Wednesday, August 11, 2010

The medicalization of life marches on: Being physically inactive is 'a disease'

Another excuse for government invasion of private life. Compulsory drill for everyone? Computer nerds taken away from their parents like fat kids now sometimes are?

The excuse is that that making people more active would pay off as preventive medicine. But, despite the popularity of the concept, preventive medicine measures are not in general cost-effective. They have very little impact and cost more than they save: "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not"

Physical inactivity should be classed as "disease in its own right", a pair of leading public health experts have proposed. Dr Richard Weiler and Dr Emmanuel Stamatakis have put forward the idea because they say the the link between inactivity and poor health is so strong.

Writing in the British Journal of Sports Medicine, they explained: "Given the significant associated mortality and morbidity, we propose that perhaps physical inactivity should also be considered for recognition as a disease in its own right."

Obesity is already classed as a disease by the World Health Organisation, noted Dr Richard Weiler, a specialist registrar in sports and exercise at Imperial College Healthcare and a GP. But he said obesity was often at least partially the result of a deeper cause - not doing enough exercise.

Speaking about the article, he said: "Money is pumped at treating the symptoms of physical inactivity - at obesity, diabetes, hypertension, heart disease - but not at the root cause."

He added: "It is neglected because of the way that modern medicine is taught and the way the NHS is run. "We need to put the health back into the NHS - we need to promote wellness as well as treat illness." In May Dr Weiler said that the evidence showed that lack of fitness was the root cause of more illness than being fat. Despite such evidence, he said it remained the poor relation of the public health family.

He said GPs should be financially rewarded for promoting exercise through the Quality and Outcomes Framework, an action which he estimated would cost £1 million. This was "peanuts" set against the estimated cost of problems associated with lack of exercise, of £8.2 billion a year, he argued.

His comments follow those made at the weekend by Prof Steve Field, chairman of the Royal College of General Practitioners, who said many people needed to "face facts and take responsibility" for their own health.

Dr Weiler said recent studies showed only one in 20 people took the minimum amount of recommended exercise, but there was still "no co-ordinated plan" to tackle the problem.

He and Dr Stamatakis, of University College London, concluded in their paper: "Can we afford to leave physical activity promotion in primary care as the ‘would-be-nice’ preventive option, offered typically in the form of unstructured advice by inadequately trained professionals?"


Some alarming bacterial evolution

PLASTIC surgery patients have carried a new class of superbugs resistant to almost all antibiotics from South Asia to Britain and they could spread worldwide, researchers say.

Many hospital infections that were already difficult to treat have become even more impervious to drugs thanks to a recently discovered gene that can jump across different species of bacteria.

This so-called NDM-1 gene was first identified last year by Cardiff University's Timothy Walsh in two types of bacteria - Klebsiella pneumoniae and Escherichia coli - in a Swedish patient admitted to hospital in India.

Worryingly, the new NDM-1 bacteria are resistant even to carbapenems, a group of antibiotics often reserved as a last resort for emergency treatment for multi-drug resistant bugs.

In the new study, led Walsh and Madras University's Karthikeyan Kumarasamy, researchers set out to determine how common the NDM-1 producing bacteria were in South Asia and Britain, where several cases had turned up. Checking hospital patients with suspect symptoms, they found 44 cases - 1.5 per cent of those screened - in Chennai, and 26 (eight per cent) in Haryana, both in India.

They likewise found the superbug in Bangladesh and Pakistan, as well 37 cases in Britain, where several patients had recently travelled to India or Pakistan for cosmetic surgery. “India also provides cosmetic surgery for other Europeans and Americans, and it is likely that NDM-1 will spread worldwide,” said the study, published in the British medical journal The Lancet.

NDM-1 was mostly found in E. coli, a common source of community-acquired urinary tract infections, and K. pneumoniae, and was impervious to all antibiotics except two, tigecycline and colistin. In some cases, even these drugs did not beat back the infection.

Crucially, the NDM-1 gene was found on DNA structures, called plasmids, that can be easily copied and transferred between bacteria, giving the bug “an alarming potential to spread and diversify,” the authors said.

“Unprecedented air travel and migration allow bacterial plasmids and clones to be transported rapidly between countries and continents,” mostly undetected, they said.

The emergence of these new drug-resistant strains could become a serious global public health problem as the major threat shifts toward a broad class of bacteria - including those armed with the NDM-1 gene - known as “Gram-negative”, the researchers warn.

“There are few new anti-Gram-negative antibiotics in development, and none that are effective against NDM-1,” the study said. NDM-1 stands for New Delhi metallo-beta-lactamase-1.

Johann Pitout from the University of Calgary in Canada said patients who have medical procedures in India should be screened for multi-resistant bacteria before they receive care in their home country.


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