Tobacco Could Kill One Billion By 2100, WHO Report Warns

Daily Science Journal (Feb. 11, 2008) — WHO has released new data showing that while progress has been made, not a single country fully implements all key tobacco control measures, and outlined an approach that governments can adopt to prevent tens of millions of premature deaths by the middle of this century. Unless urgent action is taken, tobacco could kill one billion this century.

Cigarette butts. Unless urgent action is taken, tobacco could kill one billion this century, WHO report warns. (Credit: iStockphoto/James Curtis)

Current status of tobacco-related deaths

• 100 million dead in the 20th century

• Currently 5.4 million deaths every year

Unless urgent action is taken

• By 2030, there will be more than 8 million deaths every year

• By 2030, more than 80% of tobacco deaths will be in developing countries

• One billion estimated deaths during the 21st century

In a new report which presents the first comprehensive analysis of global tobacco use and control efforts, WHO finds that only 5% of the world’s population live in countries that fully protect their population with any one of the key measures that reduce smoking rates. The report also reveals that governments around the world collect 500 times more money in tobacco taxes each year than they spend on anti-tobacco efforts. It finds that tobacco taxes, the single most effective strategy, could be significantly increased in nearly all countries, providing a source of sustainable funding to implement and enforce the recommended approach, a package of six policies called MPOWER.

“While efforts to combat tobacco are gaining momentum, virtually every country needs to do more. These six strategies are within the reach of every country, rich or poor and, when combined as a package, they offer us the best chance of reversing this growing epidemic,” said Dr Margaret Chan, Director-General of WHO. Dr Chan launched the WHO Report of the Global Tobacco Epidemic at a news conference with New York Mayor Michael Bloomberg. Bloomberg Philanthropies helped fund the report.

“The report released today is revolutionary,” Mayor Bloomberg said. “For the first time, we have both a rigorous approach to stop the tobacco epidemic and solid data to hold us all accountable. No country fully implements all of the MPOWER policies and 80% of countries don’t fully implement even one policy. While tobacco control measures are sometimes controversial, they save lives and governments need to step up and do the right thing.”

The six MPOWER strategies

• Monitor tobacco use and prevention policies

• Protect people from tobacco smoke

• Offer help to quit tobacco use

• Warn about the dangers of tobacco

• Enforce bans on tobacco advertising, promotion and sponsorship

• Raise taxes on tobacco

The report also documents the epidemic's shift to the developing world, where 80% of the more than eight million annual tobacco-related deaths projected by 2030 are expected to occur.

This shift, the report says, results from a global tobacco industry strategy to target young people and adults in the developing world, ensuring that millions of people become fatally addicted every year. The targeting of young women in particular is highlighted as one of the “most ominous potential developments of the epidemic’s growth".

The global analysis, compiled by WHO with information provided by 179 Member States, gives governments and other groups a baseline from which to monitor efforts to stop the epidemic in the years ahead. The MPOWER package provides countries with a roadmap to help them meet their commitments to the widely embraced global tobacco treaty known as the WHO Framework Convention on Tobacco Control, which came into force in 2005.

WHO is also working with global partners to scale up the help that can be offered to countries to implement the strategies.

Dr Douglas Bettcher, Director of WHO’s Tobacco Free Initiative, said the six MPOWER strategies would create a powerful response to the tobacco epidemic. “This package will create an enabling environment to help current tobacco users quit, protect people from second-hand smoke and prevent young people from taking up the habit,” he said.

Other key findings in the report

• Only 5% of the global population is protected by comprehensive national smoke-free legislation and 40% of countries still allow smoking in hospitals and schools;

• Only 5% of the world’s population lives in countries with comprehensive national bans on tobacco advertising and promotion;

• Just 15 countries, representing 6% of the global population, mandate pictorial warnings on tobacco packaging;

• Services to treat tobacco dependence are fully available in only nine countries, covering 5% of the world’s people;

Tobacco tax revenues are more than 4000 times greater than spending on tobacco control in middle-income countries and more than 9000 times greater in lower-income countries. High- income countries collect about 340 times more money in tobacco taxes than they spend on tobacco control.

PDF of full report: http://www.who.int/entity/tobacco/mpower/mpower_report_full_2008.pdf

Adapted from materials provided by World Health Organization.

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Botox Linked To Respiratory Failure And Death, FDA Advises

Daily Science Journal (Feb. 11, 2008) — The U.S. Food and Drug Administration has notified the public that Botox and Botox Cosmetic (Botulinum toxin Type A) and Myobloc (Botulinum toxin Type B) have been linked in some cases to adverse reactions, including respiratory failure and death, following treatment of a variety of conditions using a wide range of doses.

In an early communication based on the FDA's ongoing safety review, the agency said the reactions may be related to overdosing. There is no evidence that these reactions are related to any defect in the products.

The adverse effects were found in FDA-approved and nonapproved usages. The most severe adverse effects were found in children treated for spasticity in their limbs associated with cerebral palsy. Treatment of spasticity is not an FDA-approved use of botulism toxins in children or adults.

The adverse reactions appear to be related to the spread of the toxin to areas distant from the site of injection, and mimic symptoms of botulism, which may include difficulty swallowing, weakness and breathing problems.

The FDA is not advising health care professionals to discontinue prescribing these products.

The agency is currently reviewing safety data from clinical studies submitted by the drugs' manufacturers, as well as post-marketing adverse event reports and medical literature. After completing a review of the data, the FDA will communicate to the public its conclusions, resulting recommendations, and any regulatory actions.

Adapted from materials provided by US Food And Drug Administration.

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Chronic Pain Harms The Brain

Daily Science Journal (Feb. 7, 2008) — People with unrelenting pain don't only suffer from the non-stop sensation of throbbing pain. They also have trouble sleeping, are often depressed, anxious and even have difficulty making simple decisions.

Comparison of brains. These images show the brain from the left side, demonstrating striking differences between chronic pain patients and healthy subjects. They illustrate with colors how much activation (red-yellow) or deactivation (dark/light blue) was found at each location. (Credit: Image courtesy of Northwestern University)

In a new study, investigators at Northwestern University's Feinberg School of Medicine have identified a clue that may explain how suffering long-term pain could trigger these other pain-related symptoms.

Researchers found that in a healthy brain all the regions exist in a state of equilibrium. When one region is active, the others quiet down. But in people with chronic pain, a front region of the cortex mostly associated with emotion "never shuts up," said Dante Chialvo, lead author and associate research professor of physiology at the Feinberg School. "The areas that are affected fail to deactivate when they should."

They are stuck on full throttle, wearing out neurons and altering their connections to each other.

This is the first demonstration of brain disturbances in chronic pain patients not directly related to the sensation of pain.

Chialvo and colleagues used functional magnetic resonance imaging (fMRI) to scan the brains of people with chronic low back pain and a group of pain-free volunteers while both groups were tracking a moving bar on a computer screen. The study showed the pain sufferers performed the task well but "at the expense of using their brain differently than the pain-free group," Chialvo said.

When certain parts of the cortex were activated in the pain-free group, some others were deactivated, maintaining a cooperative equilibrium between the regions. This equilibrium also is known as the resting state network of the brain. In the chronic pain group, however, one of the nodes of this network did not quiet down as it did in the pain-free subjects.

This constant firing of neurons in these regions of the brain could cause permanent damage, Chialvo said. "We know when neurons fire too much they may change their connections with other neurons and or even die because they can't sustain high activity for so long," he explained.

'If you are a chronic pain patient, you have pain 24 hours a day, seven days a week, every minute of your life," Chialvo said. "That permanent perception of pain in your brain makes these areas in your brain continuously active. This continuous dysfunction in the equilibrium of the brain can change the wiring forever and could hurt the brain."

Chialvo hypothesized the subsequent changes in wiring "may make it harder for you to make a decision or be in a good mood to get up in the morning. It could be that pain produces depression and the other reported abnormalities because it disturbs the balance of the brain as a whole."

He said his findings show it is essential to study new approaches to treat patients not just to control their pain but also to evaluate and prevent the dysfunction that may be generated in the brain by the chronic pain.

The study will be published Feb. 6 in The Journal of Neuroscience. Chialvo's collaborators in this project are Marwan Baliki, a graduate student; Paul Geha, a post-doctoral fellow, and Vania Apkarian, professor of physiology and of anesthesiology, all at the Feinberg School.

Adapted from materials provided by Northwestern University.

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