Monday, 17 November 2014

Good News From Grim Headlines

Today is world prematurity day and several news outlets have been covering a recent global study published in the Lancet which reveals that problems related to pre term birth are now the single biggest cause of death in the under 5's. I can imagine nothing more tragic in this world than the death of a child and prematurity is an issue that has effected several people dear to me but, believe it or not, there is actually some good news behind these grim headlines. The main news outlets have touched on this but I think it's at least worth a few paragraphs on my little blog.

Clearly there is a great need for more understanding of pre-term birth, more research is needed into why it happens, how to prevent it and how best to care for these tiniest of babies. But it's not really prematurity that I'm going to talk about, others can do that much better than me*.

If you were to read only the headlines (as many people do) you could well think that more and more babies were being born dangerously early, driven by some new and worrying factor in modern life. The media coverage even offers up suggestions for what those causes may be (more on that later). But, if you read the actual paper it seems that deaths related to pre-term birth have actually reduced over the period of the study (2000-2013) by 20-30%  The reason they are now the leading concern in infant survival is because so many other causes of death have decreased even more and this is where we can find the good news story.

In the year 2000, for every 1000 babies born alive around the world, 76 wouldn't make it to their 5th birthday, by 2013 that number was 46. It's a remarkable change in just 13 years. The biggest difference has been made by reducing cases of pneumonia, diarrhea and measles. These haven't been big killers of children in developed nations for decades, but in other parts of the world they carried on needlessly taking young lives. But humans can be be amazing sometimes and through hard work, research and frankly a fair bit of cash, we have saved literally millions of young lives. All just by making sure that more children have access to vaccination, sanitation and basic medical care. In a world where the news is so often dominated by war and brutal terrorism, here is an example of people working together, across the barriers of nationality, culture and religion to protect the most vulnerable amoungst us. Personally I think we should be bloody proud of that.


That said, we could still do more, despite these improvements the world will fail to meet the millennium development goal that aimed to reduce infant mortality, but the fact that we have come so far shows that we can have an impact, now we just need to work even harder in those areas where infectious disease is still a big killer and on the harder to tackle problems such as prematurity.

I find it very frustrating that the media often focus souly on the negatives in stories about health research. I'm going off topic for a moment here (forgive me) but Cancer is a prime example of this. More people get Cancer now than have ever done before, and as a result of this some people (understandably) think that there must be something in the modern world causing the disease. Looking at it that way, decades of research costing millions upon millions of pounds seems to have been utterly pointless. Really what is the point of it all if we can do nothing?

 Except we've done a hell of a lot.  Of course smoking and obesity etc. can cause cancer but overwhelmingly the reason more people have the condition now is because they haven't died of something else first. Dying of an infection in your 20's is a sure fire way to ensure you don't get cancer when you're 75. But (at least in developed countries) we have largely conquered the diseases that made life short and brutal for our ancestors. Clean water banished many of them and vaccination headed off others. Readily available antibiotics have turned potential killers into something just a bit annoying. This is a remarkable achievement and one our species should be proud off and draw hope from. When a polio epidemic was killing children around the world in the last century, it seemed unstoppable, but a few clever humans developed vaccines and now the disease has been wiped out in all but a handful of countries. It wasn't easy, but we did it and to my mind that gives us hope that one day we will be able to say the same about these old killers in every part of the world and about premature birth, cancer and all the other other new big killers. Perhaps I'm a bit of a hopeless romantic when it comes to the achievements of science or overly optimistic about the motivations and abilities of my species. If so, I hope I get to stay that way. Surely we can both highlight the importance of what still needs to be done and celebrate what we've achieved so far?


*****

more on that later....

I mentioned above that some of the media coverage of this research was speculating about the reasons for an increase in pre-term birth. The UK press is concerned that we seem to fare quite badly and suggests various things that may contribute to that including the increase in average maternal age, obesity and fertility treatments that can lead to more twin and triplet pregnancies. That all seems pretty reasonable although from my reading of the stats, buried deep in the enormous appendix to this study, I'm not convinced that there actually is an increase in pre-term birth here (anyone reading this who can clarify that please comment and I'll amend the post, this isn't my field!). 

However, one suggestion on the BBC news article, which was also brought up by one of the study's authors on today's Woman's Hour, was that the rise in the number of caesareans is a factor. I'm honestly a bit perplexed by this. I really don't believe that there are lots of women in the UK demanding to have their babies delivered surgically and premature without a very good reason. I certainly can't see their NHS doctors agreeing to it! When I had an elective c section the doctors were quite strict about it not being even a day before 39 weeks (37 weeks is considered full term). Perhaps the problem is that a caesarean increases the risk of preterm labour in future pregnancies? But I don't recall being warned of this and it's not one of the risks listed on the NHS website. I'm inclined to think the link between c-sections and prematurity is utter nonsense, in which case it's really inappropriate and potentially harmful to suggest it. But then I am perhaps biased and as soon as the author used the phrase "too posh to push" on Woman's Hour, my hackles were admittedly raised. Anyway I sent a tweet to the author asking for clarification and references, if she gets back to me I'll update the blog and if anyone else can offer an insight please comment below, I'm willing to grudgingly change my mind if presented with decent evidence, that's science folks.

SBx

* For a far more personal blog about pre term birth here is Headspace Perspective written by Leigh Kendall who sadly never got to take home her beautiful boy Hugo, but who is working to improve things for other parents of premature babies.

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