What has ‘Public health’ ever done for us ?

An apple a day might not keep the doctor away. But a good public health team can keep the doctors away for many people!

Public health is about prevention and promotion of health in the society.

Public health is largely responsible for the significant improvements in life expectancy over the last 150 years.

Providing people with clean drinking water, removal of rubbish from houses and streets, good sewage system, and vaccination has saved many millions of lives over the years.

The recent smoking ban in work-places, public places and indoor venues is a modern example of public health activity.

The one area where public health has not been hugely successful is obesity. It may be because of the reliance on nudging the individual to change rather than dealing with underlying structural problems.

Read my letter in BMJ and make your views known at the BMJ rapid response section.

Sundar S. Public health needs to go back to basics, not rely on nudge theory.

Toll-free link:
http://bmj.com/cgi/content/full/bmj.n1153?ijkey=CUQNozGH9yJeK57&keytype=ref

References:

BMJ. Lifestyle and socioeconomic group on health
Public health needs to go back to basics, not rely on nudge theory
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1153 (Published 06 May 2021)
Cite this as: BMJ 2021;373:n1153

BMJ. Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2161 (Published 08 June 2010)
Cite this as: BMJ 2010;340:c2161

BMJ. Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n604 (Published 14 April 2021)
Cite this as: BMJ 2021;373:n604

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

New drug treatments for COVID-19

More good news in fight against COVID-19 pandemic !

Steroids were previously proven to be effective against severe Coronavirus (COVID-19) infection. The steroids are believed to work by dampening the inflammation caused by coronavirus.

Dexamethasone and Prednisolone are the commonly used steroids.

Now two other drugs have been reported to work in COVID-19 infection. (yet to be published).

Both the anti-inflammatory drugs are not entirely new drugs as they are already routinely used for treatment of various arthritis.

The BBC reports: “The anti-inflammatory medications, given via a drip, save an extra life for every 12 treated, say researchers who have carried out a trial in NHS intensive care units”.

The two drugs “tocilizumab and sarilumab” may become available for treatment of severe COVID-19 shortly.

All these additional drug treatments are needed ONLY for severe Coronavirus (COVID-19) infection. Mild COVID-19 infections do NOT need these drug treatments.

References . BBC news. Two more life-saving Covid drugs discovered. By Michelle Roberts. Health editor, BBC News online. Published 7 Jan 2021.

BBC news. Coronavirus: Dexamethasone proves first life-saving drug. By Michelle Roberts. Health editor, BBC News online. Published 16 June 2020

BBC News. Tocilizumab: Arthritis drug may treat severe Covid. By James Gallagher. Health and science correspondent. Published 19 November 2020

BMJ. Dexamethasone in management of covid -19. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2648 (Published 03 July 2020)
Cite this as: BMJ 2020;370:m2648

BMJ. Rapid Recommendations. A living WHO guideline on drugs for covid-19. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3379 (Published 04 September 2020). Cite this as: BMJ 2020;370:m3379

BMJ. Covid-19: Arthritis drugs improve survival in intensive care patients, shows study
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n61 (Published 08 January 2021)
Cite this as: BMJ 2021;372:n61

eMC. Sarilumab is a human monoclonal antibody selective for the interleukin-6 (IL-6) receptor, produced in Chinese Hamster Ovary cells by recombinant DNA technology. (Sarilumab, administered as a subcutaneous injection is routinely used for treatment of arthritis and is not an entirely new drug).

eMC. Tocilizumab is a recombinant humanized, anti-human monoclonal antibody of the immunoglobulin G1 (IgG1) sub-class directed against soluble and membrane-bound interleukin 6 receptors. (Tocilizumab, as a intravenous or subcutaneous formulation, is routinely used for treatment of various arthritis and is also not an entirely new drug).

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Hope and incurable Cancer: does hope torment or does it help to cope?

A diagnosis of incurable and advanced cancer is often a massive shock to everyone.

Should we ask them to face reality , accept death and extinguish all hope.

Or should we be offering hope of living a bit longer with treatments while being honest with prognosis.

Hope can be tormenting to some.

Hope can be comforting to some.

What are you views?

Contribute your views at online rapid response @BMJ journal

Don’t torment me with hope. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3016 (Published 09 September 2020)Cite this as: BMJ 2020;370:m3016

In defence of Hope: https://www.bmj.com/content/370/bmj.m3016/rr-3

Is Honey a better treatment for coughs and colds ?

Possibly yes, in some cases of viral infections , according to a paper published a BMJ group journal ( BMJ Evidence Based Medicine) .

The paper has been widely quoted in various newspapers today.

The BMJ group journal authors report: “Honey was superior to usual care for the improvement of symptoms of upper respiratory tract infections.

It provides a widely available and cheap alternative to antibiotics…….but further high quality, placebo controlled trials are needed.”

A word of caution: Honey has high sugar content. Diabetics need to be careful. People will allergies need to take care. Of course bacterial infections need antibiotics particularly in old and vulnerable!

References

1. BMJ Evidence Based Medicine. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis .

Abuelgasim H, Albury C, Lee J Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis BMJ Evidence-Based Medicine Published Online First: 18 August 2020. doi: 10.1136/bmjebm-2020-111336.

2. Guardian Newspaper:

3. Daily Mail.

4. BBC paper review .

5. Evening Express

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can you get Coronavirus infection more than once?

If you are one of the unlucky ones to have already been infected with Coronavirus infection but recovered from it, can you become unlucky again and get another Coronavirus infection later this year ?

Unfortunately, the answer is a YES.

Some Viral infections can sometimes lead to life long immunity. For example, most people who had chicken pox as a child tend to have lifelong immunity and it would be uncommon to get chicken pox again. (except in some circumstances).

But infection with ‘Coronavirus causing COVID-19’ doesn’t seem led to long lasting immunity or resistance to a second Coronavirus infection.

A Newspaper report on a study by a team from King’s College London suggests that susceptibility to a second infection may occur as short as 3 months in some patients. This because the level of antibodies produced by the immune system after first infection start to fade away within a few months in some patients.

If confirmed, this is probably one of the most worrying news during this pandemic.

This study result could also affect Vaccine development and how frequently it may need to be administered.

References

Guardian Newspaper: Coronavirus outbreak. Immunity to Covid-19 could be lost in months, UK study suggests. Ian Sample. Science editor. @iansample. Sun 12 Jul 2020 17.31 BST

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Cancer and COVID-19

Coronavirus infection seems to be more deadly in patients whose immune systems are not functioning very well.

So cancer patients who have reduced immunity due to chemotherapy are understandably at higher risk of death.

Among cancer patients, those patients whose cancer is progressing ( i.e cancer not under control ) seem to at even more from COVID-19.

A study presented at the ASCO ( American Society of Clinical Oncology) reports that ” after a COVID-19 diagnosis, patients with progressing cancer were found to be 5.2 times more likely to die within 30 days”.

So stay safe and consider shielding if your cancer is not under control .

Furthermore, there is lot of interest in use of Chloroquine, an anti-malaria drug for treatment of COVID-19. The study reports that “Treatment with the drug combination hydroxychloroquine and azithromycin was also strongly associated with greater risk of death”. So best to avoid unproven treatments outside a trial setting.

References

1. ASCO News. Early Data Show Cancer Progression Associated With Increased Risk of Death in Patients With COVID-19. May 28, 2020.

2. ASCO News. Chemo Within 3 Months of COVID-19 Diagnosis Associated With an Increased Risk of Death in Patients With Thoracic Cancer. May 2020.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Blaming the tools

Tools

Any one from any trade would be expected to use the tools of the trade appropriately.

Tweaking the tools unnecessarily or blaming the tools if things do not pan out as planned is generally frowned upon .

Same with medical professionals !

Please contribute your thoughts at BMJ rapid response page.

Interpreting test results: dont blame the tools

Access the article at: http://bmj.com/cgi/content/full/bmj.m1162

Toll-free link:
http://bmj.com/cgi/content/full/bmj.m1162?ijkey=sZarWS4YlJf9NS0&keytype=ref

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Crowdfunding expensive stem cell therapies

Crowd fund metaphor

If you have come across a desperate request to crowdfund an expensive stem cell therapy, read this well researched BBC article before you contribute.

Hope is a powerful driver particularly when someone is facing immense difficulties in life. Human beings have a natural inclination to fight against all odds and it seems to be inbuilt in our DNA and psyche.

But not all promising treatments do help desperate people searching for a cure.

Reference.

BBC news. The unwarranted hype of stem cell therapies. By Jules Montague. 21 August 2019

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

What’s in a name?

awareness cancer design pink Photo by Miguel on Pexels.com

The word cancer is a dreaded one. Not without a good reason. Cancer is the number one killer. Even when someone has a good outcome, the cancer journey is torture. Emotional turmoil is immeasurably horrendous.

But many people would be surprised to hear that there exists a category of low risk cancers. “Low-risk Cancers are cancers which usually don’t kill; These Cancers are found either incidentally on scans performed for some other reasons or found as part of routine cancer screening.”

Because they are not deadly, Should the patients diagnosed with low-risk cancers be spared the dreaded label of cancer?

Should low-risk cancers be labelled something else and the word cancer used only for the “serious” high-risk cancers ?

Personally, I do not agree with renaming of the low risk cancers..Others disagree

Joint the debate at the BMJ.

Submit your views through rapid response

Reference: 
Should we rename low risk cancers? BMJ

several assorted color tags Photo by rawpixel.com on Pexels.com

How to communicate that the disease is mild even though symptoms are disabling?

women s white long sleeved top

Beth McHugh makes a strong argument for doctors “not to explicitly discuss disease severity scale”.

But

(1) A valid informed consent would then become difficult

(2) Not discussing severity, is not a practical option for patients with certain illness.

My BMJ eLetter on this topic…

Risk categorisation will continue to be the norm in future as genomic data leads to personalised medicine.

England’s 100 000 Genomes Project