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| Catching
your Death |
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Listen
here |
From the advent of penicillin right through till
the late 1970s, we were convinced that we had the
measure of infectious diseases. However, along came
two very bad bits of news - antibiotic resistance
and HIV. As HIV is a virus, penicillin was never
going to touch it, but the drug could treat some
of the infections that come with having a suppressed
immune system such as TB for example. As HIV rates
go up, TB rates go up and with the risk of the infectious
agent becoming resistant to antibiotics, some unusual
approaches to getting patients to comply with their
treatment are being adopted. In KwaZulu Natal, traditional
healers are being drawn into the web of people who
dispense and watch over patients with TB.
The programme also looks at what's being done to
fight HIV itself. The main hope still lies with
a vaccine, but will it ever appear and will it be
affordable if it does? And to cap it all there may
be even more unpleasant infections round the corner
as population pressure pushes us further into the
depths of the rain forest.
But while we concentrate on emerging diseases and
also on re-emerging diseases, there's still a place
for looking at the old killers. According to Michael
Bennish who heads the Wellcome Trust's Africa Centre
in Mtubtuba, it is the old fashioned disease of
diarrhoea that has to be addressed. The rate of
diarrhoea deaths in Africa today is the same as
that of the USA at the beginning of 19th century.
He feels it is the responsibility of governments
around the world to provide clean water, decent
housing, sewage systems. If we are hoping to reduce
the world's burden of infectious disease by 2020,
we should not only be concentrating on hi-tech medicine
but on the very basic public health needs. |
| Listen
to Dr
Gro Brundtland, Director General of the WHO (World
Health Organisation) talk about disease in the 21st
Century |
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| Big
Killers |
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Listen
here |
A diagnosis of cancer is a terrifying thought for most
people. But will we be more, or less, likely to receive
one in 2020? According to Karol Sikora, oncologist at
the Hammersmith Hospital in London, wherever you are in
the world, the rate of cancer in the population is likely
to rise. Now, environmental factors, particularly smoking,
contribute to your risk. However, the biggest risk for
populations rather than individuals is that more people
are reaching a ripe old age. Cancer is a disease of old
age, so paradoxically, a rising cancer rate can mean your
country is on the up. For the individual, however, cancer
is never good news though there have been many advances
in treatment over the past 50 years. Indeed, things are
looking promising for the next 50 years. The race is on
to develop a vaccine against cancer.
A promising line of research is attacking cervical cancer
caused by the human papilloma virus - HPV. These won't
work like the preventative vaccines that we get as children.
They will be given to women who've had surgery for cervical
cancer and the vaccine will target remaining cells infected
with the virus that might start the cancer up again. And
it is not just cancer that's a big killer. Cardiovascular
disease is the cause of death for a large number of people
throughout the world, largely in the form of heart attacks
and strokes.
The risk factors for these are very similar to those for
cancer - smoking, diet, genetic factors and possibly infection,
but people can help themselves to avoid these diseases
by looking after themselves. However, there are some factors
you can do very little about. According to epidemiologist
Michael Marmot, you are far more likely to die of heart
disease if you are out of work or in a lowly position
than if you have a high powered job - a fact to throw
at your boss the next time he pleads 'executive stress.'
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| Listen
to Professor
Robert Baker, specialist in Medical ethics talks about
the future of health care in the 21st Century |
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| Mind
Matters |
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Listen
here |
Mental illness is perhaps the last great stigma of the
20th century. Psychiatric hospitals may be a thing of
the past but for the majority of sufferers around the
world mental ill health is still a taboo. It is estimated
that 1 in 4 people, worldwide, have some kind of mental
health problem and that figure is on the increase. Each
year, millions more people move to the city and this seems
to dramatically increase the risk of them becoming mentally
ill. Social isolation and poverty are key factors in this
increase. Drug and alcohol misuse are also triggers. This
is what the world looks like in 2000; what will the world
look like as we travel into the early decades of the 21st
century?
Well some of the news is good. New drugs with fewer side
effects could revolutionise the treatment of serious conditions
like schizophrenia. The strange gait, the involuntary
tongue movements, the endless pacing and the blank staring
eyes - typically associated with condition - are not caused
by schizophrenia at all, but by the drugs which are prescribed
to control it. Drugs are getting better all the time so
there's hope that soon people with schizophrenia may appear,
and feel, "quite normal".
Depression, on the other hand, may increase so fast that
it becomes a major problem. It is second only to heart
disease in terms of the disability which is caused. However,
the economic cost in terms of days taken off work, and
the impact on physical well-being is only just beginning
to be realised. While some people are able to overcome
the stigma of mental illness and admit to being depressed,
the majority of people find it easier to disguise their
depression as other problems - an aching back or insomnia
for example. Its already worth admitting to depression
as new anti-depressant drugs really can help. And according
to Raj Persaud, by 2020 we may all be popping mood-enhancing
drugs in the same cavalier fashion that we reach for the
vitamin pills today.
But, not everyone is convinced. As Elizabeth Wurzell,
author of Prozac Nation says, "there's no emotional or
intellectual miracle that's going to happen" when you're
depressed. As well as chemical cures, perhaps the focus
in the future will be on "talking" therapies to help people
understand why they feel the way they do. And if doctors
don't have time to talk, perhaps portable personal computers
will.
For mind matters there are no easy answers, now or in
the near future. However, as with the rest of medicine,
the distribution of the resources available will need
some careful planning in the 21st century. |
| Listen
to Professor
Norman Sartorius, Director of WHO Mental Health Division |
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| The
Ageing World |
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Listen
here |
The world is getting older. If you take a million people
born in 1880 then some 38,00 of them would reach 85. If
you take a million people born in 1990 then that figure
increases to 200,000. And there is an ever increasing
numbers of people with birthday cakes too full of candles
to be safe. What does that mean for society?
As people live longer, the big question is whether they
spend their old age as decrepit old wrecks, or live 99
fit years, and then drop dead after a very short illness.
Obviously the latter is the better of the two options
and the good news from this programme is that it looks
as if the ageing game is playing out that way. We have
good clot busting drugs for heart attack and stroke victims
whilst a drug which stops the brain tangles that cause
Alzheimer's disease is round the corner. So, if people
avoid infectious diseases and live healthily, then a little
way down the next road, there is no reason that they shouldn't
live to a ripe old age.
If that turns out to be the case, what will we die of?
According to old age expert Ray Tallis, we will just wear
out slowly like a vintage motor car - a much gentler death
than many people experience today. But as ever there's
a fly in the ointment. For us to stay well physically
we have to have good social support. Will the break up
of the traditional family structures mean elderly people
become isolated and have to fend for themselves? It could
happen but in Pune at the moment, groups of elderly people
are banding together to help each other out. And Michael
Marmot is recommending a redistribution of grannies -
if yours lives too far away to help and be helped - just
borrow someone else's. |
| Listen
to Dr Mary Ann
Tsao who runs programmes to help the World's aged |
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| Fixing
Genes |
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Listen
here |
It's the second week in January 2021 and you don't feel
well. You decide to pick up your credit card and scan
the information held on it into your computer and send
it off to the doctor. In no time at all he e-mails you
a prescription designed to suit your genetic make up.
A personal pill to cure your particular illness. Guaranteed
to work for you and not cause any side effects. A fanciful
scenario, perhaps, but not too fanciful.
The Human Genome Project is coming to fruition and, early
this year, we may soon know every gene it takes to make
up a human being. That knowledge will revolutionise medicine.
Drugs will be easier to design once we're sure of the
targets that we want to strike within our bodies. Side
effects will be easier to avoid once we know the different
ways people will react to medicine because of their genetic
make up. And there's the prospect of fixing faulty genes
that lead to conditions like cystic fibrosis, sickle cell
anaemia, and cancer.
And it is not just knowing about human genes that will
be useful. In an attempt to 'know thine enemy', laboratories
around the world are checking out the genetic make up
of the organisms which attack us. Antibiotic resistance
may well be a thing of the past. We will watch bugs developing
resistance and develop new drugs that will attack different
sites along their DNA that have not developed any resistance.
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| Listen
to Professor
Günter Blobel, cell biologist and nobel prize winner,
talk about genetic research |
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