World Health Assembly: putting mental health on the agenda

Dr. Shekhar Saxena, WHO director of mental health and substance abuse, at the Palais de Nations in Geneva during the 66th World Health Assembly. (Jennifer Yang/Toronto Star)

A major topic and agenda item at this year's World Health Assembly is non-communicable diseases (NCDs), or what some people refer to as "lifestyle" diseases — things like cardiovascular disease, cancer, diabetes and chronic lung disease.

Every year, NCDs kill 14.2 million people between the ages of 30 and 69  — 85 per cent of whom live in the developing world. Yet, NCDs were left out of the Millenium Development Goals and some feel these diseases have been abandoned in the "wilderness" of the global health agenda. 

But if NCDs are in the wilderness, then global mental health has been wandering in a kind of "double wilderness," according to Dr. Shekhar Saxena, WHO's director of mental health and substance abuse. Even within the NCD umbrella, it has been difficult to make mental health a priority, Saxena says — the majority of countries spend less than 2 per cent on mental health issues but they cause 14 per cent of the overall burden of disease. (Mental health, as defined by WHO, also includes substance abuse issues.)

"Mental health has been ignored by policy makers and by communities for far too long," Saxena said Monday in an interview at the Palais de Nations during the 66th World Health Assembly.

"It was not part of the MDGs and even when NCDs were brought on the agenda in the UN general assembly in 2011, mental disorders were not explicitly included in the agenda. However, the world is waking up very well in increasing the importance of mental health."

This is the first time WHO has developed a mental health plan for global use, Saxena says — and it was put together in a mere nine months. "Member states felt that this issue is so important that there’s no time to lose," he says.

This week, a draft plan for mental health be put before member states at the World Health Assembly, with four objectives:

1) strengthen leadership and governance for mental health

2) provide comprehensive mental health and social care in communities

3) implement promotion and prevention strategies

4) strengthen information systems and evidence and research

Saxena is hopeful the plan will be adopted at the World Health Assembly — but the biggest challenge lies beyond. Rustling up the necessary funding will be challenging in these times of economic hardship and contracting budgets, he acknowledges.

 

But for Saxena, the difficult economic climate only means that a global mental health plan has never been more necessary.

"The timing (of the plan) is bad in terms of the decrease in the availability of money — but good in terms of a better realization of the mental health issues during an economic downturn," he says. "If 50 per cent of young people have no jobs, will they face mental health problems? The answer is yes."

"When resources are less, the need for mental health care is even larger."

Correction: The above post has been changed to say that the majority of countries spend less than 2 per cent on mental health issues, not 20 per cent.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. This week she is blogging from Geneva, where she is attending the World Health Assembly under a UN Foundation press fellowship. Follow her on Twitter: @jyangstar

In Geneva, a sit-down chat with WHO's coronavirus expert

WHO director general Dr. Margaret Chan addresses the 66th World Health Assembly in Geneva. (Jennifer Yang/Toronto Star)

This week, I will be blogging from the 66th World Health Assembly in Geneva, which I'm attending under a UN Foundation press fellowship. One of the first main events was a speech by WHO director-general Dr. Margaret Chan, who chose to open her statement by invoking the memory of SARS.

Why bring up SARS now? Because these days, public health officials are wringing their hands over two new viruses with pandemic potential: the H7N9 bird flu in China and a SARS-related coronavirus that has emerged in the Middle East, now being called MERS (Middle East Respiratory Syndrome).

Both viruses "remind us that the threat from emerging and epidemic-prone diseases is ever-present," Chan said in the Palais de Nations. 

"Constant mutation and adaptation are the survival mechanisms of the microbial world," she said. "It will always deliver surprises."

But while Chan publicly thanked China for "collecting and communicating such a wealth of information" on H7N9, she made no mention of how Middle Eastern governments have responded to MERS. Thirteen months after the first known cases, the world still has very little information about this deadly virus, which has now killed 20 people and infected at least 31. A recent outbreak in the eastern part of Saudi Arabia — the country where the majority of cases have been reported — has also infected 22 people and killed nine, and very little is known about these latest cases.

There are no specific events at the World Health Assembly dedicated to discussing the coronavirus (update: according to this Saudi Gazette report, Saudi Arabia has requested that coronavirus be discussed in Geneva this week) but on Monday morning, I sat down briefly with the pleasant and soft-spoken Dr. Tony Mounts, WHO's technical lead on the coronavirus, to talk MERS — what we know about it, what we don't know, and how worried we should be. 

How concerned are you about the novel coronavirus? 

So far, the mitigating feature is we haven't seen this spread beyond health care facilities and close family, except for the two cases that were recently announced. So that’s reassuring — that it’s mostly a hospital-based outbreak among people that may have increased susceptibility.

There are a few things that have been happening recently that I think raise our level of concern. If this was just a hospital outbreak, that would not be so concerning. We’ve seen that before — we think the Jordan cluster back in April 2012 was probably a hospital outbreak that burned itself out and did not extend beyond the hospital. 

But here you also have cases that are showing up in other countries; you have a case in France and local transmission in France. Again, it seems to have limited itself to the hospital setting but to see it spread to other countries like that is a real concern. There are a lot of workers from the Indian subcontinent and the Philippines working in the Middle East — people are also going back to some of these areas where there may not be the same facilities for picking up cases.

So my concern is that there may be travelers who are taking this back to Karachi or to Delhi or to Mumbai or Manila who are not being detected and you could have local transmission in those settings and it wouldn't be discovered until it's spread quite far.

What do we know so far about the possible source of this virus?

Still, we don’t know any more than we did in the beginning. The genetics of the virus make it look like a bat virus. But today, in spite of quite a bit of work going on to try and find the sources, nobody's been able to demonstrate the virus in an animal species. We think it must be an animal virus — it just doesn’t make sense that this would be a human virus circulating for a long period of time undetected. We just haven't been able to find the animal; there's no smoking gun.

WHO experts recently went to Saudi Arabia to help investigate the recent outbreak. What did WHO learn?  

We came back with some idea of what the government is doing — the extent of the acitvities and intensity of the investigations that are going on. The (WHO) participants, when they returned, they were actually fairly reassured that everything is being done that possibly could be done to investigate the causes of this outbreak and try and find the source. The (Saudi Arabian) ministry of health and the hospital where this outbreak was based had instituted some measures that seem to be stopping the transmission that was occurring in the hospital. So that was reassuring.

Can you describe some specific measures being taken in Saudi Arabia?

The results of their early investigation indicates this is a nosocomial outbreak, meaning it's spread within the hospital environment. So they're doing the kinds of things you’d normally do with a hospital outbreak: spacing the patients a little more, doing isolation when somebody has respiratory symptoms, trying to be more rigorous about all of the infection control practices ... they've instituted all of these things and as you know, they've invited people from the outside — a hospital infection control specialist from Canada — who's helping to advise them on the specifics of the interventions. It does seem to have stopped the transmission in the hospital.

Why is there still so little known about this novel coronavirus?

I think the investigation is still going on and they’re still trying to collect and collate all of the information. The story we got from the (WHO) mission that returned is that the Saudis feel a little bit like they’re drinking from a fire hose — it’s just a huge amount of information that they’ve been collecting in a very short period of time and they just haven't had the time to completely analyze and put it all together in summaries.

We have every expectation that they’re going to put this (information) together and share it with the world.

Some have raised concerns about a lack of transparency around the sharing of information about the coronavirus. Do you share these concerns?

(Saudi Arabia) has shared information about the cases when asked and they've notified us of new cases when they occur. So they are fulfilling all of the obligations under the International Health Regulations but we do need this additional information to really understand the threat that this virus poses. The biggest question we need to know is what kind of exposures are happening that cause people to get infected; what are people doing, what are they coming into contact with, what are they eating or doing that results in infection. 

The Saudis are giving us information. We would like more of it. Hopefully we’re working a bit more closely with them during the World Health Assembly and helping them understand what we need. I think that they’re starting to wrap up some of their early investigations; I’m hoping some of that information will become available very soon.

There have been some reports following the recent outbreak in Saudi Arabia that the coronavirus has mutated — can you confirm that?

We haven’t seen the virus from this outbreak. There’s no genetic sequencing from this outbreak. I presume it’s being sequenced but it takes some time. 

How similar is the current novel coronavirus situation to the early days of SARS?

There’s a limited amount of information about the very beginning of SARS so we don’t really know what happened leading up to when it became very public and very evident. There are some similiarities — the type of illness it causes is similar, although of course the virus is in the same family. But we’re not seeing the kind of easy transmissions with this virus that we saw in SARS.

Are there serological studies currently underway?

The Jordanians have just completed an investigation using serology of their cases that happened a year ago. We’re expecting the results from that study in the next couple of weeks. 

In that initial cluster, we only had two confirmed cases — there were about a dozen people that had a similar illness but there were only clinical materials remaining to be tested from two or three people. So what they have to do now is go back and draw blood from all of those people to see if the illness that they had was actually this infection. 

The coronavirus is not on the official agenda this week at the World Health Assembly. Do you expect it to come up?

A lot of what happens at formal meetings like this is a lot of the work actually gets done at informal sites — at coffee time and at lunch time. I know there are lots and lots of those kinds of meetings going on and lots of discussions. So even if it isn't raised formally on the floor of the plenary session, there are lots of discussions with the Saudis and other countries in the region. There’s already been some discussions around the need to ramp up and increase the level of surveillance in other countries in the Middle East and try to get lab capacity up to speed in other countries so they can detect the virus. There’s no reason to expect that this virus is limited to Saudi Arabia.

What would it take for you to start really getting worried about the coronavirus situation?

The biggest warning sign would be onward transmission. Right now the only places that we’ve seen human-to-human transmission is two settings; one is the hospital, and one is close family members. We've had several clusters like that ... local transmission where contact is very close, where there are factors that facilitate transmission of viruses between people — but we’ve not ever seen that extend beyond that, to transmit onward into the community. So the minute we see transmission occurring in a setting that doesn’t normally facilitate transmission, that would be a concern.

This interview has been edited and condensed.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. This week she is blogging from Geneva, where she is attending the World Health Assembly under a UN Foundation press fellowship. Follow her on Twitter: @jyangstar

China busts bursting condoms at home, but exports on sale in Africa

A worker tests condoms in a factory in the Chinese province of Guangzhou in 2005. (AP Photo)

Well it’s official: China’s world-famous fake manufacturers have boldly gone where no men have gone before – manufacturing fake condoms.

Chinese state media trumpeted the fact this week that police had busted a fake condom operation in the southern province of Fujian – back in March, actually.

Why authorities are making a big deal of it now isn’t clear.

Perhaps they’re hoping to sound alarm bells – and alarming it is: police started to investigate after finding condoms selling on taobao.com, China’s largest online marketplace, for just 1 Yuan, or about 16 cents.

The investigation led them to a workshop in the southern province of Fujian, where they arrested two owners and 10 workers, and confiscated 2 million fake condoms.

The workshop was pushing out 20,000 “condoms” per day, packaged under brand names like Durex, as well a popular Chinese brand known as Jissbon – a somewhat unfortunate translation of the name “James Bond.”

Two other workshops were also busted, one in the central Chinese province of Henan, and another in Zhejiang province, on the south east coast.

But the story is bigger.

Chinese entrepreneurs have also been exporting the product.

Media reports from Africa, where China has spent the better part of the last decade making itself an indispensable trading partner, show fake condoms from China have landed in Nigeria, Africa’s most populous nation, as well as in other countries.

Earlier this month, Nigeria’s National Agency for Food and Drug Administration announced the arrest of a trader in the capital of Lagos who had hauled in counterfeit drugs, medicines and fake Rough Rider condoms from China.

Olisameka Osefoh told police he had been working with a cartel in China.

He wasn’t the first: Osefoh’s arrest followed reports last month from the West African country of Ghana. FDA officials there warned the public to be on the look out for fake condoms from China marketed under the brand name “Be Safe.”

The state agency said batches of the condoms were inadequately lubricated, had visible holes and were prone to burst.

Bill Schiller has held bureau postings for the Star in Johannesburg, Berlin, London and Beijing. He is a NNA and Amnesty International Award winner, and a Harvard Nieman Fellow from the class of '06. Follow him on Twitter @wschiller

Global health by the numbers

Did you know that life expectancy in China is now higher than most countries in Eastern Europe?

Or that 800 women die every day from complications relating to pregnancy or childbirth? Or that the government of Luxembourg spends more money on health per person than any other country in the world?

These statistics all come from the World Health Organization's recently-released 2013 statistical report on global health. Every year, the UN health agency tackles the gargantuan task of measuring the globe's health by combing through countless birth and death registries, hospital records, research reports and household surveys. For countries where data is poorly kept or missing altogether, the agency will also perform statistical modelling and adjustments.

According to the report, significant gains have been made — particularly with improving health in the poorest countries — but the world still has a long way to go if it hopes to achieve all eight Millenium Development Goals by 2015. The WHO's summary of their 168-page report outlines some key trends in this year's accounting of health on Earth:

Child health: Huge gains have been made in this area. In 1999, nearly 12 million children under five died; in 2011, that number was nearly halved, with fewer than 7 million deaths. Still, not enough progress has been made to meet the global target set by the Millenium Development Goals (a two-thirds reduction in 1990's levels of mortality) by 2015. A mere six conditions kill 75 per cent of all children under five: neonatal complications and premature birth, pneumonia, diarrhea, malaria, HIV/AIDs and measles.

Premature birth: Every year, 15 million babies are born too soon and one million will die as a result. Preterm birth is the leading cause of death for newborns and the second-biggest killer of children younger than five (number one is pneumonia). 

Malnutrition: This is what WHO describes as a "double burden" because malnutrition is driving both underweight and overweight issues in children — Africa, for instance, has the highest proportion of stunting but also saw a doubling of overweight children between 1990 and 2011. Overall, the number of children who are stunted is decreasing worldwide but there are still some countries where more than half of all children are stunted. When it comes to overweight kids, Europe has the highest proportion, with 12.5 per cent of children considered overweight — a trend that will certainly drive future increases in non-communicable diseases such as cancer and diabetes.

Diabetes: WHO says that nearly one in 10 people worldwide now have diabetes, with the highest prevalence rates in the Eastern Mediterranean Region and Americas (11 per cent of both men and women). The lowest rates are in Europe and the Western Pacific region, where 9 per cent of both sexes have diabetes.

HIV: The good news is that fewer people are dying from HIV — in 2011, an estimated 1.7 million died from AIDS-related causes, a 24 per cent decrease from 2005. But at the same time, more people are now living with the virus and an estimated 34 million people worldwide have HIV (the vast majority of them — 70 per cent — are in sub-Saharan Africa). The number of new infections is also dropping around the world but "not enough," according to WHO — in 2011, an estimated 2.5 million people were infected with HIV.

Access to water and basic sanitation: Since 1990, 1.9 billion people have gained access to improved sanitation facilities. But today, more than 2.5 billion people — or about one third of the world's population — still lack access to proper sanitation facilities. As for water, access to safe drinking supplies has largely improved in the last two decades but in some sub-Saharan countries, only one third of the poorest households have access to adequate water supplies.

Access to medication: Affordable medicines are still scarce in many low and middle-income countries and too many patients are forced to turn to the private sector, where prices could be 16 times higher. In certain countries, as little as 3 per cent of certain generic medicines are available in the public sector. 

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

The race to save cassava in Africa is on

A Nigerian farmer holds cassava roots. Experts have reported new outbreaks of virus that damage the vegetable crop. (AFP photo)

Cassava, the vegetable that could be Africa’s miracle crop, is in trouble.  

Scientists say a disease destroying entire crops has spread out of East Africa and into the heart of the continent and is attacking plants as far south as Angola and now threatens to move west into Nigeria, the world’s biggest producer of the potato-like root that helps feed 500 million Africans.

Claude Fauquet, co-founder of the Global Cassava Partnership for the 21st Century, told The Associated Press that the devastating results are already dramatic today but could be catastrophic tomorrow if nothing is done to halt the Cassava Brown Streak Disease, or CBSD.

He said that Africa is losing as much as 50 million tonnes of cassava each year to the disease.

The tropical root vegetable grows well in poor quality soil and high temperatures, making it resistant to climate change. It requires almost no labour to grow.

That’s not all: its roots are rich in carbohydrates, vitamins and minerals. It is already a dietary staple throughout the continent, and it could feed more. The vegetable can also be used as an industrial starch to produce plywood, textiles and paper.

It is also a vital cash-crop for millions of small farmers.

But now, there are fears that the epidemic is pushing into West Africa, and could reach Nigeria. Fauquet said scientists must act fast to keep it from reaching West Africa.

A group of scientists are meeting in Italy this week to work out a plan to fight the disease that is killing cassava. The conference is "dedicated to declaring war on cassava viruses in Africa."

READ MORE: Does cassava hold the secret to climate change adaptation?

Raveena Aulakh is the Star's environment reporter. She is intrigued by climate change and its impact, now and long-term, and wildlife. Follow her on Twitter @raveenaaulakh

Donating fancy medical equipment to the developing world? Think first

Donating medical equipment to poor countries -- it sounds like a great idea but in reality, the altruistic gesture could wind up doing more harm than good.

Scientific American recently reported on a study looking at seven hospitals in Haiti, which collectively received 115 pieces of medical equipment following the devastating 2010 earthquake. Their findings were pretty discouraging:

- Only 28 per cent of the equipment was still working and being used

- Another 28 per cent was sitting idle due to technical reasons

- 30 per cent was no longer working but could be repaired

- 14 per cent was no longer working and impossible to repair

Even worse, some of the donated items were never even used -- incubators for premature babies, for example, required an electrical voltage that was too high for Haiti.

This is not the first study to scrutinize the benefits of donated medical equipment. This one analyzed hospital equipment in 16 countries between 1986 and 2010 and found that an average of 38.3 per cent was no longer in service. Scientific American also points to a WHO report that estimates only between 10 and 30 per cent of medical equipment is being used in countries where up to 80 per cent of equipment is donated by foreigners.

In August, The Lancet published a study reporting that as much as 40 per cent of health-care equipment in low-income countries is out of service; this compared to rich countries, where only 1 per cent of medical equipment is out of commission.

The Lancet paper points out that most medical equipment used in wealthy countries has been designed for, well, wealthy countries -- they assume hospitals will have access to technical expertise, spare parts to repair the machines, health workers that can operate the equipment and reliable electricity.

So how can foreign countries donate to low-income countries without cluttering their supply rooms with useless state-of-the-art equipment? The Lancet study suggests investing in "process innovations" (solutions for improving healthcare delivery that are appropriate to the country) and developing "frugal technologies" -- like, perhaps, this low-tech $5 toolkit that one Toronto doctor is using to save newborn lives in rural Pakistan.

And making an intelligent donation can require a lot more effort than you might think, as this WHO report shows. In 2000, a group of wealthy North American philanthropists actually travelled to a teaching hospital in Gambia to ask them what they needed. The hospital requested and received more than 20 oxygen concentrators -- but the first ones they used stopped functioning after just 30 minutes and local technicians were unable to fix them. The donors even sent a technical assistant to Gambia to help -- but ultimately, the oxygen concentrators wound up in storage within a matter of weeks.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

What is sarin gas? A look at one of the world's most dangerous chemical weapons

There is still no concrete proof of chemical warfare in Syria but discussions of the possibility all seem to centre around the same chemical agent: sarin gas, one of the world's most dangerous chemical weapons.

Sarin gas, according to the U.S. Centers for Disease Control and Prevention, is man-made and "the most toxic and rapidly acting of the known chemical warfare agents."

If released into the air as a gas, sarin is very difficult to escape or even notice -- it's colourless, tasteless and odourless and people can be exposed through skin contact, eye contact, breathing in contaminated air or eating contaminated food.

People can also be poisoned by drinking water mixed with sarin. And when sarin vapour or liquid gets onto clothing, it can continue to poison for 30 minutes -- people who've been exposed are advised to quickly take off their clothes, seal them in a plastic bag, and wash themselves vigorously with soap and water.

Originally developed by Nazi scientists as a pesticide, sarin gas works similarly to the insect killers in terms of its effect and how it causes bodily harm -- essentially, by disrupting the nervous system and overstimulating the body's glands and muscles. People exposed to low doses can recover but high exposures can cause victims to suffocate by paralyzing the muscles around their lungs, according to the Council for Foreign Relations. CFR also says sarin is 500 times more toxic than cyanide -- just one drop can kill the average person in a matter of minutes.

Sarin causes a variety of symptoms, including runny nose, watery eyes, pinpoint pupils, eye pain, blurred vision, drooling, excessive sweating, cough, chest tightness, rapid breathing, confusion, headache, nausea, diarrhea and fluctuations in heart rate or blood pressure -- in severe cases, it can cause convulsions, paralysis and death.

There are antidotes for sarin but they are only effective when given quickly. Sarin has been used as a chemical weapon in the past, most notably by Iraq in the Halabja massacre of 1998 and in Japan, where a doomsday cult called Aum Shinrikyo carried out two sarin gas attacks in the mid-90s.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

The novel coronavirus reminds us of its presence: 3 new cases

While all eyes were on China's bird flu outbreak, Saudi Arabia reminded the world of another brewing virus every bit as worrisome: the novel coronavirus.

Oh yeah - remember the novel coronavirus? Until H7N9 came along and shone the world's klieg lights on China, the coronavirus was the scary new disease keeping public health officials awake at night. The virus is genetically related to the virus that caused SARS and up until Wednesday, it had already infected 17 people and killed 11.

Then, like a jealous first-born fed up with playing second fiddle to mommy's new baby, the coronavirus decided to screech at the top of its lungs and reclaim our attentions. On Wednesday, in one fell swoop, the Saudi Arabian government announced seven new cases -- five already dead. Suddenly, the coronavirus' tally shot up to 24 cases and 16 deaths.

Very few details were given and the timing of the announcement, along with its paucity of information, prompted some to question the transparency of the Saudi Arabian government in communicating news about this new virus. Not even the World Health Organization had much information by the time evening rolled around in Geneva, not even the patients' ages, genders or illness onset dates.

But this morning, the Saudi Arabian deputy minister for public health, Dr. Ziad Memish, revealed many more details about these new cases on ProMed, including the patients' ages, genders and illness onset dates. He also announced three additional cases, bringing the global total to 27. 

Based on the information provided, every new patient is a man with the exception of one 53-year-old woman who fell sick on April 27. The ten are all between the ages of 24 and 94 and every single patient had at least one comorbidity, meaning they had a concurrent but unrelated illness. The first person to get sick was a 59-year-old man who became ill on April 14 and died five days later; the most recent person to get sick developed symptoms on April 30 and has pneumonia but is doing 'well.'

One thing stands out from this update: the fact that one patient is a "family contact" of another patient who is already dead. The WHO followed up with its own press release on Friday and acknowledged that two confirmed cases belong to the same family -- which raises the possibilities that both were exposed to the same source of infection or one relative gave the virus to another. The second, of course, is the more concerning scenario of the two -- and we already have evidence that the virus can spread from person to person, at least in a limited way.

As little as we know about H7N9, we know even less about the coronavirus -- but this one has already shown signs of being capable of spreading between people and will certainly prove more difficult to treat.

So yes, coronavirus, thank you for the reminder. We will continue to worry about you too.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

Training rats in Tanzania to detect tuberculosis

 

NPR's excellent health blog, Shots, has a post today that alerted me to a living, breathing, four-legged tool for diagnosing tuberculosis in low-resource areas: rats.

More specifically, giant African pouched rats -- a rodent that is native to most of Africa and has an excellent sense of smell.

Journalist and photographer Jonathan Kalan reports that a nonprofit organization called APOPO, which has been using the animals for landmine detection, is teaching giant African pouched rats to sniff out tuberculosis in samples of human sputum (mucus from the upper airways).

Kalan explains:

"The team trains the critters with a Pavlovian click-and-reward approach. When the rats are just a few weeks old, technicians teach the animals to associate a click sound with a small bite of mashed bananas and a special pellet of food. The next step is to link the scent of TB with the reward."

Basically, if the rats smell Mycobacterium tuberculosis in a sputum sample, they will pause over it; if they don't, they move on. (For more information, APOPO's website has a helpful infographic that explains how the process works).

Kalan interviewed chemist Negussie Beyene, who said that APOPO's trained rats (they have 54, according to the website) can accurately sniff out a TB sample roughly two-thirds of the time. When two or three rats are used, however, the accuracy rate increases to about 80 per cent.

Some rats are already being put to work at a lab in Morogoro, Tanzania, Kalan reports. And not only are the four-legged helpers catching positive samples being missed by lab workers, the smell test works much faster than microscopy -- the rodents can evaluate up to 200 samples in a session and one particular rat, named Harod The Rat, can perform 10 evaluations in just 20 seconds.

At least one study has shown that the rats can improve TB detection by 31.4 per cent. APOPO researchers have also published a paper about the use of rats in TB detection that includes some interesting data, which you can check out here.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

The downsides of overdiagnosing

The New York Times recently published two thought-provoking pieces on the downsides of overtesting and overdiagnosing women: in the Sunday magazine, a cover story about breast cancer "overawareness" by Peggy Orenstein; and on Monday, a post on the Well blog about the value of pelvic exams by Jane E. Brody.

Both pieces raise questions about procedures that have become all too familiar to North American women: the mammogram and bimanual exam (if you don't know what a bimanual exam is, Brody describes it thusly: "The doctor inserts a lubricated, gloved finger into her vagina and, with the other hand, presses down on her abdomen to check the shape and size of her uterus and ovaries.")

These procedures save lives -- or so women have been told over and over again. But Orenstein and Brody ask: do they really? And at what cost?

Orenstein's story is interesting because she is a breast cancer survivor herself and once wrote a piece in the New York Times crediting the mammogram with saving her life.

She now regrets writing this article, as she tells the Times' 6th Floor blog, having learned more about the science of breast cancer and how awareness campaigns have overemphasized the mammogram's value without also acknowledging the risks.

Orenstein writes:

"For an individual woman in her 50s, then, annual mammograms may catch breast cancer, but they reduce the risk of dying of the disease over the next 10 years by only .07 percentage points — from .53 percent to .46 percent. Reductions for women in their 40s are even smaller, from .35 percent to .3 percent.

If screening’s benefits have been overstated, its potential harms are little discussed. According to a survey of randomized clinical trials involving 600,000 women around the world, for every 2,000 women screened annually over 10 years, one life is prolonged but 10 healthy women are given diagnoses of breast cancer and unnecessarily treated, often with therapies that themselves have life-threatening side effects."

Yet, women have been bombarded with messaging about the importance of mammograms and regular self-exams, often by breast cancer awareness campaigns that have deluged the world with pink ribbons. As one surgical oncologist said to Orenstein: "There is so much ‘awareness’ about breast cancer in the U.S. I’ve called it breast-cancer overawareness. It’s everywhere. There are pink garbage trucks. Women are petrified.” 

With Brody's piece, she points out the paucity of scientific evidence supporting annual bimanual exams for healthy women -- something even the American College of Obstetricians and Gynecologists acknowledges. Nonetheless, 63.4 million pelvic exams are performed in the United States every year and the routine performance of this invasive procedure "increases costs of medical care and discourages some women, especially adolescents, from seeking needed care."

Moreover, Brody writes, "the exam sometimes reveals benign conditions that lead to follow-up procedures, including surgery, that do not improve a woman’s health but instead cause anxiety, lost time from work, potential complications and unnecessary costs."

One journal article mentioned in Brody's post suggests that routine bimanual exams in the U.S. could partly explain why rates of ovarian cystectomies and hysterectomies are more than double the rates in European countries, where only symptomatic women are given pelvic exams.

In another study she cites, researchers found that ovarian cancers were not detected by pelvic examination alone and is not in itself an effective screening tool -- yet, almost 70 per cent of ob/gyns believed it was.

"Whenever doctors are doing things by rote, we have to rethink whether what they're doing is really helpful," Dr. George F. Sawaya told Brody in an interview.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar