Faith McLellan

Marketing and advertising: harmful to children's health

Marketing and advertising: harmful to children’s health One of the biggest contributors to the explosive increase in childhood obesity, including such complications as type 2 diabetes, is aggressive marketing and advertising by the food industry, according to a group called Stop Commercial Exploitation of Children Coalition (SCEC). The group held its second annual Summit on the Commercialisation of Childhood in New York City on Sept 20. Susan Linn (Harvard Medical School, Boston, MA) said that in the early 20th century, children did hard physical work in factories, with the result that companies essentially owned their bodies. Now marketers are attempting to own children’s minds. Although marketing to children has been seen as acceptable only in the past decade or so, corporations have seized the advantage quickly: in 1999 they spent approximately US

Controversy surrounds proposed xenotransplant trial

12 billion on such efforts. Part of the philosophy now, according to Bob Ahuja, a professor of marketing at Xavier University (Cincinnati, OH), is not to appeal directly to parents, but to teach kids to influence their parents’ purchases. Children inundated with commercialism and surrounded by rampant materialism suffer not only from obesity but also from bodyimage and other emotional problems, eating disorders, and tendencies toward violence. “The sick child as viewer/consumer has replaced the healthy child of play, sports, and make-believe”, said Michael Brody (University of Maryland and chair of the TV/Media Committee of the American Academy of Child and Adolescent Psychiatry). Brody noted that while storytelling is the very essence of play, with toys as its catalyst, today’s toys, with their commercial links, actually act as “story blockers”.

Introducing The art of medicine

A much controversy, the Cook Islands government is expected to confirm this week that it will allow a small safety study of transplantation of encapsulated pig pancreatic islet cells into patients with type 1 diabetes. Plans to do the trial in neighbouring New Zealand have already been rejected by that country’s government on safety grounds. The International Xenotransplantation Association (IXA) has also raised concerns about the research. In July last year, the New Zealand Ministry of Health rejected an application from Diatranz, an Auckland-based drug company, to do a trial in New Zealand, mainly on grounds of concerns about the risk of transfer of porcine endogenous retroviruses (PERV). A Ministry statement at the time noted that this was the fourth time an application had been lodged by Diatranz: “The first application was approved because it was before information about [PERV] to humans was published. The second application was withdrawn after this information was published and the most recent two applications have been declined because of concern about retroviruses.” Diatranz subsequently applied to do the research in the Cook Islands in the South Pacific. The Cook Islands is an internally self-governing island state in free association with New Zealand. The nation of 20 000 people has one of the world’s highest rates of diabetes. Cook Islanders are New Zealand citizens and can travel to New Zealand to receive health care. The New Zealand Ministry of Health wrote to the Cook Islands government to express its concern and has provided a copy of its decision that was given to Diatranz. Bob Elliott, the medical director of Diatranz, rejected the New Zealand ministry’s concerns, saying that any risk of retroviral infection was “miniscule” and that similar transplantations had taken place “hundreds of times without infection”. Elliott said that Diatranz would do the research as though it was taking place in the USA, in accordance with Food and Drug Administration (FDA) guidelines.

US judges seek medical records in abortion cases.

Most of the pages of The Lancet are naturally devoted to scientifi c research, the technical underpinning and engine of medical progress. But medicine is infl uenced by a host of factors that have little to do with science. It is a socially and culturally embedded dynamic process. It is informed by and inextricably bound up with history, literature, ethics, religion, and philosophy—in short, the concerns of the humanities, those branches of learning traditionally identifi ed more with analysis and interpretation than with empiricism and evidence. In recognition of the vital place of the humanities in medicine, we will be publishing, from today, a weekly essay devoted to the topic, in a new section entitled The art of medicine. Our tastes for this venture are catholic; our defi nition of relevant topics is broad. We intend for these essays to be stimulating and accessible to the general reader. The contributions we have already commissioned, true to their intended interdisciplinarity, range widely. We hope this new section will provide insight, provocation, and illumination for the richly varied practice of medicine.

Human rights: a critical framework for the response to HIV/AIDS

The US Department of Justice has issued subpoenas to at least six hospitals (including New York City’s Columbia Presbyterian Weill Cornell and St Luke’s- Roosevelt; the University of Michigan Health System in Ann Arbor; Hahnemann University Hospital in Philadelphia; and Northwestern Memorial Hospital in Chicago) for the medical records of patients who have undergone abortions. The department claims it needs the records to enforce the federal Partial Birth Abortion Ban Act which went into effect in November 2003. The banned procedure “intact dilatation and extraction” is estimated to comprise 2200 to 5000 of the 1·3 million abortions performed yearly in the USA. The Justice Department says it is seeking to uphold a finding by Congress that the procedure is “never medically necessary”. (excerpt)

“Personal account”: a new feature from the patient's perspective

As part of the 3-day UN General Assembly Special Session on HIV/AIDS panelists in a round table discussion on HIV and human rights focused on the status of women and children. The panelists pointed out that the lack of respect for human rights is driving the spread of the AIDS epidemic. Chaired by Polands Minister for Health Grzegorza Opala statements were given by the heads of several UN organizations who emphasized that HIV/AIDS is a human rights violation that intensifies other rights violations especially those affecting women and children. Caroll Bellamy of the UN Childrens Fund and others stressed the need to focus on education urging the governments throughout the world to ensure that at least 90% of all young people aged 15-24 years have access to youth-specific AIDS education by 2005. Mary Robinson UN High Commissioner for Human Rights urged governments to take the lead in forcing discussion about the epidemic. Moreover Noeleen Heyzer of the UN Development Fund for Women added that there is a need to make gender equality a guiding principle in the global communitys response to the epidemic.

The dying of the light

See page 311 It seems ironic that the pages of medical journals seldom allow the voices of one important audience an opportunity to be heard. The contribution of patients to medical research is obvious, yet concealed. No one doubts the value of individuals who participate in clinical research—the articles on participation in cancer trials and on the prenatal testing of pregnant women, both published in this week’s issue, being two such examples. But it can be all too easy to lose sight of the fact that behind every randomised trial where n=10 000 or anonymised case-report are individuals living with illness. Marina Green’s essay detailing her experiences of postnatal depression marks the first of an occasional feature which should give readers a moment to pause for thought— a reminder of what medicine may mean to the individual. Under the heading of “Personal Account”, these one-page essays commissioned by The Lancet will usually accompany a seminar or review article in the journal. Contributors are urged to focus on how illness affects their lives, whether that is an adaptation to changing fortunes or the everyday reality of living with permanent illness or disability, rather than the mechanics or politics of health care. We are interested in how health and disease shape and are shaped by the lives of individuals. Location and culture will provide important context; the first three contributors live thousands of miles from each other in South Africa, western Canada, and southern India. We thank them for what we hope will be a thoughtful and important contribution from individuals hitherto all too silent in the medical literature.

Annan calls for action on AIDS at UN meeting

And how this book will influence you to do better future? It will relate to how the readers will get the lessons that are coming. As known, commonly many people will believe that reading can be an entrance to enter the new perception. The perception will influence how you step you life. Even that is difficult enough; people with high sprit may not feel bored or give up realizing that concept. Its what dying of light will give the thoughts for you.

Heads of state meet to plan “a world fit for children”

The 3-day UN General Assembly Special Session on HIV/AIDS during June 25-27 2001 in New York aimed to draft a political Declaration of Commitment and increase support for a global AIDS fund. Other highlights of the meeting were the tension between prevention and treatment strategies cultural controversies over categories of high-risk behavior and the debate on appropriate responses of individual countries to the crisis. Commitments to the global fund have been modest compelling Carloas Lage Davila Vice-President of the Republic of Cuba to call for the placing of all of the worlds resources in the service of humanity. During the special session some 3000 delegates argued on issues such as the language of the draft declaration empowerment of women the inclusion of gay and lesbian groups as participants in the debates and description of vulnerable groups.

Obesity rising to alarming levels around the world

B on Sept 19, the United Nations (UN) will host its firstever Special Session dedicated to children’s issues. Extensive preparations for the 3-day conference, which will take place in New York City, and a series of regional, preparatory, and planning meetings have been underway since December, 1999. More than 78 heads of state are expected to attend the session, along with Nobel laureates, grassroots organisers, artists and writers, and UN and UNICEF celebrity ambassadors. “This extraordinary gathering of heads of state is very promising and also very appropriate”, said Carol Bellamy, UNICEF’s Executive Director. The conference will result in two documents addressing various issues related to children, including, among others, child health, nutrition, HIV/AIDS, sanitation, eduction, literacy, child labour, armed conflict, and sexual abuse and exploitation. One document, which is already available, is a review of the progress, since the 1990 World Summit for Children, of 165 countries on behalf of children: We the Children (see www.unicef.org/specialsession/documentation/index.html). The second document, entitled A World Fit for Children, is a declaration and plan of action for the coming decade by the UN member states and will result from the session itself. A draft version of the document is posted on the UNICEF website (www.unicef.org). Approximately twothirds of the text has been hammered out in the run-up to the conference, and organisers hope that consensus will quickly emerge on the remainder. Recent press reports, however, suggest that consensus may not be so easy to achieve, thanks in large part to efforts in the USA by the Bush administration to influence the conference agenda in a conservative direction. The USA has aligned itself with conservative Muslim countries, including Sudan, Libya, and Iran, and also with the Vatican and Poland over some language in the draft document. One phrase at issue is “reproductive health rights”, which the Bush administration views as an endorsement of abortion and abortion counselling services. American negotiators are also said to oppose language in the document that specifically mentions abuse and rehabilitation of girls in war zones and that refers to health care for children as an entitlement. Representative Carolyn B Maloney (Democrat-New York) was critical: “The Bush administration”, she said, “is so obsessed with abortion that they see it in everything, even in a conference to help children. This document doesn’t even mention abortion, but they see the term ‘reproductive health care’, and decide it means abortion. This is wrong. What they need to do is focus on what the conference is about—helping the world’s children. Instead, this administration is continuing a pattern of running away from every international conference and agreement when what the world really needs is our leadership on these issues.”