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June in PLoS Medicine: Conflict and Reproductive Health; Antibiotics are not Automatic; Water in Wired; and much more

New articles are published by PLoS Medicine every week, but in our archive you can see that articles are also organised into monthly issues. There was a diverse and provocative mix of articles published in June, reflecting the aim of the journal to engage with the major environmental, social, political as well as biological determinants of health. A few of the highlights from the issue and some of the news and blog coverage follows:
Image: Donald MacLeod

June 2009

The June editorial argued that with an increasing number of people worldwide who do not have access to clean drinking water or sanitation – and it’s estimated that 2.8 billion people will have to cope with water stress and scarcity in 2025 – access to clean water should be considered a basic human right. Two of the arguments for this are that access to clean water would reduce the global burden of disease (millions die of water borne infections, such as cholera, or conditions caused as a result of poor sanitation, such as diarrhea), and the prospect of global water scarcity – exacerbated by climate change and population growth amongst other factors – means that no country is immune to water crisis.

Jocalyn’s earlier blog post about the ideas and inspiration behind the editorial mentioned Maude Barlow, Canadian activist, author and senior adviser on water issues to the UN General Assembly’s president. In Wired Magazine’s article about water scarcity, prompted by our editorial, Barlow is quoted as saying that the “high water rates, cut-offs to the poor, reduced services, broken promises and pollution have been the legacy of privatization.” This legacy of privatization, which disproportionately effects the poor who suffer most from lack of access to clean water,  has led to political turmoil in Bolivia and other countries, and is another argument the editorial advances for making access to clean water a human right. (You can read the comments we’ve received about the editorial and contribute to the debate).

Research published in June included an article by Preeti Patel and colleagues, who used databases maintained by the UN and OECD and found that low income, conflict-affected countries such as Afghanistan, Sudan and Somalia receive less development money for reproductive health than countries that are not experiencing conflict. Other research focused on a neglected but important global public health issue: poisoning with insecticides, a common method of suicide in some countries, which results in 200,000 deaths per year. The article by Michael Eddleston and colleagues found no evidence to suggest that a controversial antidote recommended by the WHO – pralidoxime – improves the chance of survival of patients who have poisoned themselves.

We were contacted by several French journalists interested in the research examining a French national public health campaign – Antibiotiques c’est pas automatique (Antibiotics are not automatic) – which was associated with a marked reduction of unnecessary antibiotic prescriptions, particularly in children. The paper, by Didier Guillemot and colleagues, and a Perspective discussing the research were covered in newspapers across the political spectrum in the French media, featuring in Liberation, Le Figaro and Le Monde. (The latter reproduced Figure 2 from the Research Article: maps of France showing the number of winter antibiotic prescriptions by region between October 2000 and March 2007):

Figure 2 from Sabuncu E et al PLoS Med 6(6) e1000084
Figure 2 from Sabuncu E et al PLoS Med 6(6) e1000084

What astonished Middlemarch‘s Tertius Lydgate, George Eliot’s idealist young doctor who has now moved on to write the OnMedica’s On the Pulse blog, “was the staggeringly high level of prescribing before the campaign: an average of 72 prescriptions per 100 people each winter.” He wonders what the figures are for the UK.

The Magazine section tackled troubling and topical issues.  An Essay by Gary G. Bennett and colleagues discussed how dramatic rise in home foreclosures, particularly in the US, may have health consequences.

Image: respres
Image: respres

Two debates were published. One of the debates, involving Nicholas J. White, Robert Webster, Elena Govorkova and Timothy Uyeki, aired different viewpoints about the optimal treatment for H5N1. In another debate, the question of whether clinical trials should ever be stopped early was discussed by James Lavery and colleagues and David Buchanan. And – in keeping with the attempt of the journal to emphasize the extent that human health is intertwined with the environment, in its fullest sense – an Essay by Stephen Devereux and colleagues argued seasonal starvation is not inevitable, and can be overcome with the right mix of ideas, backed up with resources and political will. (On the IRIN website, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs, Stephen Devereux discusses further how cyclical hunger often falls through the gap when the international focus is on chronic poverty-related hunger or acute hunger ).

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