More healthcare news snippets...

TB causes most deaths in SA

HIV/AIDS has moved up two places to become South Africa's seventh-biggest natural killer. The number of deaths directly attributed to the disease rose from 13 561 in 2007 to 15 097 in 2008, though Statistics South Africa's (Stats SA) Statistician-General, Pali Lehohla, warned the figure could be significantly higher. Stats SA yesterday released the report entitled Mortality and causes of death in South Africa 2008: Findings from death notification, which also found tuberculosis (TB) to be the leading cause of death, followed by influenza and pneumonia. Lehohla said about 80% of TB cases were related to HIV/AIDS, but because it was not a notifiable disease - meaning a death certificate cannot stipulate HIV/AIDS as the cause of death - it is not recorded as such. Lehohla said the findings were based on data collected from death certificates, and Stats SA did not make assumptions on the underlying causes. However, there was a link, he added. The report is based on information obtained from 592 073 deaths registered with the Department of Home Affairs in 2008, and its objective is to provide trends and differentials in the country's mortality figures. While the number of HIV/AIDS deaths has increased, there was a general decline in the total number of natural (1.7%) and non-natural (2.8%) deaths. More males (51.1%) than females (48.7%) died in 2008, with the median age increasing to about 45 years. Western Cape had the highest number of non-natural deaths in the country, while death by assault was high in Eastern Cape, and transport accidents remained high in Limpopo. A total of 52 950 people died of non-natural causes, 33 983 died of other externally caused accidental injuries (including drowning and smoke inhalation), 6 479 of undetermined intent, 5 785 in transport accidents, 5 467 of assault, 734 from complications in medical and surgical care, 442 of intentional self-harm and 60 from externally caused morbidity and mortality.

Chandré Prince: The Times, 19 November 2010

Pharmacists relieved as dispensing row settled

THE Department of Health has published revised dispensing fees for pharmacists, putting to rest a six-year legal battle that has cost the industry more than R30 million in legal fees and clouded the sector's relations with the Government. The new fees, gazetted on Friday, are a major improvement on the R24.00 maximum originally proposed by the department in January 2004, which pharmacists felt was so low it rendered many of their businesses unviable. That prompted a legal challenge that went all the way to the Constitutional Court. The new regulations set out four price bands for medicines, each with its own maximum fee. Medicines with a single exit price of less than R75.00 have a mark-up cap of R6.00 plus 46% of the medicine price, or R40.50. The cap rises for more expensive medicines, with a top limit of R121.00 plus 5% of the single exit price for medicines that cost R700.00 or more. The single exit price is the price charged by manufacturers and is set by the department. The regulations apply to all medicines sold in a pharmacy, except those classed as schedule 0, which includes such items as antiseptic soap. Pharmacies must display a notice advising consumers of the fee structure used to determine their dispensing fees, and provide invoices detailing the single exit price and the dispensing fee for each medicine. The Pharmacy Stakeholders' Forum welcomed the new fees, with joint coordinator Ivan Kotze saying it was "a huge relief". However, he sounded a note of caution to consumers, warning that medical schemes were not bound to reimburse members for the full extent of the fees. In the absence of Government regulations, pharmacies have until now been able to charge whatever they deemed reasonable. Clicks, Dis-Chem and Pick n Pay have been charging R26.00 for each line item, while many independent pharmacies have charged higher rates. Clicks said it would not charge the maximum rates set out in the new fee structure. Pick n Pay has also been charging no more than R26.00 for medicines. Its pharmacy coordinator, Hippocrates Zourides, said the company was reviewing its dispensing fees, but would not charge the maximum allowed by law. The resolution of the high-stakes fight is a mixed blessing for independent pharmacies, as it brings them much-needed certainty on the size of the mark-ups they can add to the medicines they sell, but will not offer any relief from the growing threat posed by the retail chains. Anban Pillay, head of the department's Pharmaceutical Economic Evaluation unit, said the next step was to cap the logistics fees charged by drug manufacturers. Draft regulations for this sector were being considered by the Minister of Health and would be published for comment "soon" he said. Health Minister Aaron Motsoaledi said the dispensing fee must be reviewed annually. taking into account the need to ensure availability and affordability, annual inflation rates and information supplied by pharmacists.

The fee structure and dispensing fee regulations could be viewed on: www.pssa.org.za

Tamar Kahn: Business Day, 22 November 2010
Slindile Khanyile: Business report, 22 November 2010
SAPA, 20 November 2010

Good news in UN report: HIV infection rate falls

THE number of new HIV infections is almost one fifth lower than it was a decade ago, indicating that the world has "turned the corner in the fight against HIV/AIDS", according to the UNAIDS Global Report on HIV/AIDS. According to the report, the biggest epidemics in sub-Saharan Africa - Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe - have either stabilised or are showing signs of decline. In the past five years, antiretroviral(ARV) treatment has had a "profound effect" on mortality rates, with AIDS-related deaths having decreased by 18% in southern Africa. Botswana, which has the region's most successful ARV programme, has cut its AIDS deaths in half. In 2009 alone, 1.2 million people received HIV antiretroviral therapy for the first time - a 30% increase in the number of people receiving treatment of  in a single year.

The ARV roll-out in sub-Saharan Africa has been rapid, reaching almost one in four people who need it. Seven years ago, only 2% of people in the region were on ARVs. In Botswana, Namibia, South Africa and Swaziland, coverage of ARVs for preventing mother-to-child transmission of HIV reached more than 80%. This is good news for babies, with an estimated 370 000 newborns getting HIV in 2009 as opposed to 500 000 in 2001. In 33 countries, HIV incidence has fallen by more than 25% between 2001 and 2009. Of these countries, 22 are in sub-Saharan Africa. In contrast, however, in parts of Eastern Europe and Central Asia, including the Ukraine, Russia and Uzbekistan, HIV incidence increased by more than 25% between 2001 and 2009. Drug addicts' sharing of needles is believed to be the main reason for the rapid spread of HIV. Despite the good news, sub-Saharan Africa continues to bear the brunt of the epidemic. Of the 33.3 million people living with HIV in the world, almost seven out of 10 (22.5 million) live in sub-Saharan Africa. Of the estimated 1.8 million people who died of HIV-related illnesses worldwide, 1.3 million (72%) lived in sub-Saharan Africa. South Africa still has the biggest HIV-positive population in the world, with an estimated 5.6 million people living with HIV in 2009. Swaziland has the highest HIV prevalence rate in the world, with more than a quarter of adults living with HIV. But, warns UNAIDS, for the estimated 33.3 million people living with HIV after nearly 30 years into a very complex epidemic, the gains are real but still fragile. 10 million people living with HIV who are eligible for treatment under the new WHO guidelines are still in need. Women are still most affected by HIV in sub-Saharan Africa, with 13 women becoming infected for every 10 men.

A copy of UNAIDS report on the global AIDS epidemic 2010 is available from:
http://www.unAIDS.org/documents/20101123_GlobalReport_em.pdf

Kerry Cullinan Health-e News via The Cape Times, 24 November 2010

Brits mislead GPs about health habits

New research suggests that one in five British patients lie to their GP about the extent of their bad habits. A poll by Saga Health Club found that 22% of people would not give their GP a true picture of their alcohol consumption, even if asked directly. Nearly a fifth of respondents (17%) said they would cover up the truth about their dietary habits and almost as many admitted they would lie about their exercise levels. The survey - which questioned over 12 000 people over the age of 50 - suggested that many people could be putting their own health at risk by failing to come clean about their lifestyle. Ros Altmann, Director-General of Saga, said it was a shame that people were not comfortable being honest about health and lifestyle issues, even with their GP. She added that the fantastic medical advances of recent years should enable the over-50s to stay fit and healthy so they could enjoy extra leisure time as they came up to and entered retirement. A separate Saga survey, published in April this year, found that almost half of over-50s say they are doing more exercise than at any other stage in their life. The research also found that just 15% of today's over-50s are smokers, compared with 40% in the mid-1970s.

Netdoctor.co.uk, 3 December 2010

Cancer breakthrough

Ii is not yet a panacea for all ills, but it is getting close. Researchers have announced the first proof that aspirin can cut the risk of a range of cancers by up to 50%. It is already taken by millions to protect against heart attacks and strokes and has an established role in preventing diabetes, dementia, pregnancy complications and pain. Scientists stopped short of recommending it be added to the water supply but declared it was "the most amazing drug". The latest positive findings on cancer had shifted the balance in favour of mass medication of the population, but it was still too soon to recommend everyone take it, they said. The study of eight trials involving 25 000 patients taking a low daily dose of aspirin to ward off heart disease found the humble drug reduced deaths due to all cancers by more than a fifth (21%). If a new medicine were launched tomorrow with a similar-sized effect it would be hailed as a miracle cure. However, instead of being priced at tens of thousands of pounds a head, aspirin costs 1p (about 11c) a tablet. After five years on the drug, cancer death rates fell further - by a third overall and by half (54%) for cancers of the digestive tract (including oesophagus, stomach and the bowel). The benefit did not improve with higher doses of aspirin but increased the longer it was taken. It was also greater in older people because of the higher incidence of cancer. Over 20 years, the reduction in risk ranged from 10% for prostate cancer to 60% for oesophageal cancer. The findings, published in "The Lancet", follow an earlier report in the journal last October showing that low doses of aspirin cut the risk of bowel cancer by a third. Peter Rothwell, professor of neurology at the University of Oxford, who led both studies, said the benefit of taking aspirin was consistent across all the trials, "suggesting that the findings are likely to be generalisable". He said the results did not mean that all adults should immediately start taking aspirin, but they did demonstrate major new benefits that had not been previously factored into guideline recommendations. The problem with aspirin is that in a small number of people it is an irritant to the stomach, causing indigestion, nausea and sometimes bleeding. Thousands of people end up in hospital every year with bleeding and ulcers caused by aspirin and similar painkillers. The risk, though small, has to be set against the likely benefit and has prevented its wider use. Asprin cuts the risk of heart disease and stroke and has been prescribed for decades to people who have had one heart attack in order to prevent a second. However, because of the bleeding risk, it is not recommended as a preventive measure against a first heart attack. Professor Rothwell said that with the added benefit against cancer, the balance might now need to be reassessed. Aspirin thins the blood, making it harder to form clots which could cause a heart attack or stroke, providing protection against these conditions. Its impact on cancer is less well understood. As an anti-inflammatory, it may curb the spread of the disease by reducing inflammation, which is a key factor in cancer development. A further theory is that an aspirin helps replace a missing constituent from our diet. Plant salicylates, similar to the active ingredient in aspirin, have reduced since we started growing crops with pesticides and fertilisers. The daily pill may help restore the body's natural balance. Professor Rothwell said if people were going to take a low dose 75mg daily aspirin, to gain the maximum lifetime benefit they should start in their late 40s or early 50s and continue for 20 to 30 years, After five to 10 years the results suggest overall deaths from all causes (including internal bleeds) would be 10% lower and the benefit would grow as the years advanced. Previous studies suggest aspirin also protects against breast cancer, but the researchers said more data was required to confirm this and its effect in other cancers of women. Further work was also necessary to identify any late worsening of cancer deaths beyond 20 years. Professor Rothwell said that perhaps the most important finding was the proof of principle that cancers could be prevented by simple compounds like aspirin. He added that chemoprevention (for cancer) was a realistic goal.

Jeremy Laurance: The Independent via The Cape Times, 9 December 2010