FT Health: Time to reclassify tobacco?

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If in doubt, reclassify. That is the latest proposal to boost lagging efforts to tackle the global burden of smoking, a legal but lethal practice for over a fifth of the world’s population aged over 15 which kills 8m people a year.

Writing in the BMJ, two professors at the Chinese Academy of Medical Sciences argue that the current focus on nicotine dependence — which makes quitting so difficult — means that tobacco use is often categorised as a mental health condition.

Instead, they suggest it should be considered as a leading non-communicable disease on a par with hypertension, diabetes and heart disease, to encourage greater prominence and research, the development of disease management programmes, new treatments and prevention efforts.

However it is classified, World No Tobacco Day should be a moment to reflect on the human tragedy and costs to society of a habit that clearly causes conditions such as lung cancer and respiratory disease, and the risks of poorly investigated but heavily-marketed alternatives such as vaping. 

Three questions

Lelio Marmora, executive director of Unitaid, the UN-backed funder of global health innovation

What makes Unitaid distinctive?

We connect the two worlds of research and downstream, between the offer of innovation and the demand for it. We work with industry, government, civil society, the World Health Organization and product development partnerships to operate by consensus. We get industry to develop products, countries willing to adopt them, civil society to create demand, regulators to approve and funders to support.

What have been its most important successes?

In HIV, to support an oral self-test diagnostic to cut the price from $45 to $2 and give more access to the third of HIV positive people who don’t know their status. In TB, to support development and approval of a paediatric drug regime now used in over 90 countries. In malaria, to fund African-proposed trials showing how to prevent child deaths by seasonal preventive drug treatment.

How can funding received be disbursed more rapidly?

Donor countries face a lot of pressure from internal controls. Implementers have a lot of problems because they have to work in a difficult environment. Recipient governments need to be less political in the final use of funds. Everyone of us needs to be more flexible, less bureaucratic and take more risks because the person who is sick in the field is not getting the help needed.

Chartwatch

Reasons to be cheerful Singapore is the top country for taking care of its children, according to Save the Children's Global Childhood Report. More children all over the world are surviving past their fifth birthday than at any time in the last twenty years; more than ever before eat well enough to avoid stunting; more are in education; and more are safe from violence.  

News round-up

Drugmakers and prices The World Health Assembly agreed to push for more transparency on drug pricing, but was criticised for not making pharma companies reveal their R&D costs. Most life sciences CEOs received hefty pay rises in 2018 according to a new analysis. Of the top 25, GSK's Emma Walmsley was the only woman. (Reuters, BioPharma Dive)  

The cost of ill health Preventing non-communicable diseases should be a priority for the next European Commission, according to a new report that says Europeans spend up to a quarter of their lives in ill-health. Some €700bn is spent on treating NCDs in the EU each year, even though many chronic conditions are preventable. (ECDA, EPHA, NCD Alliance)

Afghan health crisis Decades of war have left Afghanistan's health services in a perilous state. Against the odds, child and maternal mortality have dropped significantly, but without new emergency funds, the country faces a severe malnutrition crisis. (Al Jazeera, UN)

Opioid reckoning Johnson & Johnson faced Oklahoma in the first civil trial targeting manufacturers, distributors and sellers of prescription opioids. Israel's Teva and Purdue Pharma settled in advance. US politicians alleged WHO guidelines on prescribing were tainted by industry influence. A range of new digital tools are trying to fill the gap that means only a fifth of the crisis' two million victims are receiving treatment. (CNN, BMJ. FT, FT video)  

Vexing antivaxxers The disgraced UK former doctor who inspired the anti-vaxx movement is making another film, this time focusing on vaccines for the human papillomavirus (HPV). Here's a read on how the movement became part of the mainstream of the US Republican party. (Politico, Telegraph)

Babylon blues A smartphone-based doctor consultation service has become a test case for tech companies claiming they can help cut costs of primary care for the UK's state-funded care system. (FT)

Screen debate Is heavy screen use a cause of depression, or are depressed people more likely to spend time online? Some point to its effect on sleep, others say the type of content viewed is the correct way to assess usage, not the time spent online. (Time, The Conversation)

Best from the journals

Mastering mosquitoes Trials using an engineered version of a naturally occurring fungus to poison mosquitoes that spread malaria have produced promising results. The tests — the first such trials outside a lab setting — were carried out in an enclosed, simulated village setting in Burkina Faso, west Africa. (Science)

War and health Armed conflicts are no longer synonymous with deaths from infectious diseases and malnutrition but living in a war zone can mean increased risk of heart disease — even years after the conflict is over. (Heart)

Gender inequality Governments are failing to make progress on gender equality despite evidence of its impact on health. A set of studies builds on the idea that biological sex is only responsible for a fraction of the differences in health outcomes for men and women — the rest is explained by the unwritten rules of society on how men and women should behave. (The Lancet)

Burnout The cost of burnout among US physicians, measured by doctor turnover and reduced clinical hours, was estimated at $4.6bn a year. The problem was acknowledged this week by the WHO as an “occupational phenomenon” with symptoms listed as “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy.” (Annals of Internal Medicine, WHO)  

Food for thought A bad week for makers of ultra-processed food, a category including everything from ice cream to breakfast cereals to chocolate cookies. One study associated high consumption with heart disease and another with a much higher chance of an early death. (BMJ)

Fat on the menu An analysis of children's menus at popular chain restaurants — especially “meal deal” options — show them falling foul of nutrition guidelines. In many cases, full-service restaurants were even less healthy than fast-food outlets. England's chief medical officer is considering a tax on unhealthy food as part of a new review into childhood obesity. (Journal of Nutrition Education and Behaviour, BBC)

Diabetes in the US After 20 years of increasing rates of diabetes in the US, new figures showed the number of new cases falling. Causes are unclear but could include changes in testing and success in getting people to improve their health before becoming diabetic. (BMJ)

Deaths of despair Falling life expectancy and rising inequality are signs of a society in trouble, according to renowned researcher Sir Michael Marmot. An increase in “deaths of despair” in the UK suggests the country is starting to mirror trends in the US. (BMJ)

Menstruation message  Menstruation remains low on the global health agenda, despite affecting 300m women and girls every day.   A sign of good health, “it must be normalised, and celebrated”. A campaigner suggests the stigma over periods will not end until boys learn about them too. (The Lancet, Guardian)

Podcast of the week

A discussion of the abortion debate gripping the US, from the history of Supreme Court judgments to the actions of individual states trying to restrict or expand current rights. (Kaiser What the Health, 41 mins)

FT event

FT Digital Health Summit Berlin Join us on June 18 at this one-day strategic conference bringing together healthcare leaders and experts to explore how innovation can help address healthcare’s escalating costs and rising demand. Book now with a 15 per cent discount for FT Health subscribers using code FT15D.

Final thought

Ethics dilemma The use of medical data from the Nazi period has long been a matter of debate, whether over ethics or its scientific worth. But what if the work — in this case an anatomical manual — could help stop unbearable pain? (Stat)