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Recent rapid responses
Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on bmj.com. Although a selection of rapid responses will be included as edited readers' letters in the weekly print issue of the BMJ, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window.
Displaying 1-4 out of 4 published
13 September 2011
Harmful effects of Tobacco and Alcohol were known to the ancient Hindus 6000 years back. Two modern religions (Islam and Christianity) started nearly 2000 years ago, also looked down upon these two as evils. History will never forgive us for turning a blind eye to the miseries of billions of humans who have died miserably only to give livelihood to few million and allow hundred odd business houses to amass vulgar profits. HIV, Terrorism, Natural Disaster, Global warming etc together kills less than those killed by tobacco and alcohol but they caught the attention of world much earlier. I am sorry for being impolite. I work with patients and their families who are ultimate victims of this state-supported genocide. Dead bodies of my patients and cries of their dear ones always haunt me.
Of the four causative agents of the NCDs, Tobacco and Alcohol are predominantly "industry driven" where as the other two (unhealthy diet and lack of exercise) are predominantly "behavior driven". The control of "industry driven" factors requires one sensible Head of State and he/she can save millions of lives. Whereas, to change the behavior one needs to work with millions to save one life. It is logical that changing the behavior of the Head of State will have a far reaching impact than attempting to reform their subject. It is ridiculous that Bhutan is the only nation that has banned tobacco. It always baffles me why tobacco control pundits are always afraid to use the word "ban or eradicate" when the same is the "selling point" for the communicable diseases. How can a massive group of powerful leaders and intellectuals look dwarfs against a bunch of shrewd business people? Opium has been banned despite being the raw material for several crucial pain killers and life saving medicine. Tobacco has no usage what so ever except causing death and disability but continues to be a profitable consumer good. People outside are suspecting seriousness of UN in preventing the NCDs and they believe that it is only making a platform for the medical and biomedical industry to make a killing.
Tobacco is the "weapon of mass destruction". Do we have the courage to invade those countries that protect and patronize it? It is unfortunate that most nations have decided to give priority to revenue over the suffering of their countrymen. Why cannot we put sanctions on those countries that do not follow the basic tenets of the NCD prevention? I am sure that political patronage will disappear if World Bank and other similar funding agencies link the disbursal of funds to positive actions to prevent NCDs.
We are losing thousands of lives every day....it is a matter of urgency. We have discussed this issue ad nauseam for several decades, now it is time for affirmative action. I sincerely urge every Head of State present here to change their outlook towards tobacco and alcohol ......it may kill their own children and grandchildren tomorrow.
Competing interests: None declared
Tata Memorial Hospital, Mumbai
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2 September 2011
The current standstill in the negotiations of the United Nations High -Level Meeting (HLM) on Non-Communicable Diseases (NCDs)  member states has shocked the international community. Judging from articles written in The New York Times, the Financial Times, the Huffington Post and even Le Monde, morale is at its lowest for a conference which promised to be a historical landmark in global health .
NCDs, such as obesity, type 2 diabetes and certain cancers, have been at the center of global health discussion for quite some time now. This group of diseases, once traditionally considered restricted to developed nations, is now becoming a real issue for the developing world where nearly 80% of NCD deaths occur [2, 3]. If no plans are made to combat NCDs it is feared they will kill more people in Africa than Communicable Diseases such as HIV and malaria which have been traditionally associated with the continent .
The Moscow Conference which took place in April marked a first step in the international community's recognition of the threat of NCDs. One of the reasons behind the enthusiasm is the fact that these diseases are generally avoidable by removal of risk factors. 80% of type 2 diabetes and heart problems as well as 40% of cancers would thus be avoided with increased physical activity, an improved diet and no exposure to tobacco .
Following the Conference, a United-Nations High Level meeting was scheduled with the idea of establishing a global action plan to put a halt to the NCD pandemic. Unfortunately, discussions have been recently put on halt as a conflict has emerged between the G77 and a group formed by the USA, Canada and the European Union. The main areas of discourse concern the financial aspect of the plan as well as the difficulty of quantifying the objectives and feedback on set targets. And these countries do have a point.
With the financial crisis affecting all nations, the idea of having to provide more financial aid to foot a global effort to reduce NDCs is one that may seem hard to imagine for many governments that already have to cut costs elsewhere. But as Andrew Jack from the Financial Times suggests the extra resources could be generated by taxing the risk factors themselves . Creating a global equal tax for tobacco products could for example contribute to the budget for the global fight against NCDs all the while (financially) deterring individuals from using one of the main risk factors for certain cancers. Nalini Saligram and Sandeep Kishore explain the financial issue from a different perspective . In their view the current budget is not enough to support a global initiative and although more financial contribution will be needed at first they will eventually result in savings in the long term as the cost of preventing becomes less than the cost of treating .
The objectives set out by the UN HLM to combat the pandemic of NCDs need to be achievable. As Margaret Chan, director general of the WHO, stated in her review of the Zero Draft , these need to be quantifiable and therefore clear measurable targets should be set. Just as the member states agreed only recently to treat 15 million people with HIV by 2015, so they should agree on a practical target for NCDs such as reducing preventable deaths from NCDs by 25% by 2025, suggests Ann Keeling, chair of the NCD Alliance . Measurable targets will enable realization of the scale of the task and help generate more interest in methods of combating the problem; furthermore these can always be readjusted when a review of the progress is done.
One final point to add to Deborah Cohen's Feature Article in the BMJ  is the regulation of salt and sugars (as well as saturated fats etc.) in ready-made foods. They represent a risk factor group which contributes to the risk of contracting NCDs  and as thus their use should be governed by international regulations, suggests Jorge Alday, director of the World Lung Foundation.
We now have to wait for the discussions to continue and await with eagerness the results of the UN HLM. In the meantime it is up to us health professionals and medical students to continue to challenge the international community with debates and discussions. As future policy makers and implementers, recent medical graduates and medical students in particular should aim to take part in this debate through initiatives such as the Young Professional Chronic Disease Working Group, an online discussion group. In any situation, the discussions need to press on and differences be put aside so as to put a halt to a pandemic responsible for nearly 100,000 deaths a day.
2. Global Status Report on Noncommunicable Diseases 2010. WHO 2011. Available at: http:// www.who.int/chp/ncd_global_status_report/en/index.html (accessed 30 May 2011)
3. Global Status Report on Noncommunicable Diseases 2010. WHO 2011. Available at: http://www.who.int/chp/ncd_global_status_report/en/index.html (accessed 30 May 2011)
4. Chronic Disease Report. World Health Organisation. 2005. Available at: www.who.int/chp/chronic_disease_report/media/CANADA.pdf. Accessed on 26 August 2011
5. Jack A. Efforts to tackle diseases under threat. Financial Times. 18 August 2011. London
6. Saligram N, Kishore SP. We Need Measurable Outcomes From The UN High-Level Meeting on NCDs. Huffington Post. 17 August 2011.
7. Rijken PM, Bekkem N. Chronic Disease Management Matrix 2010. Results of a survey in ten European countries. On behalf of the European Forum for Primary Care. NIVEL, Dutch Institute for Health Services Research, 2011.
8. Draft outcome document of the High-level Meeting on the prevention and control of non-communicable diseases". United Nations; published 23 June 2011. Available at: http://www.un.org/en/ga/president/65/issues/ncdiseases.shtml (accessed on 28 June 2011).
9. Kelland K. Europe and US accused of stalling UN disease talks. Reuters. 17 August 2011.
10. Cohen D. Will industry influence derail UN summit? BMJ 2011; 343:d5328
11. Grant W. The Political Economy of Food Governance. International Studies Review. Volume 13, Issue 2, pages 304-309, June 2011
Competing interests: Member of the Young Professional Chronic Disease Working Group
Global Brigades ASG-UK
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28 August 2011
This report by Deborah Cohen on the politics and influences behind the story is to the point in worrying if anything valuable will be agreed. For the governments and donors on the consumer sides, agreements may be real problem unless the investigations and drugs having no impact or negative impact on the CURE RATE of the relevant disease(S) are not prohibited or at least restricted. Industry including private medical practice being commercially oriented may press for continued experimentation and evidence irrespective of impact on cure rate. Hopefully something will surely come out on chronic non-infective diseases which often have underlying unread infective and in-festive basis too.
Competing interests: None declared
JNMC, AMU, Aligarh, India
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25 August 2011
That the UN Summit on AIDS ten years ago was already a success even during its planning stages is just one of the glaring differences between NCDs and AIDS, or almost any other health issues with existing programs for that matter.
From a certain perspective, the care for NCDs is generally unexciting. Aside from some forms of cancer, there is no race for cure; only the long, arduous, unpredictable, and often costly trek of case management to control the conditions, and people afflicted of NCDs will eventually die of their disease. A utilitarian versus libertarian debate may lead one to conclude that people with NCDs will only cause further strain on already heavily-burdened health systems and economies, thus it is better not to care for them anymore in the hope that they will die sooner and ease some of the burdens that they impose.
Prevention of NCDs by addressing certain risk factors as was proposed in the NCD Alliance outcome document (http://www.ncdalliance.org/sites/default/files/resource_files/UN%20High-...) is equally unexciting. The maximum benefits of the efforts - decreasing prevalences of NCDs - may no longer be reaped during the lifetime of those who will advocate, initiate and/or fund any NCD control or prevention programs. From a business point of view, the seeming balance between the "hand that doles out the food" with "the hand that takes away the food" becomes lost when dealing with the care and prevention of chronic diseases. Donors will not get a good deal of tangible returns from their investments on NCDs; what takings would one expect if the main strategies would be increasing physical activity and reducing use or intake of harmful or health risk products? Compared to AIDS, TB, or malaria to cite a few, there will probably be less involvement of (commercially-inclined) industries who are usually tapped to deliver a number of goods related to these disease programs and to embark on related researches which in turn may produce more marketable goods. Conversely, commercial industries might suffer from profit losses if the calls for reformulation, higher taxes and more strict regulations are enforced. If this happens, they will reflect their losses on society. This leads to the argument that donor countries will likely tend to lose more than what they are willing to give if they support strategies such as strict regulations and restrictions of health risk products. It seems that the prevention and control of NCDs ask too much, and the word "altruism" is yet to be personified.
Very sadly, the only conclusion that could be drawn now seems to be that both control and prevention of NCDs are not lucrative for these people; and inequities will always reverberate from inequalities that arise within and between societies because of this.
Competing interests: GMVKu is a member and one of the spokespersons of the Network 'Switching International Health Policies and Systems' (SWIHPS), an international network of individuals and institutions to disseminate and exchange information, expertise and practice to contribute to stronger health systems and improved policy making. The network has a strong thematic focus on the organization of care for chronic diseases in low income countries. The secretariat of the network is hosted by the Institute of Tropical Medicine Antwerp, Belgium.In addition, GMVKu was diagnosed with diabetes mellitus type 2 at the age of 30, She has been able to control her NCD for the past 11 years without any occurrences of life-threatening complications or co-morbidities; and has been a useful member of the society with a number of contributions especially in the field of Family & Community Medicine in the Philippines. Currently, she is involved in the organization of community-oriented primary care for diabetes in several sites in the Philippines.
Veterans Memorial Medical Center, Philippines / Institute of Tropical Medicine, Belgium
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