Author: Hugh O'Brien

The Global Challenges of Noncommunicable Diseases: A PLOS Medicine Collection: The First Installment

Image Credit: (Clockwise from top left)  Image Credit: No Smoking (Top Left): Satish Krishnamurthy, Flickr; Body Scale (Top Right): Daniel Oines, Flickr; Finger Test (Bottom Left): Biswarup Ganguly, Wikimedia Commons; Gauge (Bottom Right): Bernard Goldbach, Flickr

Image Credit: (Clockwise from top left) Image Credit: No Smoking (Top Left): Satish Krishnamurthy, Flickr; Body Scale (Top Right): Daniel Oines, Flickr; Finger Test (Bottom Left): Biswarup Ganguly, Wikimedia Commons; Gauge (Bottom Right): Bernard Goldbach, Flickr

In December 2012, PLOS Medicine launched a call for papers on noncommunicable diseases including mental health.(1) In this first installment of the PLOS Medicine Collection, “The Global Challenges of Noncommunicable Diseases,” we feature 38 articles, from research to essays.  The research ranges from policy to public health to translational medicine, with plenty of clinical medicine in between. The studies show that nonsteroidal anti-inflammatory drugs associated with increased cardiovascular risk not only accounted for one-third of NSAID use in 15 low-, middle-, and high-income countries, but also were included in Essential Medicines Lists (2); higher long-term fine particulate air pollution was associated with increased intima-media thickness, a marker of atherosclerosis (3); cognitive-behavioral therapy, interpersonal therapy, and problem-solving therapy all had robust effects for patients with depression (4); the most effective way to improve hypertension control from a systems standpoint is to reduce or eliminate the patient’s treatment copayment (5); walking and bicycling to work was associated with reduced cardiovascular risk in India (6); endometrial, breast, and ovarian cancer could be predicted using new risk prediction models (7); and colon cancer could be classified in a prognostically important way using new gene expression classification into molecular subtypes (8). A study surveying policies found that, although nearly 80% of the over 36 million people who die each year from NCDs live in low- and middle-income countries and NCDs are all related to the risk factors of tobacco use, physical inactivity, and the harmful use of alcohol and unhealthy diets,(9) most national policies of low and middle income countries don’t propose actions to promote healthier diets and physical activity (10). The Magazine includes the Grand Challenges in Mental Health series (11-15), plus a Health in Action article (16) and Editorial (17) on mental health, Perspectives placing Research Articles in context, Essays on access to drugs (18) and improving research in LMICs (19), and more. Read, enjoy and share — open access — this outstanding collection on the all-important global public health, policy, and clinical health challenge of NCDs.

Authors, the call for papers is still open through the end of 2013, and PLOS Medicine’s interest  in NCDs including mental health will continue long after the call is done. We will update the collection after the call has closed and related papers have been published.
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The Global Challenges of Noncommunicable Diseases: A PLOS Medicine Collection: The First Installment

Image Credit: (Clockwise from top left)  Image Credit: No Smoking (Top Left): Satish Krishnamurthy, Flickr; Body Scale (Top Right): Daniel Oines, Flickr; Finger Test (Bottom Left): Biswarup Ganguly, Wikimedia Commons; Gauge (Bottom Right): Bernard Goldbach, Flickr

Image Credit: (Clockwise from top left) Image Credit: No Smoking (Top Left): Satish Krishnamurthy, Flickr; Body Scale (Top Right): Daniel Oines, Flickr; Finger Test (Bottom Left): Biswarup Ganguly, Wikimedia Commons; Gauge (Bottom Right): Bernard Goldbach, Flickr

In December 2012, PLOS Medicine launched a call for papers on noncommunicable diseases including mental health.(1) In this first installment of the PLOS Medicine Collection, “The Global Challenges of Noncommunicable Diseases,” we feature 38 articles, from research to essays.  The research ranges from policy to public health to translational medicine, with plenty of clinical medicine in between. The studies show that nonsteroidal anti-inflammatory drugs associated with increased cardiovascular risk not only accounted for one-third of NSAID use in 15 low-, middle-, and high-income countries, but also were included in Essential Medicines Lists (2); higher long-term fine particulate air pollution was associated with increased intima-media thickness, a marker of atherosclerosis (3); cognitive-behavioral therapy, interpersonal therapy, and problem-solving therapy all had robust effects for patients with depression (4); the most effective way to improve hypertension control from a systems standpoint is to reduce or eliminate the patient’s treatment copayment (5); walking and bicycling to work was associated with reduced cardiovascular risk in India (6); endometrial, breast, and ovarian cancer could be predicted using new risk prediction models (7); and colon cancer could be classified in a prognostically important way using new gene expression classification into molecular subtypes (8). A study surveying policies found that, although nearly 80% of the over 36 million people who die each year from NCDs live in low- and middle-income countries and NCDs are all related to the risk factors of tobacco use, physical inactivity, and the harmful use of alcohol and unhealthy diets,(9) most national policies of low and middle income countries don’t propose actions to promote healthier diets and physical activity (10). The Magazine includes the Grand Challenges in Mental Health series (11-15), plus a Health in Action article (16) and Editorial (17) on mental health, Perspectives placing Research Articles in context, Essays on access to drugs (18) and improving research in LMICs (19), and more. Read, enjoy and share — open access — this outstanding collection on the all-important global public health, policy, and clinical health challenge of NCDs.

Authors, the call for papers is still open through the end of 2013, and PLOS Medicine’s interest  in NCDs including mental health will continue long after the call is done. We will update the collection after the call has closed and related papers have been published.
Continue reading »

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Restoring Invisible and Abandoned Trials: A Creative Approach to a Public Good; Now a Creative Approach to Implementation is Needed

Margaret A. Winker, MD, Senior Research Editor, PLOS Medicine, and Virginia Barbour, MD, Chief Editor, PLOS Medicine, on behalf of the PLOS Medicine Editors.

Image Credit: Flickr Jenni C

Image Credit: Flickr Jenni C

The power of the concept that making results of all clinical trials accessible to researchers, clinicians, and the public to promote transparency and make the best evidence available for informed clinical decision making is not only self-evident, but is illustrated by the number of organizations that have signed on to the AllTrials initiative (of PLOS, among others) as well as its translation into 30 languages. However, it is one thing to support trials and transparency and it is quite another to actually get the job—of analyzing, authoring, peer reviewing, and publishing the trials–done. Getting the job done for unpublished, distorted, or abandoned trials is even harder and is the goal of the initiative Restoring Invisible and Abandoned Trials (RIAT), published today in the BMJ with an accompanying editorial signed by, in addition to BMJ’s Clinical Epidemiology Editor and Editor-in-Chief, PLOS Medicine Chief Editor Ginny Barbour and myself on behalf of the PLOS Medicine editors.
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Category: Policy, Research Ethics | 3 Comments

Facing Up to the US Gun Problem: Steps in the Right Direction

The United States has a gun problem, but if the Sandy Hook Elementary School shooting has any silver lining, perhaps the US public, and most importantly the US government, will finally acknowledge the problem as a first step toward addressing it. While every US physician and health care professional is affected by gun violence directly or indirectly, three initiatives resulting from the new urgency that emerged since Sandy Hook will directly affect health and medical research.

Image Credit: Charles Knowles

First, President Obama lifted the virtual ban on federal agencies conducting research on gun violence that was imposed 17 years ago . Banning research – a remarkable step in a long line of remarkable actions regarding guns– could only have benefited those threatened by the answers, gun manufacturers and the National Rifle Association. Research that had been conducted to date found that a major argument for gun ownership, protecting oneself at home, was not effective, and gun ownership was in fact associated with an increased risk of homicide. This threat to pro-gun lobbyists was blocked through NRA lobbying Congress, preventing research on a public health threat that claims 30,000 lives a year in the United States. Lifting the ban will reinvigorate this critical area of research; unfortunately, few researchers would pursue a career path with essentially no steady source of funding, so much-needed gun research will not happen overnight.

The second initiative is President Obama’s directive that a letter be sent to doctors indicating that they may ask patients about guns in their homes. The common sense preventive measure was challenged in June 2011, when Florida passed a law against doctors talking with patients about guns after the NRA and other pro-gun organizations claimed that doctors asking such questions of patients violated their Second Amendment right to keep and bear arms. While the law was passed in Florida only and promptly challenged in court, the controversy generated confusion on the part of physicians and did little to promote open discussion between doctors and patients. Prompted by American physician organizations, President Obama is clarifying that no federal law prohibits such discussions.

The third initiative is less clear cut but may have even greater consequences for healthcare, particularly for the substantial proportion of the population with mental health concerns. The issue of mental health and violence has erupted with each multiple-victim shooting incident, but a comprehensive approach has not been developed. Fundamentally, few such incidents are perpetrated by individuals with a psychiatric diagnosis, but new proposals include requiring therapists to inform agencies about any patients who may be a source of harm to themselves or others. Such proposals could have far more adverse consequences for patients fearing to come forward and wind up on national databases than the multi-victim shooting crimes they might prevent.  At the same time, increased discussion of mental illness, how it manifests, and how it is diagnosed, is bringing with it increased awareness and even increased funding . While the new federal funding proposed for mental health treatment is only $155 million, new awareness of mental illness concerns may finally help it be recognized as a major noncommunicable disease with significant morbidity and mortality.

The lives lost at Sandy Hook are not isolated events; on January 16 President Obama stated that 900 more individuals had died in the US from gun violence since the shooting 1 month ago. However, with national attention focused on Sandy Hook, the US may have a unique opportunity to come to terms with its gun problem and begin having honest discussions about gun policy based on the will of the people, rather than the will of the lobbyists.

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