Tweeterview with Tony Mounts from WHO
As is traditional at this time of year we look back over some of the best blogs published in Speaking of Medicine in 2013. These posts represent our personal favourites and are not presented in any particular order. If you feel we’ve missed out one of your favourite posts let us know in the comments section at the end.
If you are interested in submitting work to Speaking of Medicine in 2014, please email us at email@example.com.
The Millennium Development Goals outlined eight aims for international development, to be achieved by 2015. With just over year to go, Sara Gorman considered the success of MDG 5: to improve maternal health, in a blog about the overlooked issue of maternal mental health.
For all of Sara Gorman’s posts for Speaking of Medicine, please click here.
As 2014 begins we’d like to thank those who made it possible for the PLOS Medicine Group journals to serve the scientific community and the public in 2013, in particular our dedicated and insightful peer reviewers. During last year, 663 people reviewed for PLOS Medicine, 2205 for PLOS Neglected Tropical Diseases, and 3008 for PLOS Pathogens. These generous individuals donated their time to ensuring the level of constructive evaluation that researchers rightly expect of peer-reviewed journals. Their combined efforts enabled the PLOS medical journals (PLOS Medicine, PLOS NTDs and PLOS Pathogens) to publish an outstanding array of papers in 2013, gathering 4107155 online views and 501871 PDF downloads so far!
Thank you, our reviewers, for contributing your knowledge to the Open Access literature. Your critical insight, support, and hard work are indispensable both to our day-to-day operations and to our overall mission.
We’d also like to draw attention to the folks who have reviewed for the other PLOS journals:
PLOS ONE’s peer reviewers: http://blogs.plos.org/everyone/2014/01/06/thanking-peer-reviewers/
PLOS Biology, PLOS Computational Biology and PLOS Genetics peer reviewers: http://blogs.plos.org/biologue/?p=5003
Ginny Barbour, Medicine Editorial Director at PLOS, discusses a recently-published UK Government spending report on access to clinical trial information and the stockpiling of Tamiflu.
Yesterday the UK Parliament’s Public Accounts Committee, which monitors UK Government spending – focusing on “value-for-money criteria which are based on economy, effectiveness and efficiency” – published a rather amazing report; not just because of the topic of its enquiry but in particular its conclusions, which have implications well beyond the UK. The topic was “Access to clinical trial information and the stockpiling of Tamiflu”: the conclusions were that the money spent on Tamiflu was likely misspent, and moreover the lack of access to clinical trial data more widely is unacceptable.
Tamiflu was the drug which the UK stockpiled back in 2009 when the last influenza pandemic seemed to be coming, but much of which it subsequently had to destroy because of poor record keeping once the scare was over.
The cost of the Tamiflu that was destroyed was £74 million; what the committee now makes clear in public is that there was no good evidence that it worked anyway (“The case for stockpiling antiviral medicines at the current levels is based on judgement rather than evidence of their effectiveness during an influenza pandemic”) and what evidence there was, was largely hidden away from those who most needed to see it including doctors, academics (despite dogged pursuit by researchers from the Cochrane Collaboration and others), the general public and even the regulator – the Medicines and Healthcare products Regulatory Agency (MHRA) the relevant UK Governmental agency. Thus there is a real question over the whole £424 million that was spent on stockpiling Tamiflu between 2006-07 and 2012-13.
On the 11th December, the MHTF and PLOS joined forces to celebrate the second Year of the Maternal Health Collection, highlighting the theme ‘maternal health is women’s health’ at the Harvard School of Public Health. The special event also featured the official launch of the Year 3 Call for Papers with a discussion on the latest theme for the Collection “integrating health care to meet the needs of the mother-infant pair” with PLOS Senior Editor, Dr. Rhona MacDonald.
Led by Dr. Ana Langer, Director of the MHTF, a selection of the Year 2 Collection authors presented and discussed their papers and the importance of their work for the improvement of maternal health worldwide. These authors included Dr. Nosakhare Orobaton, Dr. Cynthia Stanton and Dr. Suneth Agampodi.
A prominent topic of this discussion was addressed by Dr. Agampodi through his PLOS ONE paper, ‘Antenatal Depression in Anuradhapura, Sri Lanka and the Factor Structure of the Sinhalese Version of Edinburgh Post Partum Depression Scale among Pregnant Women’. This initial conversation focused on working towards a coordinated consensus in order to treat ‘minor aliments’, such as nausea, vomiting and lower back ache, during pregnancy, primarily concentrating on best-practice treatment for Sri Lankan women.
Seena Fazel from the Department of Psychiatry, University of Oxford, UK reviews The Bitterest Pills: The Troubling Story of Antipsychotic Drugs by Joanna Moncrieff.
The first antipsychotic drugs were introduced to treat psychiatric patients in the 1950s, and since that time, they have become the principal pharmacological treatment for a wide range of severe psychiatric illnesses. These include schizophrenia, and bipolar disorder, which together effect 1.5-2% of the general population. They are also prescribed for other psychiatric conditions, particularly severe depression and anxiety, and personality disorders, where they are thought to relieve distressing symptoms. Prescription rates for antipsychotic drugs have increased over the last few decades, partly as the number of conditions for which they can be used has been widened. This increase has coincided with the introduction of a second generation of antipsychotics during the 1990s, which were reported to have less neuromuscular side effects. Spending on the antipsychotics has reached almost $17 billion in the US, and in the UK, it is estimated that the cost to the NHS is £282 million, overtaking antidepressants in 2007. Their increasing use has not been without its problems, particularly in individuals with behavioural problems. For example, in older people with dementia, research has demonstrated that they worsen cognitive impairment and this has led to their less frequent use in this population. Their use in children with challenging behaviours is controversial as the evidence for their efficacy is weak. In addition, antipsychotics are occasionally abused by adults as a ‘downer’, and there is an illegal market in prisons and elsewhere.
Sara Gorman explores some of the factors behind anti-vaccination movements.
Last year, polio eradication efforts were severely compromised by a rash of killings by militants in Pakistan and Nigeria. Between December 2012 and January 2013, at least 16 polio workers were killed in Pakistan. In early February, more bad news arrived: 9 health workers were murdered in northern Nigeria while working on the polio eradication campaign.
Potential explanations and suggestions for future action poured out following the attacks. Some people thought the CIA’s actions years earlier in the Bin Laden assassination laid the groundwork for Pakistani suspicion of Western vaccination campaigns. By employing a Pakistani doctor to gain entry into what was thought to be the Bin Laden compound by feigning a vaccination program, the agency perhaps stirred local suspicion of the real motives behind Western-based vaccination campaigns. Of course, the resistance to polio vaccination is also largely political, especially in countries like Pakistan, where polio workers have been seen as “soft targets” for anti-Western terrorism. Some people believe that the murders are connected to beliefs that the vaccination campaign is really an effort to sterilize Muslim children. In response to these allegations, some are suggesting better education, outreach, and communications about the devastating effects of polio and the real benefits and risks involved in vaccination.
The following new articles are publishing this week in PLOS NTDs:
The United Nations Millennium Development Goals (MDGs) expire in 2015, and there is currently much debate, discussion and jostling for position regarding what should replace them. The results of which is likely to prove extremely important for determining the global health budget over the coming decades. Here James Smith and Michelle Taylor discuss the history of NTDs in the context of the sixth MDG goal (to combat HIV/AIDS, malaria and other diseases), as well as the case for including them in the post-2015 agenda.
Resource constraints prevent adequate surveillance of neglected diseases such as rabies in developing countries, leading to a poor understanding of the disease burden and limited evidence with which to design effective control measures. Using a low cost mobile phone-based system, Syed Mohammad Asad Zaidi and colleagues carried out a prospective surveillance of dog bites and rabies in Pakistan by screening all patients presenting to nine emergency rooms in eight cities over a two-year period.
A host pro-inflammatory immune response is widely believed to contribute to the clinical complications that occur in some patients with dengue. Synthetic glucocorticoids, immunomodulatory agents commonly used in medicine, have been suggested as a therapy for dengue. Here Nguyen Thi Hanh Tien and colleagues report on immunological changes occurring during prednisolone therapy with a view to understanding the lack of clinical benefit by glucocorticoid therapy and to guide future intervention strategies for dengue.
The following new articles are publishing this week in PLOS Pathogens:
To coordinate the expression of genes involved in its growth and survival, S. aureus uses, among other factors, around 250 regulatory RNAs. In their review, Brice Felden and colleagues provide an inventory of those RNAS and discuss what is known about their functions in stress response, metabolism, and virulence.
Isabel Gordo and colleagues have devised an experimental system to observe and study the evolution of bacteria in response to encounters with cells of the mammalian immune system. They found that in less than 500 generations, originally commensal E. coli became more resistant to being killed by macrophages and acquired the ability to cause disease in mice.
Interested in the innate defense mechanisms at the maternal-fetal interface, Anna Bakardjiev and colleagues adopted a system of differentiated murine trophoblast stem cells to be able to study placental defenses. They report on some unique properties of the syncytium that forms the placental barrier, and on how those affect susceptibility to bacterial infection.
This week PLOS Medicine publishes the following new articles:
Erik Volz and colleagues use HIV genetic information from a cohort of men who have sex with men in Detroit, USA, to dissect the timing of onward transmission during HIV infection. In particular, it allowed the researchers to estimate that, in the current HIV epidemic in Detroit, 44.7% of HIV transmissions occur during the first year of infection. These findings may not be generalizable to other cities or to other risk groups. Nevertheless, the findings of this analysis have important implications for HIV control strategies based on the early treatment of newly diagnosed individuals. Because relatively few infected individuals are diagnosed during early HIV infection, when the HIV transmission rate is high, it is unlikely, suggest the researchers, that the ‘‘treatment as prevention’’ strategy will effectively control the spread of HIV unless there are very high rates of HIV testing and treatment. In a related Perspective, Tim Hallett reflects on the influence of early HIV infection on disease epidemic dynamics.