JANUARY 2004 NEWS
(Last update was: Monday, January 26, 2004 09:11:25 AM )

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JANUARY 2004 NEWS

Lawyers warn on drugs pricing - One of the country's leading law firms has warned that government's draft regulations on the pricing of medicines could be unconstitutional, opening the way to legal challenge if they were implemented in their current form.

The draft regulations propose the introduction of caps on the markups levied by wholesalers, distributors and pharmacists.

"We have been approached by clients who are concerned about the legality (of the regulations)," said Webber Wentzel Bowens' partner specialising in public law, Glenn Penfold.

Penfold said the draft regulations also appeared to infringe on an individual's constitutional right to freedom of trade.

Health Minister Manto Tshabalala-Msimang might have exceeded her powers as described in the Medicines and Related Substances Control Act, he said.

In other news, it has come to the attention of the Treatment Action Campaign (TAC) that MSD, the holder of exclusive rights to market and distribute Efavirenz in South Africa, has run out of stock of the tablet used in the treatment of HIV infection in children over the age of three years.

As far as can be ascertained, very few pharmacies are currently holding any stock of 50mg Efavirenz.

"A serious consequence of stock shortages is that resistance to the particular antiretroviral medicine can develop if patients default," said TAC chairperson Zackie Achmat.

Sources: Business Day & Citizen

Article Source & Reference: SA Medical Association - http://www.samedical.org/, 2004/01/23

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WHO pushing to rapidly scale-up measures to fight TB and HIV GENEVA - Collaborative approach to speed distribution of AIDS treatment and reduce spread of tuberculosis in high HIV prevalence areas.

The World Health Organization (WHO) announced today a plan to expand collaboration between national tuberculosis and HIV/AIDS programmes to curb the growing pandemic of TB/HIV co-infection, with a principal focus on Africa where 70% of the world's 14 million people who are co-infected live.

The new policy guidelines define activities necessary to address the dual epidemic of TB and HIV and gives clear guidance for countries on the circumstances under which these effective activities need to be carried out. It will give critical support for ‘3 by 5’, the WHO plan to provide antiretroviral (ARV) treatment to three million people living with AIDS by the end of 2005.

"TB/HIV is a deadly combination and needs to be tackled with an approach treating the whole person," said Dr. LEE Jong-wook, Director-General of the World Health Organization. "With effective treatment, TB can be cured, HIV managed, and the health of millions of people preserved."

A key element will be to rapidly expand voluntary HIV testing and counselling in TB programmes, with the aim of identifying and referring more than half a million TB patients who are HIV positive for ARV treatment in the next two years. With additional training for health workers, TB programmes will also assist in HIV prevention, ARV distribution and patient care.

At the same time, TB case-finding will be intensified in high HIV prevalence settings by introducing screening and testing for tuberculosis into HIV/AIDS service delivery points. In Africa, up to half of all people with HIV/AIDS develop TB, and up to 80% of tuberculosis patients are HIV infected.

By routinely screening and testing people with HIV/AIDS for TB, co-infected cases, without TB disease, can be treated with prophylactic drugs that prevent development of active tuberculosis, and cured if they already have it. This will prolong the lives of people with HIV/AIDS until they can benefit from the expanded availability of ARVs in the coming years.

UNAIDS Executive Director, Dr. Peter Piot, said: “TB is perhaps the greatest and most deadly opportunistic infection associated with AIDS. By tackling TB and HIV together, we can have a significant impact on improving the quality of life of people infected with HIV, while also controlling TB and preventing new infections.”

The vast majority of HIV-infected people do not know their HIV status and seek health care from general service providers. HIV testing and counselling for TB patients using rapid tests offers an entry point for a continuum of prevention, care, support and treatment for HIV/AIDS as well as for tuberculosis.

"Evidence has shown that the uptake of HIV testing by TB patients is high, so mainstreaming HIV testing and counselling into TB programmes will identify many more candidates for ARV treatment," said Dr. Mario Raviglione, the Director of WHO's Stop TB Department. "We also know that ARVs reduce the development of TB in people with HIV, in some cases by up to 80%. So promoting and expanding a collaborative approach makes perfect sense."

The launch of the “Interim Policy on Collaborative TB/HIV Activities” guidelines coincides with the fourth round call for proposals by the Global Fund to Fight AIDS, TB and Malaria. The deadline for submissions is April 2004. The interim policy will enhance proposals which address the dual epidemic of TB and HIV. Already, the Global Fund has committed US$ 2.1 billion over two years to programmes in 120 countries.

Taken together, the two epidemics represent a massive challenge to public health. Forty million people are currently infected with HIV, and 5 million more are infected every year. According to WHO, one third of the world's population is now infected with the TB bacillus, with more than 8 million people developing the active disease and 2 million dying of it each year.

Article Source & Reference: World Health Organization - http://www.who.int/mediacentre/releases/2004/pr5/en/, 2004/01/22

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Regulations on the Prices of Medicines - The latest Government Gazette (16 January 2004) carries draft Regulations Relating to a Transparent Pricing System for Medicines and Scheduled Substances made in terms of the Medicines and Related Substances Control Amendment Act of 1997.

These regulations are a major development in our effort to ensure that South Africans have access to affordable, good quality medicine. You will recall that when this Act was passed in 1997, it was strongly opposed by pharmaceutical companies. It took these companies almost four years to withdraw their court action in 2001 and finally accept the legitimacy of our efforts and genuineness of our respect for the international trade treaties that we are party to.

We are now in the process of implementing various provisions of this Act. These Regulations articulate the processes and mechanisms to be followed to give effect to the provisions of Section 22G.

This section makes provision for:

• The introduction of a "transparent pricing system" for all medicines and Scheduled substances sold in South Africa. This includes the requirement that a manufacturer or importer must set a price at which a particular medicine shall be sold to any person other than the State. The price is termed "single exit price" and will be published on the container of a medicine.
• An "appropriate dispensing fee" to be charged by a pharmacist or by a person licensed in terms of Section 22C(1)(a) to dispense medicines.
• An "appropriate fee" to be charged by pharmaceutical wholesalers or distributors or any person selling Schedule 0 medicines.

In terms of the draft regulations, distributors and wholesalers can only charge a fee up to 15% of the manufacturer's exit price for a medicine that costs less that R40. Where the price is R40 or more, the maximum fee is R6.

A pharmacist can charge a dispensing fee to the maximum of 24% of any medicine with an exit price of less than R100. Where the single exit price is R100 or more, the dispensing fee will not exceed R24. Any other person who is licensed to dispense medicine can charge a fee of not more than 16% of a single exit price of less than R100 and R16 for medicine with a price that is higher than R100.

The regulations require the manufacturer - not the Government - to set the exit price for each medicine. However, they do establish a ceiling for the original exit price and provide that the price may be increased only once a year - while it may be reduced any number of times, in the spirit of competition.

Our research has indicated that formally listed Manufacturer Net Price of medicines has been inflated to allow for the impact of a complex system of bonuses, rebates and other incentive schemes within the pharmaceutical industry. This incentive system allows hospital groups, pharmacy groups and other major outlets to obtain medicines at prices about 50% below the listed Manufacturer Net Prices. Due to complex mark-ups in the distribution chain the consumer seldom benefits from this incentive system. Furthermore, not all outlets are eligible for the bonuses and rebates.

Section18A of the Medicine Amendment Act, which comes into effect on the 2nd of May 2004, will prohibit the supply of medicines through these incentive schemes. The single exit price and regulated fee system will become effective at the same time, thus ensuring that all the consumer pays less for medicines.

In the light of the current gap between the "listed" price (the Manufacturer Net Price) and price effectively charged, the regulations require that the single exit price should be set no higher than 50% of the present "listed" price.
 
When these regulations are fully implemented, the price of medicines to consumers would be between 40 and 70% lower than the current levels and this is a major saving for consumers. In general, medicines with the lowest prices will have small percentage reductions and those with the highest prices will have greater reductions. This should put a reasonable halt to the trend of a general increase in medicine prices in South Africa over the last few years.

These draft regulations will be open for public comment for three months as from tomorrow. We urge all interest parties to submit written comments or representations on the proposed regulations to the Director General of Health. We fully understand that these regulations will have a profound impact on the entire medicines sector in this country and, as Government, we are concerned to get things right.

We are well aware that our primary goal of affordable medicine for all is served through a healthy manufacturing, wholesale and retail industry. We have no wish to undermine this industry - only to make it fully accountable in the interests of the consumer.

Dr Manto Tshabalala-Msimang
Minister of Health

Article Source & Reference: Department of Health - http://www.doh.gov.za/docs/pr/pr0113-f.html, 2004/01/21

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Doctors take grievances to parliament - Doctors will be marching to parliament on Friday, February 6, to express their dissatisfaction with the alarming state of the public health care delivery system, the unacceptable working conditions of doctors in the public sector, and current and proposed legislation that compromises patient care in the private sector.

The march is being organised by the South African Medical Association (SAMA), the professional body that represents more than 16 000 doctors. ‘The main aim of this march is to highlight the plight of doctors who find it increasingly difficult to act in the best interests of patients due to major shortcomings in the public health sector. This includes poor conditions of service, inadequate facilities and shortages of professional health personnel’, said Dr Kgosi Letlape, chairperson of SAMA.

SAMA will hand over a memorandum comprising all its concerns to the Department of Health on February 6. These concerns include the following:

• Appalling state of public health care facilities;
• Inability to recruit and retain adequate number of health care professionals ;
• Lack of career prospects and promotion opportunities for doctors in the public sector;
• Health legislation restricting doctors from dispensing medicines to their own patients, thereby compromising patient care and limiting access to medicines;
• Proposed Certificate of Need that makes provision for the licensing of private practices that intrudes on doctors’ right to human dignity; freedom of movement and residence; freedom of trade, occupation and profession; and property rights; and
• New competitive and unrealistic reimbursement levels for doctors’ services with shortfalls that will be borne by patients, increasing the financial burden on members of medical schemes.

The Association further calls on government to:

• Allocate more money to upgrade public health facilities;

• Establish a separate bargaining forum for health care professionals where public sector doctors can negotiate on their salaries and conditions of service;
• Recognise existing mechanisms that regulate dispensing doctors and their ability to continue dispensing responsibly and in the interests of their patients;
• Include the medical profession in the strategic planning process, pooling the collective skills and resources of the profession to find practical and viable solutions to South Africa’s health care needs.

‘The Medical Association believes that the proposed restrictions by government impose on doctors` rights, their professional autonomy and clinical independence, which are not conducive to delivering quality health services. It is time for constructive engagement between the profession and government in finding solutions that concentrate on the delivery of care, and adequate distribution of medical skills and resources in both the public and private sector. Legislation is not the way to go. It just creates a huge bureaucracy that is costly to support.

‘Doctors countrywide have thrown their weight behind SAMA’s mass action on February 6. The Association has reminded its members wishing to participate in the march, that patient care should not be compromised in any way,’ Letlape said.

Source: SAMA Corporate Communication: Press Release 

Article Source & Reference: SA Medical Association - http://www.samedical.org/, 2004/01/20

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New drug plan may shut down manufacturers (Sapa) - Consumers on Friday hailed savings said to result from new drug pricing regulations, but local pharmaceutical manufacturers were worried about their continued existence.

The regulations, which the government projected would yield savings of up to 70 percent in medicine prices, may knock between 10 and 20 percent off medical aid costs, industry players said.

But manufacturers feared that a compulsory 50 percent cut in current listed prices would affect their continued viability.

Medical aid administrator Medscheme said the regulations would have a "dramatic effect" on costs to consumers. Medicines comprised between 25 and 30 percent of the average medical aid premium.

"Medical aids may see a real reduction of 10 to 20 percent if the savings in medicine costs projected by the draft regulations materialise," Medscheme group services managing-director Gary Taylor said in a statement.

The Pharmaceutical Manufacturers' Association of South Africa (PMA) said a compulsory 50 percent cut on current listed prices appeared to have been determined on the supposition that all manufacturers had factored discounts, bonuses and special deals into their prices.

"This arbitrary selection of 50 percent of the current price of medicine will adversely affect those manufacturers which have not built such factors into their prices," it said in a statement.

"It may well affect the continued viability of these companies in this country."

Spokesperson Maureen Kirkman said the PMA had received calls from several companies since Thursday to express concern about their futures. But she would not name them or give figures of how they would be affected.

Health Minister Manto Tshabalala-Msimang unveiled the new regulations in Pretoria on Thursday, saying they should see drug prices drop by between 40 percent and 70 percent. They were expected to come into effect on May 2, depending on public comments over the next three months.

The regulations, published in draft form in the Government Gazette on Friday, made provision for a transparent medicine pricing system and limited distribution and dispensing fees.

They determine that the basic "single exit price" of drugs be printed on all medicine containers in future, and could not be increased for a period of one year.

Annual price rises would be limited to a ceiling determined by the government in line with inflation and exchange rate considerations.

Wholesalers or distributors could add no more than R6 to the manufacturer's exit price and pharmacists were limited to a dispensing fee of no more than R24.

The National Association of Pharmaceutical Wholesalers said the final regulations would have to provide a truly level price playing field so that effective competition could take place on service offerings.

"It would appear as if the proposed regulations have these objectives in mind, although there are certain aspects thereof which require certification."

It said it was considering the details of the document, and would do everything in its power to ensure the final regulations were "as beneficial as possible" to all South Africans.

The National Education, Health and Allied Workers' Union welcomed what it described as the government's "direct tackling of profiteering of pharmaceutical companies at the expense of ordinary South Africans".

"We are glad that at long last the minister has a political will to deal with these parasitic layers in the supply chain of drugs."

The Pharmaceutical Society of South Africa has also welcomed the move.

"This is strongly supported by the Pharmaceutical Society of South Africa because it removes the focus from the price of medicine as a mere commodity of trade," it said on Thursday.

"(It) shifts it to providing an appropriate medicine for the indication. The objective of a transparent pricing system is to bring equity into the system."

Article Source & Reference: IOL Health -http://www.iol.co.za/index.php?click_id=125&art_id=qw1074264301634B253&set_id=1, 2004/01/19

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Unique opportunity for eradication success now rests with key governments - “We Will Finish Polio Before Year’s End,” say Ministers of Health.  Polio should be relegated to the history books within the next twelve months, Ministers of Health and representatives from the six remaining polio-endemic countries declared today at a high-level meeting in Geneva. The Ministers unveiled a bold new plan to immunize 250 million children multiple times during a series of massive polio immunization campaigns in 2004.

Article Source & Reference: World Health Organization - http://www.who.int/mediacentre/releases/2004/pr4/en/, 2004/01/16

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Asian bird flu scare possible bigger threat than Sars - More suspected human cases of bird flu in Vietnam have raised serious concern of an outbreak that could be worse than Sars. The World Health Organisation (WHO) said tests were being conducted to determine if the deaths of an additional six children in Vietnam were linked to the virus, but had stressed that there had been no person-to-person spread of the disease.

Article Source & Reference: SA Medical Association - http://www.samedical.org/, 2004/01/15

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Tax breaks for medical fees to be scrapped - In a move that could hit high income earners, tax breaks for medical expenses will be scrapped by next year, if the government adopts recommendations made by two task teams investigating ways to ensure medical aid members pay the same for benefits.

South Africa's highest earners, who spend large amounts on medical cover and get significant tax breaks, are likely to lose money from the changes. Middle and low-income earners would not on average find themselves out of pocket because their medical aid premiums would probably decrease.

The work of the task teams is part of a move towards a National Health Insurance System, through which the government aims to regulate the medical aid industry and improve the health service.

The task teams were set up to make recommendations about a risk equalisation fund, through which the government could ensure that all members of medical aid schemes pay the same amount for the basic health care package that by law must be provided.

This package is known as prescribed minimum benefits (PMBs).

"The news is only positive," said actuarial Professor Heather McLeod, head of one of the teams. "The aim is to ensure that everybody in the public health sector pays the same rate for the prescribed minimum benefits. It will, in effect, be like making one big medical aid scheme to cover prescribed minimum benefits.

"The question, to put it crudely, is who the winners and losers will be."

The recommendations were "hugely likely" to be adopted by government, McLeod said, because of the overwhelming need to equalise the cost of prescribed minimum benefits.

It is expected that the risk equalisation fund will be established by the beginning of 2005.

The move towards a National Health Insurance System, through which government aims to regulate the medical aid industry and improve the health service means all employed people will be obliged to buy medical aid cover, just as they are obliged to pay taxes, under this new system.

The government subsidises private hospitals, by giving tax rebates for medical expenditure, to the tune of R1 000 per beneficiary annually - more than the amount spent per person in the public health system.

Medical aid schemes spend varying amounts on prescribed minimum benefits, depending on their members' ages and health, and charge their members accordingly.

Children less than one-year-old, and people over the age of 45 need much more to spend on their health, so schemes that are able to attract younger members charge less.

It has been calculated that the average amount spent on a member of a medical aid scheme is R200, but one closed scheme is charging members R800 for this package and others are charging around R500.

The risk equalisation fund would distribute money to medical aids that now pay more for the minimum package of benefits, so that all schemes would have to pay only the average amount per member.

The report states that if the risk equalisation fund had been set up in 2002, 54 percent of all schemes would have paid the same amount or less for all their members' minimum package of benefits, and 46 percent would have paid more.

An international panel of experts who have helped to develop health systems elsewhere will review the report, and a final version will be written in March.

Article Source & Reference: IOL Health - http://www.iol.co.za/index.php?click_id=125&art_id=vn20040114032009346C747711&set_id=1, 2004/01/14

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UK research raises cancer concerns over deodorants (Reuters) - Chemicals found in underarm deodorants have been detected in the tumours of breast cancer sufferers, British scientists said today.

Researchers at the University of Reading found traces of the chemicals parabens in tissue samples, proving that the preservatives can accumulate inside the body, although a direct link with breast cancer has not been proven.

"Their detection in human breast tumours is of concern since parabens have been shown to mimic the action of the female hormone oestrogen, and oestrogen can drive the growth of human breast tumours," Philippa Darbre, lead author of the study, said in a statement. "It would therefore seem especially prudent to consider whether parabens should continue to be used in such a wide variety of cosmetics applied to the breast area," she added.

However, Philip Harvey, European editor of the Journal of Applied Toxicology, which published the research, stressed the need for more investigation. "Further work is required to examine any association between oestrogenic, and other, chemicals in underarm cosmetics and breast cancer," he said.

Despite previous suggestions that chemicals in deodorants and anti-perspirants may be adding to a rising incidence of breast cancer, charities stress that no evidence exists to support any link.
"Breast cancer is a complex disease and we do not yet understand all its causes," said Delyth Morgan, Chief Executive of breast cancer charity Breakthrough. "There has been a lot of discussion surrounding a link between anti-perspirants and the disease but there is still no scientific evidence of a causal link," she added.

Breast cancer is the most common cancer in women world wide, with one in nine UK women likely to develop the disease at some time in their life.

Article Source & Reference: SABC Health - http://www.sabcnews.com/world/europe/0,2172,71894,00.html, 2004/01/13

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Broad coalition launches new global alliance to prevent violence GENEVA - Ministers of health and other officials from countries around the world are today laying the foundation for the Global Interpersonal Violence Prevention Alliance (GIVPA). GIVPA will bring together national governments, United Nations agencies, academic institutions, civil society groups, and philanthropic and corporate foundations to advance the goal of preventing violence and reducing its adverse health and social consequences.

“Interpersonal violence kills 1,400 people every day and causes untold injuries and suffering," said WHO Director-General, Dr LEE Jong-wook. “This alliance is uniting a range of organizations and Member States around mutual violence prevention principles and policies and will strengthen our ability to address the problem.”

The creation of this alliance comes 15 months after the global launch of WHO’s World report on violence and health—the first comprehensive report of its kind to examine violence as a public health problem that causes 1.6 million deaths a year.

Governments around the world have already taken action on the report — undertaking violence prevention activities in more than 40 countries. National reports that examine specific country situations have been initiated in at least 10 countries. More than 15 governments have committed to developing a national plan of action for the prevention of violence.

In addition, significant resolutions have been adopted and policy debates have been the focus of international fora including major meetings of the WHO, the African Union, the United Nations Commission on Human Rights and the World Medical Association.

“Our shared understanding of the complex underpinnings of violence is essential to creating solutions that will prevent people from becoming victims and perpetrators,” said Dr Etienne Krug, Director, WHO Department of Injuries and Violence Prevention. “GIVPA will bring together strong partners in research and data collection, training, advocacy and prevention programmes. The continuing high trends of violence will not be reversed without this kind of commitment to cooperation and investment in prevention,” he added.

At today’s meeting, co-hosted by the government of the Republic and Canton of Geneva and WHO, leading decision-makers, from Belgium, Canada, Colombia, Costa Rica, Germany, Jordan, Mozambique, South Africa, the United Kingdom, the United States and the former Yugoslav Republic of Macedonia will examine the progress of violence prevention efforts in the last year and determine ways to continue to turn the report’s recommendations into action.

Article Source & Reference: World Health Organization - http://www.who.int/mediacentre/releases/2004/pr2/en/, 2004/01/13

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SA varsities sitting on Aids time bomb (Edwin Naidu) - South African universities and technikons are sitting on an HIV and Aids time bomb.

A survey has revealed that most students at tertiary institutions continue to have unprotected sex despite being aware of HIV and Aids and its dangers.

These students imagine they are immune to HIV infection and continue to practise unsafe sex, according to a study by University of Cape Town academics Fiona Ross and Susan Levine. Their study, based on interviews with 480 students between 19 and 30, found many had unprotected sex despite being aware of HIV transmission.

Reasons given to the researchers for the students' behaviour included: having gone too far without thinking, did not have condoms handy, being drunk, being in a long-term relationship and assuming it would be alright, among others.

Students interviewed also complained about HIV information fatigue. "We are sick and tired of hearing about Aids, Aids, Aids," said one student.

Details of the study, conducted in October 2002, were released by the newly formed higher education HIV and Aids programme (Heaids), which has launched Your Move, a CD-Rom of which 7 000 copies will be distributed to tertiary institutions throughout the country later this month.

It will be used in induction and initiation programmes for first year students, as a teaching aid, for skills development and on-campus clinics.

Some students canvassed by Ross and Levine revealed a shocking level of ignorance. Some said HIV and Aids was punishment for being promiscuous or having sex outside of marriage.

Another student suggested Aids was introduced as a measure of population control by white people, while another said the acronym stood for "American Idea to Destroy Sex".

Alternatively, the use of condoms was cited as socially acceptable. "It has become fashionable to say you are having protected sex," said one student.

"Every guy I know, even if they are not sexually active, has a condom in his wallet," added another.

One student reported that the distinctive shape of a condom in the back pocket of a tight pair of jeans sends a (not so subtle) message about sexual potency and availability.

Barbara Michel, programme director of Heaids, said the initiative aims to prevent, manage and eliminate HIV infection at universities and technikons.

Although statistics were not available, UNAids in its 2003 report said HIV infection in the country was highest among young people, especially girls between 15 and 24 and males aged 16 to 25.

"There is a lot of depression about HIV infection rates in South Africa, however, considerable good work is being done to curtail and manage the virus," she said.

Brian O'Connell, vice-chancellor of the University of Western Cape, said higher education institutions should provide leadership to tackle Aids.

He said the war would not be easy, but tertiary institutions must provide leadership, by developing comprehensive HIV and Aids policies, provide support and promote research.

Article Source & Reference: IOL Health - http://www.iol.co.za/index.php?click_id=125&art_id=qw1073816822667A320&set_id=1, 2004/01/12

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Many countries not on target to reach health-related Millennium Development Goals GENEVA - World Bank, World Health Organization convene high-level meeting to map out strategy for meeting health MDGs. 

The World Health Organization (WHO) and the World Bank yesterday warned that many developing countries will not be able to reach health-related Millennium Development Goals (MDGs) unless clear actions are taken, starting now and with a concerted effort over the next 12 years. More worryingly still, the organizations noted that the health Goals are particularly difficult to meet and that progress towards them is slower than towards some other MDGs.

The eight MDGs were set at the United Nations Millennium Summit in September 2000, where 189 countries committed to ambitious targets for improving the health and well-being of hundreds of millions of people in the developing world by 2015 . Four of the Goals relate to health: to reduce maternal mortality by three-quarters and child mortality by two-thirds, halve the proportion of people who suffer from hunger, combat HIV/AIDS, malaria and other infectious diseases, and improve access to safe drinking water and essential drugs.

"When these kinds of targets are set, it seems too soon to take urgent action, and then, after a few short years, it seems too late," said Dr LEE Jong-wook, Director-General of WHO. "Where the targets are the product of a large consensus there is also the hazard of everyone waiting for everyone else to risk making the first move. We still have time to avoid these pitfalls with the targets for 2015, but to do so we have to act now."

The World Bank estimates that progress against child mortality has so far been so slow that no sub-Saharan country in Africa is on target to reach that MDG. At the current pace in the developing world as a whole, only 16% of countries (representing 19% of the developing world’s population) are on track for this goal. Similarly, only 17% of developing countries are likely to meet the maternal mortality MDG; here, Latin America and the Caribbean are faring worst, with just 4.2% of countries on track to meet the target. In addition, only 40% of developing countries are on track to reach the malnutrition MDG.

"Even with general economic growth and faster progress on the non-health MDGs, many regions will still miss many of the health MDG targets. We need to look at measures such as committing increased resources to meeting the health-related MDGs, and using those resources more effectively in countries," said Mr James Wolfensohn, President of the World Bank. “Donor harmonization in resource mobilization and use, strengthening human resources in the health sector and improving monitoring and evaluation, through the optic of a strong country and equity focus, will be particularly important.”

Lack of progress towards the health MDGs is likely to affect progress towards other MDGs, such as those concerned with education. Furthermore, for example, access to clean water and education for mothers are both key determinants of infant and child mortality rates. Coming together in a high-level meeting in Geneva on 8 and 9 January, some of the most influential people in the development field, including representatives from concerned countries, development agencies and UN organizations will assess progress so far towards meeting the health MDGs, and most importantly, map out what needs to be done if the world is to stand a realistic chance of reaching those goals.

The meeting will note that slow progress in health is particularly distressing as many of the "technologies" needed to improve health are available and affordable. The difficulty is getting them to people: in other words, building strong health systems in all countries. Lack of resources is a huge constraint but that it is not the only issue. Delivering quality health services in poor countries is a complex challenge, involving human resources, reliable health information and ensuring that the poorest people are reached. Countries providing aid need also to work together better - both to raise more money and to ensure that advice given to poor countries is consistent. All these issues will be discussed in detail during the meeting.

Recognizing the complexity of the health agenda, participants represent a broad group with differing perspectives: Ministers of Finance alongside Ministers of Health, donor agencies alongside recipient countries. The meeting will issue a final communiqué which is expected to identify critical actions - both at the country and international community levels - which will facilitate the scaling up of interventions aimed at reaching the MDGs.

Article Source & Reference: World Health Organization - http://www.who.int/mediacentre/releases/2004/pr1/en/, 2004/01/09

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Snail venom drug relieves pain (HealthDayNews) - A novel, non-addictive drug derived from the venom of a marine snail provides significant relief for cancer and Aids patients who suffer from intractable pain.

Results of a new study indicate that more than half of these patients who don't respond to other painkillers found relief when they were given the drug, called ziconotide.

Snail a threatened species
Ziconotide is made of venom from the cone snail, which uses the toxin to immobilize both predators and prey. Scientists have warned the cone snail is fast becoming a threatened species because of pollution, overfishing, development and the exploitation of its beautiful shells. They fear the species could disappear before biomedical research can take full advantage of the analgesic properties of the venom.

1000 times more potent than morphine
Ziconotide is an entirely new, non-narcotic pain medication that is 1,000 times more potent than morphine without the problems of addiction or withdrawal. It works by blocking the N-type, neuron-specific, voltage-sensitive calcium channels, which are found at presynaptic nerve terminals.

A team led by Dr. Michael G. Byas-Smith, an assistant professor of anaesthesiology at Emory University Medical School, treated 111 patients with cancer or AIDS who had failed to find relief with other pain medications. The patients were randomly assigned to receive ziconotide or a placebo. Most of the patients were taking morphine at the start of the study. Ziconotide was given continuously through a pump that delivers a measured dose.

The researchers found 53 percent of the patients receiving ziconotide had moderate to complete pain relief, compared with 17.5 percent of the patients receiving the placebo. In addition, five of the patients in the ziconotide group had complete relief from pain. The findings appear in the Jan. 7 issue of the Journal of the American Medical Association.

Side effects could be a drawback
The drawbacks to ziconotide are the side effects, which occur when high doses are given, Byas-Smith says. The most common was an altered mental state, but other side effects include low blood pressure and dizziness.

Patients who have severe pain from AIDS or cancer, and who do not get good relief with morphine, can use ziconotide alone or in combination with morphine and achieve better pain management, he adds.

Ziconotide, Byas-Smith notes, seems to be most effective in relieving neuropathic pain, which does not respond well to morphine. Typically, you have to use an opiate and ziconotide to get the best pain relief, he says.

We have another weapon to control pain. But it remains an ongoing process to figure out who is going to respond best to this treatment, Byas-Smith says.

"Not the magic bullet"
Dr. Michel Y. Dubois, a professor of anesthesiology at New York University School of Medicine and director of the NYU Pain Center, says ziconotide is not the magic bullet.

Dubois notes that in his study with patients who had pain from other nonmalignant problems, the results were similar, with about half responding, and no one knows why. When it works, the relief does last, he adds.

Unfortunately, it's not as spectacular as we expected it to be. However, ziconotide does have a place in some patients who have uncontrolled pain from cancer and AIDS, Dubois says. But it is not going to revolutionise pain management.

Dr. Michael S. Leong, an assistant professor of anesthesia at Stanford University Medical Center, adds that his experience indicates that ziconotide can provide significant benefit for all types of intractable pain, including back pain, neck pain and other neuropathic pain.

In some cases, ziconotide may be more effective then morphine, he adds. However, ziconotide is expensive and difficult to administer and monitor, so its use will probably be limited.

Leong notes that trials using a combination of ziconotide and morphine are almost complete. He believes that when these drugs are used in combination, more patients will respond. Also, lower doses of each drug will be needed, thus reducing side effects.

Physicians are still learning how best to use ziconotide, he says.

Article Source & Reference: Health 24 - http://www.health24.co.za/news/Pain/1-935,25916.asp, 2004/01/08

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Nasal flu vaccine safe for kids (HealthDayNews) - Here's some good news for parents who have to drag their kids kicking and screaming to get their annual flu shot.

It turns out an influenza virus vaccine delivered as a nasal spray protects healthy children against certain strains of influenza, says a report in the January issue of The Archives of Pediatrics & Adolescent Medicine.

Doctors at the Scott & White Memorial Hospital and Clinic in Temple, Texas, found children who received the nasal vaccination were protected against influenza infection during the 2000 flu epidemic.

The study involved 2,794 healthy children aged 1.5 to 18 years who received the nasal vaccine at least once from 1998 to 2000. Their health was compared to 9,325 healthy local children who didn't get the vaccine and 16,264 children from other areas.

Nasal flu vaccine OK for kids older than 5
That is the kind of evidence that has led the American Academy of Pediatrics (AAP) to announce that nasal flu vaccines are safe for kids older than 5.

The announcement came as the AAP issued its 2004 childhood immunization schedule for the United States.

The AAP says the nasal vaccine is an acceptable alternative to the inactivated influenza vaccine for healthy people aged five to 49.

The AAP is currently considering joining the Advisory Committee on Immunization Practices and the American Academy of Family Physicians in recommending universal influenza immunization of all children between six months and 23 months old, as well as routine influenza immunization of all household contact and out-of-home caregivers of children younger than 24 months.

Previously, the academy has encouraged such immunizations but has not taken the step of formally recommending them. If such a change happens, the three groups will release an updated immunization schedule that reflects the new recommendations.

Article Source & Reference: Health 24 - http://www.health24.co.za/news/Flu_Influenza/1-912,25910.asp, 2004/01/07

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Angels with wings - and stethoscopes (Karyn Maughan) - While some have wings and others stethoscopes, Western Cape emergency and rescue workers have been the province's angels over the festive season.

But the doctors, emergency pilots, paramedics, technical rescuers, co-ordinators and volunteers who have kept this year's festive mortality rate at one of its lowest levels seem unlikely to seek praise for sacrificing their holidays to help those in need.

Rather than munching festive fare, popping champagne on New Year's Eve or recovering from their celebrations on New Year's Day, Red Cross Air Mercy Service (AMS) staff were rescuing and transporting emergency patients to various Cape Town hospitals.

According to Gary McCormick, Cape Town AMS base manager, this year's festive season was a "relatively busy" period for the non-profit organisation, which provides an air ambulance network and emergency rescue service to metropolitan areas and remote rural localities.

On the afternoon of New Year's Eve, the AMS Sky-Med 2 staff rescued a man and two young boys from the Hermanus mountains behind Maanskynbaai.

The boys, both under 10, had apparently started hiking on the mountain at 9am. Their father became worried when his sons failed to return and went to find them.

After discovering where they were, the man realised that he would not be able to reach them safely and contacted emergency workers, AMS staff said.

AMS co-ordinator Sandy van Wyk spent New Year's Eve organising the transfer of a 46-year-old George man - who had suffered a cerebral haemorrhage - to the Groote Schuur private ward.

The man arrived at the ward at 6am on New Year's Day and is in a stable condition.

On New Year's Eve morning a 75-year-old Calvinia man who had suffered a heart attack was transported to Panorama hospital.

On New Year's Day AMS transported an unconscious critically injured 30-year-old man - who received a closed head injury when assaulted on New Year's Eve - from Citrusdal to the Tygerberg Trauma Unit.

The same day AMS rushed a five-year-old girl, who had fallen three metres from the balcony of her grandmother's home, from doctor's rooms in Simon's Town to the Red Cross Children's Hospital. The child survived the fall with only an orbital fracture around her eye and was discharged the following day.

Iefan Blake, an AMS helicopter pilot for the past 18 months, was reluctant to be interviewed about his role in rescuing people from the waves, wind, mountains and remote rural areas.

Instead, he honoured the paramedics, rescuers and doctors he works with.

"I do this job because I am able to help people and make a difference indirectly, but they (his colleagues) are the people who save lives."

Formerly a South African Defence Force pilot for six years, Blake described his present job as "rewarding and interesting" - but said it could also be emotionally difficult.

His most challenging mercy flights involved rescuing people in windy weather or from locations close to mountains. "But I would never endanger the people I worked with by staying in a situation I wasn't comfortable with."

Blake said people rescued by AMS sometimes sent cards and letters, the children often sending pictures they had drawn for their rescuers.

Groote Schuur cutting registrar Dr Sean Burmeister, who worked in the trauma unit over the festive season, said the number of cases seen by the unit normally doubled over the period, and this year had been no exception.

The trauma unit would normally see about 22 cases on an ordinary weekday, Burmeister said. New Year's Day was the busiest of the festive season, with 53 cases. On Christmas Eve 46 patients required treatment - seven of them needed resuscitation. Christmas Day's patient load was 45 and New Year's Eve's was 43.

Most trauma cases involved bullet wounds, stabbings and car accident injuries, he said.

"Any period which involves time off and where people have greater access to alcohol tends to result in a greater number of trauma cases.

"We were expecting it to be busier than is was, but it was not as bad as we expected."

According to Burmeister, the most difficult cases for trauma staff involved patients who were drunk and still conscious and became aggressive when staff attempted to treat them.

"It is very hard to help someone who keeps pulling their drip out and fighting against the staff.

"Obviously we restrain patients as a last resort. Most people will calm down if you just talk to them and explain that you are trying to help."

Asked if he felt any disappointment about exchanging Christmas turkey for emergency surgery, Burmeister said working during the season was "part of my job".

"Sure, when it's four o'clock in the morning and a drunk guy with a stab wound is getting abusive, this kind of work is the last thing you feel like doing. But it's what I chose to do and, even if it sounds cheesy, I'm glad that I get to help people."

Burmeister said he appreciated the efforts of the nursing staff he worked with.

"They are the people who really give up an enormous amount to keep the ward running smoothly," he said.

Peter Adamo, station commander at the Hout Bay NSRI, said helping people over the festive season was "just a part of my life".

"I really don't see myself as having a choice. The station must be manned at all times," he said.

Adamo was part of a team that fought to resuscitate Time magazine photographer Edward Ruiz, 37, on Christmas Eve after he was washed into the sea at Noordhoek by a freak wave.

Despite the best efforts of 14 NSRI members he could not be saved.

Article Source & Reference: IOL Health -http://www.iol.co.za/index.php?click_id=125&art_id=vn20040105111420220C686597&set_id=1, 2004/01/07

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Nitric Oxide for Preemies CHICAGO (Ivanhoe Newswire) - Each year, about 60,000 babies are born prematurely, meaning they are born more than three weeks before their due date. Those little bodies often mean big health problems, but a new therapy may let little ones, and their parents, breathe a big sigh of relief.

Jorge Ramos, his wife Linda, and their daughter Sara look like any other family of three. “It’s the best thing,” Linda says. “There’s nothing better than being a mom, I can honestly say.” Jorge says: “It gives you a reason to live. You come home. You have something to look forward to.”

But Sara’s entry into the world was quite an event. She was born three months early and weighed less than two pounds. This was her first dress, her first diaper, and her first bathtub was a butter tub.

“I didn’t realize all the complications that were involved. I didn’t realize all the risks,” Linda says.

One of those risks is lung disease, a common condition in preemies. “It leads to an increased likelihood of developing asthma, an increased susceptibility to infections, and severe chronic lung disease can be associated with poor brain function later on,” says neonatologist Michael D. Schreiber, M.D., of University of Chicago Children’s Hospital.

Sara received an investigative treatment of nitric oxide that Dr. Schreiber was studying to reduce lung disease in preemies. He says, “Nitric oxide is an anti-inflammatory, and inflammation plays a major role in the development of chronic lung disease.”

A recent study shows a continuous dose of nitric oxide for one week reduced the risk of lung disease in preemies by 25 percent and reduced brain bleeds -- another common risk -- by nearly 50 percent. Dr. Schreiber says, “I think it’s one more tool that the neonatologists will have to help improve outcomes for these tiny little babies.”

It worked for Sara. Linda says, “We’ve had everything good, all good turnouts, and you can’t ask for more than that.”

Three different studies of nitric oxide are currently ongoing. Dr. Schreiber hopes these studies will clarify which preemies will benefit most from nitric oxide. If studies confirm the effect, he says doctors could use nitric oxide as an off-label treatment almost immediately in preemies, since it’s already approved for full-term infants. However, it could take at least a year to petition the FDA to approve it specifically for preemies.

Article Source & Reference: Ivanhoe - http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=7702, 2004/01/06

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Work out for good night's Zzz (HealthDayNews) - A little workout in the morning could translate into a lot more shut-eye at night, particularly if you are an older woman who has trouble sleeping.

Morning exercisers had fewer complaints about a bad night's sleep and those who stretched in the morning had somewhat better sleep, scientists at the Fred Hutchinson Cancer Research Center in Seattle report in the November issue of the journal Sleep. Women who exercise in the evening, on the other hand, were more likely to be up at night, they say.

Brisk walk is all it takes
The women in the study didn't need much morning activity to get the benefit. "It's like doing a brisk walk," researcher Anne McTiernan told the Associated Press. "Nobody is saying people have to be athletes and do marathons."

The research involved post-menopausal women between 50 to 75 who were cancer-free, and not exercising at the start of the project. Eighty-seven were placed in an exercise programme, which involved 45 minutes of walking or exercise bike, five days a week. Eighty-six women in a stretching programme, which was done for an hour a week under supervision and a half-hour three times a week on their own. Both groups were followed for a year.

Women who exercised, averaged 70 percent better sleep and women who stretched, averaged 30 percent better sleep, the study found.

Article Source & Reference: Health 24 - http://www.health24.co.za/news/Fitness/1-911,25582.asp, 2004/01/05

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South Africans like junk food far too much (Zondi Mahlangu) - Unlike their British and American counterparts, South Africans seem to be set in their ways when it comes to so-called junk foods.

According to a report in the London Daily Mail, "sales of Diet Coke have overtaken regular Coca-Cola for the first time in the UK as big brands feel the force of a backlash against fattening foods and drinks. Sales of Kit-Kat, the UK's top biscuit brand were down eight percent," the report said.

But Mike Sarr, head of communications for the South African Breweries, owners of both Sterling Light and Castle Light, says: "Our country is a long way away from that phenomenon".

"Our light market is extremely small compared to the American market where leading brands are beers such as Miller Lite and Bud Lite. The SAB sells 24,4 million hectolitres of beer a year, the light beer market is just less than half-a-million of that, says Sarr.

The corporate affairs manager of Nestle South Africa, Heather Robinson, says: "Although there is a growing global awareness of eating a healthy balanced diet, this has not affected sales of the company.

"Our sales have not been negatively affected within the chocolate and confectionery category. We have seen some growth in this market. We also do not believe that there is any reason to panic over the UK situation as that market is quite different from South Africa."

Sarr emphasises that locals still choose flavour and taste rather than look at the amount of carbohydrates and the amount of alcohol in the product. He adds: "Castle Light sells more products in the light market. It has an alcohol content of 4,5 percent compared to the five percent in the regular Castle. So there is really not much differences between the two".

Robinson attributes the change in what people eat to global trends such as "ageing populations and escalating healthcare costs".

She explains: "In the UK, in particular, there has been substantial media coverage on the increase in obesity amongst the population and the role that a balanced diet plays in maintaining a healthy lifestyle. In South Africa, the issue is no less important and consumers are becoming aware of the factors that contribute to their overall health".

Joburg-based registered dietician Carlette Julius agrees: "Yes, there is a growing awareness of making healthy food choices.

"Most people I see suffer from diabetes, high blood pressure, heart attacks caused by unhealthy foods. They do not exercise and are overweight. They are digging their graves with their knives and forks.

"But after consultations, the general response is such that people are in charge of their bodies. They start making the right choices," says Julius.

Article Source & Reference: IOL Health - http://www.iol.co.za/index.php?click_id=125&art_id=ct20040103101145502F313816&set_id=1, 2004/01/05

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Villagers rushed to hospital after meat scare (Sapa) - At least sixty people were rushed to a hospital near Port St John's in the Eastern Cape after apparently eating contaminated beef, SABC radio news reported on Friday.

The residents of Kuzele village, near Libode, experienced diarrhoea, vomiting and headaches on Thursday.

There were complaints of poor medical attention at the hospital. A doctor appeared after apparently being alerted that the Eastern Cape health MEC was flying in.

Enviromentalists and laboratory staff in Umtata will conduct tests on the meat.

Article Source & Reference: IOL Health - http://www.iol.co.za/index.php?click_id=125&art_id=qw1073026620582B243&set_id=1, 2004/01/02

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Survivors of Bam earthquake urgently require public health supplies and medicines GENEVA - The World Health Organization (WHO) emphasizes the urgent health needs of the tens of thousands of people affected by the recent earthquake in Bam, Islamic Republic of Iran. The health risks of exposure to cold night temperatures, inadequate access to safe water and sanitation, and insufficient care for people's injuries are amongst the many serious health concerns.

To date, at least 26, 700 people have been buried as a result of the Bam earthquake. Approximately 30,000 are injured, and more than 12,000 of these people have been admitted to hospitals in other parts of the country. In total, the earthquake destroyed approximately 20,000 homes of the 90,000 inhabitants.

The physical structures of the main hospitals in Bam, and several urban and rural health clinics, have also collapsed. Many medical staff and other health workers have been injured or killed. With the immediate response and the coordination efforts of the Ministry of Health and Medical Education, the Red Crescent and other sectors, sufficient manpower and facilities have been dispatched and are now providing preventive and curative health emergency services to all needing it.

Dr LEE Jong-wook, the Director-General of WHO, in his letter of condolences to the Minister of Health and Medical Education of the Islamic Republic of Iran, said: "The profound tragedy of thousands of people killed has caused emotional and psychological trauma for the tens of thousands of people who have survived. It is now imperative to ensure their mental and physical well-being to the fullest extent possible during this fragile period".

Dr Hussein A. Gezairy, the Regional Director for the WHO Eastern Mediterranean Regional Office, in his condolences message to the President and to the Minister of Health and Medical Education, reaffirmed the commitment of WHO to provide necessary technical and material support to the Islamic Republic of Iran. He said: "The priorities are to take care of the survivors, reduce the negative health impacts of the harsh environmental conditions on them, re-establish systems that keep a look out for communicable diseases and - if they are detected - make sure that they are quickly controlled, and re-start health care services ensuring adequate psychological counselling and care to those who survived the tragedy".

The Minister of Health and Medical Education, who is coordinating the overall health aspects of the response, has specified that there are many health needs. However, he has indicated that, at this stage, there is no further need for field hospitals or human resources, as most of the seriously wounded have been airlifted to health facilities in other cities, or treated in field and makeshift hospitals established in Bam.

Preliminary estimates by the Ministry of Health and Medical Education consider that the reconstruction and operationalization of the health system in Bam and its district, which still need an in-depth assessment, will require at least US$25 million.

To improve the health conditions of the earthquake survivors, WHO is now appealing for US$3.5 million for immediate use by the Iranian authorities to purchase supplies, rehabilitate health facilities and provide vital public and community health services.

Since the earthquake on 26 December, WHO has set up a team that is working with the Iranian Ministry of Health and Medical Education and local officials in the affected area. Team members include experts in emergency health care, epidemiology of diseases, information collection and analysis, environmental health, and health service planning. WHO experts are also ready to set up emergency teams to respond to disease outbreaks and contain epidemics.

To make sure that the external assistance now reaching the Islamic Republic of Iran is well used, national authorities are establishing coordination mechanisms. WHO is supporting the Iranian health authorities to coordinate assistance for health by helping to circulate information among partners, encouraging the discussion of needs and lines of action, and helping those concerned to reach consensus on how to get the best response to the health risks faced by all of those who are affected.

Article Source & Reference: World Health Organization - http://www.who.int/mediacentre/releases/2003/pr95/en/, 2004/01/02

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