Is greatly shortened yes, yes. I think they are aware of that. But if you’re living a hand to mouth existence I think some of them have this fatalistic view on life; meaning if you talk to them about climate change and other issues about the world what they’ll tell you is I have to feed my family and that’s what’s paramount to them.


JV And it’s not going to get any better. Within 20 years the Philippines is expected to be using an extra 10m or 15m cars – that’s per year! And there’s no sense that the industry, the fuel companies or the city are able to do anything about it. And that’s not even counting the air pollution that comes from factories or homes. The problem is it’s shortening the lives of everyone. Pollution here follows the poor. It’s a world problem but they’re breathing most of it.


HM Earlier this year, in March, some unseasonably warm weather affected countries in northern Europe. Not a bad thing in itself. But when combined with sand blown in from the Sahara desert, and the fumes from cars and power stations, well, it caused panic in the newsrooms. So what really happened? Sarah Boseley, the health editor here at the Guardian explains.


SB There really was a bit of a panic about the air pollution levels in the UK and in parts of Europe as well. I think that’s maybe partly because we’re increasingly aware that air pollution is very problematic. So the Saharan sand is a very minor issue actually by comparison with what we’re getting from diesel cars and, more to the point, diesel lorries and taxis and the like.


At the end of March, we had the release of a really important report from the Institute for Health Metrics and Evaluation, based at the University of Washington in Seattle. They have been responsible for a whole series of papers, really good papers, looking at what they call the global burden on disease. So they’ve been calculating what diseases the world suffers from, how many lives are lost and how many years people live with disabilities because of those diseases. Now they’ve looked at transport as well, which is a bit of a departure from the usual infectious diseases, chronic diseases, including cancers and such like.


What was really interesting in this was that they put together both the air pollution factors and also road injuries. And when you do that you actually come up with some quite stunning and worrying figures about the damage that our road transport is doing to us.


KLK Hello everyone. Thank you all for coming today and for your interest in this research.


SB Katie Leach-Kemon from the Institute of Health Metrics and Evaluation at the University of Washington in Seattle, who produced the paper, had some interesting things to say about the way they collected the data, which is not always easy because countries put it together in different ways.


KLK You can also use the tools to look at risk-factor rankings across countries; so this shows in Nigeria and China what the risk factors are for premature death and disability. You can see in China air pollution, ambient air pollution from all sources not just vehicles, actually ranks fourth and in Nigeria it ranks eighth.


SB They say, in fact, that deaths from road transport are higher. They have a greater burden on the population of the planet than deaths from the things that we all think of as being the big killers: HIV, tuberculosis and malaria. And that injuries and pollution from vehicles jointly contribute to six of the top 10 causes of deaths every year.


AC: As more people are living next to busy roads, the population exposure to traffic related air pollution is increasing.


SB And also we had Aaron Cohen, who is principal scientist at the Health Effects Institute in Boston, which is a non-profit … And their interest is air pollution. He was talking about the ultra-fine particles that emanate from diesel school buses.


AC The geographer Michael Jarrett at University of California at Berkeley in a recent HGI report estimated the proportion of the population living near busy roads in several major world cities. This slide shows residential proximity to the burgeoning road network in Beijing, where he estimates that 76% of residents currently live within 500 metres of major highways; and 50 metres of busy streets where levels of traffic-related air pollution emissions are the highest.


SB It’s increasingly worrying that there are such high levels of pollution in developing countries. Very likely developing countries haven’t taken this on board yet because most people think of transport as being a really fundamental important thing for developing countries because you have to get your goods from A to B in order to be able to sell them. People have to be able to get to the jobs. Obviously having good transport, having a car, all helps development. But unfortunately the downside for health is very much something that people think of as an afterthought.


HM Sarah Boseley in London. And I don’t know about you but now I’m trying to work out how far I live from a major road. Of course air respects no borders. Different countries deal with the problems of pollution in different ways. So what are governments doing to make our cities more liveable? We sent Global development reporter Sam Jones to Mexico City to find out.


SJ I’m standing on a roof garden in Mexico City with Ana Peñalosa, who works for the environmental secretariat of Mexico City. We’re surrounded by grey, lots of traffic noises and some aeroplanes but there’s a sudden stretch of green here, Ana, can you tell us a little bit about it?


AP We’re at the top of one of the buildings, the offices of the environment department secretary of Mexico City, and we have a green roof here. It’s open to all the people who work here. In this building we have the air quality direction. So they are doing all the analyses about the air quality and monitoring of the whole city. We’re actually in downtown, and it’s a lot of cars passing around all the time.


SJ I think we can hear those.


AP So this space, it’s like being away from that.


SJ What’s the public reaction been? You say it serves a very useful purpose, it helps purify the air because it drags down some of the nasty gases which are there because there’s a lot of motor vehicles in Mexico City, as we can hear loud and clear. And it’s good for children, and if you work in this bit of the environment department you can come and have exercise classes on the roof. But what has the public reaction been, what of the people who live in Mexico City, what have they told you about what the project means to them having these green roofs.


AP Well, I think that in general people are very keen. There are a lot of people growing plants and even vegetables in their available spaces at home, like some balconies or even in their rooftop. And the environmental Education department has a lot of these kind of projects and workshops teaching people to grow their own food. Even though there are some big parks like Chapultepec, we’re trying to bring closer to people these green spaces. Like, for example, in hospitals it’s really important because it helps to heal people as well. And in public schools, to teach children to grow plants and vegetables and have green spaces where it’s available, where it’s possible.


SJ And the government, this is one of the measures that they’ve put in place to try and improve the air quality. And there’s a bicycle scheme, similar to the Boris bikes in London or the bicycle scheme in Paris, what other steps has the government taken to try and reduce the problems of very polluted air in the city?


AP Well having implemented things … but of course we believe that transportation modes are directly related to air quality in the city. And of course we’re working really hard on that. For example, the public bike scheme started four years ago and it’s been a tremendous success. And of course people are realising that the alternatives, like transportation alternatives, that are actually more convenient … It’s important that citizens realise that every action they take it’s important, and it counts for having air quality and quality of life in general.


SJ You’re from Mexico City. Can you describe what the pollution was like 10 years ago or 20 years ago?


AP Yeah, it has changed, it has improved – but it’s always more and more people living here, and the city is growing, and you have to monitor and control it continuously.


SJ And as a native of Mexico City, how would you rate the air quality today, this afternoon. If you look around and you take a big, deep breath, how would you describe the air this afternoon?


AP It could be better. I’m from here as you said, you know, it’s fair enough, it’s all right.


SJ There’s noticeable smog, I think, and some of the buildings as we get towards the sides of the valley fade away into blues and greys – but it doesn’t feel quite as bad as it was when I was last here 11 years ago. I mean you think there’s definitely been an improvement?


AP Yeah, when I was a child, yeah, it’s definitely a really noticeable difference. All I can say is that we have to keep working on this and of course changing habits; choosing bicycles instead of your car.


SJ So progress.


AP Yes, definitely. And I really think that Mexico should be a global example of policies to improve air quality in one of the largest cities of the world.


HM Sam Jones speaking to Ana Peñalosa. Well I’m pleased to say we’ve gathered all the correspondents you’ve just heard in our studio: that’s John Vidal, Sam Jones and Sarah Boseley – welcome to all of you. Sam, let me start with you; tell me a bit about what it’s like because you left London you went to Mexico City was it obvious that the air was different, was it obvious that the atmosphere was different to you?


SJ It’s a very noticeable difference. There’s a constant haze, a kind of pall that hangs in the sky. If you try and climb up a few flights of stairs you’ll find your lungs are working a little bit harder than they would in London.


HM Of course we heard about the green roofs and cycle schemes, do those sort of things really make a difference?


SJ I think they have made a difference. The Mexico City I saw last week was very different to the Mexico City I saw 11 years ago. Going back 11 years, there was much more pollution, it was denser, the streets were still full of the kind of iconic green-and-white Volkswagen Beetle taxis, they’ve disappeared now. You’re seeing liquid gas-powered buses; and perhaps the most noticeable difference is seeing people cycling in Mexico City, which I wouldn’t have imagined a little over a decade ago. Brave people take to their bikes in Mexico City – about 27,000 journeys a day so far and that’s rising.


In terms of the green roofs, it seems to have captured the public’s imagination to a certain extent. I mean putting green roofs on top of buildings is not going to cure problems in a city of 21 million people with a massive, massive pollution problem. But it does seem to be serving an educational purpose and people are starting to think about the way they travel. But, clearly, you’re going to need rather more than that to sort out the effects of millions and millions of highly polluting cars.


HM John Vidal, we’ve recently seen Paris halving the amount of traffic that it’s allowing into its city centre to reduce smog, and Beijing tried that too – does that work?


JV No.


HM Why not?


JV There’s still far too much of it. The scale of what’s going on at the moment is so enormous, and I’m a bit of a pessimist. If you can see pollution that’s only the very top bit. What really gets people is what you can’t see, they’re so small, we’re talking about the 2.5 microns; this is the stuff that goes right down in your lungs, you can’t see that. We think that if we can smell pollution, that it’s bad. It’s not. The worst stuff is the stuff you can’t smell, you can’t see it, it’s invisible, it gets right down in there – that’s the really dangerous stuff. That’s the stuff the WHO is now realising is leading to the heart attacks and so many respiratory problems. We’ve just swapped one kind of pollution, which was factories burning coal, for another kind of pollution, which is really largely from gases like NO2 and the particulate pollution, and that’s the dangerous stuff. So just getting rid of a few cars is not going to be enough. You have to do it on a very large scale to make any difference at all.


HM And, Sarah Boseley, it’s not just about a shorter life expectancy is it there are implications for children as well; tell us about those.


SB Well it’s interesting. Once upon a time we used to think that pollution perhaps made things lot worse for people, and particularly for kids. And as time has gone on, we’ve realised that actually you’re talking about an awful lot of diseases and cancers. And the latest thing, I mean I was quite stunned to see a study in October last year that said that air pollution could actually cause low birth rate in babies. And that is really quite an incredible link. In fact it’s a European study so you’re not even looking at the developing world. I’ve been to Kathmandu and seen horrible, horrible pollution … Again, as John is saying, it’s often the stuff we’re not seeing. You’re seeing low birth weight babies and they think that air pollution may have been a cause for that.


JV In east London I was talking to respiratory doctors at King’s College, and they’re measuring, by the age of five they can see that the birth weight of babies has gone down and you can already see the neurological effects on children that age.


HM And why east London? What do we know about east London?


JV Because there’s very, very heavy traffic going through those main roads. If you’re living within a 100 yards of those roads, you are effectively being polluted – and seriously polluted.


SB It does stand to reason, actually, because we know that smoking causes low birth weight so why shouldn’t air pollution.


HM Sam Jones, do you feel that people you met in Mexico City actually felt that this was a priority; obviously the politicians go to international gatherings and they know that globally people think it’s important, but do the people on the ground really feel we must do something about the air?


SJ I don’t think it’s reached critical mass by any means. It’s a gigantic city and most people have more pressing concerns. Many people are living a hand-to-mouth existence, and I think it’s fair to say that improving air quality is not even on their list of priorities at the moment. Politicians are doing what they can, and the environmental secretary of Mexico City is very keen to stress that it’s actually advising Tehran on its air quality at the moment. I was told while I was there that some of the C40 cities have shown an interest in some of the smartphone applications that the Mexico City government is using. But in terms of on the ground take up and involvement in any kind of push to improve air quality – no evidence of that.


JV Hugh, can I just say I think that a major problem is that we thought this was one of the environment problems which had gone away … It hasn’t. And so there’s a big perception gap with the politicians – they haven’t realised; one in 12 people dying of diseases linked directly to air pollution is extraordinary.


HM But I explained that though because it did seem logical that once you’d got rid of all the dirty fuel that this problem would be better.


JV It hasn’t gone away. We, the media, I think have been very bad at it, we haven’t realised. What has also happened is that the medics are beginning to appreciate much, much more the links. So there are a lot of advances which have been done in the field of medicine which are making people understand this is much more serious than we thought.


SB Yes, but I would say actually that pollution is a complicating factor in other diseases. So, actually, you can’t blame just the pollution for the deaths, it’s just not like that. People have a genetic propensity and there will be other things in their lives that are causing the problem. So that’s one of the reasons why it’s been overlooked.


HM So does that mean that we are underestimating the amount of it because some people will die. And, as you say, their deaths won’t be attributed to pollution – there will be other things. But in fact pollution will have been the crucial factor.


SB No, I think we are starting to appreciate it and that’s what these studies are about. The WHO has attributed far more lung cancer and bladder cancer now to air pollution, for instance. And they can do some very clever stuff with studies where they factor out everything else. So we are seeing it, as John says, for the first time. But I think in the past that perception that it had gone away was perhaps because it was mixed up with other stuff too.


HM Sam, in Mexico City, what did you feel was driving their initiative there; was it an altruism that we should think more about people’s health or was it a political imperative; what do you think was behind it?


SJ I think some of it is altruism and some of it is a kind of firefighting. When you’ve got a city that big and it’s ever growing, if you’ve ever flown into Mexico City you look past the wing and it stretches on and on and on, there’s more people arriving every day, it’s a genuine megacity, something has to be done because it won’t be habitable if things get much worse. Twenty years ago they had the bright idea of moving the refineries out of the city, which has made a massive difference, clearly.


The other factor in all this is Mexico is an emerging country, an emerging economy, it recently hosted a huge high-level meeting on global development and how to work better, and it’s projecting itself as a forward-looking country, as the kind of country that will take seriously developed country concerns such as environments, such as air quality. So it’s two pronged: yes they’re trying to make things better for the people who live there because they have to because it’s giant and it’s very polluted, and also they’re trying to show that they are capable of being this world player.


HM But, John Vidal, it’s difficult isn’t it because you have this phenomenon of countries emerging and becoming more industrially developed, but a lot of things come with that. And it’s difficult for the developed world to say to those countries that are emerging, “Don’t do this” because they say, “Well hang on, that’s what you did to become as powerful and as rich as you are.”


JV Yes but there are lessons to be learned from everyone’s progress, if you like. I think what’s happening in China is very, very interesting because there you have pollution on a very, very great scale now. And that’s mainly industrial pollution mixed with the traffic. And there, I think, the authorities are realising that unless they do get it under control then they stand a real risk of civil unrest, of civil problems and all kinds of other things attached to it. So if you live in a polluted city, and I’ve been to these places, people get really hacked off and they really don’t like it. And that’s a trigger for political dissent. And I think that will be one of the reasons why China gets its act together much quicker than some other countries.


HM So to what extent to you think the international bodies, the international health bodies, are really gripping this? They may not have solved it but they’re on top of the scale of the problem.


SB I don’t think, actually, they’re focusing on it as perhaps a lot of people would like them to. And that’s simply because there’s so much else happening all the time. We’re now into a situation where we have to worry about the spread of chronic diseases. So we’ve got heart disease and cancers caused by other things such as lack of exercise and eating the wrong foods – that’s the up-and-coming thing now, what they call the non-communicable diseases. So what happens is that there are fashions in health in the things that people turn their attentions to, and this isn’t as high a priority as a lot of people would like.


HM What are ordinary people doing; I suppose I’d just like to get some sense of what the ordinary listener can do because all of this is being solved at a very macro level, at a governmental level but ordinary people have to go out and walk in polluted air. What sort of things were they doing in Mexico, Sam, quickly?


SJ The people who are concerned about this are trying to use carpooling to cut down on the amount of pollution, or rationalise it a little bit more. Mexico City is rather too big to walk round. Those who care and who can get on the bike scheme and pedal their way round, that’s rising. But if you’re poor and you’ve got a long distance to travel in Mexico City, you’re not left with very many options, it’s basically the bus.


HM John, I thought technology was supposed to save us from all of this. Why isn’t it or will it?


JV Face masks, that’s what we need.


HM That’s very old technology, isn’t it?


JV It is. In a funny way you’ve got to stop breathing in the worst bits. Unfortunately, most of the masks are really not much use at all, frankly.


SB I was just going to say, actually it doesn’t stop the particulates.


JV Exactly. But every time you see somebody with a mask you think this area’s polluted so you do actually take more care, so in a way it is quite good. No, the only way anyone has ever found to reduce air pollution is to either cut down, get the factories burning much less fuel and get the cars to burn electric or something completely different, or get rid of the cars. That’s the only way you’re going to do it, otherwise it will build up and build up.


HM And, Sarah, what’s the health advice? Is there any credible, sensible health advice being given to people who live in areas that have this serious problem?


SB Well, the distressing thing is how little you can do about it, and pregnant women are a case in point; what do you do? You can give up smoking, you can give up alcohol, you can’t stop yourself in Bradford breathing in the diesel fumes from the buses and the lorries, and it’s not just cars of course. But you can try to help the community as a whole by walking, by cycling, by those sort of things, but you can’t actually protect yourself – you have to make a fuss about it.


JV Hugh, there was one thing which I noticed … which was rather beautiful; the most polluted place in the whole of Britain happens to be Kensington and Chelsea – the richest borough in the whole of London. And this was quite extraordinary. Why? Because of the cars. They all drive very large diesels around there and also because they’ve got some big railway engines which burn a lot of diesel. But it is funny that the pollution does actually follow the rich as well.


HM Well it does show, doesn’t it, how things change because not so long ago diesel was supposed to be the thing that was going to save us from all of this.


JV Exactly.


HM And that thinking has all been turned on its head.


But that’s it for this edition of the Guardian Global development podcast. My thanks to John Vidal, Sam Jones and Sarah Boseley, to all our contributors, and of course to you for listening. If you have any comments about the programme or want to add your voice to the discussion, head to theguardian.com/global-development and please subscribe to hear future podcasts via iTunes or another pod catching service. My name’s Hugh Muir, the producer was Matt Hill. Until next time, goodbye.



The international battle for clean air podcast transcript

Wellpoint Boosts Profit Forecast On Younger, Greater ACA Enrollment

Wellpoint (WLP), one particular of the nation’s greatest overall health insurance coverage businesses, extra 1.3 million more subscribers across its government and industrial firms thanks in massive part to the Reasonably priced Care Act.


Wellpoint now explained it expects its healthcare enrollment to increase for the full year by 1.three million to one.4 million members, like more than 400,000 that came from government-run exchanges in the very first quarter, in accordance to the company’s earning report today. Wellpoint also raised its earnings per share forecast to “greater than $ 8.forty per share.”


“Our membership is developing across our platforms and we are pleased with the progress we have seen in the exchanges,” Wellpoint chief executive officer Joe Swedish said.


Wellpoint’s revenue outlook is enhanced in portion since the combine of company is monitoring how the firm projected from the exchanges.Wellpoint is a significant operator of Blue Cross and Blue Shield strategies, which includes these operated beneath the Anthem brand.


Even though some observers of enrollment anxious that the population signing up for coverage would be older and sicker and value health programs far more income, Wellpoint executives mentioned subscribers trended younger every day of the signup period in the last weeks as more and much more Americans took to the exchanges in the waning days of the open enrollment time period, which ended last month.


Insurance coverage businesses for significantly of this quarter possessing been telling Wall Street that they are going to be able to deal with the 1st year of chance from newly insured buyers acquiring subsidized personal wellness plans by way of government-run exchanges. Beneath the law, hundreds of thousands of Americans can get subsidies to buy an array of overall health prepare alternatives.


In the first quarter, Wellpoint said net income was $ 701 million or $ two.forty per share. Revenues rose 1.two percent to $ 17.six billion.


The enhanced forecast is the most recent in a parade of rosy monetary projections from health insurance businesses benefitting from the overall health law. Other insurers performing well consist of UnitedHealth Group UnitedHealth Group (UNH), Humana Humana (HUM), Cigna Cigna (CI) and Aetna Aetna (AET).


Just final month, Swedish raised the company’s earnings outlook from “greater than $ eight.00 per share to higher than $ eight.20 per share” and noticed growth of “1 to one.three million net new health-related members.”


When a company raises its earnings forecast, that implies it will make more cash than it originally believed.


In addition to promoting overall health benefits to employers and people, Wellpoint is a significant contractor to states and the federal government by supplying coverage underneath Medicaid packages for the bad and the Medicare overall health insurance coverage system for the elderly. In the initial quarter, Wellpoint said it additional 75,000 new enrollees in its government organizations and that was largely Medicaid.


Wellpoint CEO Joe Swedish



Wellpoint Boosts Profit Forecast On Younger, Greater ACA Enrollment