Why are ObGyns Talking Toxins ?

Let’s make environmental health part of health care

Doctors from 125 countries want policies to prevent exposure to toxic chemicals

Produced for PRHE by Susan Lamontagne, Public Interest Media Group, for the International Federation of Gynecology and Obstetrics (FIGO) XXI World Congress on September 30, 2015.

Why are Doctors Talking Toxins ?

And how to reduce exposure to toxic chemicals worldwide ?

It’s time to shift the burden of proof, from scientists, back to the chemical industry

Video published on 5 June 2019, by UCSF Program on Reproductive Health and the Environment.

Cancer of the cervix uteri

Half a million new cases of cervical cancer are added each year

Abstract

Since the publication of the last FIGO Cancer Report there have been giant strides in the global effort to reduce the burden of cervical cancer, with WHO announcing a call for elimination. In over 80 countries, including LMICs, HPV vaccination is now included in the national program. Screening has also seen major advances with implementation of HPV testing on a larger scale. However, these interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for management of these cases. The FIGO Gynecologic Oncology Committee has revised the staging system based on these advances. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.

Reference.

Environmental threats to human health

FIGO Media Briefing, Environmental Health, London, 1 October, 2018

In the last 40 years, there has been a global increase in human exposure to a variety of potentially toxic chemicals in the environment.

Research shows that whether we are concerned with reproductive health, cancer, infertility, neonatal and childhood health or neurodevelopment; toxic exposures are implicated.

World leaders have acknowledged that minimising environmental threats to human health and reproduction is a necessity if we are to substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination, and therefore progress towards the 2030 Agenda for Sustainable Development (SDGs).

“We are at the very beginning of a tsunami that will require local leadership: California has placed a priority on energy independence which can improve air quality and reduce birth defects, prematurity, asthma and heart disease. The European Union has limited exposure to endocrine disruptors. China instituted a host of measures in 2013, so that by 2018 there has been a reduction of air particulate matter by 32%. They declared a war on pollution and are winning!”

Jeanne Conry, MD, PhD, Co-Chair, FIGO Working Group on Reproductive and Developmental Environmental Health, USA.

91% of the world’s population lives in places where air quality exceeds WHO guideline limits. Air pollution is a major environmental risk to health. By reducing air pollution levels, countries can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma. The lower the levels of air pollution, the better the cardiovascular and respiratory health of the population will be, both long- and short-term.

“Our first challenge is awareness: Most clinicians are not aware that environmental exposures impact health. Most of us assume that the chemicals released into the environment, that we are exposed to as we apply make-up, prepare food, or breathe air, have been studied. They have not. Clinicians need to understand that the lack of research doesn’t mean they are safe, and makes the burden of proof very difficult, because our patients are exposed repeatedly to many chemicals in many ways through many types of exposure”.

Jeanne Conry, MD, PhD, Co-Chair, FIGO Working Group on Reproductive and Developmental Environmental Health, USA

This month, October 14 – 19, over 10,000 health professionals are attending FIGO World Congress 2018 in Rio de Janiero. Environmental Health is a core theme throughout the event, with key sessions being covered include:

  • Impact of Environmental Toxics on Global Women’s Health
  • Environmental Reproductive Health and the Heath Care Provider: Evidence based approaches to providing advice
  • Research agenda to illuminate how the environment affects reproductive and developmental health
  • “Training the Trainers” to talk with their patients and the public about environmental impacts on health

“Our challenge is priorities: When we are faced with maternal mortality, cancer, and violence, it may seem we do not have the “band width” or capacity to discuss the environment. BUT we need to help clinicians understand they are equipped to discuss this subject and lead their patients in awareness, and that advocacy for change is essential”.

Jeanne Conry, MD, PhD, Co-Chair, FIGO Working Group on Reproductive and Developmental Environmental Health, USA.

Reference.

Ce que les soignants doivent savoir du marketing pharmaceutique dans l’Union Européenne

Information ou influence ? Traduit en français par la Troupe du RIRE

Les professionnels de santé sont fortement exposés aux activités marketing de l’industrie pharmaceutique. Plusieurs études montrent que l’exposition à l’information provenant des laboratoires pharmaceutiques ne conduit pas à une amélioration de la prescription. Au contraire, cela peut nuire à l’objectivité de la prescription et au professionnalisme des prescripteurs.

Fait ou fiction? Ce que les professionnels de la santé doivent savoir sur le marketing pharmaceutique dans l’Union européenne

Avec un accent particulier sur la promotion pharmaceutique dans l’Union européenne, ce nouveau guide de Health Action International enseigne aux étudiants à identifier et évaluer les méthodes utilisées dans les activités de promotion pharmaceutique, ainsi que leur impact sur la pratique clinique et la santé publique. Ils développent également la capacité d’évaluer de manière critique les activités de promotion pharmaceutique d’une manière qui préserve l’accès aux médicaments.

Comprendre et répondre à la promotion pharmaceutique: un guide pratique

Publié en collaboration avec l’Organisation mondiale de la santé en 2010, ce livre enseigne aux étudiants les techniques de marketing utilisées par l’industrie pharmaceutique. Il leur donne également les compétences nécessaires pour analyser de manière critique le marketing pharmaceutique et accéder à une information de meilleure qualité, impartiale et indépendante sur les médicaments.

Le guide est largement utilisé dans le monde entier par les facultés de médecine, de dentisterie, de pharmacie, de sciences pharmaceutiques et de santé publique en tant que complément du Guide de l’OMS pour une bonne prescription.

Understanding and Responding to Pharmaceutical Promotion

A Practical Guide, 2010

Patients place great trust in doctors and pharmacists to properly prescribe and dispense medicines. But health professionals receive little to no instruction on how to critically assess pharmaceutical marketing. Many of them underestimate the influence that industry marketing has on their prescribing and dispensing practices.

Published in collaboration with the World Health Organization in 2010, this book teaches students about the marketing techniques used by the pharmaceutical industry. It also equips them with skills to critically analyse pharmaceutical marketing and access better-quality, unbiased and independent information on medicines.

Understanding and Responding to Pharmaceutical Promotion: A Practical Guide is used widely around the world by faculties of medicine, dentistry, pharmacy, pharmaceutical sciences and public health as a companion to the WHO’s Guide to Good Prescribing.

Guide to Good Prescribing – A Practical Manual

A World Health Organization resource, 1994

Abstract

Pharmacology training for most medical students concentrates more on theory than on practice. The material is often drug centred and focuses on indications and side effects of different drugs. But in clinical practice the reverse approach has to be taken, from the diagnosis to the drug. Moreover patients vary in age, gender, size and sociocultural characteristics, all of which may affect treatment choices. Patients also have their own perception of appropriate treatment and should be fully informed partners in therapy. All this is not always taught in medical schools, where the number of hours spent on therapeutics may be low compared to traditional pharmacology teaching. As a result although pharmacological knowledge is acquired, practical skills remain weak.

This training manual meets that need. It provides step by step guidance to rational prescribing and teaches skills that are not time limited but which remain valid throughout a clinical career. It demonstrates that prescribing a drug is part of a process that includes many other components. The manual explains the principles of drug selection and how to develop and become familiar with a set of drugs for regular use in practice, called P(personal)-drugs. Practical examples illustrate how to select, prescribe and monitor treatment, and how to communicate effectively with patients. The advantages and disadvantages of different sources of drug information are also described. The manual can be used for self-study or as part of a formal training programme.

Although intended primarily for undergraduate medical students who are about to enter the clinical phase of their studies, postgraduate students and practising doctors may also find it a source of new ideas and perhaps an incentive for change.

Early childhood health

Maternal, newborn, child and adolescent health

Every young child deserves to thrive

An estimated 43 percent—249 million—of children under five in low-and middle-income countries are at an elevated risk of poor development due to extreme poverty and stunting.

Air Quality in Europe 2017

European Environment Agency regular assessments of Europe’s air pollutant emissions, concentrations and their associated impacts on health and the environment

Based upon the latest official data available from countries, this updated 2017 report presents new information, including:

  • updated data on air pollutant emissions and concentrations, and urban population exposure (for the year 2015);
  • updated assessments of total population and ecosystems exposure data, and air quality impacts on health (for the year 2014);
  • a sensitivity analysis of the health impact assessments, considering two different counterfactual concentrations for particulate matter (PM) with a diameter of 2.5 µm or less (PM2.5) and nitrogen dioxide (NO2).
  • a summary of emissions from agriculture and how they impact on air quality and climate change, which in turn impact on agricultural yields. Selected examples of measures that may mitigate emissions of air pollutants and greenhouse gases are provided.

Executive summary

Air pollution is a key environmental and social issue and, at the same time, it is a complex problem posing multiple challenges in terms of management and mitigation of harmful pollutants. Air pollutants are emitted from anthropogenic and natural sources; they may be either emitted directly (primary pollutants) or formed in the atmosphere (as secondary pollutants). They have a number of impacts on health, ecosystems, the built environment and the climate; they may be transported or formed over long distances; and they may affect large areas. Effective action to reduce the impacts of air pollution requires a good understanding of its causes, how pollutants are transported and transformed in the atmosphere, and how they affect humans, ecosystems, the climate, and subsequently society and the economy.

The current report presents an updated overview and analysis of air quality in Europe from 2000 to 2015. It reviews the progress made towards meeting the air quality standards established in the two European Ambient Air Quality Directives, and towards the long-term objectives of achieving levels of air pollution that do not lead to unacceptable harm to human health and the environment. It also presents the latest findings and estimates on population and ecosystem exposure to the air pollutants with the greatest impacts and effects on human health and the environment. The evaluation of the status of air quality is based mainly on ambient air measurements, in conjunction with data on anthropogenic emissions and their evolution over time.

Air quality policies have delivered, and continue to deliver, many improvements. Reduced emissions have improved air quality in Europe, and, for a number of pollutants, exceedances of European standards are rare. However, substantial challenges remain and considerable impacts on human health and on the environment persist. A large proportion of European populations and ecosystems are still exposed to air pollution that exceeds European standards and, especially, the World Health Organization (WHO) Air Quality Guidelines (AQGs).

Effective air quality policies require action and cooperation at global, European, national and local levels, which must reach across most economic sectors and engage the public. Holistic solutions must be found that involve technological development and structural and behavioural changes. These will be necessary to achieve human wellbeing and social development, to protect the natural capital and to support economic prosperity, all of which are part of the European Union’s (EU) 2050 vision of living well within the limits of the planet.

The world is running out of antibiotics, WHO report confirms

Too few antibiotics in pipeline to tackle global drug-resistance crisis, WHO warns

A new report, Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis, launched this week by WHO shows a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.

Most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections identified by WHO as posing the greatest threat to health, including drug-resistant tuberculosis which kills around 250 000 people each year.

“Antimicrobial resistance is a global health emergency that will seriously jeopardize progress in modern medicine,”
“There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery.”

says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.

In addition to multidrug-resistant tuberculosis, WHO has identified 12 classes of priority pathogens – some of them causing common infections such as pneumonia or urinary tract infections – that are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only 8 are classed by WHO as innovative treatments that will add value to the current antibiotic treatment arsenal.

There is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli) which can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

There are also very few oral antibiotics in the pipeline, yet these are essential formulations for treating infections outside hospitals or in resource-limited settings.

“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,”

says Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) set up the Global Antibiotic Research and Development Partnership (known as GARDP). On 4 September 2017, Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust pledged more than €56 million for this work.

“Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years,”
“If we are to end tuberculosis, more than US$ 800 million per year is urgently needed to fund research for new antituberculosis medicines”.

says Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme.

New treatments alone, however, will not be sufficient to combat the threat of antimicrobial resistance. WHO works with countries and partners to improve infection prevention and control and to foster appropriate use of existing and future antibiotics. WHO is also developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.