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April 24, 2014

World News

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Gary Culliton compiles some of the healthcare-related news making the headlines around the world.

NHS ‘wasted’ Stg£625m on synthetic insulin

The NHS has stumped up an extra £625 million (€715 million) over the past decade on synthetic forms of insulin, when the recommended human alternatives — which are considerably cheaper — would have probably been just as effective, reveals research published online in BMJ Open.

The findings of the new report come as a UN health summit in New York last week debates how to step up international efforts to tackle the rising global burden of non-communicable diseases, including diabetes.

The authors based their findings on an analysis of publicly-available data from the four UK prescription pricing agencies for the years 2000 to 2009.

Costs were adjusted for inflation and reported at 2010 prices.

Over the 10 years, the NHS spent a total of £2,732 million (€3,119 million) on insulin, the annual cost rising from £156 million to £359 million (€178 million to €411 million) — an increase of 130 per cent.

The annual cost of synthetic (analogue) insulin rose from £18.2 million (€20.7 million), or 12 per cent of the total, to £305 million (€348 million), or 85 per cent of the total. The cost of human insulin fell from £131 million (€149 million), or 84 per cent of total, to £51 million (€58 million), or 14 per cent of the total.

On the assumption that all patients prescribed insulin analogues could have been prescribed human insulin instead, the NHS could have saved itself £625 million (€715 million), said the authors.

But even if only half of those patients could have been switched, that’s still more than £300 million (€342 million) of savings for the NHS, they said.

The number of people diagnosed with diabetes in the UK has risen to 2.8 million, around 90 per cent of whom have type 2 diabetes. Whereas those with type 1 disease require insulin from the get-go, those with type 2 disease tend to be started on insulin later on.

Insulin analogues were developed to better mimic the actions of the insulin manufactured by the body, but it is not clear if the benefits are sufficient to justify their additional cost, said the authors.

“We know that the rise of insulin analogues has had a substantial financial impact on the NHS, yet over the same period there has been no observable clinical benefit to justify that investment,” they concluded.

Warning issued over danger of baby slings

An expert in Australia has warned that baby slings may cause suffocation, after it emerged a sling was implicated in the death of a two-day-old boy in South Australia.

Baby slings worn around a parent or caregiver’s neck provide a soft and rounded sleeping surface that may promote a potentially dangerous posture that impedes normal respiration, according to a Letter to the Editor in the latest Medical Journal of Australia.

Prof Roger Byard from the University of Adelaide, and co-author, said that infants may suffocate in baby slings if they are positioned with their chin to their chest or if their mouth and nose are obstructed. The Australian Competition and Consumer Commission has recently issued warnings about the use of baby slings.

Prof Byard said it was important that parents and carers were made aware of the potential safety issues.

“Sixteen deaths attributed to the use of slings have occurred in the United States and Canada, resulting in calls for mandatory standards by the US Consumer Product Safety Commission”, Prof Byard said.

“Constant monitoring of infants in slings is advised, to ensure that the infant’s head is facing outwards, with no covering of the face.”

Risk of disease from the use of ‘raw’ milk

Health Canada says the risk of disease means raw or unpasteurised milk should not be used, even though there has been a trend toward the use of ‘raw’ foods that have undergone less processing.

“While pasteurised milk is now the standard, there are some Canadians who continue to prefer raw milk because of perceived health benefits,” Health Canada, the federal government department, stated in a recent advisory note. “However, any possible benefits are far outweighed by the serious risk of illness from drinking raw milk.”

The sale of raw milk is prohibited in Canada to protect against bacteria such as salmonella, E.coli and listeria. “These bacteria can lead to very serious health conditions ranging from fever, vomiting and diarrhoea to life-threatening kidney failure, miscarriage and death,” Health Canada warned.

Children, pregnant women, older adults and people with a weakened immune system are particularly at risk.

According to the British Columbia Centre for Disease Control, at least 37 disease outbreaks related to the use of raw milk occurred in North America between 2000 and 2010, resulting in 672 cases of illness, at least 32 hospitalisations and seven infant deaths.

Four of the reported outbreaks occurred in Canada, where they resulted in 30 cases of illness and several hospitalisations.

EU/US bilateral talks on antibiotic resistance

EU Commissioner for Health and Consumer Policy John Dalli visited the US last week to hold a series of bilateral meetings on public health, food safety and consumer issues in Washington DC.

The Commissioner was to meet with US Health Secretary Kathleen Sebelius to discuss obesity, health security, pharmaceutical matters and antibiotic resistance.

Together, they were to endorse the Transatlantic Taskforce on Antimicrobial Resistance’s report with recommendations for EU/US collaboration to keep antimicrobials effective.

Commissioner Dalli was to present his vision of putting Europe at the forefront of innovation while strengthening citizens’ safety at the European Institute.

Big Apple leads the way on NCDs — Bloomberg

Addressing the UN General Assembly’s two-day summit on non-communicable diseases as it drew to a close, Michael Bloomberg, Mayor of the City of New York, implored governments worldwide to adopt the type of public policies and strategies that had enabled his administration to reduce deadly chronic illnesses and promote healthy lifestyles among the city’s 8.4 million people.

Thanks to a ban on smoking in restaurants, bars, parks and public beaches, a steep excise tax on cigarettes, hard-hitting media campaigns about the dangers of smoking and widely-available smoking cessation programmes, the percentage of adults who smoke in New York City had fallen from 22 per cent in 2002 to 14 per cent today, while the number of teenagers who smoke had dropped from 18 per cent to 7 per cent over the same period.

“We’ve already saved at least 1,500 lives annually,” Mayor Bloomberg said, adding that “such results can be and must be replicated worldwide”.

New York City had also taken the lead in promoting healthier eating habits, as part of its overall efforts to make reduction of non-communicable diseases a public health priority, he said.

In 2008, the city had become the first jurisdiction in the US to require restaurants and eateries to post calorie charts of food items for sale.

Licensing for ‘green’ street carts selling fresh fruits and vegetables had been expanded, grocers and manufacturers were encouraged to commit to reducing salt content in food, and public education campaigns had been launched about the health dangers of excessive sugar and salt intake.

As a result, life expectancy in New York City, which grew by more than 1.5 years from 2001 to 2008, was higher than in the United States overall.  “I believe all nations worldwide can achieve similar success,” Bloomberg said.

Disease-oriented approach criticised by WMA

There is a risk that children born today will have a lower life expectancy than their parents, the World Medical Association (WMA) has warned.

The United Nations has been urged by the WMA to change its strategy towards non-communicable diseases (NCDs) by widening its activities to include other preventable diseases. WMA President Dr Wonchat Subhachaturas said he had concerns about the present narrow disease-orientated approach to NCDs being adopted by the UN. The WMA is appealing to member states to pay more attention to preventing, treating and rehabilitating NCDs, many of which had reversible causes.

A common approach should be promoted that addresses the link between NCDs and the social determinants of health, with a particular focus on the broader factors that influence behaviour and associated health risks. Dr Subhachaturas called on UN members to emphasise primary healthcare as the way to strengthen health systems through a comprehensive approach integrating prevention, specialised treatment and rehabilitation.

“With the focus mainly on cardiovascular disease, cancer, diabetes and chronic respiratory disease, we fear that governments will concentrate only on improvements in these areas, detracting from other significant needs of other major NCD threats, such as mental disorders, musculoskeletal diseases, oral diseases and accidents. The effect of this vertical ,or ‘silo’ approach, will be to deprive other important areas of healthcare of necessary resources,” said Dr Subhachaturas.