eLetters

177 e-Letters

  • 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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  • Author equity of access guidelines: at least there has been some progress

    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...

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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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  • 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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  • 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????

  • 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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  • 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 .

  • Fundamental values cannot be defeated by the argument from proportionality

    The article does not adequately take into account a crucial ethical and (by implication, legal) fact: the argument from proportionality does not justify arbitrary violations of the right to life or the removal of the right to free medical consent, for the following reasons.

    Summary of the three strongest arguments against the ethical permissibility of vaccine mandates and why any medical procedure imposed by coercion must be refused.

    1. Vaccine mandates imply that all humans are born in a defective, inherently harmful state that must be biotechnologically augmented to allow their unrestricted participation in society, and this constitutes discrimination on the basis of healthy, innate characteristics of the human race. (This point derives from my paper published here: https://jme.bmj.com/content/48/4/240).

    2. Medical consent must be free – not coerced – in order to be valid. Any discrimination against the unvaccinated is economic or social opportunity coercion, precluding the possibility of valid medical consent. The right to free, uncoerced medical consent is not negotiable, under any circumstances, because without it we have no rights at all; every other right can be subverted by medical coercion. Crucially, by accepting any medical treatment imposed by coercion we would be acquiescing to the taking away of the right to free medical consent not just from ourselves but from our children and from futur...

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  • Caution advised when comparing or pooling seropositivity proportions

    We read the systematic review by Dong et al. [1] with great interest. The authors aimed to describe global seroprevalence estimates for B. burgdorferi s.l., the causal agent of Lyme disease.

    First, estimating seropositivity for a target population (here, the global population) has two challenges we would like to address:
    1) The age and sex distribution of the population providing sample(s) and the target population should correspond. The simple reason is that advancing age and male sex are well-established risk factors for a positive IgG antibody serostatus [2]. Therefore, one may not conclude the general population seropositivity from an aged sample with a large share of males if not corrected accordingly, e.g., by applying weights; otherwise, seropositivity may be overestimated. Unfortunately, the age and sex profiles of the individual studies were seemingly not considered or discussed for their final seropositivity estimates.
    2) Then, as already stated in the first reply to this manuscript by A. Semper et al., the studies containing subjects with medical conditions or even patients with suspected or confirmed Lyme disease symptomatology are of little use for general population estimates of seropositivity (e.g., [3, 4], included by Dong et al.), as these populations do not correspond to the global population. Also, pooling seropositivity proportions for high-risk populations to obtain global estimates potentially introduces bias and, hence, should be a...

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