The African Population and Health Research Center (APHRC) has a new leader and a new strategic vision.
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The African Population and Health Research Center (APHRC) has a new leader and a new strategic vision.
Catherine Kyobutungi leads an organisation with a broad mandate to generate evidence and strengthen research capacity in Africa. As Executive Director of the Nairobi-based African Population and Health Research Center (APHRC) since Oct 1, 2017, she’s clear about her mission: “For me the important thing is that we are doing research not for the sake of research, but to generate policy-relevant evidence while building credible profiles to be able to speak and be listened to where it matters. So that people making policy decisions have the best evidence available to them and they think about it and they look for it, and the evidence actually goes into policies.” Ibrahim Abubakar, Director of University College London’s Institute for Global Health, UK, welcomes her appointment.
It has been a long and winding road towards acceptance of LDL cholesterol as a pivotal and causal factor in the development of atherosclerosis and cardiovascular disease. The evidence was first derived from experimental, epidemiological, and genetic studies, as well as from clinical trials with statins and ezetimibe.1 The Further cardiovascular OUtcomes Research with PCSK9 Inhibition in subjects with Elevated Risk (FOURIER) trial2 extended the body of evidence, showing that evolocumab, a fully human proprotein convertase subtilisin-kexin type 9 (PCSK9) monoclonal antibody, when added to conventional lipid-lowering therapy, not only lowered LDL cholesterol to extremely low concentrations but also had a beneficial effect on cardiovascular disease risk.
The global nephrology community recognises the need for a cohesive plan to address the problem of chronic kidney disease (CKD). In July, 2016, the International Society of Nephrology hosted a CKD summit of more than 85 people with diverse expertise and professional backgrounds from around the globe. The purpose was to identify and prioritise key activities for the next 5–10 years in the domains of clinical care, research, and advocacy and to create an action plan and performance framework based on ten themes: strengthen CKD surveillance; tackle major risk factors for CKD; reduce acute kidney injury—a special risk factor for CKD; enhance understanding of the genetic causes of CKD; establish better diagnostic methods in CKD; improve understanding of the natural course of CKD; assess and implement established treatment options in patients with CKD; improve management of symptoms and complications of CKD; develop novel therapeutic interventions to slow CKD progression and reduce CKD complications; and increase the quantity and quality of clinical trials in CKD.
The NHS Blood and Transplant Service has recently told the BBC that over the past 5 years more than 500 families in the UK have blocked organ donation from a deceased relative, despite them being on the organ donor register. In the USA, more than 117 000 people await an organ transplant, says a report from the National Academy of Sciences (NAS) on the Opportunities for Organ Donor Intervention Research, published on Oct 10. The Global Observatory on Donation and Transplantation reports that despite there being over 126 000 organ transplants each year across more than 100 countries, many patients remain on waiting lists.
Exploiting a gap in regulation, clinics offering risky, unproven stem-cell treatments are spreading across the world, as researchers and regulatory bodies call for action. Dara Mohammadi reports.
Smoking causes more than 7 million deaths each year1 and tobacco companies have known, since at least 1950, that their products are lethal and addictive. Now Philip Morris International (PMI) is committing nearly US$1 billion over 12 years to the Philip Morris Foundation for a Smoke-Free World that will “fund scientific research designed to eliminate the use of smoked tobacco around the globe”.2 In a Lancet Viewpoint in this issue, the Foundation’s President Derek Yach argues it will support “an unswerving focus…to improve public health and human wellbeing”.
Harmful drug use continues to be a serious public health issue in Australia with 1,808 drug induced deaths registered in 2016 according to the latest records of the Australian Bureau of Statistics.
This is the highest number of drug deaths in 20 years, and is similar to the number recorded in the late 1990s when a steep increase in opioid use, specifically heroin, led to deaths peaking at 1,740 in 1999.
Substantial evidence from published studies shows that codeine contributes to both accidental and intentional deaths.
Many of these deaths can be attributed to the misuse of combination codeine medicines, particularly related to paracetamol-induced liver toxicity and ibuprofen-induced stomach ulceration.
In 2014, the TGA database of adverse event notifications contained 59 cases of stomach ulcers or bleeding related to codeine/ibuprofen combination and 57 cases of liver toxicity from combination codeine/paracetamol products.
A study in the Medical Journal of Australia has found that increased prescribing of opioid analgesics during the past decade has resulted in rises in mortality caused by overdose in many developed countries.
Other relevant data includes:
MEREDITH HORNE
AMA President Dr Michael Gannon |
“…evidence shows that codeine is not that good an analgesic and doctors should be prescribing superior alternatives for acute pain, and codeine has no role in the management of chronic pain.”
“Too many people are found with codeine in their body at post mortem examinations. This is a harmful drug. It’s hurting people, it’s killing people.”
“There is compelling evidence to support the decision to make codeine prescription only.”
“We already know that pharmacist control of codeine use does not work.” |
The Therapeutic Goods Administration’s (TGA) Principal Medical Officer, Dr Tim Greenaway
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“It’s important that people realise that the decision’s been taken based on safety predominantly and based on the risk of abuse.”
“Medication that are available over the counter or through pharmacies should be substantially safe and not subject to abuse. This is clearly not the case with codeine.”
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President of the Chapter of Addiction Medicine, Associate Professor Adrian Reynolds
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“Addiction specialists have seen the number of patients with addiction to over the counter codeine grow at an alarming rate.
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Dr Michael Vagg, Deakin University School of Medicine, & Pain Specialist
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“It’s also a pretty rubbish drug that doesn’t actually help people as much as they think it does.”
“Every hospital in Australia will tell you stories of addiction to such combined drugs (paracetamol and ibuprofen with codeine). You often see it in young women. Some have to be tube-fed because their guts are so damaged. Others have to go on dialysis because their kidneys are wrecked.”
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Dr Jacinta Johnson, Principal Researcher at University of South Australia who led the Australian first study analysing the costs of 99 hospital admissions related to over-the-counter combination painkillers containing codeine (OTC-CACC) from 2010-2015 at a South Australian hospital. |
“Apart from serious health issues relating to misuse of these over-the-counter painkillers, data shows us that lower doses of codeine found in OTC combination products don’t actually provide any additional pain relief.”
“There is no clear evidence that taking a low dose of codeine in combination with paracetamol or ibuprofen is any better than just taking the single-ingredient products without the codeine.”
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Dr Chris Hayes, Dean of the Faculty of Pain Medicine (FPM) |
“For acute pain most of the studies show that the combination of paracetamol and anti-inflammatories works as well, if not better, and without the risks of codeine.”
“There’s reasonable evidence to say with certain types of pain that if you go on for a week or more with opioids therapy then that leads to worse outcomes.” |
Mary “Peggy” Crow was not one of those people who always wanted to be a doctor. “I absolutely was not on a track toward either medicine or research”, Crow, Physician-in-Chief at the Hospital for Special Surgery (HSS), New York City, USA, and a past President of the American College of Rheumatology, told The Lancet. She took biology in 7th grade and loved it, Crow says, but at her private high school in Westchester County, NY, girls didn’t get to take science—she “was not even offered science courses”, recalls Crow.