News briefs

Texting in the dark affects teens’ sleep patterns

A study published in the Journal of Child Neurology, and reported by ScienceDaily, has linked “nighttime instant messaging habits of American teenagers to sleep health and school performance”. The researchers distributed surveys to three New Jersey high schools and evaluated the 1537 responses contrasting grades, sexes, messaging duration and whether the texting occurred before or after lights out. They found that “students who turned off their devices or who messaged for less than 30 minutes after lights out performed significantly better in school than those who messaged for more than 30 minutes after lights out”. “Students who texted longer in the dark also slept fewer hours and were sleepier during the day than those who stopped messaging when they went to bed. Texting before lights out did not affect academic performance,” the study found. “The effects of ‘blue light’ emitted from smartphones and tablets are intensified when viewed in a dark room. This short wavelength light can have a strong impact on daytime sleepiness symptoms since it can delay melatonin release, making it more difficult to fall asleep — even when seen through closed eyelids.”

Is it time to show everyone your data?

The International Committee of Medical Journal Editors (ICMJE) has proposed that research authors must share “deidentified individual-patient data (IPD) underlying the results presented in the article (including tables, figures, and appendices or supplementary material) no later than 6 months after publication” as a condition of publication in ICMJE’s member journals. Published in the Annals of Internal Medicine, the ICMJE’s proposal included the requirement that “authors include a plan for data sharing as a component of clinical trial registration”. “This plan must include where the researchers will house the data and, if not in a public repository, the mechanism by which they will provide others access to the data … Sharing data will increase confidence and trust in the conclusions drawn from clinical trials. It will enable the independent confirmation of results, an essential tenet of the scientific process. It will foster the development and testing of new hypotheses. Done well, sharing clinical trial data should also make progress more efficient by making the most of what may be learned from each trial and by avoiding unwarranted repetition. It will help to fulfill our moral obligation to study participants, and we believe it will benefit patients, investigators, sponsors, and society.”

Zika infections reported in 22 countries, territories

The US Centers for Disease Control and Prevention reports that Brazil’s Ministry of Health estimated that between 440 000 and 1 300 000 suspected cases of Zika virus infection occurred in Brazil in 2015 alone. By 20 January 2016, cases had been reported to the Pan American Health Organization from Puerto Rico and 21 other countries or territories in the Americas, including in French territories, St Martin and Guadeloupe. The New York Times reports that pregnant women and newborns should be tested for Zika infection if they have visited or lived in any country experiencing an outbreak. “The new guidance applies only to infants of mothers who reported symptoms of Zika virus infection — rash, joint pain, red eyes or fever — while living abroad in an affected country or within 2 weeks of travel to such a destination.” Australian virologists have confirmed that Zika has already been discovered in Australia in travellers returning from South America, according to the ABC. “However, for the virus to spread, it would need the right species of mosquito to act as a vector. So far only one such mosquito is present in Australia — the Aedes aegypti mosquito — which is found only in far north Queensland.”

Mass media can slow progress of an epidemic

Medical News Today reports that a new study in the Journal of Theoretical Biology has found that mass media coverage about an epidemic can help slow the spread of the disease. The research, a joint project between Chinese and Canadian authors, studied the effect of mass media coverage on the H1N1 epidemic in the city of Xi’an in the Shaanxi province of China. “They compared the number of hospital visits with the number and duration of news reports about the epidemic. Their results show that more news reports resulted in fewer hospital visits and vice versa … The researchers now plan to take the time lag between the media coverage and changes in newly reported cases into account, to find out how this factor affects epidemics.”

[Comment] Rheumatology—a call for papers

Rheumatoid and autoimmune diseases are a heterogeneous group of disorders, many of which are of unknown aetiology and have heterogeneous clinical presentation. Often difficult to diagnose and to treat, these conditions are an under-appreciated group of non-communicable diseases that, according to latest Global Burden of Disease estimates,1 contribute as much as 20% of years lived with disability, worldwide. Research into the treatment, epidemiology, and public health and education interventions that might help to combat this diverse group of diseases is an urgent, unmet need.

[Correspondence] Faith-based health care

The Lancet should be commended for the recent Series on faith-based health care, which is timely and welcomed. The authors offer a balanced viewpoint, neither missionary nor reactionary secularist. However, it is important to understand that faith can be an important determinant of health and affects culture, law, and health policy. The authors are quite right in highlighting that there is a dearth of research on the topic, with more known about involvement by Christians than by other religions, such as Islam.

[Perspectives] Charlotte Watts: from pure maths to HIV and gender-based violence

Appointed last October as Chief Scientific Adviser to the UK Government’s Department for International Development (DFID), epidemiologist Charlotte Watts of the London School of Hygiene & Tropical Medicine (LSHTM) is, by training, a pure mathematician. Indeed, her PhD from the University of Warwick was titled “stochastic stability of diffeomorphisms”. Although a background in applied maths might have offered her a natural progression into statistics and epidemiology, the relevance to health of “diffeomorphisms” is harder to discern—although not, it seems, to Anne Mills, Professor of Health Economics and Policy at LSHTM.

[World Report] Profile: Boston University School of Public Health at 40

One building Dean Sandro Galea has no interest in erecting on the Boston University School of Public Health (BUSPH) campus, MA, USA, is an ivory tower. “This is a school of believers”, Galea tells The Lancet. “We have faculty and staff who are drawn here because this is a school that does top-tier research but is deeply committed to real-world practice. The people who we attract are students who want to change the world.”

[Comment] Retraction—Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects

On Oct 6, 2015, we asked the Dean of Medicine of Memorial University, St John’s, Newfoundland and Labrador, Canada, to conduct a formal investigation into the research by Dr Ranjit Kumar Chandra that culminated in his publication in The Lancet in 1992.1 Chandra gives Memorial University as his address in the 1992 paper, and Memorial University is also acknowledged as supporting the research through a University Research Professorship Award.

[Comment] Offline: Stillbirths—the last great myth

Stillbirths are dismissed, stigmatised, and ignored by governments, media, and even health systems. Last week, a coalition of international researchers launched a new campaign to persuade political leaders to take stillbirths a great deal more seriously. The whole subject of stillbirths is bedevilled with myths. Stillbirths are not an important global health challenge? There are 2·6 million stillbirths annually, 1·3 million of which (horrifically) occur during labour. Stillbirths are inevitable? No, most causes of stillbirths (eg, infection, malnutrition) are entirely preventable.

Minister takes on health funds as election looms

Health Minister Sussan Ley has stepped up her pressure on the private health insurance industry, demanding all 35 funds reduce planned premium increases or justify higher charges.

Positioning herself as a strong advocate for consumers ahead of the federal election due later this year, Ms Ley has written to all insurers asking them to re-submit their applications for premiums increases due to come into effect from 1 April.

“Consumers have strong concerns about the affordability of their premiums; hardly surprising given premiums have increased at a rate of around 6 per cent per year for the past five years,” the Health Minister said. “It is important I am armed with the full picture before approving any premium increase, particularly as consumers are telling me they are finding it increasingly difficult to simply shop around for a better deal.”

Under current arrangements, health insurers receive around $6 billion a year from the Federal Government each year and, in return, have to get proposed premium increases approved by the Health Minister.

For the last two years, premiums have increased by an average 6.2 per cent, even as a proliferation of policies with multiple exclusions and large excess has undermined the value of cover on offer.

Ms Ley said health funds would need to lower their planned premium increases or provide evidence as to why they cannot do it.

But there are suggestions that the Minister is grandstanding on the issue for short-term political gain rather than trying to achieve sustained reform.

The funds lodged their proposed premium increases with the Health Department late last year, but Ms Ley made her announcement just a week before the Government traditionally notifies insurers of its decision.

Peak industry body Private Healthcare Australia told The Australian health funds undertook months of research and taking actuarial advice in coming up with their premium proposals, and for the Minister to make her request so late in the process was “quite challenging for the funds to comply with”.

Leading industry figures including PHA Chief Executive Dr Rachel David and NIB Managing Director Mark Fitzgibbon said premiums were being driven up systemic pressures including the rising cost of prostheses and hospital care.

Dr David told The Australian a “one-off discount on pricing is unlikely to address the fundamental problems”.

Jumping the gun

But the nation’s largest insurer, Medibank Private, pre-empted Ms Ley’s move by a week when it announced it was re-submitting its proposed premium increases for 2016.

While Medibank has not disclosed what size of premium increase it is proposing, a financial update from the fund suggests it is likely to be below the industry-wide average rise of 6.2 per cent approved last year.

In the financial update, which coincided with the premium announcement, Medibank reported that it had revised its premium revenue growth projections down from “above 5.5 per cent” to between 4.5 and 5 per cent.

Managing Director George Savvides said the recently-privatised fund was passing the benefits of cost-cutting measures on to its customers through lower premiums.

“Medibank has been working hard to address private health insurance affordability issues at their source by working in partnership with hospitals and other providers to reduce waste and inefficiency in the healthcare system,” Mr Savvides said. “Medibank members will directly benefit from the savings achieved as we invest in delivering more value to our members through more competitive pricing and enhanced product benefits.”

Medibank announced its move after releasing preliminary figures showing an operating profit in the first half of the financial year of $270 million and a $100 million boost to its full-year profit outlook from above $370 million to in excess of $470 million.

The improved financial performance has been underpinned by a crackdown on benefit payouts and a series of tough deals struck with private hospitals involving shifting the financial burden of medical complications away from the insurer onto providers.

Medibank’s decision to resubmit its proposed premiums for 2016 was hailed by Ms Ley, who said any move to cut costs was welcome.

The price of war

But AMA President Professor Brian Owler warned patients could be the losers in any price war that breaks out between the major health funds.

Professor Owler told Channel Seven he was concerned that people lured into taking out a health insurance policy by cut-price premiums might later find it does not provide the cover they expected, leaving them out-of-pocket for important medical care.

Without accompanying regulatory measures to buttress the quality of health insurance cover, the AMA is concerned any premium price war could result in even more policies riddled with multiple exclusions and hefty excess charges.

In its submission to the Federal Government’s Private Health Insurance Review, the peak medical group warned that industry practices including downgrading existing policies, habitually rejecting claims, lumbering patients with bigger out-of-pocket costs, pressuring policyholders into reducing their cover and selling people cover they don’t need, were badly compromising the value of private health cover and could eventually upset the delicate balance between the public and private health systems.

“On their own, these activities reduce the value of the private health insurance product,” the AMA said in its submission to the Review. “Collectively, they are having a destabilising effect on privately insured in-hospital patient care and treatment.”

Professor Owler said there were several emerging trends in private health insurance that were alarming, most notably a steady downgrading in the quality of cover on offer.

He said that in the last six years the proportion of people with policies that had exclusions had jumped from 10 to 35 per cent, often with serious consequences.

The AMA President said it had become virtually a daily occurrence for patients booked in for common treatments to discover upon arrival that they were not covered by their insurance.

He said all too often insurers made changes to a policy after it had been bought without informing policyholders, leaving many unexpectedly stranded.

“People are shocked to make this discovery only when they need a particular treatment, and doctors are seeing this happen on a daily basis,” Professor Owler said.

Adrian Rollins

News briefs

Harvey named to Friends of Science in Medicine board

Associate Professor Ken Harvey, from Monash University’s School of Public Health and Preventive Medicine, has been appointed to the executive of Friends of Science in Medicine (FSM). He has been an influential member of the Commonwealth Pharmaceutical Health and Rational Use of Medicines Committee and most recently served on the Federal Government’s Natural Therapies Review Committee, which found no evidence for the effectiveness of any of the 18 common taxpayer-supported alternative treatments reviewed. Dr Harvey was a member of the expert group that drafted the World Health Organization’s Ethical Criteria for Medicinal Drug Promotion. FSM was established in 2011 and is supported by almost 1200 leading Australian scientists and clinicians. “No one has done more to protect consumers from the unethical marketing of prescription and ‘alternative’ medicines in our country,” said FSM president, Professor John Dwyer, AO.

Anatomy bestseller from 1613 published online

Columbia University in New York has digitised the 1661 translation of an anatomy “flapbook”, first published in 1613, and which remained a bestseller for 150 years. Catoptrum Microcosmicum, originally in Latin, “explains the human body, using movable flaps to take people down through successive layers”, reports Gizmodo. “The first layer was the person delicately draped in a way that preserved their modesty. The layer of drapery came off first. The book features a female figure and a male figure, both shown from the front and the back. Each figure is drawn with one foot standing on a skull.” Also featured is a pregnant female torso, which Gizmodo described as “the creepiest experience imaginable” and includes a “crotch-demon”. Available online at https://archive.org/details/ldpd_11497246_000.

Chromium in the spotlight

Gizmodo reports that University of New South Wales and University of Sydney researchers have found that popular chromium supplements are partially converted into a carcinogenic form when they enter cells. The National Health and Medical Research Council recommends 25–35 micrograms of chromium daily as the adequate adult intake. A maximum of 200 micrograms per day is considered safe by the US National Academy of Sciences. Over-the-counter supplement tablets, available in Australia and most commonly used for weight management, body building and type 2 diabetes, have been found to contain up to 500 micrograms each. The research, originally published in the chemistry journal Angewandte Chemie, was conducted on animal fat cells, which were x-rayed to allow scientists to observe the behaviour of chromium in the cell. The researchers say more study is needed to conclusively say whether the supplements significantly alter cancer risk.

Zika joins list of mosquito-borne nasties

A rare mosquito-borne virus called Zika is spreading from its African home through Asia and the Americas, with the United States Centers for Disease Control issuing its first travel advisory for the disease, for travellers through Puerto Rico, Wired reports. “In Brazil, the number of infants born with shrunken, malformed brains has gone up by a factor of 10 since Zika entered the country, and scientists there are trying to establish a causal link to the virus.” Closely related to dengue fever and yellow fever, Zika is hard to detect because “the classic test for Zika — checking a person’s blood for antibodies that bind to the Zika virus — spikes a false positive when it sees antibodies for those other two diseases”. Complicating the issue is that Zika also appears to be spread through sexual contact.

[Comment] Surgery—a call for papers

The Review on periprosthetic joint infection by Bhaveen Kapadia and colleagues in this issue shows just how many unknowns haunt modern surgery, and the importance of research for better understanding of biomechanics, anticoagulation, perioperative care, biofilms, and patient reported outcomes to improve surgical care. With this in mind, The Lancet invites submissions of surgical research for our annual surgery-themed issue to coincide with the American College of Surgeons’ Clinical Congress in Washington, DC, USA, on Oct 16–20, 2016.