An Indian doctor examines a tuberculosis patient in a government TB hospital on World Tuberculosis Day in Allahabad, India, Monday, March 24, 2014. India has the highest incidence of TB in the world, according to the World Health Organization's Global Tuberculosis Report 2013, with as many as 2.4 million cases. India saw the greatest increase in multidrug-resistant TB between 2011 and 2012. The disease kills about 300,000 people every year in the country. (AP Photo/Rajesh Kumar Singh)
An Indian doctor examines a tuberculosis patient in a hospital in Allahabad © AP

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More people in poorer countries die from low-quality healthcare than from lack of access. That's 5m out of a total 8.6m deaths from treatable causes. Or put another way, five times more than the yearly total for HIV/Aids. The annual cost to the world economy is £6tn. 

That's the stark message this week from the Lancet Global Health Commission on High-Quality Care, which aims to shift the longtime emphasis in global health policy from quantity to quality.

An accompanying report shows the effect of poor-quality care and how expanding healthcare coverage does not necessarily result in better outcomes. Poor-quality care also corrodes trust and leads to situations such as Africans being twice as likely to die after surgery than the global average.

The past decades have seen great progress in tackling infectious diseases, thanks to factors such as improved sanitation and wider vaccination. But non-communicable diseases such as heart problems and diabetes are gaining ground, especially in more disadvantaged areas, and can be made worse by poor-quality care. 

The report author’s view? “Health systems without quality are like cars without engines; they look like the real thing but do not generate motion.”

The Lancet podcast is a good summary of the debate.

Three questions

Ekaterina Malievskaia is chief medical officer and co-founder of Compass Pathways, which has just launched trials to test psilocybin, the psychedelic compound in magic mushrooms, combined with psychotherapy for people with treatment-resistant depression.

Why did you become interested in psilocybin?

At college, my son had severe depression and was getting worse with traditional treatment. I looked for solutions for two years before finding research using psilocybin. It was a short, small study but it was a signal. People often hear the story of the kid who took mushrooms and got better, so the parents started the company. That’s not how it goes. We’re testing to see whether a combination of drugs with therapy and support works for people who would never take something illegal.

Why did you create your own company?

We met researchers but realised their interest was to answer cute, interesting questions. Drug development requires a completely different set of skills. They would not help, so we decided to do it ourselves. Our goal from the very beginning was not only to find an effective treatment but to get it approved, reimbursed and integrated into the health system.

What are your future challenges?

We need to find patients who are not just interested but also suitable. Some will be very ill and coming off their usual medications. This is about much more than giving a pill. It’s an interaction between a therapist and a patient. We need consistency between the study sites and therapists with different backgrounds, convictions and experience. We need to flesh out the actual model of delivery: how many therapists, for how long? The drug synthesis is complex and we need to bring cost of manufacturing down.


Global inactivity More than a quarter of the world's adults are not doing enough physical exercise, a position barely improved since 2001. The situation in richer countries is generally worsening as people become more sedentary. Britain's new health secretary said the NHS should expand “social prescribing” including sports. If you want to live longer, try tennis. (Lancet Global Health, BBC, Guardian, NYT)

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News round-up

Ebola fears escalate “When you have an Ebola case confirmed in a city with 1m people, no one should be sleeping well tonight around the world,” said the WHO co-ordinator of relief efforts in the Democratic Republic of Congo, as the disease reached the city of Butembo, a trade hub with Uganda. Attacks from rebels who oppose the Congolese government have complicated the response. (Huffington Post)

Violence and children Unicef reported that half of students aged 13 to 15 worldwide — around 150m — experienced peer-to-peer violence in and around school, not just affecting their education but contributing in the long term to depression, anxiety and even suicide. (Unicef)

Measuring Modicare India's proposed National Health Protection Scheme or “Modicare” will be the largest government-funded scheme in the world covering 1.3bn people. Still to be clarified however is its relationship with the country's private sector — currently responsible for 80 per cent of outpatient and 60 per cent of inpatient care. (Devex)

What next for the Sacklers?  Richard Sackler, whose family owns Purdue Pharma, the company behind the notorious painkiller OxyContin, stands to profit from the US opioids epidemic after he patented a new treatment for drug addicts. Read our special report on a pharma dynasty under siege. (FT)

Brexit blues The European Medical Agency — already set to leave London for Amsterdam — has now cut Britain out of its drug evaluation contracts, seven months ahead of Brexit. Novo Nordisk, Britain's biggest insulin supplier, is building up a four-month stockpile in case of a “no-deal” situation. Doctors warned NHS visa costs for foreign workers could hit £500m. (Guardian, Independent, Royal College of Physicians)

Cancer landmarks China approved its first homegrown cancer drug, Chi-Med’s fruquintinib, a treatment for colorectal cancer. In the UK, the first of a new wave of personalised cancer treatment will soon be available for children after the NHS agreed a deal with Novartis, the Swiss pharma company, to use its leukaemia therapy. (Evaluate, FT)

Abe acts on ageing Shinzo Abe, Japan's prime minister, said he wanted to raise the country's retirement age beyond 65 and allow people to defer their pension beyond 70 in a move that could set a precedent for other countries wrestling with the challenges of an ageing population. (FT)

The scourge of loneliness  Loneliness — defined as perceived social inaction — and its connection to ill health is increasingly worrying policymakers. Measures to combat the problem range from “social robots” in Japan to “social prescribing” in England. (The Economist) 

Bad blood Theranos, the scandal-hit US blood-testing company, is to dissolve. Founder Elizabeth Holmes and another former executive are facing criminal charges alleging they defrauded investors, doctors and patients. Here's our review of the book detailing the saga. (WSJ, FT)

Combating counterfeits Up to 14 per cent of medicines in poorer countries are estimated to be counterfeit, expired or of insufficient quality. A group of teenage girls in Nigeria have come up with an app to detect fakes by using barcode technology to check authenticity and expiration dates. (Reuters, Nigerian Healthwatch)    

War on drugs failing Faced with several US states relaxing laws on cannabis, a secret White House committee has been instructing federal agencies to depict marijuana as a threat to the country. Usage is still growing among US baby boomers, especially for those who first tried it in their teens. (BuzzFeed, Drug and Alcohol Dependence)

Fall in UK suicides The UK male suicide rate has dropped to 15.5 deaths per 100,000, the lowest level since 1981. For women the rate held steady at 4.9. Rates in the UK, as elsewhere, tend to rise in the oldest age groups due to psychiatric illness, deterioration of physical health and social factors. (ONS)

Food poverty The food budgets of more than half UK households are insufficient to afford the government’s recommendations for a healthy diet. Households with lone adults — with or without children — and those with three or more children are least likely to be able to follow the Eatwell Guide. (Food Foundation, Public Health England)

No-Joe zones  Coffee will be banned from schools in South Korea after fears were raised of children drinking too much caffeine during exam periods. (CNN)

Best from the journals

Battling superbugs Reducing antibiotic consumption alone will not curb antimicrobial resistance and needs to be complemented by public health measures such as improving sanitation. England's top medical officer warned parliament of the need for urgent action. A new anti-bacterial coating on the garments worn by pilgrims in Saudi Arabia could help stop infections. Here's a guide to the five scariest antibiotic-resistant bacteria. (The Lancet, Guardian, UK parliament video, Arab News, The Conversation)  

Effects of obesity Mild obesity is associated with the loss of one in ten potential disease-free years later in life and severe obesity with the loss of one in four. A battle is brewing in the UK government over the use of calorie labelling on menus. Here's our earlier podcast on the government's anti-obesity strategy. (The Lancet Gastroenterology and Hepatology, FT) 

Female-friendly toilets Inadequate access to private, comfortable and convenient toilets is a daily problem for many women around the world — especially those living in poor areas and refugee camps — and can lead to stress, embarrassment, physical discomfort, and gender-based violence. (Water)

Health in all policies With social and environmental influences thought to be responsible for around half of the variation in people's health, UK government policy should have a greater emphasis on illness prevention. (BMJ)

Milking the past Analysing the milk teeth of 10th century Anglo-Saxon child skeletons could help us identify which of their modern counterparts are most at risk from conditions such as obesity, diabetes and heart disease. Teeth are a better indicator of the effects of diet and health than bone. (American Journal of Physical Anthropology, YouTube video)

Podcast of the week

Tackling TB Tuberculosis is the top infectious disease killer yet the threat to children is often overlooked, especially in poorer countries. Dr Farhana Amanullah, a TB expert in Pakistan, describes the challenges. (CSIS Take as Directed, 30m)

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Final thought

Deciphering doctors Exasperated by the jargon-heavy language used by clinicians when writing to their patients? Help is at hand: new guidance suggests ditching the Latin, using “twice-daily” instead of “bd”, “kidney” instead of “renal” and “irregular pulse” instead of “atrial fibrillation”. Now if only we could read their handwriting . . .

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