Stem cell therapies: medical experts call for strict international rules

Experts from 15 countries tell regulation needed to prevent vulnerable patients pursuing unproven and potentially deadly treatments

Medical and legal experts from around the world have unified to call for more stringent regulation of stem cell therapies to prevent people pursuing unproven and potentially deadly treatments overseas.

In a perspective piece for the US journal Science Translational Medicine, 15 experts from countries including the UK, the US, Canada, Belgium, Italy and Japan wrote that national efforts alone would not be enough to counter an industry offering unproven therapies to vulnerable patients.

Stem cell-based interventions are classified under diverse and potentially incompatible national regulatory frameworks, the authors wrote.

Approaches for international regulation not only need to develop consistent regulations over the commercialisation of medical practices and products but also need to give them teeth by developing cross-border partnerships for compliance.

Stem cells found in bone marrow and umbilical cord blood have long been used to successfully treat blood cancers including leukaemia and some immune illness. But those are among the few proven therapies. Legitimate and ethics-approved clinical trials by academic centres are also resulting, investigating the potential of stem cells to treat a wider range of diseases.

But some physicians are directly offering to the general public stem cell treatments for illness still under clinical trial or for which no evidence exists and for which the safety and efficacy is as yet unproven.

Deaths as a result of stem cell treatments have already resulted. In 2013 Sheila Drysdale died in a New South Wales nursing home after undergoing an unproven liposuction stem-cell therapy at a western Sydney clinic. Following Drysldales death, her doctor, Ralph Bright, gave a statement to police in which he claimed that stem-cell therapy could improve comorbidities and that stem cells could move from joints to other parts of the body to improve illnes in distant sites including lungs and brain, vision, mentation and pain.

In his report into Drysdales death, the coroner Hugh Dillon wrote that he could not say what motivated Dr Bright to perform this unproven, dubious procedure on Sheila Drysdale.

But regardless of his motivating, Dr Brights performance as a medical practitioner was, for the reasons outlined above, poor and resulted in Sheila Drysdales death.

The Medical Council of NSW investigated Bright and placed a number of restrictions on his right to practise. Bright is still authorised to practise stem cell therapy for patients with osteoarthritis or who are taking part in research studies approved by an ethics committee. He is also still allowed to treat patients returning for remaining injections of stored cells.

In 2013 a Queensland woman, Kellie van Meurs, died when she travelled to Russia to undergo stem-cell treatment for a rare neurological disorder. She died of a heart attack as a result.

Australias drug regulator, the Therapeutic Goods Administration, last year sought feedback on the regulation of autologous stem-cell therapies but is yet to publish those submissions. A TGA spokeswoman said the Administration was still examining the options for changes to the legislation to reflect public and industry opinions. The TGA currently considers autologous therapies, which involve treating someone with their own tissue or cells, to be a therapeutic good and, hence, does not govern them. Stem cells used for medical practise and therapeutic purposes are covered by different regulatory frameworks.

Associate Professor Megan Munsie, a University of Melbourne stem cell scientist and a co-author of the paper, said: The notion that stem cells are magical holds court in the community, along with this idea the advances in treatment are being held up by red tape.

Unethical health practitioners exploited this, she said, along with the vulnerability of patients with difficult-to-treat or incurable conditions.

There is a precedent for international regulation of this industry because regulations already exist around narcotics the way they are manufactured, she said.

This could be extended to the regulation to the stem cell and tissue-based therapies. This international stance would then force or foster stronger local regulations.

There have been successful endeavors by scientists to push back against unscrupulous physicians. In Italy scientists and regulators highlighted the unproven yet government-subsidised treatments being offered by the entrepreneur Davide Vannoni and fought to stop him. He was convicted of criminal charges but the sentence was subsequently suspended.

Read more: www.theguardian.com

The hard truth about back ache: don’t will vary depending on medications, scans or quick fixes | Ann Robinson

Most treatment is wasteful, wanton and incorrect, tells the Lancet. The key is to try to keep walking and working, tells the GP Ann Robinson

Back pain is the biggest cause of disability globally, and most of us will have at least one nasty bout of it. But treatment is often wasteful, wanton and incorrect,according to a series of papers in the Lancet.” Worldwide, overuse of inappropriate tests and treatments such as imaging, opioids and surgery entails patients are not receiving the right care, and resources are wasted ,” it says.

It’s perfectly understandable to want a quick-fix solution to construct the ache go forth and maybe a scan to set your intellect at rest. But there isn’t a reliable instant answer. Scans don’t induce you better, and analgesics can be harmful. The vast majority of low back pain is musculoskeletal– caused by damage caused to ligaments, joints and muscles surrounding the spine. A tiny percentage is due to a serious or dangerous underlying cause that it was necessary to specific diagnosis and intervention- such as cancer, infection or a fracture.

An underlying cause is more likely if you have so-called red-flag symptoms; previous or current diagnosis of cancer, fever, unexplained weight loss and sweats, night ache, ache in the middle of your back rather than lower, inability to stand, urinate or open your bowels, or severe and unremitting pain that is getting worse.

The good news is that if your backache is musculoskeletal- and it usually is- 90% of cases will be better within six weeks. And that is irrespective of what you do. There’s no good proof that interventions, ranging from Tens machines( which use a mild electric current ), acupuncture, physio, osteopathy and chiropractic to epidural injections and surgery, significantly affect the outcome. Prolonged bed rest- still advocated in some countries- is positively dangerous, as it can cause blood clotting( thrombosis) and builds recovery from back pain less likely.

‘The
‘ The proof may not be great but it’s cheap, safe and happens to work for me .’ A Tens machine. Photo: Alamy Stock Photo

It’s seducing to wishing a scan or special investigations if you develop back ache. But scans don’t correlated well with symptoms; you can have a dire-looking scan with no symptoms or a fairly normal-looking one with dreadful pain. A scan is useful for surgeons if you need an operation, and other imaging is important if an underlying fracture is suspected. If your back pain was made in association with an underlying inflammatory condition like Crohn’s, ulcerative colitis or psoriasis, you will need investigation and referral to a rheumatologist.

The key to recovery is to try to keep walking and operate. Different approaches help different people; it’s good to find the least risky option that suits you. My own favourite is a Tens machine: the evidence may not be great, but it’s cheap, safe, and happens to work for me.

Painkillers can be useful in the short term, if that’s the only way you can move up. There are two main groups of effective painkillers, and they both come with health warnings: non-steroidal anti-inflammatories, ( NSAID ) such as ibuprofen, and opioids such as tramadol. There is already an epidemic of opioid overuse and addiction in the US, with Europe and lower-income countries catching up fast. NSAIDs are less addictive but can cause heart, kidney and intestine damage if used for more than a few days at a time.

Prof Nadine Foster of Keele University, one of the authors of this series of papers, says:” In many countries, painkillers that have limited positive impacts are routinely prescribed for low back ache, with very little emphasis on interventions that are evidence-based, such as exercisings. As lower-income countries respond to this rapidly rising cause of disability, it is critical that they avoid the waste that these misguided practises entail .”

One in three people who has an episode of low back pain will have a recurrence in the following year. So it is important to look at adaptations to the workplace, avoiding heavy lifting and concentrate on core muscle strengthening with pilates, swimming and some types of yoga once you recover from the acute attack.

Prof Jan Hartvigsen, of the University of Southern Denmark, who also contributed to the Lancet series, tells:” Millions of people across the world are getting the incorrect care for low back ache. Protection of the public from unproven or harmful approaches to managing low back ache requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interest, and financial and professional incentives that maintain the status quo … Funders should pay merely for high-value care, stop fund ineffective or harmful tests and therapies, and importantly intensify research into prevention, better tests and better treatments .”

He’s right, of course, but there is no point withdrawing funding without any explain. Healthcare professionals need to take the time to explain to patients that it’s not vindictive cost-cutting that is behind the restriction of access to scans and drugs. It’s in everyone’s best interests that we stop seeking bad medication and invest in detecting better and safer solutions to this global problem, which is likely to affect all of us sooner or later.

* Ann Robinson is a GP

Read more: www.theguardian.com

The hard truth about back pain: don’t rely on drugs, scans or quick fix | Ann Robinson

Most treatment is wasteful, wanton and wrong, says the Lancet. The key is to try to keep walking and working, says the GP Ann Robinson

Back pain is the biggest cause of disability globally, and most of us will have at least one nasty bout of it. But treatment is often wasteful, wanton and wrong,according to a series of papers in the Lancet.” Worldwide, overuse of inappropriate testing and therapies such as imaging, opioids and surgery entails patients are not receiving the right care, and resources are wasted ,” it says.

It’s perfectly understandable to want a quick-fix solution to construct the ache go forth and maybe a scan to set your mind at rest. But there isn’t a dependable instant solution. Scan don’t build you better, and painkillers can be harmful. The vast majority of low back pain is musculoskeletal– caused by damage caused to ligaments, joints and muscles surrounding the spine. A tiny percentage is due to a serious or dangerous underlying cause that needs specific diagnosis and intervention- such as cancer, infection or a fracture.

An underlying cause is more likely if you have so-called red-flag symptoms; previous or current diagnosis of cancer, fever, unexplained weight loss and sweats, night pain, pain in the middle of your back rather than lower, inability to stand, urinate or open your bowels, or severe and unremitting pain that is getting worse.

The good news is that if your backache is musculoskeletal- and it usually is- 90% of cases will be better within six weeks. And that is irrespective of what you do. There’s no good evidence that interventions, ranging from Tens machines( which use a mild electric current ), acupuncture, physio, osteopathy and chiropractic to epidural injections and surgery, significantly affect the outcome. Prolonged bed rest- still advocated in some countries- is positively dangerous, as it can cause blood clotting( thrombosis) and constructs recovery from back ache less likely.

‘The
‘ The proof may not be great but it’s cheap, safe and happens to work for me .’ A Tens machine. Photograph: Alamy Stock Photo

It’s seducing to want a scan or special investigations if you develop back pain. But scans don’t correlate well with symptoms; you can have a dire-looking scan with no symptoms or a somewhat normal-looking one with dreadful ache. A scan is useful for surgeons if you need an operation, and other imaging is important if an underlying fracture is suspected. If your back ache was made in association with an underlying inflammatory condition like Crohn’s, ulcerative colitis or psoriasis, you will need investigation and referral to a rheumatologist.

The key to recovery is to try to keep walking and work. Different approaches help different people; it’s good to find the least risky option that suits you. My own favourite is a Tens machine: the evidence may not be great, but it’s cheap, safe, and happens to work for me.

Painkillers can be useful in the short term, if that’s the only way you can keep moving. There are two main groups of effective painkillers, and they both come with health warnings: non-steroidal anti-inflammatories, ( NSAID ) such as ibuprofen, and opioids such as tramadol. There is already an epidemic of opioid overuse and addiction in the US, with Europe and lower-income countries catching up fast. NSAIDs are less addictive but can cause heart, kidney and gut damage if used for more than a few days at a time.

Prof Nadine Foster of Keele University, one of the authors of this series of newspapers, tells:” In many countries, analgesics that have restriction positive impacts are routinely prescribed for low back ache, with very little emphasis on interventions that are evidence-based, such as workouts. As lower-income countries respond to this rapidly rising cause of disability, it is critical that they avoid the waste that these misguided practises entail .”

One in three people who has an episode of low back ache will have a recurrence in the following year. So it is important to look at adaptations to the workplace, avoiding heavy lifting and concentrate on core muscle strengthening with pilates, swimming and some types of yoga once you recover from the acute attack.

Prof Jan Hartvigsen, of the University of Southern Denmark, who also contributed to the Lancet series, tells:” Millions of people across the world are getting the incorrect care for low back ache. Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo … Funders should pay merely for high-value care, stop fund ineffective or harmful testing and treatments, and importantly intensify research into prevention, better tests and better treatments .”

He’s right, of course, but there is no phase withdrawing funding without any rationale. Healthcare professionals need to take the time to explain to patients that it’s not vindictive cost-cutting that is behind the restriction of access to scans and drugs. It’s in everyone’s best interests that we stop seeking bad medicine and invest in procuring better and safer solutions to this global problem, which is likely to affect all of us sooner or later.

* Ann Robinson is a GP

Read more: www.theguardian.com

I shouldn’t be criminalised for using cannabis to ease my constant ache | James Coke

A new bill could give hope to millions of people suffering in the UK, argues the writer James Coke

For much of my adult life I’ve had to rise each morning and battle multiple sclerosis. Sometimes it’s a thankless task- my legs scissored together, locked in cramp as I opposed to break free of its stranglehold.

I’m convinced cannabis has allowed me to live more of a normal life than would have been possible with the constant pain. I’ve always smoked it. But in recent years I’ve been attaining cannabis oil and turning it into tinctures. A few drops of my special brew numbs any niggling aches, clear my mind and help me get a good night’s sleep, spasm-free.

But smoking a joint or inducing cannabis tinctures could land me in jail for five years under our current drug statutes. For someone living with MS or any other affliction that can be soothed by cannabis- including Parkinson’s disease, post-traumatic stress disorder or cancer- the stigma of a criminal record is not ethical or fair.

Since the” war on drugs” was launched in the early 1970 s millions of people with medical problems have been get a bum deal. Cannabis, for centuries lauded for its therapeutic benefits, was unjustly demonised, tossed in with the likes of heroin and cocaine, to be expunged from the reach of society. However, the war was lost long ago. It was found that the illegal global drug marketplace is worth about $400 bn a year. The figure represents the total failure of the policy and omits the billions wasted opposing it.

Several UK police force, including Durham, effectively decriminalised the personal employ of cannabis to prioritise resources. And public opinion supportings a change in the law, especially when it comes to medical cannabis. That is only likely to increase after the fight by the mother of a six-year-old boy with a rare form of epilepsy who has been refused a licence to be treated with cannabis petroleum.

Changes in the law in parts of the US, Canada and Germany mean that the use of medical cannabis is now legal there. The shift in policy has given people the opportunity to choose their medical path, allowing many to escape addiction to prescription opioids.

The UK government appears reluctant to follow suit. Yet since 1998 it has licensed GW Pharmaceuticals to render Sativex. The medicine, for people with MS, are from cannabis plants, mostly grown by British Sugar. It is a step forward, but ultimately it has ringfenced the developing and sale of medical cannabis at a massively inflated price. Only a handful of those with MS receive it: the National Institute for Health and Care Excellence( Nice ), which authorises the use of drugs by the NHS deems it too expensive( a year’s furnish can cost upwards of PS5, 000 ). You either have to live in parts of Wales or be able to afford a private prescription to benefit.

The formula in each 10 ml Sativex bottle includes the chief components in cannabis- THC and CBD( 2.5 mg of each ). It costs PS125 a bottle and lasts on average 10 days. In comparison an ounce of medical cannabis will cost me PS250 and hold upwards of 900 mg of each component. Once extracted into cannabis oil and dosed accordingly, it can produce about 350 bottles of a product that does the same undertaking, at a fraction of the cost.

Obviously by making the spraying I am transgressing the law- but it helps indicate the hypocrisy of the government’s posture and its inertia in facilitating real reform. The production process is surely not rocket science, and cannabis is a common herb in many countries, and should not cost an arm and a leg. People are just being held to ransom by an outdated law.

Much rests on the second reading of Paul Flynn’s private member’s bill on Friday advocating cannabis be made legal for medical use. If it eventually passed into statute, it would be a landmark day for people living with a chronic illness or in constant pain.

Big pharma and major corporations involved in the industry such as British Sugar may balk at a regulated free market in medical cannabis, seeking to protect their interests. The drugs pastor, Victoria Atkins, has shown antipathy for any kind of reform to the laws on medical cannabis.( Incidentally her husband Paul Kenward, is the managing director at British Sugar .)

Flynn has got a lot of backers in his corner, though. Legalising medical cannabis might be personal to me, but it should be personal to us all. There are more than 11 million people living with a disability in the UK, and an ageing population entails few will be immune from the pain that lies ahead. The benefits seen from the US and across the world offer us a template to build upon.

* James Coke is a writer. He blogs at thedisabledchef.com

Read more: www.theguardian.com

How to stick with your exert resolving: Drink beer

( CNN) Your six-pack abs may actually benefit if you share a six pack with your friends. Beer, or any alcohol for that matter, when ingested in moderation, may be a brilliant motivator to keep people working out. Scientists still need to do more research as to exactly what the connection is, but several analyzes discover that people who drink reasonably tend to exercise more than abstainers.

Mike Zamzow, the brewmaster and owner of Bull Falls Brewery in Wausau, Wisconsin, guesses burpee exercises and beer will be a winning combination for fans of his business. Starting next week, Bull Falls will host “Butts and Beers, ” an exercise class that combines some cardio and yoga with beer.

HIV infecting 2m more people every year, warns UN

Goal of eradicating Aids by 2030 will be impossible without more work on prevention, tells UNAids report

Talk of the end of Aids was premature, according to a new UN report that exposes the steady decline in new HIV infections stalled five years ago and that, in some areas, the numbers are rising again.

We are sounding the alarm, told Michel Sidib, executive director of UNAids. The power of prevention is not being realised. If there is a resurgence in new HIV infections now, the epidemic will become impossible to control. The world needs to take urgent and immediate action.

Nearly two million people have been newly infected with HIV every year for the last five years, tells UNAids, one week before the International Aids Conference in Durban. If that continues, it will be impossible to meet the UN goal of eradicating Aids by 2030.

Even though there are many well-understood ways to prevent infections including education about health risks, furnishing condoms and, most recently, narcotics that can protect the partners of those who are infected the numbers are going up , not down, in many regions.

Between 2010 and 2015, there was a 57% increase per year in new infections in eastern Europe and central Asia. The numbers of new infections had been falling for years in the Caribbean, but over the same period they rose annually by 9 %. The annual rise in the Countries of the middle east and North Africa was 4% and in Latin America it was 2 %. Although other regions did not insure a rise in infections, there was no drop-off either.

The trend is a blow to those who had predicted that the epidemic would be over in the foreseeable future. In 2011, Hillary Clinton, then US secretary of state, foresaw the end of Aids, saying that US endeavors had helped to lay the foundations for an historical opportunity, one that the world has today to change the course of this pandemic and usher in an Aids-free generation.

In June, the UN general assembly issued a declaration committing to speed up efforts to end the epidemic by 2030. The roll-out of antiretroviral drugs to people with HIV has cut the death toll, but the above figures from UNAids show that much more will need to be done on prevention.

Money is a major issue. The medication therapy programmes are costly and experts agree that maintaining all those infected now 36.7 million people worldwide on drugs for life is not sustainable if the numbers continue to rise.

But Aids has a lower profile now that the deaths are falling and this has led to a drop in funding from international donors, from a peak of $9.7 bn in 2013 to $8.1 bn in 2015, although the affected countries have increased their spending on HIV, so that now they contribute 57% of the total which was $19.2 bn last year.

Most of the money goes on treatment simply 20% is spent on prevention, says UNAids. The report recommends that resources should be focused on high-risk groups.

In east and southern Africa, for example, three-quarters of all new HIV infections among 10 to 19 -year-olds are of daughters, tells research reports. They do not know enough about HIV and are prey to older men, unequal in their societies and subjected to violence.

Worldwide only three in ten adolescent girls and young women between the ages of 15 and 24 years have comprehensive and proper knowledge about HIV, says research reports. Reaching adolescent girls and young women, especially in sub-Saharan Africa, will be a key factor in ending the epidemic, it says.

Elsewhere, there are other issues. In eastern Europe and central Asia, 51% of new HIV infections occur among persons who inject narcotics. More than 80% of the regions new HIV infections in 2015 were in Russia. There are few damage reduction programmes to help those at risk.

In western and central Europe and Northern america, about half of all new HIV infections pass among gay humen. Between 2010 and 2014, new HIV diagnoses among men who have sex with humen increased by 17% in western and central Europe, and by 8% in North America.

The International HIV/ Aids Alliance, which represents community groups worldwide, said it was concerned about the trend.

Shaun Mellors, the alliances associate director for Africa, said: It is significant that UNAids has publicly acknowledged the concerns that remain about HIV prevention. To respond to this global prevention gap, we need rapid investment and implementation of tailored combining prevention services for all populations at risk of HIV.

Meeting these targets requires a rapid acceleration in treatment and prevention programmes, rooted in human rights and gender equality, and centred on people living with or affected by HIV.

Read more: www.theguardian.com

The hard truth about back pain: don’t will vary depending on narcotics, scans or quick fixes | Ann Robinson

Most treatment is wasteful, wanton and wrong, tells the Lancet. The key is to try to keep walking and run, tells the GP Ann Robinson

Back pain is the biggest cause of disability globally, and most of us will have at least one nasty bout of it. But treatment is often wasteful, wanton and incorrect,according to a series of papers in the Lancet.” Worldwide, overuse of inappropriate testing and treatments such as imaging, opioids and surgery entails patients are not receiving the right care, and resources are wasted ,” it says.

It’s perfectly understandable to want a quick-fix solution to induce the ache go forth and maybe a scan to set your intellect at rest. But there isn’t a reliable instant solution. Scans don’t induce you better, and painkillers can be harmful. The vast majority of low back ache is musculoskeletal– caused by damage caused to ligaments, joints and muscles surrounding the spine. A tiny percentage is due to a serious or dangerous underlying cause that it was necessary to specific diagnosis and intervention- such as cancer, infection or a fracture.

An underlying cause is more likely if you have so-called red-flag symptoms; previous or current diagnosis of cancer, fever, unexplained weight loss and sweats, night ache, pain in the middle of your back rather than lower, inability to stand, urinate or open your bowels, or severe and unremitting pain that is getting worse.

The good news is that if your backache is musculoskeletal- and it usually is- 90% of cases will be better within six weeks. And that is irrespective of what you do. There’s no good evidence that interventions, ranging from Tens machines( which use a mild electric current ), acupuncture, physio, osteopathy and chiropractic to epidural injections and surgery, significantly affect the outcome. Prolonged bed rest- still advocated in some countries- is positively dangerous, as it can cause blood clotting( thrombosis) and stimulates recovery from back pain less likely.

‘The
‘ The evidence may not be great but it’s cheap, safe and happens to work for me .’ A Tens machine. Photo: Alamy Stock Photo

It’s seducing to wishing a scan or special investigations if you develop back ache. But scans don’t correlate well with symptoms; you can have a dire-looking scan with no symptoms or a somewhat normal-looking one with dreadful ache. A scan is useful for surgeons if you need an operation, and other imaging is important if an underlying fracture is suspected. If your back ache is associated with an underlying inflammatory condition like Crohn’s, ulcerative colitis or psoriasis, you will need investigation and referral to a rheumatologist.

The key to recovery is to try to keep walking and run. Different approaches help different people; it’s good to find the least risky option that suits you. My own favourite is a Tens machine: the evidence may not be great, but it’s cheap, safe, and happens to work for me.

Painkillers can be useful in the short term, if that’s the only way you can move up. There are two main groups of effective painkillers, and they both come with health warnings: non-steroidal anti-inflammatories, ( NSAID ) such as ibuprofen, and opioids such as tramadol. There is already an epidemic of opioid overuse and addiction in the US, with Europe and lower-income countries catching up fast. NSAIDs are less addictive but can cause heart, kidney and gut injury if used for more than a few days at a time.

Prof Nadine Foster of Keele University, one of the authors of this series of newspapers, says:” In many countries, analgesics that have restriction positive effect are routinely prescribed for low back ache, with very little emphasis on interventions that are evidence-based, such as workouts. As lower-income countries respond to this rapidly rising cause of people with disabilities, it is critical that they avoid the waste that these misguided practises entail .”

One in three people who has an episode of low back pain will have a recurrence in the following year. So it is important to look at adaptations to the workplace, avoiding heavy lifting and concentrate on core muscle strengthening with pilates, swimming and some types of yoga once you recover from the acute attack.

Prof Jan Hartvigsen, of the University of Southern Denmark, who also contributed to the Lancet series, tells:” Millions of people across the world are get the wrong care for low back pain. Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo … Funders should pay only for high-value care, stop funding ineffective or harmful tests and treatments, and importantly intensify research into prevention, better tests and better treatments .”

He’s right, of course, but there is no point receding fund without any explanation. Healthcare professionals need to take the time to explain to patients that it’s not vindictive cost-cutting that is behind the restriction of access to scans and drugs. It’s in everyone’s best interests that we stop pursuing bad medicine and invest in finding better and safer solutions to this global problem, which is likely to affect all of us sooner or later.

* Ann Robinson is a GP

Read more: www.theguardian.com

Rise in use of contraception offers hope for containing global population

More women than ever use family planning, tells the UN, and having one child fewer could dramatically curtail the global population by 2030

The number of women use contraceptives in developing countries has risen to record levels in recent years, such that projections for global population growth could be cut by as much as 1 billion over the next 15 years.

The latest figures by the UN prove more females than ever now use family planning, with some poorer regions recording the most wonderful pace of growth since 2000.

In 2015, an estimated 64% of married females, or women living with a partner, aged between 15 and 49, were utilizing modern or traditional forms of family planning. In 1970, the rate was 36%.

The population division of the UNs Department of Economic and Social Affairs( Undesa) predicts high rates of contraceptive use in Africa over the next 15 years; a region with the largest demand but least access to modern contraceptives.

Undesas projections for global population range between 8 billion and 9 billion by 2030.

The UN projections of population growth already give us an idea of the impact that increased access to family planning could have. If by 2030 the average family size is just one child fewer, then by 2030 the world population is estimated to be approximately 8 billion rather than 9 billion, told Jagdish Upadhyay, head of reproductive health commodity security and family planning at the UN population fund( UNFPA ).

Evidence shows that women who have access to family planning choose to use family planning, often resulting in smaller families, higher educational achievements, healthier infants[ and] greater economic power as well as influence in their households and communities, told Upadhyay.

If all actors can work together to provide women in every country with the entails, which is their right, to voluntarily exert yet another right to freely ascertain their family size, then we are likely to see a significant slowing of global population growth.

In Nigeria, one of the countries predicted to see the biggest population growth over the next few decades and with a contraceptive prevalence rate of 16%, an increase of one percentage point in the use of modern contraceptives would entail about 426,000 more females would be using family planning.

Upadhyay said many countries, particularly those in west Africa which has a high unmet need for contraception, to have been able to reap the demographic dividend: a boost to the economy that occurs when there are growing numbers of people in the workforce relative to the number of dependants.

However, he cautioned that despite the successes of the past 40 years, huge, and sustained, investment in family planning is needed to keep up with demand and gratify the needs of women who are unable to access services.

Julia Bunting, president of the Population Council, told: To impact population projections will require real commitment from countries like Nigeria to invest in high quality, voluntary family planning programmes to expand access to contraceptives.

The timing, scale and pace of those efforts will determine the dimensions of the impact on population projections.

According to Undesa figures, 142 million married women or those living with a partner, who would like to avoid pregnancy and use a modern sort of contraception, are unable to access them. When single females are included, the number rises to 225 million.

Africa has the highest unmet require, with an estimated 33% of women use contraceptives in 2015. East, central and south Africa are expected to increase coverage over the next 15 years, but over that time its big youth population will be reaching reproductive age.

Sarah Onyango, a senior consultant for service delivery at the International Planned Parenthood Federation, said continued increases in contraceptive utilize could have an impact on population figures, but the trend necessitates more detailed analysis.

Over the next 15 years, were going to see growth in contraceptive use and demand because an increasing number of women of reproductive age will require contraceptive services, she said.

Right now, the population of Africa is generally young people almost 50% of the population are youths. If current trends in contraception employ continue, we will probably insure some shiftings in population.

At an international summit on family planning in London in 2012, donors pledged $2.6 bn ($ 1.8 bn) to improve access to contraceptives for 120 million women and girls by 2020.

Last September, world leaders promised to ensure universal access to family planning by 2030, recurring a pledge they had built in 1994.

Read more: www.theguardian.com

The hard truth about back ache: don’t will vary depending on narcotics, scans or quick fix | Ann Robinson

Most treatment is wasteful, wanton and wrong, tells the Lancet. The key is to try to keep walking and run, says the GP Ann Robinson

Back pain is the biggest cause of disability globally, and most of us will have at least one nasty bout of it. But treatment is often wasteful, wanton and wrong,according to a series of papers in the Lancet.” Worldwide, overuse of inappropriate tests and therapies such as imaging, opioids and surgery means patients are not receiving the right care, and resources are wasted ,” it says.

It’s perfectly understandable to want a quick-fix solution to attain the pain go away and maybe a scan to set your mind at rest. But there isn’t a dependable instant solution. Scan don’t build you better, and painkillers can be harmful. The vast majority of low back ache is musculoskeletal– caused by damage caused to ligaments, joints and muscles surrounding the spine. A tiny percentage is due to a serious or dangerous underlying cause that needs specific diagnosis and intervention- such as cancer, infection or a fracture.

An underlying cause is more likely if you have so-called red-flag symptoms; previous or current diagnosis of cancer, fever, unexplained weight loss and sweats, night ache, pain in the middle of your back rather than lower, inability to stand, urinate or open your bowels, or severe and unremitting pain that is getting worse.

The good news is that if your backache is musculoskeletal- and it usually is- 90% of cases will be better within six weeks. And that is irrespective of what you do. There’s no good proof that interventions, ranging from Tens machines( which use a mild electric current ), acupuncture, physio, osteopathy and chiropractic to epidural injections and surgery, significantly affect the outcome. Prolonged bed remainder- still advocated in some countries- is positively dangerous, as it can cause blood clotting( thrombosis) and builds recovery from back pain less likely.

‘The
‘ The proof may not be great but it’s inexpensive, safe and happens to work for me .’ A Tens machine. Photograph: Alamy Stock Photo

It’s tempting to wishing a scan or special investigations if you develop back pain. But scans don’t correlated well with symptoms; you can have a dire-looking scan with no symptoms or a somewhat normal-looking one with dreadful ache. A scan is useful for surgeons if you need an operation, and other imaging is important if an underlying fracture is suspected. If your back pain is associated with an underlying inflammatory condition like Crohn’s, ulcerative colitis or psoriasis, you will need investigation and referral to a rheumatologist.

The key to recovery is to try to keep walking and operate. Different approaches help different people; it’s good to find the least risky option that suits you. My own favourite is a Tens machine: the evidence may not be great, but it’s inexpensive, safe, and happens to work for me.

Painkillers can be useful in the short term, if that’s the only way you can keep moving. There are two main groups of effective painkillers, and they both come with health warnings: non-steroidal anti-inflammatories, ( NSAID ) such as ibuprofen, and opioids such as tramadol. There is already an epidemic of opioid overuse and addiction in the US, with Europe and lower-income countries catching up fast. NSAIDs are less addictive but can cause heart, kidney and intestine damage if used for more than a few days at a time.

Prof Nadine Foster of Keele University, one of the authors of this series of papers, tells:” In many countries, analgesics that have restriction positive impacts are routinely prescribed for low back ache, with very little emphasis on interventions that are evidence-based, such as workouts. As lower-income countries respond to this rapidly rising cause of disability, it is critical that they avoid the waste that these misguided practises necessitate .”

One in three people who has an episode of low back pain will have a recurrence in the following year. So it is important to look at adaptations to the workplace, avoiding heavy lifting and concentrate on core muscle strengthening with pilates, swimming and some types of yoga once you recover from the acute attack.

Prof Jan Hartvigsen, of the University of Southern Denmark, who also contributed to the Lancet series, says:” Millions of people across the world are getting the wrong care for low back ache. Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo … Funders should pay only for high-value care, stop fund ineffective or harmful tests and therapies, and importantly intensify research into prevention, better tests and better treatments .”

He’s right, of course, but there is no phase withdrawing fund without any justification. Healthcare professionals need to take the time to explain to patients that it’s not vindictive cost-cutting that is behind the restriction of access to scans and drugs. It’s in everyone’s best interests that we stop seeking bad medicine and invest in finding better and safer solutions to this global problem, which is likely to affect all of us sooner or later.

* Ann Robinson is a GP

Read more: www.theguardian.com

The hard truth about back ache: don’t rely on medications, scans or quick fix | Ann Robinson

Most treatment is wasteful, wanton and incorrect, tells the Lancet. The key is to try to keep walking and working, tells the GP Ann Robinson

Back pain is the biggest cause of disability globally, and most of us will have at least one nasty bout of it. But treatment is often wasteful, wanton and wrong,according to a series of papers in the Lancet.” Worldwide, overuse of inappropriate tests and treatments such as imaging, opioids and surgery means patients are not receiving the right care, and resources are wasted ,” it says.

It’s perfectly understandable to want a quick-fix solution to attain the pain go forth and maybe a scan to set your mind at rest. But there isn’t a dependable instant answer. Scan don’t attain you better, and analgesics can be harmful. The vast majority of low back ache is musculoskeletal– caused by damage caused to ligaments, joints and muscles surrounding the spine. A tiny percentage is due to a serious or dangerous underlying cause that it was necessary to specific diagnosis and intervention- such as cancer, infection or a fracture.

An underlying cause is more likely if you have so-called red-flag symptoms; previous or current diagnosis of cancer, fever, unexplained weight loss and sweats, night ache, pain in the middle of your back rather than lower, inability to stand, urinate or open your bowels, or severe and unremitting pain that is getting worse.

The good news is that if your backache is musculoskeletal- and it usually is- 90% of cases will be better within six weeks. And that is irrespective of what you do. There’s no good evidence that interventions, ranging from Tens machines( which use a mild electric current ), acupuncture, physio, osteopathy and chiropractic to epidural injections and surgery, significantly affect the outcome. Prolonged bed rest- still advocated in some countries- is positively dangerous, as it can cause blood clotting( thrombosis) and induces recovery from back ache less likely.

‘The
‘ The evidence may not be great but it’s cheap, safe and happens to work for me .’ A Tens machine. Photograph: Alamy Stock Photo

It’s tempting to want a scan or special investigations if you develop back pain. But scans don’t correlated well with symptoms; you can have a dire-looking scan with no symptoms or a reasonably normal-looking one with dreadful ache. A scan is useful for surgeons if you need an operation, and other imaging is important if an underlying fracture is suspected. If your back pain is associated with an underlying inflammatory condition like Crohn’s, ulcerative colitis or psoriasis, you will need investigation and referral to a rheumatologist.

The key to recovery is to try to keep walking and work. Different approaches help different people; it’s good to find the least risky option that suits you. My own favourite is a Tens machine: the evidence may not be great, but it’s inexpensive, safe, and happens to work for me.

Painkillers can be useful in the short term, if that’s the only way you can move up. There are two main groups of effective analgesics, and they both come with health warnings: non-steroidal anti-inflammatories, ( NSAID ) such as ibuprofen, and opioids such as tramadol. There is already an epidemic of opioid overuse and addiction in the US, with Europe and lower-income countries catching up fast. NSAIDs are less addictive but can cause heart, kidney and intestine damage if used for more than a few days at a time.

Prof Nadine Foster of Keele University, one of the authors of this series of newspapers, says:” In many countries, painkillers that have limited positive impacts are routinely prescribed for low back pain, with very little emphasis on interventions that are evidence-based, such as exercises. As lower-income countries respond to this rapidly rising cause of disability, it is critical that they avoid the waste that these misguided practices necessitate .”

One in three people who has an episode of low back pain will have a recurrence in the following year. So it is important to look at adaptations to the workplace, avoiding heavy lifting and concentrate on core muscle strengthening with pilates, swimming and some types of yoga once you recover from the acute attack.

Prof Jan Hartvigsen, of the University of Southern Denmark, who also contributed to the Lancet series, says:” Millions of people across the world are getting the wrong care for low back pain. Protection of the public from unproven or harmful approaches to managing low back ache requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo … Funders should pay merely for high-value care, stop funding ineffective or harmful tests and therapies, and importantly intensify research into prevention, better tests and better treatments .”

He’s right, of course, but there is no phase receding fund without any explanation. Healthcare professionals need to take the time to explain to patients that it’s not vindictive cost-cutting that is behind the restriction of access to scans and drugs. It’s in everyone’s best interests that we stop seeking bad medication and invest in determining better and safer solutions to this global problem, which is likely to affect all of us sooner or later.

* Ann Robinson is a GP

Read more: www.theguardian.com