Thursday, April 17, 2003

SARS update: fear more important than the virus

1. It is absolutely amazing to think that we can go, in a matter of months, from finding a novel disease to identifying the agent responsible (a coronavirus), apparently having a test for it, and with a rapidly improving understanding of how to treat people. The parallels with 1918 might have been relevant, but the fact is that in a world not suffering the disruption of world war, and with 80 years of scientific development, this disease is actually a nasty but manageable problem.

2. It is clear that the fear of the disease is more of a problem than the disease itself, as the New York Times illustrates. No-one has yet died from SARS in the US. Meanwhile, the impact on China and Hong Kong continues. Economic growth is expected to be hit in China. Apparently, many travel agents in Hong Kong are on the point of collapse.

Tuesday, April 15, 2003

Exercise and heart disease

The BBC reports that a new study has found that moderate exercise does not reduce your risk of heart disease. It is the intensity of exercise that is important, not the duration, says the report produced by John Yarnell of Queens University Belfast.

Current health guidelines suggest a brisk for half an hour, five times a week, is good for your heart. But this research found no such effect. Even the effects cited for intensive exercise are not huge. Those who had engaged in more intensive exercise showed a reduction of 16 percent in early mortality and 27 percent in deaths due to heart disease.

Would it be cynical of me to suggest that the advice to engage in moderate exercise, like the advice to eat five pieces of fruit or vegetables a day, is an attempt by the authorities to get us to participate in something, to demonstrate that they are our moral leaders?

Brisk walk 'not healthy enough', BBC News, 14 April 2003

Sexual health

Is promiscuity leading to an epidemic of disease?

'It is no exaggeration that we now face a public health crisis in relation to sexual health', concludes Professor Michael Adler in an editorial for the journal Sexually Transmitted Infections. The article notes that the UK government has completely failed to meet the targets for sexual health set in the Health of the Nation report in 1992 and that things have only got worse since the Blair administration came into office in 1997. Between 1997 and 2001, rates of diagnosis have gone up for gonorrhoea (78 percent), chlamydia (73 percent), genital warts (six percent), genital herpes (13 percent), and syphilis (374 percent). 2001 also saw the largest single-year reporting of new HIV infection in the UK, with 4,419 cases diagnosed. The rate of pregancy in women under 16 is almost double the target set in 1992.

These figures should be treated with caution. Diagnoses may have gone up in part because of greater awareness of sexually transmitted infections. For example, ten years ago, young people would have been forgiven for thinking chlymidia was a character in a Shakespeare play, but it would be difficult to avoid discussion of it now. Adler also notes that attendance at clinics has doubled. Yet, diagnosis rates have not risen as quickly.

Moreover, some of the percentage rises mask quite small absolute rises. The figure for syphilis seems alarming but there were still only 697 cases in 2001. HIV remains a disease predominantly of homosexual men, and heterosexuals who contracted the disease in Africa. 79 percent of new infections among heterosexuals were acquired abroard. That is not to belittle the problem for those groups, but indicates that there is little in the figures that is new or which suggests a problem for the population as a whole. As for underage pregnancies, the current rate of conceptions is 8.3 per 1000 - exactly the same as it was in 1992.

This is not an indication of a massive threat to public health but rather shows that government moralising dressed up as health concern has been a failure. It is likely that more people are having sex with more different people, and starting younger.

Adler's article gives the impression of special pleading for more resources. 'Sexual health is not an NHS or political priority', he complains. Heaven forbid it should ever be one.

Sexually Transmitted Infections, April 2003

Expert warns of sex disease crisis, BBC News, 15 April 2003

Anti-tobacco sponsorship

Sponsorship is an important way in which the wheels of society get greased. But sometimes, it comes out with some bizarre combinations.

Such is the new deal between the Williams grand prix racing team and GlaxoSmithKline's NiQuitin CQ. 'This is a landmark deal for a sport which has been bombarded by tobacco messages for 30 years. This is ground-breaking and could well pave the way for other companies to do the same. This could open the door to a new commercial era for F1,' said the team's head of marketing. Fair enough. After all, tobacco sponsorship will be banned very soon.

It's the attempt to make nicotine replacement sexy that makes me laugh. GSK's spokesman said, 'After years of seeing tobacco advertising across the sport, we are offering something different. And from our point of view it offers those trying to give up smoking a more exciting reason.'

Yeah, right. I can see it now, in pubs up and down the land. 'I was going to give up because of the expense or the effect on my health. Yet, somehow, it was never reason enough. But now I've seen a tiny advert on a car whizzing past me at 200 miles per hour for a nicotine replacement, it's all the incentive I need.'

Williams agree anti-smoking deal, BBC News, 15 April 2003

Monday, April 14, 2003

SARS: a gloomy prognosis

There is an interesting article by Nigel Hawkes in The Times today entitled, Why I believe we should all be worried about Sars.

The gist of the argument is that we foolishly believed that infectious disease was a thing of the past but actually it is rearing its ugly head again and again. SARS is just the latest new disease to strike. AIDS demonstrates that it is still possible for novel diseases to have devastating impacts. It is only a matter of time before another super bug comes along that wipes out large numbers of people like Spanish Flu did in 1918.

What seeps through every word is an utterly pessimistic view of human capacity to deal with disease. The fact is that, for the most part, the major contagions of the past have been dealt with. Smallpox has been eradicated, malaria and TB are less significant than they were (although the ban on DDT may effectively mean fighting malaria with one hand tied behind our backs). Within weeks, SARS is better understood and treated (if not cured).

What is clear is that medicine and the general state of society go hand in hand. AIDS is no longer a major killer in the West because of the availability of anti-retrovirals. They don't offer a cure, but they allow the disease to be managed. It is poverty that is the killer in sub-Saharan Africa and elsewhere. With access to better nutrition, sanitation and medical care, the problems of those countries would be greatly reduced. But we should not be so downhearted about our capacity to understand and deal with new threats. The problems are political, not scientific.

Passive smoking: proposed UK legislation

Harrow MP Gareth Thomas has put forward a bill to ban smoking in premises where food is served. This would include the bar area of restaurants. Figures from that ASH report last week (see my comments about it) are rolled out without criticism in the BBC report about the bill. The risks from passive smoking are small if they exist at all. This legislation is unnecessary.

And if it succeeds, and it stops me from having a burger with my pint in Wetherspoons, there will be trouble.

MPs vote on restaurant smoking ban, BBC News, 14 April 2003