TOPSHOT - A smoker is engulfed by vapours as he smokes an electronic vaping machine during lunch time in central London on August 9, 2017.
World stock markets and the dollar slid Wednesday after US President Donald Trump warned of "fire and fury" in retaliation to North Korea's nuclear ambitions, sending traders fleeing to safe-haven investments. In Europe, equities dived with London losing 0.6 percent, while Frankfurt shed 1.1 percent and Paris fell 1.4 percent. / AFP PHOTO / Tolga Akmen        (Photo credit should read TOLGA AKMEN/AFP/Getty Images)

World Cancer Day last Sunday reminded us of the toll exacted by the world's second biggest killer, with almost 9m deaths a year. Smoking — the disease's biggest single cause — was responsible for more than a fifth of these.

In that context, the swift resignation of Brenda Fitzgerald, CDC chief and America's top public health official, for investing in tobacco stocks should come as no surprise. As her predecessor Tom Frieden put it this week: “Public health and healthcare professionals simply should not be involved in industries of death.”

The search for ways to wean smokers off the habit took a step forward on Tuesday as English authorities provided qualified support for ecigarettes. Although fears of an association with pneumonia were also raised this week, their overall risk of harm is estimated to be less than 5 per cent of smoking tobacco and the risk of cancer less than 1 per cent.

Big Tobacco has acted quickly to capitalise on these “next generation” products, eyeing a market that could top $15bn by 2020. But researchers fear this could confuse anti-smoking messages in an industry known for its obfuscatory tactics and where organisations such as the Foundation for a Smoke-Free World are funded by Philip Morris International. Could Big Tobacco be transforming into Big Vape?


Pollution peril The Lancet’s Global Commission on Pollution: a stark reminder that its variants cause three times more deaths than those from Aids, tuberculosis and malaria. 

News round-up

Health R&D New World Health Organization data show “striking gaps and inequalities in investment” in health R&D spending. Richer countries have 40 times more researchers than their poorer counterparts and only 1 per cent of funding is allocated to malaria and TB despite accounting for 12.5 per cent of global disease. (WHO)

Disease priority The WHO updated its priority list of diseases deserving of R&D because of their potential to cause a public health emergency and the absence of effective drugs. (WHO)

Day Zero approaches Public health officials in South Africa are preparing for a public health emergency affecting 3.7m people. Drought looks set to force Cape Town to switch off the taps on April 16 — the first modern major city in the world to completely run dry. (PLOS, Time)

Flu fears The WHO warned of a worrying fall in flu vaccinations in Europe, urging countries to do more to hit the 75 per cent target for older and other at-risk groups. In the US, where hospitalisations are running at a record rate, an adviser to President Trump is recommending prayer instead of flu shots. (WHO, NYT, ABC News)

Anticipating disease Relying on crisis response rather than preparation for disease outbreaks can be costly. The west Africa Ebola crisis led to a global economic loss of $2.2bn and almost emptied the coffers of the US CDC. Improved monitoring will reduce the risks of national problems becoming pandemics. (Harvard Global Health Institute, BMJ)

Fighting FGM A new round of international opposition to female genital mutilation included the WHO urging health professionals not to perform such procedures. More than 200m girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia. (USAID, WHO)

Fertility milestone Mature human eggs (below) have been grown in the lab for the first time by scientists in the UK, extending the possibility of fertility treatment for women. The first application is likely to be to allow those about to undergo cancer treatment to prepare for later IVF. (FT)

Cuban conundrum That “sonic attack” on US diplomats in Havana? It didn't happen. Or at least that's the latest theory which says they may have suffered from a “mass psychogenic illness” or “collective stress response”. Still a real issue, but unlikely to be caused by high-tech espionage. (Slate)

UK vs USA A transatlantic spat erupted when President Trump implied UK protesters calling for more money for the NHS were demonstrating against, rather than for, universal healthcare. The United States of Care, a new non-profit, aims “to get past the politics and get affordable care for every American”. The BMJ says a new approach is sorely needed. (Twitter, NYT, United States of Care, BMJ)

Google eyes AI diagnostics Google's DeepMind technology has developed what could be the first significant application of artificial intelligence in healthcare, enabling diagnosis of eye diseases by analysing medical images, in partnership with the UK's NHS. There are concerns, however, over Big Tech's growing access to NHS data. (FT)

Food for thought Half of all UK food purchases consist of “ultra-processed” products with serious implications for obesity and ill health. New marketing restrictions in Chile are said to be the world’s most ambitious attempt to alter a nation’s diet. By contrast, the US is relaxing its calorie-count rules on menus. (Guardian, NYT, CNN) 

Opioid crisis The number of Americans killed from overdoses in the next 10 years is set to surpass those killed in the second world war. The Trade, a new TV series, aims to shock viewers with its unvarnished depiction of the opioid crisis. San Francisco is setting up America's first safe injection sites. (CNN, The Guardian) 

Coffee or tea? The good-for-you/bad-for-you debate around coffee has been brewing for ages, but opinion now seems settled on the former. As long as you're not pregnant, that is. However, hot tea (or “tea” as it is known in Britain) is associated with an increased risk of oesophageal cancer when combined with excessive alcohol or tobacco use. (Washington Post, Annals of Internal Medicine)

Music and dementia A new campaign says music can have an important effect on the lives of dementia sufferers. The FT talked to the International Longevity Centre UK and Playlists for Life, one of the organisations putting the theory into practice. A separate study showed the beneficial effects on dementia patients of just one hour a week of social interaction. (FT audio, PLOS)

Best from the Journals

Allocating aid Development assistance for health amounts to more than $36bn a year but the multilateral agencies that determine which countries should benefit can be inconsistent and lack accountability for their decisions. Unreliable economic data may exaggerate improvements and inadvertently cut poor countries’ chances of aid. (Health Policy and Planning) 

Vaccination prevents poverty Vaccines do not just save lives: they also stop millions from slipping into poverty when they are hit with unexpected costs. Policymakers should view vaccination programmes as economic tools as well as drivers of health equity. (Health Affairs)

Antibiotics in India India has among the highest resistance rates and consumption of antibiotics in the world but sales, including unapproved formulations, are rising. They need to be banned if the country’s antimicrobial resistance strategy is to be successful. (British Journal of Clinical Pharmacology)

China’s research revolution A BMJ collection examines China’s growing role in research, including the use of evidence-based policy and big data, and the growth in clinical guidelines, albeit often of poor quality. (BMJ)

Podcast of the week

Torture and ethics Previously classified guidelines from the CIA on medical practice in its secret detention facilities show the agency instructed healthcare professionals to suppress ethical considerations in favour of their torturers. Zackary Berger of Johns Hopkins School of Medicine explains. (BMJ Talk Medicine, 18m)

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Final thought

Tackling child obesity In the words of Winston Churchill: “However beautiful the strategy, you should occasionally look at the results.” A new study in the BMJ suggests anti-obesity programmes in schools are having little effect. What now? Share your thoughts with us on Twitter, Facebook or email

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