FT Health: Ending unsafe abortions

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Half of all abortions carried out worldwide are unsafe, a study revealed this week — and the situation could worsen under new restrictions on US foreign aid. Of the estimated 25m risky procedures each year, 97 per cent were in developing countries in Asia, Africa, and Latin America.

Meanwhile, Ireland has announced a referendum on whether to scrap its constitutional ban on abortion, a subject also central to the culture wars raging in the US.

In the world’s poorer countries, more efforts are needed to ensure access to safe procedures, but also to effective birth control: World Contraception Day this week highlighted the fact that 214m women worldwide lack access to reliable methods of family planning.

The key message? The only way to prevent unsafe procedures is to legalise them. In countries with a complete ban on abortion — or where terminations are permitted only to save a woman’s life or preserve her health — only one in four procedures were safe. Yet in countries where abortion is legal on broader grounds, nearly nine in 10 were done safely. 

As the WHO notes, restricting access to abortions does not reduce their number. (The Lancet, Reuters, Irish Times, Devex, WHO)

Three questions

We talk to Tom Frieden, former head of the US Centers for Disease Control and Prevention and New York City health commissioner, who, as reported previously by FT health, has been appointed to lead Resolve with $225m in philanthropic funding over the next five years to save 100m lives from heart disease and strokes and to prevent epidemics.

Why did you decide to take the job?

Having worked in public health, global health and non-communicable diseases, I asked what I could do next to save the most lives. What are the areas at a tipping point? Where can we catalyse progress and have a really strategic impact?

What are your priorities?

Cardio-vascular disease kills 18m people a year and high blood pressure kills 10m. We will chose three interventions to scale up: the elimination of artificial transfats, reducing sodium and treating high blood pressure with cheap, safe, effective medications that are not widely available. We are not reinventing the wheel, we are getting the car moving.

Are you confident you can deliver?

We are moving very quickly to put in place the policies [we need] to scale up. Our default is to grant money to [other organisations] for any area they can [work in] almost as quickly as we can. If things work out as we hope, we will look back and recognise that this is an inflection point.

Chartwatch

Patent ploy Allergan’s transfer of patent rights for its lucrative eye medicine, Restasis, to the Native American Mohawk tribe — thereby giving the drug “sovereign immunity” and protection from patent challenges — could have far-reaching implications. The pharma industry faces a patent crunch, with $194bn of sales threatened by competition from generic drugmakers between now and 2022. US senators slammed the “blatantly anti-competitive” move. (FT, Reuters) 

Quiz of the week

Which city is most disliked by employees of the European Medicines Agency? The regulator has conducted a staff survey ahead of plans to relocate from London after Brexit. But the public version has been anonymised. Which do you think would be the most and least popular?

Email health@ft.com with your thoughts, or inside information. Anonymity guaranteed! 

News round-up

Hurricane aftermath Hurricanes have hit Puerto Rico hard, with hospitals crippled by flood damage and diesel shortages. High mosquito counts could also lead to a resurgence of diseases like Zika, dengue and chikungunya. Some warn there will also be drug shortages as the island is home to a large pharmaceutical industry. (NYT, Washington Post, USA Today)

Controlling cholera The WHO’s task force on cholera will on Tuesday announce a new strategy to reduce deaths from the disease by 90 per cent by 2030. It will focus on improving water and sanitation services, strengthening surveillance and vaccination campaigns and better co-ordination of support efforts. The UN is stepping up its efforts in Nigeria. (Reliefweb, UN)

Dementia in Africa The number of people with dementia in sub-Saharan Africa will increase 63 per cent by 2030 and 257 per cent by 2050, according to  Alzheimer's Disease International. Total costs of dementia in the region are estimated at more than $6.2bn, with almost three-quarters accounted for by informal care, mainly by family members. (MedicalXpress.com, ADI)

Measles milestone The WHO said measles was no longer endemic in 79 per cent of Europe. The UK, along with Denmark and Spain, have eliminated the disease altogether. England has achieved the 95 per cent vaccination target — the rate at which experts say immunity is ensured. (WHO, BBC)

Measures against Mers An international plan has been agreed to tackle Middle-East respiratory syndrome coronavirus, the disease carried by camels that is deadly for humans. Since 2012, when it was first identified in Saudi Arabia, there have been 2,081 laboratory-confirmed cases of infection from 27 countries, with at least 722 deaths — a fatality rate of 35 per cent. (WHO)

Superbug struggle What has happened in the 12 months since the UN declared war on antimicrobial resistance? Jim O' Neill, former chairman of the Review on AMR, says the IMF should start tracking countries’ progress. Pharmacists can play an important part. A new book suggests the biggest villain isn’t Big Pharma but Big Chicken. (Time, Project Syndicate, Pharmaceutical Journal, Science) 

Obamacare reprieve Senate Republicans failed once again to find the votes to quash Obamacare, suggesting the former president’s Affordable Care Act has now gained a measure of political acceptance. Here’s a list of the issues that are left hanging. President Trump is planning to let insurers sell health plans across state lines. (NYT, Kaiser, Washington Post)

Novartis eyes ‘productivity revolution’ Vas Narasimhan, the new Novartis chief, vowed to slash drug development costs, a process that typically costs pharma companies at least $2.5bn and takes 14 years. Digital technology could cut these costs between 10-25 per cent. (FT)

Social media and self-harm The number of young women in England being admitted to hospital for self-harm has jumped over the past decade and the NHS lacks the necessary resources to cope. Low self-esteem about their appearance — often fuelled by social media — is driving the increase. (Guardian)

Violence against children A new report documents the scale of violence experienced by millions of the world’s children. Concerted action is needed from families and communities, but also from governments. (Know Violence in Childhood)

History lesson How the 1918 flu pandemic laid the foundations for public health as we know it today. (Smithsonian)

Lack of sleep is killing us We are facing a “ catastrophic sleep-loss epidemic”. Two-thirds of adults in developed nations fail to achieve the WHO’s recommended eight-hours of shut-eye thanks to increasing “electrification” of the night; anxiety and stress; porous borders between work and personal life; longer commuting times; and the effects of alcohol and caffeine. (The Guardian)

Robots to the rescue The robotics revolution in Japan is being driven by the fact that by 2065 nearly 40 per cent of its population will be aged over 65. “Robear” helps lift the elderly in nursing homes, “Paro” is a miniature robotic seal that helps ward off dementia and “Vevo”, a bear-shaped robot, can monitor children’s heart rates and body movements while they nap. (FT)

Best from the Journals

The US and global health The US cannot ignore that, in a highly interdependent world, the health and wellbeing of other countries affects Americans back home. The NEJM warns that hitherto strong bipartisan backing for overseas aid projects is now under threat, a point reinforced by the Centers for Disease Control and Prevention. (New England Journal of Medicine, CDC)

HIV in Europe A new study detailed the rise of HIV cases in Europe in people over 50 — despite more encouraging trends among younger people. It suggests prevention efforts need to refocus on the general adult population. Fresh data from the US showed STD cases hitting a record high, thanks partly to cutbacks in education and healthcare programmes, but also to that most modern of vectors: the dating app. (Lancet HIV, CNN)

Malaria hopes Researchers have discovered a bacteria that can be genetically modified and spread among mosquitoes to suppress the development of the malaria parasite. Another study showed that a genetic modification can boost the creatures' immune systems and suppress the parasite. It spreads quickly by changing mating preferences: modified males begin to prefer unmodified, wild-type females, while wild-type males go for modified females. (Science)

Ramping up rabies measures An international coalition vowed to end deaths from dog-transmitted rabies by 2030. There is encouraging news from the Philippines, where a regional programme of vaccination, surveillance and education has managed to eliminate the disease in dogs and humans in just two years. (WHO, Elsevier collection, FT)

Brexit warning Leaving the EU will have serious effects on health in the UK, pose a severe threat to NHS finances and endanger the country’s leading role in public health and scientific research. (The Lancet)

Lost in thought The complexity of medicine now exceeds the capacity of the human mind. But using computers to manage this will need fundamental changes in the way we think and how medical education and research is conducted. (New England Journal of Medicine)

Podcast of the week

The future of psychiatry: Discussion with Dinesh Bhugra of the World Psychiatric Association on the Lancet/WPA commission on the profession’s priorities. (Lancet 13m)

In case you missed it

Previous edition Dispatches from the United Nations

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Final thought

Deregulation and health Freeing business of burdensome red tape is a common theme in modern democracies. But, as we digest the lessons from hurricanes, tower block fires and flooding, are we putting profits and growth before public safety? (BMJ)