World Medical Association calls for more nations to sign treaty against nuclear weapons

The World Medical Association has issued a plea to all nuclear armed and nuclear dependent States to sign the Treaty on the Prohibition of Nuclear Weapons.

The treaty, which prohibits the development, testing, production, possession, stockpiling, use, or threatened use of nuclear weapons was signed in July by 122 non-nuclear weapon States.

The WMA is now urging all those States that have nuclear weapons, or rely on the nuclear weapons possessed by others, to also sign the treaty.

It opened for further signatures at United Nations in New York on September 20.

Other organisations joining the WMA in the call include the International Physicians for the Prevention of Nuclear War, the International Council of Nurses, and the World Federation of Public Health Associations.

All of the groups signed a joint statement welcoming the landmark treaty as “a significant forward step towards eliminating the most destructive weapons ever created, and the existential threat nuclear war poses to humanity and to the survival of all life on Earth”.

WMA President Dr Ketan Desai said: “Even a limited nuclear war would inflict a substantial death toll as well as causing cancers, chronic diseases, birth defects, and genetic damage.

“In addition, it would bring about catastrophic effects on the earth’s ecosystem. This could subsequently decrease the world’s food supply and would put a significant portion of the world’s population at risk of famine.

“We share the treaty’s conclusion that the elimination of nuclear weapons is the only way to guarantee that nuclear weapons are never used again under any circumstances.

“The States that currently possess nuclear weapons or rely on the nuclear weapons possessed by others can and must completely and irreversibly dismantle the warheads, nuclear weapons programs and facilities, and cease all nuclear weapons related activities which threaten the security of everyone, including their own citizens.”

Two days before the treaty opened for further signatures the WMA marked its 70th anniversary and World Medical Ethics Day.

The WMA was founded on September 18, 1947, just one month after the
war crimes trial of German doctors in Nuremberg.

After the experiences of World War II, representatives of the medical profession decided it was necessary to establish a new international medical organisation to develop medical ethics and to cooperate globally.

The WMA was founded with 27 countries and held its first annual General Assembly in Paris in 1947. Today the Association has a membership of more than 100 national medical associations as constituent members from around the world. It has become the global platform to develop medical ethics, the rules of the profession.

Since 1947 it has developed ethical standards that are reflected in many national laws, international regulations and treaties.

In 2003 the Association decided to mark its anniversary by holding an
annual World Medical Ethics Day on September 18 to promote the presence of
ethics in medicine. Since then, national medical associations have
celebrated the day with various activities.

Dr Desai said the achievements of the WMA over the past 70 years had been enormous in promoting the highest standards of medical ethics in the profession.

Membership has grown significantly and the WMA’s many statements have become a central part of health policy around the world.

CHRIS JOHNSON

[Comment] Beating NCDs can help deliver universal health coverage

In WHO’s drive to ensure good health and care for all, there is a pressing need to step up global and national action on non-communicable diseases (NCDs), and the factors that put so many people at risk of illness and death from these conditions worldwide. By action, we mean coordinated action that is led by the highest levels of government and that inserts health concerns into all policy making—from trade and finance to education, environment, and urban planning. Action needs to go beyond government and must bring in civil society, academia, business, and other stakeholders to promote health.

[Comment] Is there a future for mRNAs as viral vaccines?

The first trial of an mRNA vaccine in human beings against an infectious disease is reported by Martin Alberer and colleagues1 in The Lancet. Similar mRNA vaccines have been found to induce some immunity against tumour antigens when tested in patients with melanoma or prostate cancer.2,3

[Viewpoint] Measuring global health: motivation and evolution of the Global Burden of Disease Study

People everywhere, but particularly those charged with improving the health of populations, want to know whether human beings are living longer and getting healthier. There is an inherent fascination with quantification of levels and patterns of disease, the emergence of new threats to health, and the comparative importance of various risk factors for the health of populations. Before the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) was initiated, no comprehensive assessments of human health were done.

[Global Health Metrics] Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016

The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems.

[Editorial] Life, death, and disability in 2016

In this week’s issue of The Lancet, we publish the latest global, regional, and national estimates and analyses from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), covering the period 1990 to 2016. The GBD is a herculean effort that annually tracks disease burden across countries, time, age, and sex. In 2016, there were an estimated 128·8 million livebirths and 54·7 million deaths. The good news is that globally, mortality rates have decreased across all age groups over the past five decades.

[Correspondence] Life-sustaining technologies in resource-limited settings

Vivekanand Jha and colleagues (Feb 23, p 1851)1 highlighted several issues on global dialysis. As stated in their Health Policy paper, more than 2 million people died in 2010 because of insufficient access to dialysis, most of whom were from resource-limited settings.2 However, several issues remain unaddressed, particularly factors related to dialysis in resource-limited settings, where more than 80% of people affected by kidney diseases live.3,4

Indigenous sexual health

BY AMA PRESIDENT DR MICHAEL GANNON

While successive governments have made significant efforts to address major chronic health problems experienced by Aboriginal and Torres Strait Islander people, sexual health issues are often left off the agenda. The rates of HIV and sexually transmitted infections (STIs) within Indigenous communities are increasing at alarming rates, and Aboriginal and Torres Strait Islander people are disproportionately affected by these conditions.

The serious consequences of untreated STIs are well documented, some of which are known have long-term effects on health. Syphilis, for example, is highly infectious and can cause heart and brain damage, while diseases such as gonorrhoea and chlamydia can lead to infertility and chronic abdominal pain. Not only do STIs affect a person’s physical wellbeing and further increase the risk of HIV infection, but the stigma attached to STIs can result in social isolation.

In 2015, the rate of syphilis among Aboriginal and Torres Strait Islander peoples was over six times higher than that of the non-Indigenous population, and in some remote areas, this rate rose up to a staggering 132 times higher. Indeed, almost 80 per cent of STIs among Indigenous Australians are found in remote communities, and a number of underlying risk factors such as poor access to health services, culturally inexperienced clinical staff, and a particularly young population contribute to such high infection rates.

In recent years we have seen significant progress in both the diagnosis and treatment of STIs and other preventable diseases. However, a syphilis outbreak across northern Australia has recently caused the number of STIs to rapidly rise and has already led to the death of at least four Indigenous Australians. This is completely unacceptable.

These statistics, while incredibly concerning, highlight a growing problem facing Indigenous Australians when it comes to their sexual health and wellbeing. It is clear that urgent action must be taken to address the high rates of STIs in Indigenous communities.

The Federal Government has shown some promise in addressing sexual health issues in Indigenous communities, by forming a Multi-jurisdictional Syphilis Outbreak Working Group to help prevent disease transmission and outbreak, and supporting the South Australian Health and Medical Research Institute to partner with the Aboriginal Nations Torres Strait Islander HIV Youth Mob to deliver awareness and education campaigns to Indigenous Australians across the country.

Yet, in March 2017, the Government confirmed the inexplicable scrapping of federal funding for both the Northern Territory AIDS and Hepatitis Council and the Queensland AIDS Council, all without conducting any community consultations or directly evaluating the programs themselves. For more than two decades, both services have delivered vital sexual health programs to remote and regional communities that experience difficulties accessing mainstream health services, and have developed close relationships with the communities that they serve. The cut in federal funding is set to bring these programs to an unfortunate and indefinite close, but it is services like these that play a key role in improving sexual health outcomes for Aboriginal and Torres Strait Islander people.

Living with a sexually transmitted disease is not just an individual health issue, but one that can impact the entire community. As HIV and STI rates for Aboriginal and Torres Strait Islander people continues to rise, we should not be cutting existing services aimed at improving sexual health practices in Indigenous communities.

The AMA understands that the Government has confirmed it will undertake an evaluation of a $24 million funding proposal to address STIs in Indigenous communities through eliminating syphilis, preventing HIV, health education, and STI screenings through outreach in vulnerable regions. However, we also understand that an outcome on this evaluation has yet to be announced.

The AMA would like to see the Government invest in areas to support ongoing efforts to address Indigenous sexual health problems, and ensure that culturally safe health care remains accessible to all Aboriginal and Torres Strait Islander people to help control the spread of STIs.

[Editorial] Pushing the boundaries in paediatric surgery

Aside from the difficult psychosocial aspects of illness in babies and children, paediatric surgery and paediatric surgical research face inimitable challenges. These include the consequences of anaesthesia and radiation exposure in children, the implications of long-term complications, and, in many cases, the necessity of long-term care despite the inevitability of a transition to adult services. Diseases requiring paediatric surgery are sometimes rare and heterogenous in nature, with complex cases requiring multidisciplinary management.

[Perspectives] Lung cancer

At the intellectual heart of the new scientific medicine of the late 19th century was the idea of specificity: each disease had a single specific cause, and in time medicine would generate a specific and effective cure. This idea transformed the diagnosis and treatment of infectious diseases, but through the 20th century, as the burden of mortality shifted towards chronic diseases, its limitations became abundantly clear—nowhere more so than in the case of lung cancer.