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China Blows Alarm Whistle On Smoking

The risks of smoking are being addressed in China, where roughly 300 million people or one quarter of the population are puffing away. The number is rising by about 3 million new smokers each year, and according to statistics of the WHO 700,000 die each year from smoking.

In November of 2003 China joined the Framework Convention on Tobacco Control (FCTC), a subsidiary of the World Health Organization. As a member China is now obliged to tighten restrictions on cigarette marketing and consumption.
Due to an economic boom in the country foreign tobacco giants are putting their hope into this rising market, as revenue has decreased elsewhere in the world. So far tobacco taxes, which are collected from the 1.7 trillion cigarettes sold in China amount to 8 billion $US or one tenth of government revenue. In the wake of SARS, however, the realization has come to the forefront, that health care cost have a severe impact on the economy of a country. Despite the seemingly enticing short-term gain from tobacco tax revenue, short cuts in health care can economically damage a country in the long run.

Health officials will have a battle with their counterparts in finance, when it comes to implementing tobacco control. In some areas of the country the sale of tobacco products to children has been banned and an attempt has been made to restrict cigarette commercials. Powerful tobacco lobby groups actively undermine these efforts.
It is encouraging to see at least a beginning of public education about the risks of smoking. However, in a nation where cigarette manufacturing and consumption are the highest worldwide, it will be a long and arduous journey to clear the air to better health.

Based on The Lancet 363, No. 9402 (Jan. 3, 2004)

Old-Fashioned Fish Oil Boosts Heart Health

You do not need to spoil your appetite with the thought of swallowing cod liver oil, but see yourself enjoy a piece of salmon instead. Dr. Jehangir N Din and collegues published an article entitled "Omega 3 fatty acids and cardiovascular disease—fishing for a natural treatment" in the first January edition of the British Medical Journal (BMJ 2004;328:30-35,January 3, 2004). These cardiology researchers from the University of Edinburgh/England have reviewed all of the recent medical literature regarding the beneficial effects of omega-3-fatty acids on heart disease. The following are some facts they found.

The interesting story regarding the omega-3-fatty acids, which have anti-inflammatory qualities, is that they balance the detrimental effects of the omega-6-fatty acids, which lead to inflammation not only in joints, but also in blood vessels. In the standard North American and European foods the omega-6-fatty acids are overconsumed. To counter the bad effects of the omega-6-fatty acids, more omega-3-fatty acids need to be ingested.

So, what should we consume in terms of omega-3-fatty acids? The American Heart Association made these recommendations:

Current consumption of omega-3-fatty acids in North America and Europe is low. Recently an expert US panel of nutritionists determined that the US consumption per day is about 0.1 to 0.2 grams per day and should be 0.65 grams per day as a minimum according to the recommendations by the American Heart Association.

The authors of this paper from England disagree and state that at least 1 gram per day would be needed to lower the heart attack risk to the low levels in Asia. The British Nutrition Foundation has recommended to use 1.2 grams of omega-3-fatty acids per day.

How does that translate into how much fish you would have to eat to get about 1 gram of omega-3-fatty acids per day? To make things simpler I have categorized fish and seafood in the table below based on the data from this article into low, medium and high marine derived omega-3-acid foods. You obviously need to eat more of the low category seafood to achieve 1 gram of omega-3-fatty acid than of the high category seafood.

Before you overindulge in seafood from the low and medium category, check with your doctor first whether you are allowed so much protein. Some people have protein restrictions due to poor kidney function or because of gout. The authors of this study stated that you should eat a seafood meal with 1 gram of omega-3-fatty acid twice per week. Other sources of omega-3-fatty acids (=alpha-linolenic acid) are plant products such as soy beans,flaxseed, walnuts and rapeseed oil. In Asia fish and soy bean products are consumed in much bigger quantities than in the US. This would be a good complementation.

Poverty Still A Threat To Mothers' Lives

Adrienne Germain from the International Women's Health Coalition, New York, wrote a review in the Lancet (Lancet 363: 65-66, 2004) about the state of health and mortality of pregnant women (maternal death rate) around the world. 500,000 pregnant girls and women die around the globe every year from conditions that are preventable or treatable. 99% of these live in developing countries. At the same time 3.9 million newborns die every year in their first 4 weeks of life!

2004 is the 10-year anniversary of the recommendation for reproductive health from the 1994 International Conference on Population and Development (ICPD). The maternal death rate in Europe is about 1 in 4000 pregnancies; in many African countries (sub-Saharan Africa) it is 1 in 16! Despite some progress that has occurred, still 70% of all deaths associated with pregnancy occur in only 13 countries. In another article in the Lancet (Lancet 2004; 363: 23-27) Prof. Wendy Graham and co-workers used a new familial technique to determine whether there is a statistical association between poverty and the maternal death rate. The answer is not only a clear "yes" for the maternal death rate within one country, but there is a clear association between poverty and maternal death rate in countries all around the world!
A high mortality rate in babies and children in addition to the maternal death rate has traditionally been a grave concern in poor countries. Research in development countries has shown that 70% of the poorest 1.3 billion people in the world are women. The study also shows that these mothers have a high mortality rate. Maternal death can occur during pregnancy or birth, and the poorer the population group, the higher the maternal death rates will be. The reasons are varied: for the poorest of the poor, medical treatment is often unaffordable.

Also seemingly simple measures such as clean drinking water, toilets and whether floors are present in dwellings do have an impact on health. At the same time the level of education determines whether death rates are higher or lower. These results are not only true for one specific country. Even though most of the alarming numbers come from the African countries such as Burkina Faso, Chad, Ethiopia, Kenya, Mali, and Tanzania, other countries like Indonesia and the Philippines show the same troubling picture.
The main causes of maternal deaths were due to the following conditions: bleeding after delivery, early pregnancy bleeding; infections that would lead to sepsis and death; complications surrounding abortions; blood pressure problems such as eclampsia with seizures and kidney damage; and prolonged labor when the baby's head is too large. This latter condition requires an Cesarean section on an emergency basis, which is not always readily available in rural areas.

As we know from other studies, even closer to home, poverty and rural isolation remain a risk to health and life.
Adrienne Germain in her editorial review pointed out that some poor countries such as Bangladesh have taken the recommendations for reproductive health from the 1994 ICPD-conference seriously and have instituted a nationally sponsored program.

The result has been that between 1988 and 2002 the percentage of women receiving antenatal care has improved from 26% to 47% while the maternal death rates have declined from 410 to 320 per 100,000 women during and after the pregnancy. Childhood mortality also improved significantly as did the mothers life expectancy (from 58 to 60 years). There are success stories in other countries as well.
What is needed is political will around the globe, co-operation between the appropriate agencies such as the WHO, the UNICEF, the International Women's Health Coalition, and others. Locally in every country it is vital to have an interdisciplinary co-operation to fight poverty and to provide shelter with a certain minimum living standard.

Link to UNICEF. Link to WHO. Link to International Women's Health Coalition.

Flu Season Not Over Yet

Influenza type A is the cause of many flu epidemics including the one that recently affected the northern hemisphere. It is known to change its surface characteristics from time to time. This has occurred in the southern hemisphere (Australia and New Zealand) during the summer of 2003 and the same new type has caused the recent epidemic in Canada, the US and Europe.

Prior strains of flu viruses in recent years were variants of the Panama strain, that's why the infection specialists decided in the beginning of 2003 to suggest a Panama strain type vaccine to be used for protection for this flu winter season. However, 70% of the cases tested in Canada by the end of November turned out to be influenza type A/Fujian,full name A/Fujian/411/2002(H3N2), different from type A/Panama, full name A/Panama/2007/99(H3N2), according to Dr. Theresa Tam. She is a specialist in the division of respiratory diseases at the Health Canada Centre for Infectious Disease Prevention and Control. Similar observations regarding a shift from the type a/Panama to the type A/Fujian strain of the flu virus has also been reported in the US and in Europe. It appears that those who have been vaccinated with the type A/Panama vaccine have had partial protection from this new flu as some of the flu virus characterisitics (e.g. the H3N2 determinants) are the same.

Dr. Tam mentioned that the recent deaths in children from the flu in the US, England and Canada would likely be explained by the fact that in the last 3 years there have not been any H3 type flus and the flus that did circulate were relatively mild. This means that children have not developed enough background resistance to fight a flu when it comes. Most adults have background resistance, but older people are loosing some of the resistance due to aging. Dr. Tam explained that not too many children have had the flu vaccination. One would expect that children are most vulnerable for the flu and this explains why these deaths would have occurred.

Production of flu vaccines that protect from flus: One of the problems with getting the best match for an upcoming flu season is the lag period between the decision to produce a certain type of flu vaccine and the mass production of the vaccine to serve a world population. This can take 6 to 8 months. A new technique of vaccine production is being investigated, called "reverse genetics", where the lag period may only be a few weeks.

Dr. Webster, an infectious disease specialist at the St. Jude Children's Research Hospital in Memphis, has produced a vaccine with this method against an avian flu with the characteristics H5N1(different from the others mentioned above). This is an older flu transmitted by birds that has resurfaced earlier in 2003 again. However, this vaccine that has been produced in cell culture and not in egg cultures, has only been tested in animal models, not in humans yet. Both Dr. Webster and Dr. Tam agree that human trials under FDA guidelines are needed to test these newer vaccines utilizing reverse genetics. Regulatory and patent issues need to be settled for this to happen.

Use of antiviral drugs: Another issue is that type A influenza can be treated with antiviral antibiotics, but every flu season these types of drugs tend to run short. Each country should have a national stockpile of these antiviral drugs (such as Tamiflu) so that enough stock is available in case of a serious epidemic where the vaccine may not fit the flu strain that comes around. This is not happening at the present.

What is needed is that international discussions take place through the Global Health Security Network (right now consisting of the G7 countries and Mexico), Dr.Tam said.

Conclusion: The flu season has started early this season. Many people have died because of a lack of vaccination. Some of those who were vaccinated against the flu may have caught the flu as the fit this year with regard to the vaccine was not the best. However, they likely survived the flu, whereas those who did not have the vaccine were more likely to have experienced the flu more severely and some of these have died. It is not too late to get the flu vaccine before the spring season. Typically there is another peak of the flu between February and April.

Based in part on The Medical Post, Dec.9, 2003 (p.1 and 73).

Any Diet A Winner Research Says

Dr. Michael Dansinger reported at a recent annual meeting of the American Heart Association about a study where he compared the effect of 4 major diet plans on the lowering of risk factors for heart disease.

Dr. Dansinger is the director of obesity research at the Tufts New England Medical Centre's Atherosclerosis Research Lab in Boston. Originally, the objective was to see whether any of the following four diets investigated would be superior: the Atkins diet, the Ornish diet, the Zone diet and the Weight Watchers diet. In the table below there are links for each of these diet plans. Briefly, the Atkins diet is a high protein/low carbohydrate diet; the Ornish diet is a vegetarian/low-fat diet; the zone diet is a low-glycemic load/balanced protein/low fat diet; weight watchers is a calorie restricted diet.

160 obese patients were divided into 4 groups and assigend to one of these four diet plans.

They were instructed in the type of diet plan they were to follow in 4 couselling sessions in the beginning of the weight loss program. The participants ranged in age from 22 to 72 years of age (average age 50) and had on average starting weight of 220 lbs. They were to follow the diet plan for 2 months strictly and were allowed to follow less supervised for another 10 months. To the surprise of the research team under Dr. Dansinger they all lost about the same amount of weight (average of weight loss 10 lbs or 5% of body weight), in other words they were all successful with any of these programs and none was superior. Here are the results in modified tabular form:

Dr. Dansinger indicated that the focus would now have to shift from "which is the best diet plan" to "which is the best diet plan for a particular patient". The doctor should attempt to fit the weight loss programs that fit patients' food preferences best and that patients can easiest fit into their lifestyle. This will hopefully lead to the lowest dropout rate. This trial showed that the Zone diet and the Weight Watchers diet had the least dropout rates. But those who stayed on the Atkins or Ornish diet were successful with their weight loss program also, as these may have been fitting these patients best. In other words, if the one diet plan does not work satisfactorily, try another one. The common denominator with all food plans was some form of calorie restriction despite all of the differences.

Based on The Medical Post, Dec. 16, 2003 (p. 15).

Here is a link to the Net Health Book's weight loss and diet chapter.