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Processed meats need a closer look

OPINION
By Dr Alphonse Roex and Dr Heleen Roex-Haitjema

In October 2015, the authoritative International Agency for Research on Cancer (IARC) confirmed that processed meat causes cancer and red meat is a probable carcinogen (Table 1.1,2 ).

IARC Carcinogenic Classification Groups

Likelihood to cause cancer in humans

Type of meat

Examples

1

Causes cancer

Processed meats

Bacon, ham, sausages, hot dogs, hamburgers, ground beef, mince, corned beef, beef jerky, canned meat, offal and blood

2a

Probably causes cancer

Red meats

Meat from mammals: pork, veal,  beef, bull meat, sheep, lamb, horse meat and,

Meat from hunting: wild boars, deer, pigeons, partridges, quail and pheasants

Table 1. Based on the IARC’s data on the carcinogenicity of processed meat and red meat.1,2

The IARC assessed more than 700 epidemiological studies regarding red meat and more than 400 provided data on processed meat. The IARC estimates that worldwide the consumption of diets high in processed meat results in approximately 34,000 deaths annually and diets high in red meat in 50,000 avoidable cancer deaths per year. Eating an extra portion of 50 grams of processed meat daily increases the relative risk of colorectal cancer by 18 per cent.

The strength of evidence that processed meat is a carcinogen is comparable with tobacco smoking and asbestos.3,4

Diets high in animal protein show a 75 per cent increase in total mortality, a 500 per cent increase in diabetes, a 400 per cent increase in cancer risk, and produce significantly higher levels of IGF1, a potent cancer-promoting hormone.5

Chronic diseases are responsible for considerable human suffering and contribute heavily to the burden of disease nationally. Australia’s ever increasing total healthcare expenditure has in 2016 for the first time surpassed 10 per cent of its Gross Domestic Product. It is estimated that 55-60 per cent of this total is spent on chronic disease management.

Nearly two years have passed since the World Health Organisation’s report on the categorisation of processed animal products as carcinogenic. The time has come that we doctors take the initiative to inform our citizens and create systems, processes and policies to protect our patients and communities from further harm from such known carcinogens. We were finally moved to show united leadership 60 years ago in regards to smoking. Ultimately, after roughly 7000 scientific publications showing the relationship between smoking and lung cancer, healthcare providers became advocates for the best available medical evidence trumping the lures of a treasured habit for many of their patients (and indeed, fellow colleagues).

The American Medical Association in the USA has led the way by calling on hospitals there to improve the health of patients, staff and visitors by (1) providing a variety of healthful food, including plant-based meals that are low in fat, sodium and added sugars, (2) eliminating processed meats from menus and (3) providing and promoting healthful beverages.6,7,8

Springmann et al. estimated the effects of consuming less – or no – animal products on global population health should a transition to a more plant-based diet be made leading up to 2050. Conclusions reached were a reduction in premature deaths, abundant economic benefits and reduced greenhouse gas emissions. Table 2.9

Healthier diets compared to present omnivorous diet

Characteristics diets

Human health benefits:

millions of premature deaths avoided

Economic valuation: value-of-statistical life approach.

Trillion of AUD saved per year

Healthy Global Diet (WHO)

Less meat and sugar; More vegetables and fruit

5.1

27.6

Vegetarian

Minimal animal products: dairy and eggs only

 

7.3

36.8

Vegan

No animal products: plant-based only

8.1

39.4

 

Table 2. Human lives and money saved in 2050 if the world population would adapt more healthful diets. Based on publication M Springmann et al.9

We understand that our AMA is aware of the issue and we are engaging with its Public Health team.

The time for compassionate action and leadership on this important issue by the Australian medical profession has arrived. All medical administrators, procurement officers, caterers and doctors (in association with registered dietitians) should then feel encouraged, empowered and supported to play a role in implementing the elimination of processed meats in medical institutions.

 

Views expressed in the above Opinion piece are those of the authors and do not reflect official policy of the AMA.

The authors’ credentials are listed below:

Dr Alphonse Roex MD PhD, FRANZCOG

Senior Consultant Obstetrics and Gynaecology The Lyell McEwin Hospital South Australia
Senior Lecturer, The University of Adelaide
Medical degree: Utrecht University, the Netherlands
Specialist degree and PhD: Free University Amsterdam, The Netherlands
Member PCRM (Physicians Committee for Responsible Medicine (Washington DC USA)
International presenter on Nutrition and Health

 

Dr Heleen Roex-Haitjema, Paediatrician (not practising)
Certificate in Plant-Based Nutrition, Cornell University, New York
Certified Food for Life Instructor, The Physicians Committee for Responsible Medicine, Washington DC
Medical degree: Utrecht University, The Netherlands
Specialist degree: Free University Amsterdam, The Netherlands.
Member PCRM (Physicians Committee for Responsible Medicine (Washington DC USA)
International presenter on Nutrition and Health.

References

  1. Bouvard V, Loomis D, Guyton KZ et al. on behalf of the IARC Monograph Working Group. Carcinogenicity of consumption of red and processed meat. Lancet Oncology 2015.
  2. http://publications.iarc.fr/Book-And-Report-Series/Iarc-Monographs-On-The-Evaluation-Of-Carcinogenic-Risks-To-Humans. Volume 114 (2015).
  3. IARC Monographs on the Evaluation of Carcinogenic Risks to humans. Volume 83 (2004) Tobacco Smoke and Involuntary Smoking.
  4. IARC Monographs on the Evaluation of Carcinogenic Risks to humans. Volume 100C. (2012) Asbestos.
  5. Levine ME et al. Low Protein Intake is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population. Cell Metabolism 2014;19:407-17.
  6. https://janeunchained.com/2017/06/23/ama-comes-out-against-serving-processed-meats-in-hospitals/
  7. http://www.pcrm.org/nbBlog/american-medical-association-passes-healthy-food-resolutions
  8. https://wire.ama-assn.org/ama-news/ama-backs-comprehensive-approach-targ…
  9. Springmann M. et al. Analysis and valuation of the health and climate change co-benefits of dietary change PNAS doi:10.1073/pnas. 2016; 1523119113.

 

 

 

[Correspondence] Closing the NIH Fogarty Center threatens US and global health

The budget set out by the Trump administration for the 2018 fiscal year proposes cutting about US$6 billion from the National Institutes of Health (NIH). Specifically, this budget intends to eliminate the John E Fogarty International Center, which currently receives 0·2% of the NIH’s 2017 budget of $33·1 billion. Despite its modest size, the Fogarty Center has become a crucial contributor to health research worldwide over the past 50 years by funding the training of over 6000 scientists in developing countries, including many of the world’s leading scientists in infectious disease research.

[Viewpoint] A developmental approach to the prevention of hypertension and kidney disease: a report from the Low Birth Weight and Nephron Number Working Group

In 2008, the World Health Assembly endorsed WHO’s Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) 2013–2020,1 based on the realisation that NCDs cause more deaths worldwide than do communicable diseases. This plan strongly advocates prevention as the most effective strategy to curb NCDs. Furthermore, the life-course approach, which was highlighted in the Minsk Declaration,2 reflects increasing recognition that early development affects later-life health and disease.

[Comment] Offline: NCDs—why are we failing?

Why is the global health community failing to respond effectively to the rising burden of non-communicable diseases (NCDs)? The answer can be summed up in one word—fear. Fear of a species-threatening pandemic. A pervasive fear that has displaced all other health concerns. Anxiety among political elites is causing a recalibration of priorities among global health leaders. In his first speech to staff in Geneva this month, WHO’s new Director-General, Tedros Adhanom Ghebreyesus, named four urgent issues: health emergencies; universal health coverage; women’s, children’s, and adolescents’ health; and climate change.

[Comment] The International AIDS Society—Lancet Commission on the future of the HIV response and global health

HIV/AIDS has been the most severe and widespread infectious disease pandemic of our time—with more than 75 million people infected, more than 40 million deaths, and some 38 million people living with the virus in 2017 and requiring lifelong, daily treatment to stay well.1 Yet by any measure, the global response to the HIV/AIDS pandemic has been one of the extraordinary success stories of modern medicine, public health, human rights, and global solidarity. By 2016, more than 18 million people living with HIV had started life-sustaining antiretroviral therapy,2 and new preventive interventions, including pre-exposure prophylaxis (PrEP) and treatment as prevention,3 have shown remarkable effectiveness.

Why GPs prescribe too many antibiotics and why it’s time to set targets

 

Published this week, our study estimates Australian GPs are prescribing about five million too many scripts for antibiotics a year for run-of-the-mill respiratory infections. But this is not a simple case of “blame the GP”.

What our study does show is many years of educating GPs about appropriate antibiotic prescribing, and the link to antimicrobial resistance, has failed to stem over-prescribing.

So, it’s time to set a national target for antibiotic prescribing in general practice, just like we set targets for carbon dioxide emissions to control the effects of climate change. Local Primary Health Networks could support GPs to meet these targets.

We’d also need to support GPs to easily and cheaply acquire the skills to help them reduce their prescribing safely. There are already moves towards supporting GPs this way. However, we should be prepared for a slow and sustained effort.

If GPs can’t make these changes, they risk more draconian measures being imposed on them by government or bodies like the Australian Commission on Safety and Quality in Health Care. This might include GPs needing to seek an Authority Prescription from the Pharmaceutical Benefits Scheme to prescribe some antibiotics, and punitive measures being imposed on those prescribing beyond some arbitrary limits.

What did we do and what did we find?

We looked at the actual rates of antibiotic prescribing for acute respiratory infections, like sore throats, acute coughs (also called acute bronchitis), and acute middle ear infections. Our data was collected by a survey of about 500 GPs from across Australia, who recorded what they did in every consultation for two weeks.

We then compared that with the rate that would have occurred had every GP stuck rigidly to Therapeutic Guidelines, highly respected national prescribing guidelines many GPs use.

While we had expected about half of actual prescribing to meet the guidelines, we found just 11-23% met them. In national terms, that’s almost six million antibiotic prescriptions a year for these acute respiratory infections, compared with around one million a year had GPs stuck to the guidelines, a difference of roughly five million prescriptions a year.

Why is this important?

Each course of antibiotics contains roughly five grams of antibiotics. So, if GPs had stuck to the guidelines, we could safely reduce antibiotics use by 25 tonnes a year.

This mound of antibiotic represents an aspiration – what we could avoid, with minimal harm to the Australian public, and enormous benefits to reducing the generation of community acquired antibiotic resistance.


Further reading: We know why bacteria become resistant to antibiotics, but how does this actually happen?


In the past we have not really had any target to aim for, but instead wondered if we should aim for the rates achieved by other countries such as the Netherlands (about half of our rates).

Our data show we could take that target much further.

Why do GPs prescribe too many antibiotics?

There are many reasons GPs prescribe too many antibiotics. GPs (and their patients) might want to minimise the risk of their patients being exposed to a dangerous bacterial infection that might have been avoided by prescribing antibiotics early.

Then there’s the diagnostic uncertainty that bedevils this part of primary care. Every apparently trivial cough or cold a GP sees could be the early stages of a dangerously serious infection, like community acquired pneumonia, meningitis, or quinsy (a complication of tonsilitis), and it is often very difficult to be sure in a single visit.

Symptoms of a run-of-the-mill respiratory infection could be the early stages of something more serious.
from www.shutterstock.com

Improving diagnosis might be possible using near-patient testing – a quick test in the surgery, rather than sending off a sample to a laboratory for testing. But these tests are only partly satisfactory because they are not always accurate enough, and they are very expensive, perhaps doubling the cost of the consultation.

Other important factors are:

  • pressure from patients for GPs to prescribe antibiotics, either real or supposed by the GP. GPs often say this is a major influence, but other studies say it is often over-estimated by GPs
  • an assumption the consultation will be over quicker with a terminating prescription in time-poor general practice
  • commercial anxieties (“if I don’t give the patients what they’ve come for, they might go to other GPs more willing”)
  • habit (“why change what’s been working just fine 10 or 20 years ago if it isn’t broke?”), remembering that the consequences of antibiotic resistance happen in hospital care, far removed from this patient now
  • “failure of the commons”, in which a shared resource (in this case the absence of antibiotic resistance) is threatened by many individual interests (the individual is sick and wants whatever might quickest make them feel well again).

What needs to happen?

It’s easy to jump to the conclusion from our findings that GPs should “stick to guidelines” when it comes to prescribing antibiotics. But that’s unrealistic. Guidelines are no more than their name suggests, simply a guide to how to manage a patient and their illness.

The real world is much more complicated: patients have additional illnesses, and other demands (often social, psychological or even just preference – for example, avoiding the risks of some symptoms even at the expense of some harms) – and the skillful GP needs to balance all this.

The ConversationOur results, which demonstrate higher than expected rates of excess antibiotics prescribed, means we have a lot of antibiotic savings we could safely make.

Chris Del Mar, Professor of Public Health

This article was originally published on The Conversation. Read the original article.

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Australian molecular microbiology students’ breakthrough in TB

Australian researchers and students at the University of Queensland are using their innovation to tackle tuberculosis (TB) – one of the world’s leading infectious-disease killers.

University of Queensland students have identified promising inhibitory compounds during a molecular microbiology practical course this semester.

TB is the leading cause of death due to an infectious agent, globally killing approximately two million people each year.

Mycobacterium tuberculosis, the bacterium responsible, currently infects over one third of the world’s population and, although most cases respond to standard antibiotic therapy, drug resistant strains are on the rise and new antibiotics for TB are urgently needed.

Students at the University of Queensland’s School of Chemistry and Molecular Biosciences have discovered five or six compounds that inhibited growth in a harmless bacterium related to TB.

TB research head Dr Nick West said it appears that students have identified some very interesting compounds and resulted in further research now being a reality.

“There has not been a new general use anti-TB drug for 50 years,” Dr West said

The students were undertaking a UQ microbiology course in which they screened a compound library for inhibitors of TB, working through 7000 random compounds.

Dr West said the exciting breakthrough came when they realised a small number completely inhibited the bacteria.

TB resistance will be raised at the upcoming G20 summit this month in Hamburg, Germany and there is hope that political will can be fostered to tackle antimicrobial resistance (AMR) and turn the tide on tuberculosis.

This comes on top of a resolution by the United Nations General Assembly late last year that moved to ensure UNGA hold the first-ever high-level meeting on the fight against tuberculosis in 2018. 

Meredith Horne