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As the holiday season approaches and people step up their travel, one group of flyers faces particular stress when they hear the announcement: “Is there a doctor on the plane?” A recent interview in the Journal of the American Medical Association highlights some of the problems that can arise when they respond to calls for help.

Rachel Zang, an American doctor, warns that it is not clear who bears legal liability for medics on planes, and says there is no clear process for selection and pre-authorisation. There are no consistent rules on the drugs and diagnostics carried on board, and sometimes there is a contradiction between the advice given in the air and from medical crews on the ground.

Data on the frequency and nature of in-flight emergencies are also scant. One study in the New England Journal of Medicine estimated that one in every 604 flights experienced a medical emergency. The most common problems were fainting, breathing difficulties and nausea, with 0.3 per cent ending in death.

With more than 2.8bn people flying each year — and by 2023 over half projected to be aged over 50 — the volume of problems is only set to rise.

Three questions

We spoke to Carlos Morel, director of the Centre for Technological Development in Health at Brazil’s Fiocruz institute and joint author of a paper on the innovative ways developing countries are tackling epidemics.

What is the key message of your article?

It is not uncommon for developing countries to remain tied to their colonial past, relying on foreign expertise or supplies to deal with health concerns, such as France for Senegal and England for Ghana during the Ebola outbreak. We highlighted a radical departure when Brazil took the lead on Zika, uncovering its terrible impact on newborns and identifying the association between a new type of microcephaly and the virus. Developing countries are capable of innovating and effectively responding to global health challenges.

How can innovative developing countries improve their influence?

Through recognising their role in development, investing and strengthening their scientific and technological base. Our analysis, based on the recent Zika epidemics, demonstrated the importance of the pre-existing healthcare infrastructure, trained scientists, physicians and research networks to mount an effective response against an emerging health threat.

What is Fiocruz's greatest contribution to global health?

Historically, it was the discovery and description of Chagas disease, its causative agent Trypanosoma cruzi and the insect that transmits it. Recently, the discovery of the congenital microcephaly syndrome associated with the Zika virus by our scientist Celina Turchi. Its most important work now is tackling Chikungunya, dengue, Zika and the resurgence of yellow fever.


Biomedical bubble? Nesta, the UK foundation for innovation, argued research funding for biomedicine and pharma was drawing resources away from other projects that could improve health outcomes such as those involving prevention. More than half the spending is concentrated in the three cities of London, Oxford and Cambridge. 

News round-up

Quality of care New WHO guidelines to improve the quality of healthcare include tackling inaccurate diagnosis, medication errors, inappropriate treatment, unsafe facilities and poor training. It is not just poor countries that need reform: 15 per cent of hospital spending in richer countries covers mistakes in care or infections picked up in hospitals. (WHO, BMJ)

Breastfeeding battle Health officials spoke out against US moves to water down a global resolution to encourage breastfeeding, a decision said to be driven by infant-formula manufacturers. Experts say breast milk is especially important in poorer countries where water supplies may not be safe enough to use powders. Here's a cartoon take. (New York Times, Malnutrition Deeply, Huffington Post, Guardian). 

Abortion rights Pro-choice and healthcare campaigners mobilised against Brett Kavanaugh, President Trump's conservative pick to join the US Supreme Court. In the UK, health leaders said English women should be allowed to take both pills required for an early medical abortion at home, while Ireland said it would allow “safe access zones” around clinics to protect women from protesters.  World Population Day focused on the 214m women lacking effective family planning. (The Hill, BMJ Sexual and Reproductive Health, Times, Devex)

Trump v Big Pharma  Pfizer reversed drug price increases after being lambasted by the US president, who threatened — as yet unspecified — government action.   A new study showed wide variations in US drug prices by city. The pharmaceuticals industry was a big beneficiary of the president's recent tax changes. Here’s our guide to drug pricing. (Fierce Pharma, Twitter, NYT, Stat, FT)

Anti-vaxxers on the march Health experts fear the new Italian government is putting its anti-vaccination rhetoric into practice as it removed the obligation of parents to provide schools with vaccination documentation. A fake video which claims vaccination is deadly threatens the eradication of polio in Pakistan, one of just three countries where the virus still exists. Activists in Australia are fighting vaccination for horses against Hendra, a virus that can jump to humans. (Guardian, Telegraph, The Atlantic)

Antibiotic angst Novartis became the latest Big Pharma company to stop research into antibiotics and antiviral researchCritics were dismayed, pointing out that much of modern medicine depends on controlling infection. (Gizmodo, Twitter)

Brexit blast The European Medicines Agency said the supply of more than 100 medicines from UK to Europe was at risk after Brexit if marketing authorisations and safety checks were not transferred to the European Economic Area. The UK supplies 45m packs of medicine to EU and EEA countries each month. (EMA, FT)

New UK health minister A political shake-up led to the appointment of a new UK health secretary. Matt Hancock, in his previous role at the culture department, was an enthusiast for apps and for restricting junk food advertising, ideas which he could develop in his new role. He has a tough job ahead: a report said newly-pledged funding for the country's NHS would just fill the gaps caused by a decade of austerity. (Nursing Times, NHS Providers)

Smart drugs soar The use of “smart drugs” for boosting mental performance is on the rise. The rise of pharmaceutical treatments for conditions such as attention deficit hyperactivity disorder is helping drive the trend. (Nature)

The legacy of IVF This month marks the 40th anniversary of the world's first “test-tube baby”.  In vitro fertilisation has changed the world in many ways, from paving the way for stem cell research and genetic screening to the debate about the rights of the embryo. (The Guardian)

China and cheap drugs Dying to survive, a hit Chinese film about patients forced to smuggle cheap generic medicines from India has added to pressure on the country's drugmakers to cut costs. The government has vowed to tackle the price of cancer medicines, threatening revenues for multinationals such as Eli Lilly, Roche and Novartis. (YouTube trailer, FT) 

Bad blood David Crow reviews the new book on Elizabeth Holmes, erstwhile head of Theranos, the disgraced blood-testing start-up, and her attempts “to export Silicon Valley’s rotten culture into the world of life sciences”. (FT)  

Surviving underground The world breathed a sigh of relief at the rescue of the boys trapped in a flooded cave in Thailand, but the boys’ ordeal is not necessarily over. Such traumas can have serious psychological as well as physiological effects. (CNN, The Conversation)

Best from the journals

Drugs and trade President Trump’s visit to the UK has thrown the spotlight on UK-US trade deals after Brexit. His “American Patients First” policy could increase drug prices and harm the NHS. (The Lancet) 

Snakebite fears A new study shows 93m people are at risk of death by snakebite, making it one of the deadliest neglected tropical diseases. It primarily affects the poor rural communities of Asia and sub-Saharan Africa. (The Lancet) 

Vaping blows New research shows ecigarettes increase cardiovascular risk as much as traditional cigarettes while a separate report says they have not actually helped many Americans to quit smoking. Another study shows that one of the main attractions for switchers was vaping flavours. Debate is still raging about Big Tobacco's funding of health research. (Vascular Medicine, PLoS, Harm Reduction Central, Jama)

Traffic injuries More than 1.25m people die each year from road traffic injuries, and up to 50m are injured, with poorer countries disproportionately affected. Much more can be done to prevent crashes and provide a quick and effective response when they do. (BMJ)

Mental health apps New research says mental health apps can lead to overdiagnosis as well as propagating the idea that individuals can use them to easily manage their problems. (Annals of Family Medicine)

Podcast of the week

Criminal treatment Nearly 50 per cent of US prison inmates are mentally ill yet many receive very limited therapy, says Alisa Roth, author of a new book on the subject. (NPR, 39m) 

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Final thought

World Cup winners Sugary drink and fast-food companies are taking advantage of the world's biggest advertising platform to promote their products. But what effect is the promotion of match-day treats having on our health? (Healthy Stadia) 

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