Tobacco on pace to kill 1 billion people this century

The World Health Organization is warning that tobacco could kill a billion people around the world in this century.

The Global Adult Tobacco Survey noted that nearly half of all men and more than one in 10 women use tobacco in many developing countries, reported. According to the study, women are also starting to smoke at an earlier age.

The authors of the study told Time that the numbers call for urgent changes in tobacco policy and regulation in developing nations.

Gary Giovino, of the School of Public Health and Health Professions, told Time, "Our data reflect industry efforts to promote tobacco use. These include marketing and mass media campaigns by companies that make smoking seem glamorous, especially for women. The industry's marketing efforts also equate tobacco use with Western themes, such as freedom and gender equality."

Egypt is one country where researchers said they were seeing the largest increase in smoking. Edouard Tursan D'Espaignet, of WHO's tobacco control program, told CNN that the increase is partially due to the revolution.

CNN noted that government regulations limiting smoking fell apart after Hosni Mubarak's regime was ousted last year. Tursan D'Espaignet added that "the tobacco industry walked in very, very aggressively" to market its product amid the chaos. "We are hearing things like 'Smoking is a way to show you're free from the previous regime,'" he said.

According to the Atlantic, manufactured cigarettes are the most widely used form of tobacco in the countries surveyed by the GATS. Cigarettes accounted for 82 percent of tobacco consumption. The study's authors noted, "These products are technologically designed to mask harshness, provide particular taste sensations, and increase nicotine delivery."

There are still glimmers of hope in the fight against smoking. Earlier this year GlobalPost reported that a CDC study showed that cigarette smoking declined by 2.5 percent in the US from 2010.

The GATS study was funded by the Bill and Melinda Gates foundation, with additional funding from Bloomberg Philanthropies.

According to CNN, Bloomberg Philanthropies says that in 2007, it supported the WHO's efforts "to package and promote six proven policies to reduce tobacco use worldwide." It added that since then, "21 countries have passed 100 percent smoke-free laws, the percentage of people protected from second-hand smoke has increased 400%, and almost four billion people worldwide are now protected by at least one of the six proven tobacco control policies." (

We should urgently integrate TB-HIV care

Tuberculosis (TB) is responsible for 60 percent of the deaths among persons living with HIV/AIDS.

Given this relationship, the World Health Organization (WHO) recommends that care services are integrated between the two conditions. Uganda has registered some progress but the technocrats want the success rate at 100 percent. Kakaire Ayub Kirunda spoke to Dr Anna Nakanwagi Mukwaya, the Chief of Party in Uganda for the International Union against Tuberculosis and Lung Disease (The Union) to put things into perspective.

Why is the integration of TB-HIV care such a big deal these days?

HIV is the leading risk factor for the development of tuberculosis disease. At the same time, tuberculosis is the leading cause of death among people living with HIV. In a country like Uganda where the TB burden is so huge (the community has with TB germs in the air) and HIV/AIDS that is depressing the immunity of persons with HIV, then chances of picking TB are high.

That is why you see this one AIDS patient with TB but usually the TB came because of the condition of HIV which affected their immunity. We can no longer have a situation where a patient comes into a clinic, gets treatment, and we do not look out for TB. It is going to kill them. Whenever health workers see HIV/AIDS patients, they have to look out for TB as well.

And the day you confirm someone has TB, let them be advised to take an HIV test and if positive, start them on antiretroviral treatment because they will heal much faster than someone being treated for TB alone. If only one condition is treated, the patient may die along the way. If you somehow manage to treat the TB, they will get it again because the underlying problem is not being taken care of. The two diseases are no longer separable.

The latest annual health sector performance report (AHSPR) shows that integration has improved tremendously but there are some academic works that paint a contrary picture. Why the discrepancy?

You have to look at the statistics well. If I were at zero and I have moved to 10 or 20 percent of the performance, I have improved. But it doesn't mean I have reached the optimum that is required. All TB patients are expected to be tested for HIV. So when we say integrate a service, we expect that every TB patient found in this country will receive an HIV test.

So when you look at the AHSPR and last year they tell you they were at 60 percent but this year they are at 70 percent they will say they have improved but we want it at 100 percent.

So why are we not integrating?

Many health workers did not understand this linkage initially. They needed training. It has taken time to have them trained to understand the close linkage between the two diseases. Also if you look at the structure of our services, if you have HIV, you are sent to a particular clinic and if you have TB you are sent to a particular clinic.

So the way our services are organised does not easily facilitate the process of integration. If somebody is in the TB clinic and that clinic does not offer HIV testing, they will refer the patient to the site that offers HIV testing. That alone affects the uptake of services. Probably they have been waiting for long and will promise to come back another day.

But they may not due to several factors because many may not have transport, we don't give them lunch. The vertical HIV and TB programmes are problematic. So what is the teaching now? At the primary healthcare facility we should try to integrate these services as much as possible. Where there is a TB service we should try and put an HIV service and vice versa. This will reduce the inconvenience to the patient.

Now that the need for integration is well understood why are we still wasting time as country?

In countries where TB and HIV services are under the same roof things are much better. For example in Zimbabwe these services are given under the same roof. Patients are not referred. If you go to Benin, it is the same thing. In Uganda, because our services have been structured separately, it takes time. When it comes to health workers, very few in HIV know how to give TB care and in TB it is the same situation.

Uganda needs to get resources and ensure that all health workers in HIV care know how to diagnose TB, treat it and follow up the patient. It should be the same thing on the TB side. Traditionally, the training has been separate. Joint planning by the national TB and AIDS control programmes is also still weak.

But your organisation has been working with Government for some time now. Why don't we have the TB and HIV care clinics merged?

When you are a partner in a country, you do not work in isolation of the government system. Uganda is stuck with the old system structure of vertical programming. So however good your intervention may be, it will be so difficult to integrate services like TB and HIV.

You can only tell them (TB and AIDS control programmes) to talk to each other, collaborate more often, and do what they can. But still where the Union has worked, there has been improvement in the uptake of TB-HIV services in these districts. (

Bird flu claims 9th victim in Indonesia this year

The Health Ministry says bird flu has killed a 37-year-old man in central Indonesia, marking the country's ninth fatality this year.

The Ministry's website said Monday that the man died July 30 in Yogyakarta province after being hospitalized for five days.

It confirmed that the man who lived near a chicken slaughterhouse was infected with the H5N1 virus after apparently coming into contact with sick birds.

The virus, which began ravaging poultry across Asia in 2003, remains entrenched in Indonesia. Experts fear it could mutate into a form that passes easily among people, potentially sparking a pandemic. But most human cases have been linked to contact with sick birds.

The World Health Organization says 359 people have died from it worldwide. Indonesia remains the hardest-hit country, accounting for 159 deaths. (

UK doctors must prepare for the rise of the ‘ePatient’

Doctors and other healthcare professionals must prepare for the rise of 'ePatients' in the coming years and keep apace with the evolving digital landscape.

This is according to the 2012 version of 'Learning to manage Health Information', a clinical education guide that has been running since 1999.

Its aim is to understand the digital world and healthcare professionals' working requirements within it.

This year's focus is on the rise of the ePatients, who come to surgeries armed with information found on the internet about their condition - and are often more digitally aware than their doctor.

The guide says that in the near future, clinicians will be dealing more and more with the ePatient, adding that: "today, such patients need not be mere recipients of care and can become key decision-makers in their treatment process."

It adds: "Self-management programmes can be designed specifically to reduce the severity of symptoms [...], whilst online communities of patients, sharing knowledge and information about specific conditions or providing mutual support are increasingly common."

This will also see patients work in partnership with their health and social care providers, meaning they can be given greater control over their health and lives - messages pharma is also keen to deliver.

The guide says that a good example of this is Renal PatientView, which provides online information about renal patients' diagnosis, treatment, and their latest test results.

There is a potential opportunity here for pharma, as the ePatient can be informed by the industry and may be looking on pharma websites - or industry-sponsored disease awareness campaigns - for information.

Things like the Renal PatientView are already being done by firms in the guise of smartphone/tablet apps, and will be familiar to pharma.

So there could room for the industry and the more digitally savvy healthcare professionals to work on digital campaigns together, as a way of delivering more information to the patient, and for both to learn from each other on what works, and what doesn't.

This could create a new relationship between pharma, patient and doctor - all within the regulations of European law and the ABPI Code, of course.

This is also a good indicator of how patients are using digital, with the guide seeing this as changing the relationship between doctor and patient, where "the power of knowledge is held as much by patients as by their clinicians", such is the strength of digital.

Pharma could learn much by how patients are using this sort of information, and arm patients with more information, whilst also increasing marketing opportunities.

Digitally savvy?

But pharma shouldn't get too giddy about these opportunities, as the guide does not paint the picture of an aspiring digital culture coming from today's healthcare professionals.

Its rather glum conclusion states: "Many healthcare professionals continue to have limited or no education in informatics and yet the expectations of them to manage information effectively is a current and increasing requirement".

Furthermore, one of the educational courses for healthcare professionals set out in this year's guide will raise some eyebrows.

Headed under 'NHS Elite', those who have completed this course must be able to "restore and empty files from the Recycle Bin" and be able to 'access help' - perhaps the most important one to learn if you're struggling to delete a file successfully.

And this is the 'elite' level of training - one wonders what the basic level might entail.

Writing for the Guardian's Healthcare Network, Dick Vinegar (a pseudonym, of course), a specialist in health and IT, says: "I get the impression that although [the team who write the guide] was set up in 1999 and has been bashing away relentlessly, it has not made much progress in educating the lumpen mass of clinicians to make them ready for the digital age."

He said that many of them still have not got their heads around simple systems like 'Choose and Book', e-prescribing and Summary Care records.

"Assuming that most clinicians have achieved some keyboard skills over the years and can write emails and manipulate spreadsheets, doesn't mean they have a real understanding of what they ought to know about IT or how it can improve the care they provide to patients and make their own lives easier.

"What is scary is how much there is for them [clinicians] to learn," he concludes.

Younger doctors and other healthcare workers coming through the ranks will be more digitally aware than those educated in the 1960s and 1970s, the guide adds, but it seems that both patients and pharma may have to wait a little bit longer for the 'eDoctor'. (

GlobalData Report: Telehealth will Change Healthcare World Forever

Over the years, there have been many instances when healthcare changed forever. The polio vaccine, which eradicated this dreaded disease and the use of chemotherapy, beginning in the early 20th century, are just two examples.

But nothing may change it – and the way it's practiced – more than telehealth, which holds the promise of medical care dispensed remotely to allow patients more freedom and convenience, and to lower healthcare costs, according to a new report by healthcare sector experts, GlobalData.

The way it works is that doctors fit patients with monitors which transmit data remotely to healthcare providers, giving a picture of patients' vital signs, glucose levels and other important readings, thereby keeping them out of the hospital but still under physician care, for intervention at any point. It also brings specialists to rural areas through the use of video conferencing.

It's catching on so much that late last year, the U.S. Department of Agriculture (USDA) recently announced that it will provide 34 states and one territory with funds from its Distance Learning and Telemedicine (DLT) program to improve access to healthcare and education, USDA Secretary Tom Vilsack announced in December.

The GlobalData study revealed that the telehealth market was valued at $13.2 billion in 2011, but will almost triple, soaring to $32.5 billion, by 2018, a compound annual growth rate (CAGR) of 14 percent.

And it's not just here in the U.S. In Asia it's a rapidly growing market, as well. "Growth in the Asia-Pacific region is expected to be driven by improved awareness of the model's potential for expanding the penetration of affordable medical care to the wider population, with the governments of India and China rapidly adopting and pushing telehealth to cater to the needs of the huge rural patient population," the report asserted.

According to GlobalData, the need to increase the reach of quality medical care to remote locations, reduce healthcare costs and enable the optimal usage of limited provider resources are all driving the growth of this marketplace.

And the accelerated growth of telecommunication technologies, increased adoption of related healthcare IT solutions and the readiness of companies and governments to invest are also reasons for its skyrocketing growth, the study noted. (

Security concerns of WHO staffers propel government into action

Prime Minister Raja Pervaiz Ashraf has instructed the Ministry of Interior to provide protection to all vaccinators working for the polio eradication initiative in Pakistan in a bid to restore their confidence.

The instruction was given in response to concerns expressed by the regional director of the World Health Organization (WHO) Dr. Ala Alwan, who was on a brief trip to Islamabad to attend a meeting of the National Task Force on Polio Eradication here Tuesday.

Dr. Alwan is reported to have expressed utter dissatisfaction over the pace of investigations into the Karachi shooting incident targeting polio staff of WHO. He urged the PM and the President to personally look into the matter and requested that security be provided to WHO staffers in the country. The fact that a joint investigation team was not constituted even after 10 days of the incident also aroused concern.

Dr. Alwan underscored the need to vaccinate the over 160,000 children who are being missed in Bara since September 2009 and requested the government's support to reach them with polio drops. Several other participants also pointed out that the threat to vaccinators is maligning the government's efforts, and that special protective cover should be provided to women vaccinators in particular.

The meeting was chaired by the PM and attended by top officials including chief ministers, governor of Khyber-Pakhtunkhwa, Prime Minister of AJK, minister for Inter-Provincial Coordination, Special Assistant to the Prime Minister Shahnaz Wazir Ali, Dr. Azra Fazal Pechuho, Polio Ambassador Aseefa Bhutto Zardari and members of the parliament.

"We are not just saving a life but entire humanity by implementing the polio eradication initiative. Saving the vulnerable and healing the ailing is in line with the teachings of our great religion Islam," the PM is reported to have said during the meeting. He directed the polio programme to redoubled its efforts to achieve the desired results.

The National Task Force met to discuss key challenges that need to be addressed in eradicating polio. The meeting started with Shahnaz presenting an overview of the polio situation. Pakistan has reported 27 cases so far in 2012 as against 71 during the same period last year.

The PM expressed serious concern over ban on polio immunisation by certain. He asked all district 'khateebs' to become active part of the initiative. "The government is fully committed; no religion on earth opposes polio campaign," he said. He also directed the governor of KP to ensure that polio campaigns are held without hindrance in all parts of Fata.

Aseefa said, the challenge of inaccessibility needs to be overcome with appropriate strategies; this is the responsibility of not only the communities but the state as well. "The number of children being missed as a result of ban on polio campaigns in North and South Waziristan and other parts of Fata is indeed alarming," she added. We need to continue to garner the support of religious scholars and fire-walling of areas with transit teams so that all children entering or exiting the area and moving to areas not affected by polio are protected with polio vaccine," Aseefa added. (

UN backs Filipino leader in contraceptives battle

MANILA, Philippines—The United Nations on Sunday expressed its support for a proposed law that would provide Philippine government funding for contraceptives and has pitted the popular president against the influential Roman Catholic church.

The bill promotes contraceptive use in a poor country with one of Asia's fastest-growing populations. The House of Representatives plans to decide Tuesday whether to end debate on the bill and put it to a vote, reigniting acrimony over an issue that has divided Asia's largest Roman Catholic nation for years.

Catholic bishops led a rally on Saturday by thousands of followers urging the bill's rejection and attacking President Benigno Aquino III for supporting it. An archbishop, Socrates Villegas, urged Aquino to focus on his promise to eradicate corruption and poverty and not promote "a culture of contraception" that "looks at babies as reasons for poverty ... a mistake and not a blessing."

The bill's supporters plan to hold their own rally Monday outside Congress.

Aquino's camp said Sunday he would not back off from supporting the Reproductive Health bill, which he promoted in his state of the nation address in Congress last month.

The United Nations said in a statement issued in Manila on Sunday that the bill, which aims to promote responsible parenthood and teach reproductive health in schools, would help reduce an alarming number of pregnancy-related deaths, prevent life-threatening abortions and slow the spread of AIDS.

"As in many other countries where similar policies have been introduced, enacting a law that would address the reproductive health needs of the Filipino people would, over time, vastly improve health and quality of life and support development," the U.N. said.

Countering a church argument that contraceptives foster abortions, which are outlawed in the Philippines, the U.N. said that by preventing unintended pregnancies, "a reproductive health law would help prevent recourse to life-threatening abortions."

It said the country's rapid population expansion could prevent millions of Filipinos from being lifted out of poverty, adding that "hopes of future prosperity could turn to dust" if the Philippines is unable to deal with the issue.

The bill pending in Congress would require the government to provide information on family planning methods, make contraceptives like condoms available free of charge to poor couples and introduce reproductive health and sexuality classes in schools. It would encourage families to limit their children to two.

Filipino church officials have blocked the passage of birth control legislation in past years, arguing that contraceptives are as sinful as abortions. Proponents of the bill want more openness toward birth control to prevent disease and reduce population growth.

Aquino, still popular after his 2010 landslide election victory, has backed birth control even if it means going against the dominant Catholic church. He said last year he was ready to face the consequences and risk excommunication if necessary. (

SBY Tells Indonesians To Stop Seeking Medical Treatment Abroad

President Susilo Bambang Yudhoyono told wealthy Indonesians stop heading overseas for medical treatment in a criticism of medical tourism delivered at the Health Ministry on Wednesday.

"Honestly, I'm not happy if our people go abroad for medical treatment because it only benefits neighboring countries," Yudhoyono said.

Indonesia's ministers need to set an example for the rest of the nation and only seek treatment at domestic health facilities, he said. It is a policy Yudhoyono says he has followed for years.

But he may be in the minority among Indonesians with the means to seek treatment at hospitals and health centers overseas. According to the Health Ministry, some 600,000 Indonesians leave the country for medical treatment every year. They spend an estimated $1.2 billion on treatment in nations with modern, and often better-equipped, health facilities.

Among those who sought medical care overseas was Yudhoyono's own wife, Ani Yudhoyono. The first lady traveled to the United States in June to undergo treatment for a nerve problem in her neck at Allegheny General Hospital in Pittsburgh, Pennsylvania.

"He feels concerned by the many Indonesians who seek medical treatment overseas, but the First Lady herself sought medical attention abroad," said the Golkar Party's Poempida Hidayatullan, a member of the House Commission IX that deals with health affairs.

Indonesia needs to change the perception of the nation's doctors, who have the necessary skills and knowledge to treat citizens here, Poempida said.

"For me, the perception that domestic health care is not that good is clearly because of an inappropriate and unintegrated policies and strategies in the health sector," he said.

The lawmaker urged the president to push for health care reform and a larger budget in an effort to boost the system's efficiency.

"This should encourage the development of the national health sector and this should have the president's special attention," Poempida said.

Yudhoyono told a crowd of reporters and Health Ministry officials on Wednesday that he was committed to continuing the development of the nation's health system. He also asked those thinking of heading overseas to consider scheduling an appointment at a domestic hospital instead.

"Our quality [hospital] and doctors are something to be proud of," Yudhoyono said. "Many of our doctors are smart and recommended by other countries."

But for those who still plan to leave Indonesia for treatment, there is little the president can do to stop them, he said.

"I could not forbid them, as I could not issue presidential decree banning our people from seeking medical help abroad," Yudhoyono said. (