eLetters

140 e-Letters

  • Artificial intelligence as a threat for global health

    Federspiel et al. (1) argue that the health literature on AI focuses on its benefits but neglects its potential harms, particularly in clinical settings. They highlight four concerns: disinformation and surveillance, lethal autonomous weapon systems, job loss, and the existential threat of artificial general intelligence (AGI). To mitigate these threats, the authors propose supranational regulations and increased awareness. However, further exploration is needed regarding overlooked threats, the impact of AGI on global health, and appropriate responses.

    The widespread adoption of AI in healthcare systems poses new threats that often go unnoticed. First, integrating AI into healthcare blurs the boundary between clinical care and population health, making it difficult to separate the global from the individual. This creates challenges when using AI to connect personalized medicine and precision public health, as it can impact social determinants of health and exacerbate disparities in healthcare accessibility and discrimination. Second, the success of AI systems can lead to a two-tier healthcare system that would lead to diminished ability to provide human-centred care and may incur high costs with suboptimal outcomes if AI systems are ineffective or only benefiting some peoples. Third, the growing creation and use of synthetic data to optimize AI systems present a solution for more comprehensive models, but it also poses a risk of bias and tropism as it aims to incre...

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  • Breast feeding increases Prolactin and DHEA

    I suggest the basis of Mineva, et al., is dehydroepiandrosterone (DHEA). A case may be made that breast feeding increases DHEA; prolactin is directly connected with secretion of breast milk. Prolactin is a direct and specific stimulus for DHEA production. Low prolactin is frequently found in viral infections, including RSV.

  • We do not need more International Health Regulations - It is the WHO that needs to reform

    We read with interest the suggestions of Jackson and colleagues (1) in the context of the revision of the International Health Regulation and the WHO’s proposed pandemic treaty. By narrowly framing the acrimony around the COVID-19 pandemic responses, as a dispute between resource-poor countries (LMICs) on the one hand and industrially developed countries on the other, the authors seem to be missing the woods for the trees.

    The lockdowns, vaccine mandates and restrictions on the freedom of movement of the unvaccinated, were violations of the Nuremberg Code (2) and an assault on the freedoms enshrined in the Universal Declaration of Human Rights (3). People from both rich and poor nations were adversely affected.

    The prescriptions were irrational as they were unreasonable. Children were kept out of schools although the majority were not at risk of harm from contracting COVID-19 and they had the potential to safely increase herd immunity if only the vulnerable were isolated. Vaccine passports, which allowed vaccinated persons travel privileges, were perpetuated even after it was known that the vaccine would not stop the person-to-person spread of the disease.

    The public protested these encroachments on their freedoms and rights in many industrialised countries, in both democratically elected countries like Canada (4) France (5) Australia (6) New Zealand (7) and also in China with its draconian laws (8). In the end, even China was forced to bow down to...

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  • The CoViD-19 pandemic at the human-animal interface: Lessons for the present and the future

    Since the start of the CoronaVirus Disease-2019 (CoViD-19) pandemic, which has hitherto killed almost 7 million people worldwide - although the true mortality figures could be much higher -, we have witnessed a progressively expanding number of domestic and wild mammalian species acquiring Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) infection, both spontaneously and experimentally (Di Guardo, 2022b).
    The progressively expanding SARS-CoV-2 host range, hitherto encompassing more than thirty wildlife and domestic species, could be plausibly linked, among others, to the development of new, highly contagious and/or pathogenic variants of concern (VOCs) and variants of interest (VOIs) of this pandemic betacoronavirus.
    Over the past three years, in fact, a huge number of mutational events were recorded in the genetic make-up of SARS-CoV-2, with this leading to the global appearance of several VOCs and VOIs (such as those termed "alfa", "beta", "gamma", "delta" and the highly contagious and immune-evasive "omicron", alongside its BA.1-BA.5 subvariants and the more recently identified ones named "Centaurus”, “Chiron”, “Gryphon”, “Cerberus”, followed by the newly emerged and highly transmissible "Kraken"). The progressive acquirement of “non-silent” mutations in the SARS-CoV-2 genome is directly connected to enhanced viral replication and, provided that the virus genetic make-up consists of...

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  • Better Support is Needed for Individuals with Hearing Loss

    During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
    Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
    We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
    We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...

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  • Better Support is Needed for Individuals with Hearing Loss

    During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
    Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
    We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
    We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...

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  • Noise pollution

    Sir ,Voluntary noise exposure can be avoided. Every country has laws for noise pollution but the ground reality? Just by one act of "Abolishing Horn facility in vehicles" can have unimaginable health benefits to humans and animals in the whole world. I even wrote to Shri Modiji,my beloved PM but I wonder if it reached his ears since he too must be a victim of noise pollution(on a lighter note ). Can Bmj reach out to tall leaders of all countries through this Rapid Response????

  • Reporting of Adverse Drug Reactions and Pharmacokinetics of drugs will strengthen the digital dashboard for malaria

    Dear Editor,

    The article by Rahi et al1 Digitization of malaria surveillance tools is very informative, and it may raise malaria elimination activities in India. It would be a key step towards malaria elimination in India and if we need a strong malaria health information system we have to switch from aggregated data to near real time case based surveillance. We also agree that digitisation and real-time sharing of surveillance result and sharing of clinic pathological data is very essential for efficient management of disease outbreaks2 which may include Malaria outbreak by new species of Plasmodium; To their proposed platform (which may provide real time epidemiological, entomological and community surveillance data), there is a need of emphasis on drug efficacy determining factors and reporting of Adverse Drug Reactions (ADR) from each and every region and each and every case detected even in primary or community health centres of country. Drug treatment for malaria is far away from simple. Drug efficacy of anti-malarial drug depends upon various factors like a) Pharmacokinetics and pharmacodynamics of drugs commonly used and including effect of high fat meal on relative bioavailability of lumefantrines and piperaquine3 b) Severe side effects of some drugs like life threatening ADRs from quinine, possibility of delayed haemolytic anemia in cases treated with Artemether- lumefantrine (c) Drug interactions between anti-malarial drugs and other drugs i.e. Quinine...

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  • Reduction in neonatal mortality

    To,
    The Editor,
    We read with interest the article on ‘Deliberation-based learning: strengthening neonatal care in China’ by Yingpeng et.al. that has appeared in the September 2022 issue of BMJ Global health. The strategies evolved by the Govt. seem to have worked. They held detailed deliberations with staff and patients that helped in better neonatal care. On this backdrop, we submit observations from India to accentuate their study.
    The Sample Registration System of India released its data on 22nd September 20222, which has shown some promising figures.SRS data shows that U5MR( Under 5 mortality rate) to be 32 per thousand live births, IMR(Infant mortality rate) to be 28(87.5%) and NMR(Neonatal mortality rate) to be 22 (68.75% of total and 78.5 % of the IMR). This more than amply describes divergent age pattern in mortality statistics of India in 2020.
    In 2014 U5MR was 45, IMR 39(86.6%) and NMR 26(57.7of total and 66.6% of the IMR).It is thus clear that neonatal mortality as a subcomponent of IMR has declined more in terms of percentage. This probably is the result of many policy changes in national programs started by the Govt. of India like HBNC3(home based new born care), HBYC( Home based young child care), exclusive breast feeding , MAA( mother’s absolute affection)and KMC( Kangaroo mother care) . All these programs involve health professional staff to advocate and parents (caregivers) to participate. Empowerment of the mother is critical....

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  • Semantics : Acta non verba

    Pardon my literary brevity, but this article does little in the way of actually helping poor communities . All you are
    doing is changing words around to sugar coat widespread healthcare inequalities ( disparities ) in this country. Why not just call it what it is and do something about it, ipso facto ? It is dissapointing to read an article where the primary debate centers on linguistics or terminology and not practical solutions to real life health problems. So what if a country is 'developing', we used to call them "third world " what the hell is the difference? My bigger point is should we not concentrate on helping each other instead of finding different ways to be woke .

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