Humanitarian crises require a response that demonstrates compassion and concern for all concerned. This editorial failed to do that. If doctors cannot acknowledge the suffering of all humanity, what hope is there? I despair.
The recent war that was forced on Israel by war criminals who committed war crimes killing hundreds of children, women (including pregnant women), and octogenarians, youngsters in a peace festival, whose only crime was that they dreamed to live in harmony and peace with the people of Gaza. The civilians who live in the Kibbutzim near Gaza believed for dozens of years that peace and cooperation are feasible with their neighbors who live in Gaza. They were murdered brutally, cutting arms and legs of children and women while they were alive begging for some mercy or burning them alive.
The state of Israel was under the British Mandate from 1917 till 1948. Before that the Turkish Empire ruled the whole region starting in 1516. The state of Israel was born in 1948, with a United Nations partition plan for Palestine with a clear statement that the land will be shared between Jews and Arabs. The Arabs refused to accept the UN decision and opened a war, with a clear declaration to kill all the Jews who arrived to Israel after escaping the horrors of the Holocaust. The Jews had no option but to fight back and they won the war against all odds (even though they were numerically inferior). The Arabs who ran away became refugees.
This is the true and the only story. Instead of focusing on development of science, education, industry, medicine and tourism, the people of Gaza decided to be led like sheep by Iran who is using them for its own geopolitical ambitions.
Afte...
The recent war that was forced on Israel by war criminals who committed war crimes killing hundreds of children, women (including pregnant women), and octogenarians, youngsters in a peace festival, whose only crime was that they dreamed to live in harmony and peace with the people of Gaza. The civilians who live in the Kibbutzim near Gaza believed for dozens of years that peace and cooperation are feasible with their neighbors who live in Gaza. They were murdered brutally, cutting arms and legs of children and women while they were alive begging for some mercy or burning them alive.
The state of Israel was under the British Mandate from 1917 till 1948. Before that the Turkish Empire ruled the whole region starting in 1516. The state of Israel was born in 1948, with a United Nations partition plan for Palestine with a clear statement that the land will be shared between Jews and Arabs. The Arabs refused to accept the UN decision and opened a war, with a clear declaration to kill all the Jews who arrived to Israel after escaping the horrors of the Holocaust. The Jews had no option but to fight back and they won the war against all odds (even though they were numerically inferior). The Arabs who ran away became refugees.
This is the true and the only story. Instead of focusing on development of science, education, industry, medicine and tourism, the people of Gaza decided to be led like sheep by Iran who is using them for its own geopolitical ambitions.
After committing so many war crimes, after 75 years of living side by side with so many peaceful gestures by Israel, after the exit from Gaza and letting the local population live freely and without any constrains from Israel...now you are looking for the "roots of the conflict"?
It is about time to wake up and tell the truth and the true history of the region and face the reality.
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...
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 increase data variability rather than more accurately representing reality, potentially resulting in the overemphasis or neglect of crucial aspects of global human existence. Fourth, bioterrorism threats emerge from creating new pathogens or artificial life through AI-driven deeper understanding of biology. This poses risks such as manufactured pandemics, personalized infections, and the development of harmful agents for targeted harm or killings. Fifth, the environmental burden of AI is often overlooked (2). The energy consumption of AI technologies significantly contributes to CO2 emissions and climate change. Without relying on renewable energy sources, the global use of AI exacerbates environmental issues worldwide. Lastly, the lack of democratic oversight and moral alignment in the development and use of AI in society is a pressing concern (3). The ethical implications of AI deployment and its impact on society warrant careful consideration and robust governance.
In terms of AGI’s impact on global health, the authors highlight the existential threat of AGI potentially harming or subjugating humans. From a global health perspective, AGI-driven healthcare systems could lead to a decline in human health by prioritizing harmful interventions over beneficial ones. AGI may intentionally implement interventions that harm rather than prioritize human health, making it an inherent existential threat to humanity.
Regarding response strategies, the authors overlook the presence of efficient health technology assessment institutions in many countries. These institutions play a crucial role in evaluating AI technologies for health purposes but face challenges in order to address global issues of AI (4). First, the global impact of AI systems should be clearly integrated into the technological assessment process. Second, significant efforts are required to support health agencies in tackling AI regulatory challenges and emphasizing the necessity of considering the potential existential threats posed by AI, particularly regarding the ever-evolving and increasingly pervasive nature of AI systems. Third, these institutions would clearly benefit from international collaborations and consider the value of AI systems not just from a national perspective.
In conclusion, Federspiel and colleagues’ call for regulating AI and raising awareness on its health-related harms is commendable. However, it is essential to delve deeper into the subject. Identifying overlooked threats to global health, acknowledging the specific risks associated with AGI, and formulating appropriate responses are vital for effectively mitigating the potential adverse impacts of AI on human well-being.
References
1. Federspiel F, Mitchell R, Asokan A, Umana C, McCoy D. Threats by artificial intelligence to human health and human existence. BMJ Glob Health. 2023;8(5):e010435.
2. García-Martín E, Rodrigues CF, Riley G, Grahn H. Estimation of energy consumption in machine learning. J Parallel Distrib Comput. 2019;134:75‑88.
3. Bélisle-Pipon JC, Monteferrante E, Roy MC. Couture V. Artificial intelligence ethics has a black box problem. AI & Soc (2022). https://doi.org/10.1007/s00146-021-01380-0.
4. Bélisle-Pipon JC, Couture V, Roy MC, Ganache I, Goetghebeur M, Cohen IG. What Makes Artificial Intelligence Exceptional in Health Technology Assessment? Front Artif Intell. 2021;4:736697.
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...
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 public pressure (9).
The WHO must take responsibility for its part in all this mayhem.
Article 37 of the WHO’s constitution states: “In the performance of their duties the Director-General and the staff shall not seek or receive instructions from any government or from any authority external to the Organization. They shall refrain from any action which might reflect on their position as international officers. Each Member of the Organization on its part undertakes to respect the exclusively international character of the Director-General and the staff and not to seek to influence them (10).
Yet today the WHO’s program direction seems to be dictated by private entities who make voluntary contributions, constituting up to 80% of its budget. These voluntary donors include the Bill and Melinda Gates Foundation and pharmaceutical companies with vested interests, who are allowed to earmark their contributions for specific projects (11).
In the face of waning credibility, the WHO is seeking more powers for the WHO Director-General to declare a Public Health Emergency of International Concern (PHEIC) and then take over the authority of national governments to detain its citizens, restrict their travel and force testing and vaccination (12).
Jackson et al have suggested that poor nations can play hardball using their clout in numbers, but there is little unity of purpose among these nations (1). It is also suggested that scientists from developing countries must be given a place on the table, but understanding how beholden they are to charities and pharma for funding their laboratories, this seems a futile exercise.
To stay true to its constitutional obligations, the WHO must accept only voluntary contributions it can use by its priorities not donations for specific programmes. Unless this happens the WHO will not retain credibility as a scientific body or trust as an advisor on matters of health. On the other hand, if it happens there will be no need for coercive pandemic laws because people will follow its advice from self-interest. Notwithstanding this, if the WHO frames new rules to arrogate more powers to itself, the public has demonstrated that they can wrest their freedoms no matter how powerful the forces are against them.
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.
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...
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 approximately 30,000 bases, each replication cycle will imply as an average the occurrence of 1 mutation/10,000 nucleotides (Di Guardo 2022a). Indeed, by progressively undergoing mutational events in both naturally and “artificially” gregarious species like white-tailed deer and mink, respectively, the possibility that new, highly divergent and pathogenic SARS-CoV-2 lineages could emerge from “animal communities” and infect people should be seriously taken into account.
Although the vast majority of SARS-CoV-2 VOCs and VOIs have developed in humans, some of them have also happened to "spill back" from animals to mankind.
This is clearly shown, for example, by the recent case of human infection caused by a highly divergent SARS-CoV-2 lineage (B.1.641) circulating among white-tailed deer (Odocoileus virginianus) from the Canadian region of Ontario, harbouring 76 mutations (37 of which had not been previously detected in human viral isolates) and sharing a quite recent common ancestry with a mink SARS-CoV-2 strain from Michigan (Pickering et al. 2022). Indeed, white-tailed deer have already been shown to be particularly susceptible to SARS-CoV-2 infection on the basis of a high homology degree of their angiotensin-converting enzyme-2 (ACE-2) viral receptor with the human one, thereby supporting in a very efficient way the intraspecies transmission of several VOCs and VOIs infecting people (Palmer et al. 2021; Hale et al. 2022). Furthermore, a vast proportion (40%) of white-tailed deer from North-Eastern USA were proven to harbour anti-SARS-CoV-2 antibodies in their blood serum (Chandler et al. 2021), with the omicron variant having been also identified in deer from New York State and Ohio (Wetzel 2022).
Still noteworthy, during the spring/summer seasons of 2020 the "cluster 5" VOC, characterized by the S:Y453F mutation, emerged from intensely bred mink in Denmark and The Netherlands. Following transmission from infected people (viral spillover), in fact, SARS-CoV-2 was shown to evolve into the aforementioned VOC inside the body of mink, which subsequently “returned” the mutated virus to humans (viral spillback) (Di Guardo 2021a; Lassaunière et al. 2021). This led, in turn, to the "stamping-out" of 17 million mink in Denmark, due to the public health hazard posed by them.
As far as concerns SARS-CoV-2 transmission from people to animals, cases of infection caused by the “alfa” variant were described in two cats and in one dog from France with suspect myocarditis, whose owners had shown CoViD-19-associated respiratory symptoms three to six weeks before
(Ferasin et al. 2021). It has also been claimed that pet hamsters transferred the highly pathogenic "delta" VOC to pet shop workers and visitors in Hong Kong (Mesa 2022), while the Omicron BA.2 subvariant could have been passed to people in China by a dog acting as a passive SARS-CoV-2 mechanical carrier (Zhou et al. 2022).
Among the wild animal species hitherto deemed susceptible to SARS-CoV-2 infection, a number of them appear to be increasingly threatened by extinction in terrestrial as well as in marine ecosystems.
While being of great concern, this simultaneously provides a strong argument for advocating the opportunity, if not the need, of immunizing the aforementioned species against SARS-CoV-2 (Di Guardo 2022b), although we don't know yet "how" and "to which extent" SARS-CoV-2 infection could impact their health and conservation status. By doing so, in fact, we would correctly apply the so-called "principle of precaution", thus aiming at protecting the increasingly threatened animal biodiversity by conferring an adequate antiviral population immunity to those SARS-CoV-2-susceptible wildlife species facing an increased extinction risk (e.g. lions, tigers, snow leopards, gorillas, etc.) (Delahay et al. 2021). At the same time, we would likely contribute to reducing SARS-CoV-2 circulation and, consequently, the appearance of new, highly transmissible and/or pathogenic VOCs.
To this aim, the tremendous progress gained in the production of the currently available vaccines through the messenger RNA (mRNA) technology should be viewed as a great advantage and scientific achievement.
Within this framework, the SARS-CoV-2 vaccination programmes should also include animals either living in close contact with people or intensely bred (i.e. mink and pigs), as well as wildlife species with a marked social ecology that have been shown to enhance intra-species transmission of SARS-CoV-2 (i.e. white-tailed deer) (Chandler et al. 2021; Hale et al. 2022).
The first key lesson we have learned (once again!) from the dramatic SARS-CoV-2 pandemic is that human, animal and environmental health are mutually and inextricably linked to each other.
This is the reason why, in order to be better prepared for future pandemics, we urgently need to adopt a scientific evidence-based, “holistic”, multidisciplinary and "One Health-based" approach.
In this respect, let me end this commentary by affirming it is very surprising, if not almost unbelievable, that in the far too brief two years of its life, the "Italian CoViD-19 Scientific Committee" (popularly known by the acronym "CTS") has never appointed any veterinarians as members of the committee (Di Guardo 2021b), thereby completely forgetting that at least 70% of the pathogens responsible for emerging infectious diseases (including also SARS-CoV-2 and its two betacoronavirus "predecessors", SARS-CoV and MERS-CoV) have either a proven or suspect origin from one or more animal reservoirs (Casalone and Di Guardo 2020).
Errare Humanum est Perseverare Autem Diabolicum!
2) Chandler JC, Bevins SN, Ellis JW, Linder TJ, Tell RM, Jenkins-Moore M, Root JJ, Lenoch JB, Robbe-Austerman S, DeLiberto TJ, Gidlewski T, Kim Torchetti M, Shriner SA (2021) SARS-CoV-2 exposure in wild white-tailed deer (Odocoileus virginianus). Proc Natl Acad Sci USA 118(47):e2114828118. doi: 10.1073/pnas.2114828118.
3) Delahay RJ, de la Fuente J, Smith GC, Sharun K, Snary EL, Flores Girón L, Nziza J, Fooks AR, Brookes SM, Lean FZX, Breed AC, Gortazar C (2021) Assessing the risks of SARS-CoV-2 in wildlife. One Health Outlook 3:7. doi: 10.1186/s42522-021-00039-6.
5) Di Guardo G (2021a) Future trajectories of SARS-CoV-2 in animals. Vet Rec 188:475. doi: 10.1002/vetr.663.
6) Di Guardo G (2021b) No Veterinarians (yet) on the Italian COVID-19 Scientific Committee. BMJ 374:n1719.
7) Di Guardo G (2022a) Is gain of function a reliable tool for establishing SARS-CoV-2 origin?. Adv Microbiol 12:103-108. doi:10.4236/aim.2022.123009.
8) Di Guardo G (2022b) SARS-CoV-2 Susceptibility of Domestic Animals and Wildlife in the Media Narrative. Pathogens 11:1356. https://doi.org/10.3390/pathogens11111356.
9) Ferasin L, Fritz M, Ferasin H, Becquart P, Corbet S, Ar Gouilh M, Legros V, Leroy EM (2021) Infection with SARS-CoV-2 variant B.1.1.7 detected in a group of dogs and cats with suspected myocarditis. Vet Rec 189(9):e944. doi: 10.1002/vetr.944.
10) Hale VL, Dennis PM, McBride DS, Nolting JM, Madden C, Huey D, Ehrlich M, Grieser J, Winston J, Lombardi D, Gibson S, Saif L, Killian ML, Lantz K, Tell RM, Torchetti M, Robbe-Austerman S, Nelson MI, Faith SA, Bowman AS (2022) SARS-CoV-2 infection in free-ranging white-tailed deer. Nature 602:481-486. doi: 10.1038/s41586-021-04353-x.
11) Lassaunière R, Fonager J, Rasmussen M, Frische A, Polacek C, Rasmussen TB, Lohse L, Belsham GJ, Underwood A, Winckelmann AA, Bollerup S, Bukh J, Weis N, Sækmose SG, Aagaard B, Alfaro-Núñez A, Mølbak K, Bøtner A, Fomsgaard A (2021) In vitro Characterization of Fitness and Convalescent Antibody Neutralization of SARS-CoV-2 Cluster 5 Variant Emerging in Mink at Danish Farms. Front Microbiol 12:698944. doi: 10.3389/fmicb.2021.
13) Palmer MV, Martins M, Falkenberg S, Buckley A, Caserta LC, Mitchell PK, Cassmann ED, Rollins A, Zylich NC, Renshaw RW, Guarino C, Wagner B, Lager K, Diel DG (2021) Susceptibility of white-tailed deer (Odocoileus virginianus) to SARS-CoV-2. J Virol 95(11):e00083-21. doi: 10.1128/JVI.00083-21.
14) Pickering B, Lung O, Maguire F, Kruczkiewicz P, Kotwa JD, Buchanan T, Gagnier M, Guthrie JL, Jardine CM, Marchand-Austin A, Massé A, McClinchey H, Nirmalarajah K, Aftanas P, Blais-Savoie J, Chee HY, Chien E, Yim W, Banete A, Griffin BD, Yip L, Goolia M, Suderman M, Pinette M, Smith G, Sullivan D, Rudar J, Vernygora O, Adey E, Nebroski M, Goyette G, Finzi A, Laroche G, Ariana A, Vahkal B, Côté M, McGeer AJ, Nituch L, Mubareka S, Bowman J (2022) Divergent SARS-CoV-2 variant emerges in white-tailed deer with deer-to-human transmission. Nat Microbiol 7(12):2011-2024. doi: 10.1038/s41564-022-01268-9.
16) Zhou C, Wu A, Ye S, Zhou Z, Zhang H, Zhao X, Wang Y, Wu H, Ruan D, Chen S, Tang W, Xu S, Li Q, Su K (2022) Possible transmission of COVID-19 epidemic by a dog as a passive mechanical carrier of SARS-CoV-2, Chongqing, China, 2022. J Med Virol. doi: 10.1002/jmv.28408. Epub ahead of print.
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...
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, patients who are deaf or hard of hearing face prolonged wait times and are often unable to fully express their medical needs and fully comprehend what is happening with their medical care. When patients cannot adequately communicate their health needs, they are unable to get the care they need, exacerbating existing inequities.
When health systems and society do not accommodate individuals with hearing loss, they contribute to social isolation. This isolation can manifest in poorer long-term health outcomes such as dementia and premature mortality.4
As the prevalence of unsafe listening practices in adolescents and young adults continues to grow5, we need to continue our advocacy efforts to optimize the health care environment so that persons who are deaf or hard of hearing can get the best medical care possible.
This includes not only access to timely and appropriate sign language interpretation but also captioning options, American Sign Language-translated videos, assistive devices that facilitate appointment scheduling and quiet environments that allow patients to better communicate with the providers.6
We also need better training for all members of the healthcare team to understand the nuances involved in caring for deaf and hard of hearing patients. These steps are useful not only in the medical setting but in all social settings so that the deaf and hard of hearing can be fully integrated in our society.
1. Jilla AM, Johnson CE, Huntington-Klein N. Hearing aid affordability in the United States. Disabil Rehabil Assist Technol. 2020 Oct 28:1-7. doi: 10.1080/17483107.2020.1822449. Epub ahead of print. PMID: 33112178.
2. Oyler AL. Untreated hearing loss in adults. Accessed from https://www.asha.org/Articles/Untreated-Hearing-Loss-in-Adults/#:~:text=... on December 1, 2022.
3. Emmett SD, Francis HW. The socioeconomic impact of hearing loss in U.S. adults. Otol Neurotol. 2015 Mar;36(3):545-50. doi: 10.1097/MAO.0000000000000562. PMID: 25158616; PMCID: PMC4466103.
4. Ciorba A, Bianchini C, Pelucchi S, Pastore A. The impact of hearing loss on the quality of life of elderly adults. Clin Interv Aging. 2012;7:159-63. doi: 10.2147/CIA.S26059. Epub 2012 Jun 15. PMID: 22791988; PMCID: PMC3393360.
5. Dillard LK, Arunda MO, Lopez-Perez L, et al. Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis. BMJ Global Health 2022;7:e010501.
6. Tonelli M, Warick R. Focusing on the Needs of People With Hearing Loss During the COVID-19 Pandemic and Beyond. JAMA. 2022;327(12):1129–1130. doi:10.1001/jama.2022.3026
I am very glad to see this article and the research that went into it. Although the findings are disappointing on their own, an historical perspective would show they are certainly a sign of some progress compared to the days when no journal at all considered the issue of equity in authorship, let alone in peer review or subject matter. In 1992, Sundari Ravindran and I founded the journal Reproductive Health Matters (RHM). We published an issue twice a year with an editorial and 20-25 articles that included features, original research, commentaries and news summaries. We formed an Editorial Advisory Board and a Board of Trustees so as to become a charity early on, and began listing their names in the journal in 1997. One of the most important policy decisions our joint board meetings made, also around 1997, was related to equity of authorship and equity in other forms of participation, e.g. in peer reviewing. We also began to publish shorter editions of the journal with some the papers, which were translated into Spanish, French, Arabic, Chinese, and Hindi by editors from the countries/regions represented by those languages.
The journal, published by Elsevier Science, was open access throughout the time RHM existed, because we raised donor funds to pay them for this. In my opinion, if a journal is not open access, then ensuring equity of access to publication is not possible, because the authors most likely to be given grants to pay for open access are more likely...
I am very glad to see this article and the research that went into it. Although the findings are disappointing on their own, an historical perspective would show they are certainly a sign of some progress compared to the days when no journal at all considered the issue of equity in authorship, let alone in peer review or subject matter. In 1992, Sundari Ravindran and I founded the journal Reproductive Health Matters (RHM). We published an issue twice a year with an editorial and 20-25 articles that included features, original research, commentaries and news summaries. We formed an Editorial Advisory Board and a Board of Trustees so as to become a charity early on, and began listing their names in the journal in 1997. One of the most important policy decisions our joint board meetings made, also around 1997, was related to equity of authorship and equity in other forms of participation, e.g. in peer reviewing. We also began to publish shorter editions of the journal with some the papers, which were translated into Spanish, French, Arabic, Chinese, and Hindi by editors from the countries/regions represented by those languages.
The journal, published by Elsevier Science, was open access throughout the time RHM existed, because we raised donor funds to pay them for this. In my opinion, if a journal is not open access, then ensuring equity of access to publication is not possible, because the authors most likely to be given grants to pay for open access are more likely to be in global north institutions that can afford it. I believe this is one of the most important reasons why equity of access for authors and others involved in journal publication has not progressed more than it has, as shown in the current article.
A quick look through the first editions of RHM shows that we had a very international group of board members, authors and peer reviewers from a wide range of countries, including the global south (or what the authors of this article call LMIC countries). But like other journals, we did not have a policy to that effect at the beginning, only the politics of international feminism and women’s rights. This changed when one of the trustees put this subject on the agenda of an annual meeting, around 1997, and proposed that we develop written policy on equity, which we did. Its first and most important point was that any paper published about a specific country had to be by at least some authors from that country, not just as an afterthought at the end of the list or as people who were thanked for “helping with the research”. Together we enforced this policy throughout my editorship, which lasted 23 years. With each edition, I would do a count of how many authors and peer reviewers and countries were represented by the articles and from which parts of the world. I reported this to the annual meetings as well, though I can’t recall for how long.
We were very aware that few if any other journals did the same at the time, including the most important health-related journals, whose tables of contents I scoured regularly for news and partly with checking equity of authorship in mind.
When I left RHM in May 2015, its name, editorship, staff, boards, and publisher all changed. I don’t know if this policy has continued. I do know that real open access in most journals is far less available than we may be led to believe.
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....
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. This advocacy has worked and is exemplified by greater decrease in neonatal mortality. .
We declare no conflict of interest.
Phadke M. A1*, Nair R2*, Menon P3*, Jotkar R4*.
1*Sr. Adv Govt,UNICEF,Mumbai, India
2*Nutrition Specialist,UNICEF,Mumbai, Maharashtra, India
3*Asso. Prof, Pediatrics, MEDD, DY P. Med College, Pune, India
4*Sr. Consultant R.Jijau mission, DWCD,Govt of Mah Mumbai,India
References:
1.Deliberation-based learning: strengthening neonatal care in China http://orcid.org/0000-0001-5158-3267Yue Xiao1,
Yingpeng Qiu1, Lewis Husain2,Gerald Bloom2,
Liwei Shi1Correspondence to Dr. Yue Xiao; moonxy@126.com
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...
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 (drug given in complicated Falciparum malaria) and rifampicin (1st line drug for Tuberculosis).
Adverse drug reactions under- reporting is very high in India.4 Doctors, Health Care Workers (HCWs) treating malaria patients, including peripheral areas must be encouraged to report ADRs and should be trained for drug reactions management. They should also provide data on adverse drug effects of antimalarial when given during pregnancy and lactation, fetal toxicity i.e. effect of cardiac malformation and skeletal defects due to some of anti-malarial drugs and lastly G-6 PD Deficiency and use of primaquine where a significant proportion of population has high prevalence of G6PD
deficiency. Drug efficacy is also affected by may complains and ADR reporting as time may help in proper m/m at local level and incorporation of important new points in malaria treatment guidelines. For malaria elimination, thus sharing of data demonstrating or exhibiting (a) Drug efficacy and bioavailability of drugs (b) Real time reporting of ADR of individual drugs (c) Drug interactions (d) Information regarding radical cure given to patients (especially in P vivax endemic regions) and compliance of primaquine, in digital dashboard will strengthen the system and definitely a country with highest P. vivax cases (India accounts for nearly 50% cases of Plasmodium vivax cases) should think about alternative to primaquine 5 .
Reference:
1. Rahi M, Sharma A. For malaria elimination India needs a platform for data integration BMJ Global Health 2020;5:e004198.
2. Shrivastva, S., Chakma, T., Das, A. and Verma, A.K. (2021), Digitisation and realtime sharing of unified surveillance tool and clinicopathological data for efficient management of disease outbreaks. Int J Health Plann Mgmt, 36: 1352-1354. https://doi.org/10.1002/hpm.3163
3. Sim IK, Davis TM, Ilett KF. Effects of a high-fat meal on the relative oral bioavailability of piperaquine. Antimicrob Agents Chemother. 2005 Jun;49(6):2407-11. doi: 10.1128/AAC.49.6.2407-2411.2005. PMID: 15917540; PMCID: PMC1140540.
4. Tandon, V. R., Mahajan, V., Khajuria, V., &Gillani, Z. (2015). Under-reporting of adverse drug reactions: a challenge for pharmacovigilance in India. Indian journal of pharmacology, 47(1), 65–71. https://doi.org/10.4103/0253-7613.150344
5. Wells, T. N., Alonso, P. L., &Gutteridge, W. E. (2009). New medicines to improve control and contribute to the eradication of malaria. Nature reviews. Drug discovery, 8(11), 879–891. https://doi.org/10.1038/nrd2972.
Humanitarian crises require a response that demonstrates compassion and concern for all concerned. This editorial failed to do that. If doctors cannot acknowledge the suffering of all humanity, what hope is there? I despair.
The recent war that was forced on Israel by war criminals who committed war crimes killing hundreds of children, women (including pregnant women), and octogenarians, youngsters in a peace festival, whose only crime was that they dreamed to live in harmony and peace with the people of Gaza. The civilians who live in the Kibbutzim near Gaza believed for dozens of years that peace and cooperation are feasible with their neighbors who live in Gaza. They were murdered brutally, cutting arms and legs of children and women while they were alive begging for some mercy or burning them alive.
Show MoreThe state of Israel was under the British Mandate from 1917 till 1948. Before that the Turkish Empire ruled the whole region starting in 1516. The state of Israel was born in 1948, with a United Nations partition plan for Palestine with a clear statement that the land will be shared between Jews and Arabs. The Arabs refused to accept the UN decision and opened a war, with a clear declaration to kill all the Jews who arrived to Israel after escaping the horrors of the Holocaust. The Jews had no option but to fight back and they won the war against all odds (even though they were numerically inferior). The Arabs who ran away became refugees.
This is the true and the only story. Instead of focusing on development of science, education, industry, medicine and tourism, the people of Gaza decided to be led like sheep by Iran who is using them for its own geopolitical ambitions.
Afte...
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...
Show MoreWe 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...
Show MoreI 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.
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).
Show MoreThe 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...
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.
Show MoreApproximately 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...
I am very glad to see this article and the research that went into it. Although the findings are disappointing on their own, an historical perspective would show they are certainly a sign of some progress compared to the days when no journal at all considered the issue of equity in authorship, let alone in peer review or subject matter. In 1992, Sundari Ravindran and I founded the journal Reproductive Health Matters (RHM). We published an issue twice a year with an editorial and 20-25 articles that included features, original research, commentaries and news summaries. We formed an Editorial Advisory Board and a Board of Trustees so as to become a charity early on, and began listing their names in the journal in 1997. One of the most important policy decisions our joint board meetings made, also around 1997, was related to equity of authorship and equity in other forms of participation, e.g. in peer reviewing. We also began to publish shorter editions of the journal with some the papers, which were translated into Spanish, French, Arabic, Chinese, and Hindi by editors from the countries/regions represented by those languages.
The journal, published by Elsevier Science, was open access throughout the time RHM existed, because we raised donor funds to pay them for this. In my opinion, if a journal is not open access, then ensuring equity of access to publication is not possible, because the authors most likely to be given grants to pay for open access are more likely...
Show MoreTo,
Show MoreThe 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....
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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