Traditional cures provide economic benefits

Harvard researcher finds the use of traditional, natural medicines offer economic benefits

For millions of people around the world being sick doesn't mean making a trip to the local pharmacy for medicines like Advil and Nyquil. Instead it means turning to the forest to provide a pharmacopeia of medicines to treat everything from tooth aches to chest pains.

But while questions persist about whether such natural remedies are as effective as their pharmacological cousins, one Harvard researcher is examining the phenomenon from a unique perspective, and trying to understand the economic benefits people receive by relying on such traditional cures.

As reported in a paper published this week in PLoS ONE, Christopher Golden, '05, a Post-Doctoral Fellow at the Harvard University Center for the Environment has found that, in the area of northwest Madagascar he studies, people annually receive between $5 and $8 in benefits by using natural medicines.

Though seemingly slight, those benefits add up to between $30 and $45 per household, Golden said, or anywhere from 43 to 63 percent of the median annual income for families in the region.

"We documented people using more than 240 different plant species to treat as many as 82 different illnesses," Golden said. "This data suggests that it can have quite an impact, financially."

It's an impact that may not be limited to Madagascar, or other regions where access to pharmaceuticals is limited.

As part of his analysis, Golden also compared the use of natural remedies with the prices that American consumers might pay if they were purchasing the pharmaceutical equivalent online - where prices are typically lower than on pharmacy shelves. To his surprise, the results showed that the average American could save anywhere from 22 to 63 percent of their annual health care bill, simply by using natural medicines.

"If Americans were relying on traditional medicines as much as people in Madagascar, it could save them a major percentage of their health care expenditures," Golden said.

Golden, however, was quick to emphasize that his study only examined the economics of the natural remedies versus pharmaceuticals, not whether they were equally effective.

"What we're trying to do is account for the economic value the local floral bio-diversity provides to people in this area of Madagascar," Golden said. "We're not assuming there is a medical equivalency - this study is about the perceived efficacy. The people who live in this region often have taken both pharmaceuticals and traditional medicines many times, but there is a perceived efficacy for these traditional medicines."

Measuring that perceived efficacy involved surveying 1,200 households in and around Maroantsetra, a city in the northeast corner of the island nation, to determine which natural medicines they used.

To establish the economic benefit of each natural remedy, Golden asked whether people would prefer to use the natural or pharmaceutical remedy for a given illness. If, for example, 60 percent of those asked said they preferred the traditional medicine, Golden established its value as being 60 percent of the price of its pharmaceutical cousin. (

World Hepatitis Day

The silent nature of viral hepatitis infection has an enormous impact on the capacity and willingness of governments across the world to develop and implement effective policy and health responses to these diseases.

The burden of viral hepatitis is stark, particularly in Asia Pacific where the prevalence is greatest, with approximately 340 million people living with chronic hepatitis B and hepatitis C. This is almost eight times the number of people in the region infected with HIV, tuberculosis (TB) or malaria (42 million). In 2011, the World Health Organisation's (WHO) south-east Asia office reported there are 120,000 deaths annually related to hepatitis C and 300,000 related to hepatitis B.

Viral hepatitis is a significant health problem, but its silent nature – there are no symptoms in the early phases, so people are often unaware that they are infected with hepatitis B and C until it is too late – has meant that the diseases have not had the same global and regional response as HIV, TB and malaria, and this lack of co-ordination continues to undermine global health efforts.

In 2010, there were signs that things were changing, with the agreement of a resolution on viral hepatitis by the World Health Assembly, but its implementation to date has been slow and unco-ordinated. Ahead of World Hepatitis Day on Saturday, this week's publication of a global framework by WHO is another important milestone, but it runs the risk of failing to deliver if the denial that exists around chronic hepatitis, among individuals and in health systems, is not addressed.

Hepatitis B, which is transmitted from mother to child or through bodily fluids, is prevented with a safe and effective vaccine. There has been some recent good news from China, which successfully reduced the number of children under five with hepatitis B from 5.5% in 1992 to less than 1% in 2005, according to WHO.

But there remain huge barriers for implementing vaccination programmes among babies and young people in the region. Although there is access to vaccines, the implementation can be problematic where there are fundamental weaknesses in health systems. In countries such as Papua New Guinea or Laos there are simply not the health services nor workers available to carry out vaccinations.

For most people with viral hepatitis, the infection has no obvious symptoms, meaning that their disease is likely to progress to a point where treatment has limited impact. Most people with viral hepatitis do not know they are infected. Even in countries such as Taiwan and Australia where hepatitis is recognised as a priority health issue, a sizeable proportion of people are yet to be diagnosed.

There are systemic barriers to testing in many countries in the region such as Vietnam, Singapore, Philippines, or Thailand where people are required to pay for testing. This essentially limits the number of people who know they are infected and the ability to reduce the impact of infection.

Hepatitis B infection is complex, and liver damage as a result of the infection occurs over many years. Most people with chronic hepatitis B will not require treatment, but will need to be monitored to identify when liver damage is taking place. Only about 15-25% of people need to receive treatment for the infection.

However, for people who do know that they have the infection, access to health services can be an issue. Of the 300,000 to 400,000 people living with chronic hepatitis B in Hong Kong, 80,000-90,000 people (25%) need treatment, and only half are being treated

Like many 21st-century health issues, viral hepatitis knows no borders. Migration and other movements of people mean that comprehensive and co-ordinated responses to the infection within and across countries are imperative if the burden of infection is to be reduced or eliminated.

In collaboration with the Australian Research Centre in Sex, Health and Society at La Trobe University, the Coalition for the Eradication of Viral Hepatitis in Asia Pacific (Cevhap) has developed a research plan to assist countries and the World Health Assembly to identify the essential elements of a strategic response to chronic viral hepatitis. This work is under way, with assessment of the policy in Taiwan, a needs assessment of people with chronic viral hepatitis across five locations in China, and support for the facilitation of partnership development initiatives in Malaysia and India.

Lessons from other international health issues such as HIV can support the development of effective policy and health responses to viral hepatitis. One lesson is the importance of broad-based partnerships in policymaking, something that has been woefully lacking in Asia. More important, however, is the need for WHO to establish a sustainable mechanism for international funding and implementation of the new global framework and the newly formed Global Hepatitis Programme, similar to those that exist for HIV, TB and malaria.

An effective policy framework can prevent new infections, ensure people can access clinical care, and reduce the burden of infection at an individual, country and regional level. That will only be possible if funding is increased considerably. The global response provided by UNAids, the Stop TB Partnership and the Rollback Malaria Partnership show what can be achieved if governments, the medical community, donor organisations and civil society work together.

Viral hepatitis can be eliminated with resources, co-ordination and willingness, but, as the world recognises the second WHO-endorsed World Hepatitis Day, a lack of funding remains the single greatest barrier to tackling these diseases. (

Study reveals substantial misdiagnosis of malaria in parts of Asia

The authors warn that with more than two billion people at risk of malaria in this part of Asia – larger than that of Africa - this is a major public health problem which needs to be confronted.

The study was published in the BMJ.

Malaria remains one of the most important infectious diseases of poverty. Recent global malaria treatment guidelines recommend that patients are treated with anti-malaria drugs only when a diagnostic test positively identifies malaria parasites in the patient's blood.

In Africa, many patients are treated for malaria even when the parasite test is negative, resulting in other severe infections being missed and drugs being wasted. Yet the extent of this problem in south and central Asia is relatively unknown.

A team of researchers from the School therefore set out to assess the accuracy of malaria diagnosis and treatment for over 2,300 patients with suspected malaria at 22 clinics in northern and eastern Afghanistan.

Some clinics used microscopic diagnosis, while others relied on clinical signs and symptoms to diagnose malaria.

Blood sample slides were collected for every patient as a reference slide which was read by two independent experts who recorded whether the slide was positive or negative for malaria. This reference result was compared to the result of the diagnosis at the clinic and the treatment given to each patient.

In clinics using clinical diagnosis where malaria is rare, 99% of patients with negative slides received a malaria drug and just over one in 10 (11%) received an antibiotic.

This compares with clinics using newly introduced microscopy, where 37% of negative patients received a malaria drug and 60% received an antibiotic. In clinics with established microscopy, 51% of negative patients received a malaria drug and 27% received an antibiotic.

Almost all cases were due to vivax malaria, a relatively less serious form of malaria. However, only one in six cases of the rarer but potentially fatal falciparum malaria were detected and appropriately treated.

Compared with clinical diagnosis, microscopy improves the targeting of malaria drugs, but only by half, and it increases the prescription of antibiotics, say the authors.

They argue that misdiagnosis and treatment is caused in equal part by inaccurate microscopy and by the clinicians' tendency to treat with malaria drugs even when a test result is negative, resulting in a 40-50% loss of accuracy in treatment. The results are comparable to findings from Africa, confirming that inaccurate diagnosis and treatment of malaria is a worldwide problem.

Lead author Dr Toby Leslie, Lecturer at the London School of Hygiene & Tropical Medicine and Project Manager of the ACT Consortium in Afghanistan, said: "Improving malaria diagnosis and treatment is central to present day efforts to reduce malaria mortality and morbidity. Our research contributes to an emerging picture of suboptimal services across the malaria endemic world. Not only does this waste limited resources but also means that many patients are not correctly treated. This has to be corrected through improving coverage and quality of diagnosis and changing practice amongst prescribers." (

The Global Perspective on HIV/AIDS and Mental Health - As AIDS 2012 (the XIX International AIDS Conference) continues in Washington, DC, we are reminded of the numerous, multiple, and far-reaching impacts this epidemic has had in the past 30-plus years. The burden of being HIV positive, or caring for loved ones living with the disease, is not restricted to the physical toll. For many people, there are equally important mental health needs (PDF). We at HHS understand that addressing HIV means addressing the whole person.

Breaking The Cycle Of HIV, Hunger and Poverty - Hunger and malnutrition are significant obstacles to the global fight against the HIV virus. A growing consensus of experts at the International AIDS Conference in Washington DC (AIDS 2012) agreed that helping patients with HIV meet their nutritional needs can make the difference between life and death.

WASHINGTON DC — The connection between food and HIV treatment is not an obvious one, but for millions of people around the world, this connection is vital to both lives and livelihoods.

When high health care costs mean that a family can't put food on the table, when malnutrition means an HIV patient has a greater risk of dying or when not having enough to eat means experiencing intolerable side effects from treatment, food and nutrition can make the difference between life and death.

"Fortunately, we've seen both scientifically and in our own programmes, that when we help people living with HIV overcome hunger and malnutrition, we also help them to fight off illness and regain their health and strength," said WFP Chief of Nutrition and HIV Policy Martin Bloem.

AIDS 2012

At the International AIDS Conference in Washington DC (AIDS2012), Bloem moderated a discussion of health and policy experts from around the world to discuss the impact of food assistance in the fight against HIV.

"By providing a safety net for families that have lost a source of income and who face rising expenses, we encourage people to come to clinics to receive and stay on treatment," he said.

Speaking at the event, which was co-hosted by Harvard Medical School and Partners In Health, Rwandan Minister of Health Agnes Binagwaho remarked on the situation in her country.

"Food is a human right. But most people living with HIV don't have enough food, and they need more food. So the only thing to do is to give it to them."

Case in point

One of the countries where WFP has been doing this for several years is Ethiopia. In a recent interview for, Belaynish Dabe said that she used to struggle to provide for her family of eight.

When Belaynish and her husband, both of whom are HIV-positive, started receiving nutritious food from WFP, they felt healthier and were better able to adhere to their treatment.

Belaynish also participated in community activities, like urban gardening, to supplement her irregular income. Now, more than a year later, Belaynish and her husband are again strong enough to grow their own food and no longer rely on food assistance to survive.

In 2011, WFP provided food and nutrition support for 2.3 million people living with HIV and TB—the number one killer of people with HIV—moving one step closer to the goal of universal access to treatment.

Fighting AIDS: US donates an extra $150 million

WASHINGTON (AP) — Science now has the tools to slash the spread of HIV even without a vaccine — and the U.S. is donating an extra $150 million to help poor countries put them in place, the Obama administration told the world's largest AIDS conference Monday.

"We want to get to the end of AIDS," declared the top U.S. HIV researcher, Dr. Anthony Fauci of the National Institutes of Health.

How long it takes depends on how quickly the world can adopt those tools, he said — including getting more of the millions of untreated people onto life-saving drugs that come with the bonus of keeping them from infecting others.

"No promises, no dates, but we know it can happen," Fauci told the International AIDS Conference.

Part of the challenge will be overcoming the stigma that keeps high-risk populations from getting needed AIDS treatment and services.

"We have to replace the shame with love," singer Elton John told the conference. "We have to replace the stigma with compassion. No one should be left behind."

Some 34.2 million people worldwide are living with HIV, and 2.5 million were infected last year.

Secretary of State Hillary Rodham Clinton said the goal is an AIDS-free generation. That would mean no babies would be born infected, young people would have a much lower risk than today of becoming infected and people who already have HIV would receive life-saving drugs so they wouldn't develop AIDS or spread the virus.

"I am here today to make it absolutely clear the U.S. is committed and will remain committed to achieving an AIDS-free generation," Clinton told the more than 20,000 scientists, people living with HIV and policymakers assembled for the conference.

But it will require smart targeting of prevention tools where they can have the greatest effect. "If we want to save more lives, we need to go where the virus is," she said.

First, Clinton said it's possible to virtually eliminate the transmission of HIV from infected pregnant women to their babies by 2015, by getting the mothers onto anti-AIDS drugs. HIV-infected births are rare in the United States and are dropping steadily worldwide, although some 330,000 children became infected last year. Clinton said the U.S. has invested more than $1 billion toward that goal in recent years and is providing an extra $80 million to help poor countries finish the job.

Much of the AIDS conference is focused on how to get treatment to all people with HIV, because good treatment can cut by 96 percent their chances of spreading the virus to sexual partners. Fauci pointed to South Africa, where healthy people who live in a region that has increased medication now have a 38 percent lower risk of infection compared with neighbors in an area where HIV treatment is less common.

Drugs aren't the only effective protection. Fauci said male circumcision is "stunningly successful," too, at protecting men from becoming infected by a heterosexual partner. Clinton said the U.S. will provide $40 million to help South Africa reach its goal of providing voluntary circumcision to half a million boys and men this year.

A tougher issue is how best to reach particularly high-risk populations: gay and bisexual men, sex workers and injecting drug users. In many countries, stigma and laws that make their activities illegal drive those populations away from AIDS programs that could teach them how to reduce their risk of infection, Clinton said.

"If we're going to beat AIDS, we can't afford to avoid sensitive conversations, and we can't afford not to reach the people who are at the highest risk," she said.

So the U.S. will spend an additional $15 million on research to identify the best HIV prevention tools to reach those key populations in different countries, and then launch a $20 million challenge fund to support country-led efforts to implement that science.

Better prevention for gay and bisexual men is a huge issue in the U.S. as well — and a striking study presented Monday added evidence that those men are especially at risk if they're young and black.

Government-funded researchers tracked black gay and bisexual men in six U.S. cities and found that 2.8 percent a year are becoming infected, a rate 50 percent higher than their white counterparts. Worse, the rate was nearly 6 percent a year in those men who are 30 or younger.

International health panel says treat all HIV infections

(Reuters) - An international health panel has recommended for the first time that all HIV patients be treated with antiretroviral drugs, even when the virus's impact on their immune system is shown to be small.

The nonprofit International Antiviral Society-USA cited new evidence that untreated infection with the human immunodeficiency virus that causes AIDS can also lead to a range of other conditions, including cardiovascular disease and kidney disease. In addition, data have shown that suppressing HIV reduces the risk of an infected person passing the virus to another person.

"We are no longer only focused on traditional AIDS-defining infections. We know that HIV is doing damage to the body all the time when it is not controlled," said Dr. Melanie Thompson, principal investigator of the AIDS Research Consortium of Atlanta and a member of the Antiviral Society panel.

The recommendations are global, but mainly aimed at "resource-rich" countries who can cover the cost of the medications, she said. The guidelines were published in the Journal of the American Medical Association at the start of the International AIDS Society's 2012 conference, which runs from Sunday through Friday in Washington, DC.

In addition to studies showing that treatment with antiretroviral drugs reduces the risk of HIV transmission, trials have shown a protective effect when the drugs are used by at-risk people who are not already infected with the virus.

U.S. health regulators earlier this month approved use of Gilead Sciences' (GILD.O) Truvada for HIV-negative adults who are at risk of acquiring the virus. Like other antiretroviral drugs, the Gilead pill is designed to keep the virus that causes AIDS in check by suppressing viral replication in the blood.

"The drugs are convenient, have very little side effects and their benefits are becoming clearer and clearer -- both for the infected person and from a public health standpoint," said Dr. Paul Volberding, director of the Center for AIDS Research at the University of California, San Francisco and another member of the panel.


The guidelines echo those issued in March by the U.S. Department of Health and Human Services, which also cited improved drugs and new studies showing patients benefit from treatment regardless of their level of infection-fighting white blood cells.

Previous recommendations called for antiretroviral drugs to be started for only patients whose CD4 cell counts had fallen below 500 per cubic millimeter of blood.

A normal CD4 count in a healthy adult varies between 500 and 1,200, according to HHS.

Earlier guidelines were based largely on the potential for health complications associated with initial antiretrovirals as well as concerns that patients without symptoms might not adhere to the therapy.

"The risk/benefit of the kinds of therapies we had available led us to be more restrictive in terms of when to start treatment," Dr. Thompson said.

The availability of new multidrug combination pills has made it easier for patients to take them consistently and has lessened the risk of drug resistance, she said.

"We were really focusing on the treatment aspect of it and didn't have the prevention data, which we now have," Dr. Volberding said.

The United Nations estimates that around 34 million people are living with HIV, including more than 1.2 million Americans.

The World Health Organization recommends that people diagnosed with HIV start taking antiretroviral therapy when their CD4 cell count hits 350 or less. It said this week that it is reviewing recent studies pointing to the potential benefits of giving the drugs earlier, before the immune system starts to weaken.

(Reporting By Deena Beasley; Editing by Michele Gershberg and M.D. Golan)

Physical inactivity kills 5.3 million a year globally - Lack of physical activity could be causing as many deaths worldwide as smoking and obesity do, say researchers who are calling on people to take at least a 15-minute brisk walk each day.

This week's issue of the medical journal The Lancet includes a series of studies leading up to the London Olympics to highlight how little physical activity most people worldwide actually get and how dire the health consequences are.

I-Min Lee from Brigham and Women's Hospital in Boston and her co-authors estimated that worldwide, physical inactivity causes six per cent of the burden of disease from coronary heart disease, seven per cent of Type 2 diabetes, 10 per cent of breast cancer, and 10 per cent of colon cancer.

What's more, physical inactivity was blamed for nine per cent of premature mortality — more than 5.3 million deaths of the 57 million deaths globally in 2008.

Eliminating physical inactivity could increase life expectancy by 0.68 years. That may seem small, they said, but the gains are for the whole population, not just inactive people who start moving more.

Canadian health authorities recommend that adults get 2½ hours of physical activity a week.

Tanya Berry holds a Canada Research Chair in physical activity promotion at the University of Alberta in Edmonton. Berry said her research suggests half of Canadians think they're moving enough, but they're mistaken.

"If you actually put a little accelerometer or pedometer on people, something that actually objectively measures how active they are, it's closer to 15 per cent are actually active and 85 per cent of Canadians are not active enough to achieve health benefits."

The Lancet researchers said people need to be told about the dangers of being sedentary, rather than just the benefits of exercise. They urged governments to find ways to make physical activity more convenient, affordable and safer.

"This series emphasizes the need to focus on population physical activity levels as an outcome, not just decreasing obesity," Harold Kohl, a professor of epidemiology at the University of Texas and one of the Lancet authors, said in a release.

Kohl recommended prioritizing physical activity across sectors including health, transportation, sports, education and business.

Min-Lee and her co-authors acknowledged that not everyone is capable of being physically active.

"This summer, we will admire the breathtaking feats of athletes competing in the 2012 Olympic Games," the researchers concluded.

"Although only the smallest fraction of the population will attain these heights, the overwhelming majority of us are able to be physically active at very modest levels — 15 to 30 minutes a day of brisk walking — which bring substantial health benefits.