Members of the Nobel Committee for Physiology or Medicine (L-R) Jonas Bergh, Edvard Smith, Anna Wedell and Klas Kaerre sit in front of a screen displaying portraits of James P Allison (L) and Tasuku Honjo during the announcement of the winners of the 2018 Nobel Prize in Physiology or Medicine, during a press conference at the Karolinska Institute in Stockholm, Sweden, on October 1, 2018. - James P Allison of US and Tasuku Honjo of Japan won Nobel Medicine Prize for their achievements in cancer treatment. (Photo by Jonathan NACKSTRAND / AFP)JONATHAN NACKSTRAND/AFP/Getty Images

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The announcement of a Nobel Medicine Prize for cancer researchers highlights a set of diseases that will kill almost 10m people this year and become the leading cause of premature deaths in the next decade.

As James Allison and Tasuku Honjo were honoured for discovering how to enable the body’s immune system to attack tumour cells, health leaders met in Kuala Lumpur to tackle wider policy problems and practical questions such as whether cancer societies can engage with the pharma industry without compromising their independence, and whether doctors should support their patients' choice of alternative treatments.

The WHO launched its new childhood cancer initiative with the aim of raising survival rates to 60 per cent by 2030. Children in poorer countries are four times more likely to die from the disease than those in richer ones because of failures in diagnosis, high costs of treatment and lack of specialist health professionals. There is work to be done at country level too: a Lancet study laid out the importance of effective national cancer plans in addressing the disease burden.  

As science progresses — illustrated by this week's news showing Australia is on track to become the first country to wipe out cervical cancer — policymakers and funders may struggle to keep up.

Three questions

Jacqui Shea, outgoing chief executive of Aeras, the TB vaccine non-profit which is being taken over by the International Aids Vaccine Initiative (IAVI).

How do you feel about the takeover of Aeras?

Like any organisation, Aeras has to change in response to the environment. We've really worked with all major stakeholders . . . to accelerate TB vaccine development. Our vaccine manufacturing plans were about helping small organisations make their own products to take into clinical trials. The difficulty was that the pipeline wasn't robust enough to make that sustainable. A combination with another organisation makes us much stronger.

How important was the UN high-level meeting on TB last month?

I get a sense there's a real sea-change. It has been bleak for a long time. TB is something that has always been with us, but people are starting to wake up and take action. If this was a new infectious disease that affected a quarter of the world’s population, killed 1.6m each year and made 10m sick, we would be mobilising all possible resources. TB really doesn't receive what it needs in relation to its impact.

What is your assessment of the M72/AS01 TB vaccine trial results?

We think this is a game changer. It cut TB in half for adults already infected — exactly the type of vaccine that could have the greatest impact. It gives hope that a vaccine can be developed. It needs to be tested in other populations and age groups and it will need to be scaled up. But modelling has shown that, even with efficacy as low as 20 per cent, it could have a major impact and be cost-effective. [Additional comments from Ann Ginsberg, chief medical officer]


No smoke without ire Despite success in introducing plain packaging, world health leaders called for more action on tobacco advertising, promotion and sponsorship — and increased taxes. The “huge rift” in the public health community over the merits of vaping intensified, with one tobacco chief likening nicotine abolitionists to opponents of condoms. (WHO, FT)

News round-up

Cholera on the march The number of cholera cases in Yemen tripled following the summer's military offensive by Saudi/UAE forces, according to Save the Children. The disease has also resulted in a state of emergency in Zimbabwe. (Al Jazeera, The Lancet)

Venezuelan health crisis  Venezuela's economic deterioration has crippled the country's health system and caused particular problems for those on HIV/Aids treatment. (Reuters)

Chinese challenge The WHO's decision to endorse traditional Chinese medicine has come under attack from those who say it is unscientific and not supported by clinical trials. (Forbes)

Toilets for all The WHO said more investment was needed to hit the UN goal of safe toilets for all by 2030 as it issued new sanitation guidelines. It estimates every dollar invested in sanitation brings a six-fold return in lower health costs, fewer premature deaths and increased productivity. India's clampdown on defecating in public is succeeding. (WHO, South China Morning Post)    

Battling booze Ireland passed a landmark bill to cut back on problem drinking, including minimum pricing rules, segregation of alcohol from other products in stores and advertising and broadcasting restrictions. The Irish alcohol industry also fears the introduction of cancer warnings on labels. A new study says even light drinking is dangerous. (Irish Times, Alcoholism: Clinical & Experimental Research)

Burnt-out Brits UK workers are under more pressure than anytime in the last 25 years. Researchers are particularly worried about those who need to work hard but have little autonomy — a toxic combination that leads to stress, anxiety and higher risk of cardiac illness. (FT)

Biology and big data “To be a biologist now, you have to be a programmer. Knowing how to look at a gene on a gel isn't enough,” says the author of an essay on the growing role of big data and algorithms in research. (Mosaic)

Fuelling food fears Critics argue that nutrition research can be misleading, unscientific or manipulated. The appetite for online clicks means journalists are sometimes complicit too. (NYT)

Behind the opioids crisis “This is an industry that is out of control . . . if they don't follow law in drugs supply, people die.” The Washington Post and 60 Minutes won an Emmy award for their documentary on drug companies’ role in the US opioid crisis. The Senate on Wednesday passed a new package of measures to fight the problem. (CBS, The Hill)   

Digital diagnosis A big-money backed app that says it can help detect mental health problems through a person's smartphone usage — analysing for example how quickly they type — came under fire for its evidence base. The product is the most successful illustration so far of “digital phenotyping” — using a person's digital life to diagnose health problems. (Stat) 

Comforting fictions Soothing environments for dementia care homes include pretend town squares and simulated beaches. When a resident asks to go home, an aide takes them to a fake bus stop, where they wait for a bus that never comes. When they get tired and forget why they are there, they are persuaded to come back in. (New Yorker) 

Best from the journals

Text message tracking Text messages are growing in importance as a way of capturing changes in health behaviour, as illustrated by their use in the Ebola outbreak in west Africa. (Nature Digital Medicine) 

Urban health The proportion of the world's population living in cities is now 55 per cent or 4.2bn people. Such concentration gives authorities the potential to deliver substantial improvements to citizens' health, but much more must be done to address health inequalities within cities too. (BMJ)

Industry influence A new study quantifies the involvement of industry funders in reports in medical journals. Data analysis is often conducted by the funders without the involvement of the relevant academics. (BMJ)

Drugs: rhetoric and reality Policies from politicians vowing to be “tough on drugs” are rarely evidence-based. The idea that clamping down on middle-class drug users could somehow help cut gang violence is one example. (BMJ)

Obesity starts early A large study on weight gain in children from birth to adolescence shows the most rapid increase between two and six years of age. Most who are obese as children remain so in adolescence. Here's a video quick take. There is also new data on US consumption of fast food, usually associated with high calorific intake. (NEJM, CDC)

Podcast of the week

Disease outbreaks A discussion on how to improve preparation and response to epidemics such as Ebola in the Democratic Republic of Congo, including finance, research and leadership. (CSIS Take as Directed, 28m)

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Final thought

Natural medicine Scottish doctors in Shetland are to start issuing “nature prescriptions” to patients, including recommendations for rambling and birdwatching, to help with problems such as mental illness, heart disease and stress. (The Guardian) 

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