Editorial
Joe Mcdonald, Visuals Unlimited /Science Photo Library
Snake-bite envenoming: a priority neglected tropical disease
For WHO NTDs see http://www. who.int/neglected_diseases/ diseases/en/ For more on snake bite see http://www.snakebiteinitiative. org For more on antivenom development see http://www. lstmed.ac.uk/research/centresand-units/the-alistair-reidvenom-research-unit
Last month, WHO reinstated snake-bite envenoming to its list of category A neglected tropical diseases (NTDs), which is an important milestone in disease control. NTD inclusion adds impetus to antivenom development and boosts the likelihood of investor funding for snake-bite prevention and treatment access initiatives. Every year, more than 95 000 people die from snake bite, and a further 300 000 survive but with permanent disability or disfigurement. An estimated 1·8–2·7 million people a year develop serious clinical illness (envenoming) after snake bite. Most victims of snake bite live in the world’s poorest communities, with agricultural workers, children, and rural dwellers most at risk. About half of documented deaths from snake bite are in India but data from sub-Saharan Africa are fragmentary, and the burden of disease and the poverty it causes is likely to be underestimated. In Africa, a young farmer bitten by a puff adder might suffer terrible disfigurement rendering him fit only to beg, or the stigmatisation of scars from a spitting cobra bite might lead to a girl being unmarriageable.
WHO added snake bite to the list of NTDs in 2009, but it was later removed without explanation. The Bill & Melinda Gates Foundation has so far rejected approaches for funding because snake bite is not infectious and therefore cannot be eradicated by vaccination. Yet snake bite is eminently preventable and treatable through community education to reduce occupational and environmental risk, access to good-quality specific antivenoms, and by training nurses, health workers, dispensers, and doctors. Since WHO’s announcement, action has already been taken by the Ministry of Health in Kenya to develop local guidelines on snake-bite management and to engage local and international donor health agencies. Acknowledging the problem in the regions affected is an important start. Momentum is building with the support of the Kofi Annan Foundation, and snake bite is on the World Health Assembly’s agenda for the first time next year. Now, surely, the plight of snake-bite victims will be more difficult for the major global health funders to ignore. n The Lancet
Westend61/GETTY
Cosmetic procedures: a cause for concern
For the Nuffield report see http://nuffieldbioethics.org/wpcontent/uploads/Cosmeticprocedures-full-report.pdf For more on social media and mental health see https://www. theguardian.com/society/2017/ may/19/popular-social-mediasites-harm-young-peoplesmental-health For the Be Real campaign see http://www.berealcampaign. co.uk/
2
The Nuffield Council on Bioethics has called for stricter controls over the provision of non-reconstructive cosmetic procedures, citing ethical concerns about their promotion and regulation in the UK and suggesting that they be made available only to people aged 18 years or older. Social media, advertising, and apps are being used to convey the message that these procedures are not only accessible but desirable, meaning that people could feel pressured to conform to a society’s ideal of beauty at susceptible points in their development. The desire to change one’s appearance is not new, but factors such as celebrity culture, use of unrealistic images in advertising, and the stratospheric rise of social media have helped cultivate an environment that can be toxic to self-esteem and body image. Although social media can have a positive influence on wellbeing, they have also been associated with increased anxiety and feelings of inadequacy in some young people. Social media policies on health-related advertising range from fairly stringent to non-existent, and cosmetic surgery apps are easily accessible and marketed as games for children
as young as 9 years old. The very media that contribute to body dissatisfaction are not only stimulating demand but promoting so-called solutions. Demand for cosmetic procedures has increased the value of the UK cosmetic sector from £720 million in 2005 to an estimated £3·6 billion in 2015. Despite this growth, and in spite of previous safety recommendations from reviews of the industry, the UK Government has failed to introduce consistent regulation of cosmetic products and non-surgical procedures. Because of this vacuum, few data are available on how many young people have cosmetic procedures, but in theory, a 16-year-old could have certain procedures involving use of an unregulated product, done by an unskilled and unregulated practitioner, without the involvement of a parent or medical professional. Campaigns such as Be Real, which is aimed at changing attitudes to body image in young people, are a step in the right direction, and educating children about body image is crucial. Nevertheless, more must be done to moderate the exposure of young people to the irresponsible marketing of potentially life-changing procedures. n The Lancet www.thelancet.com Vol 390 July 1, 2017
Joe Mcdonald, Visuals Unlimited /Science Photo Library
Snake-bite envenoming: a priority neglected tropical disease
For WHO NTDs see http://www. who.int/neglected_diseases/ diseases/en/ For more on snake bite see http://www.snakebiteinitiative. org For more on antivenom development see http://www. lstmed.ac.uk/research/centresand-units/the-alistair-reidvenom-research-unit
Last month, WHO reinstated snake-bite envenoming to its list of category A neglected tropical diseases (NTDs), which is an important milestone in disease control. NTD inclusion adds impetus to antivenom development and boosts the likelihood of investor funding for snake-bite prevention and treatment access initiatives. Every year, more than 95 000 people die from snake bite, and a further 300 000 survive but with permanent disability or disfigurement. An estimated 1·8–2·7 million people a year develop serious clinical illness (envenoming) after snake bite. Most victims of snake bite live in the world’s poorest communities, with agricultural workers, children, and rural dwellers most at risk. About half of documented deaths from snake bite are in India but data from sub-Saharan Africa are fragmentary, and the burden of disease and the poverty it causes is likely to be underestimated. In Africa, a young farmer bitten by a puff adder might suffer terrible disfigurement rendering him fit only to beg, or the stigmatisation of scars from a spitting cobra bite might lead to a girl being unmarriageable.
WHO added snake bite to the list of NTDs in 2009, but it was later removed without explanation. The Bill & Melinda Gates Foundation has so far rejected approaches for funding because snake bite is not infectious and therefore cannot be eradicated by vaccination. Yet snake bite is eminently preventable and treatable through community education to reduce occupational and environmental risk, access to good-quality specific antivenoms, and by training nurses, health workers, dispensers, and doctors. Since WHO’s announcement, action has already been taken by the Ministry of Health in Kenya to develop local guidelines on snake-bite management and to engage local and international donor health agencies. Acknowledging the problem in the regions affected is an important start. Momentum is building with the support of the Kofi Annan Foundation, and snake bite is on the World Health Assembly’s agenda for the first time next year. Now, surely, the plight of snake-bite victims will be more difficult for the major global health funders to ignore. n The Lancet
Westend61/GETTY
Cosmetic procedures: a cause for concern
For the Nuffield report see http://nuffieldbioethics.org/wpcontent/uploads/Cosmeticprocedures-full-report.pdf For more on social media and mental health see https://www. theguardian.com/society/2017/ may/19/popular-social-mediasites-harm-young-peoplesmental-health For the Be Real campaign see http://www.berealcampaign. co.uk/
2
The Nuffield Council on Bioethics has called for stricter controls over the provision of non-reconstructive cosmetic procedures, citing ethical concerns about their promotion and regulation in the UK and suggesting that they be made available only to people aged 18 years or older. Social media, advertising, and apps are being used to convey the message that these procedures are not only accessible but desirable, meaning that people could feel pressured to conform to a society’s ideal of beauty at susceptible points in their development. The desire to change one’s appearance is not new, but factors such as celebrity culture, use of unrealistic images in advertising, and the stratospheric rise of social media have helped cultivate an environment that can be toxic to self-esteem and body image. Although social media can have a positive influence on wellbeing, they have also been associated with increased anxiety and feelings of inadequacy in some young people. Social media policies on health-related advertising range from fairly stringent to non-existent, and cosmetic surgery apps are easily accessible and marketed as games for children
as young as 9 years old. The very media that contribute to body dissatisfaction are not only stimulating demand but promoting so-called solutions. Demand for cosmetic procedures has increased the value of the UK cosmetic sector from £720 million in 2005 to an estimated £3·6 billion in 2015. Despite this growth, and in spite of previous safety recommendations from reviews of the industry, the UK Government has failed to introduce consistent regulation of cosmetic products and non-surgical procedures. Because of this vacuum, few data are available on how many young people have cosmetic procedures, but in theory, a 16-year-old could have certain procedures involving use of an unregulated product, done by an unskilled and unregulated practitioner, without the involvement of a parent or medical professional. Campaigns such as Be Real, which is aimed at changing attitudes to body image in young people, are a step in the right direction, and educating children about body image is crucial. Nevertheless, more must be done to moderate the exposure of young people to the irresponsible marketing of potentially life-changing procedures. n The Lancet www.thelancet.com Vol 390 July 1, 2017
