Yoga, stretching may ease chronic back pain

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The type of yoga used in the study focused on the back and legs, and was adapted for each individual's physical limitations.Roughly 80% of adults experience low back painAs many as 8% will experience chronic symptomsA new study found that yoga was slightly better for back pain

(Health.com) -- People who suffer from chronic back pain may find some relief in yoga or intensive stretching, but neither form of exercise appears to be more effective than the other, a new study suggests.

Roughly 80% of adults experience low back pain at some point in their lives, and as many as 8% will experience chronic symptoms that last three months or longer. Primary care physicians regularly prescribe painkillers and muscle relaxants to these patients with varying degrees of success, or refer patients to physical therapists, chiropractors, or other specialists. Many doctors also recommend exercise and stretching, but few studies have explored whether certain physical activities are especially effective for back-pain patients.

The new study, which appears this week in the Archives of Internal Medicine, is a follow-up to a small 2005 trial that found that yoga was slightly better for back pain than a comprehensive exercise program that included strength training, aerobics, and stretching. The researchers suspected this might have been due to the meditation-like "mental component" of yoga, and they expected to get a similar result this time around.

Health.com: Yoga moves to beat insomnia, ease stress, and relieve pain

The study included 228 mentally healthy adults with moderate chronic back pain, most of whom were fairly active in spite of their pain. The researchers randomly assigned them to one of three groups: One group took weekly 75-minute yoga classes, another took weekly stretching and strength classes, and a control group received a book on coping with back pain. The yoga and stretching groups also received instructional videos and were encouraged to practice at home for 20 minutes a day between classes.

Three months later, the stretching and yoga participants were far more likely than the people in the control group to report improvement in their back pain. Twice as many participants in these two groups (about 40%, versus 20% in the control group) said they'd decreased their medication use, a trend that persisted three months after the yoga and stretching classes ended.

Yoga was no more effective than stretching, however. This finding, which surprised the researchers, suggests that the back-pain benefits of yoga are mostly due to its physical (rather than mental or spiritual) aspects, the study notes. And in fact, the stretching class was not unlike a yoga class, says Karen Sherman, Ph.D., the lead author of the study and a senior investigator at the Group Health Research Institute, the research arm of a Seattle-based nonprofit health plan.

Health.com: 5 quick ways to stop back pain

The stretching classes comprised "52 minutes [of] focusing on all the major groups in the back and the legs," Sherman says. "In that sense it was more like a yoga class with specific poses than what you'd think of as regular stretching."

Scott Duke, D.C., a sports chiropractor in New York City who was not involved in the study, says he's not surprised by the results. "I recommend flexibility exercises to every single lower back pain patient I have," he says. "Therapeutic stretching combined with relaxation and deep breathing absolutely helps low back pain."

The study should encourage physicians to incorporate stretching into their standard treatment protocol for back pain, Duke says. "Doctors today are looking for ways patients can be more proactive and take care of their own back pain, versus having to go to somebody to get treated," he adds.

Health.com: Exercises for people in pain

But not just any yoga or stretching class will do the trick. The type of yoga used in the study focused on the back and legs, and was adapted for each individual's physical limitations. Sherman stresses that back-pain patients should avoid vinyasa or "power yoga" classes, and should seek out therapeutic and restorative styles instead.

Without proper guidance and limits, patients may find themselves worse off than when they started. Even in the study, about 15% of the yoga and stretching participants exacerbated their back pain, a rate Duke says is close to real-world averages. (One patient in the control group also reported injuries from attempting exercises described in the self-care book.)

"Find a class geared toward beginners, and an instructor who has experience working with and making adjustments for people with chronic pain," Sherman recommends. "Go to class, practice at home, and see if it works. And if not, try another class."

Copyright Health Magazine 2010

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What causes Chronic Fatigue Syndrome?

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24 September 2011 Last updated at 03:22 GMT By James Gallagher Health reporter, BBC News When it comes to controversy and heated debate, few illnesses come close to Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis (ME).

There have been arguments about whether it exists, the cause, the best treatments and even the name itself.

These disagreements have reached the level of abuse and death threats.

The disease itself, however, remains poorly understood - or as one doctor put it: "The whole thing is surrounded by uncertainty".

Does it exist?

For a long time, the existence of CFS/ME was widely dismissed and labelled as "yuppie flu". That opinion has largely been reversed in the past decade.

Continue reading the main story

Should the illness be called CFS, ME or CFS/ME?

Doctors prefer the term CFS as the main symptom is fatigue, while ME has a specific meaning related to inflammation of the brain and spinal cord.

However, this is not popular with some patients' groups or charities, which talk about ME as a specific disease, saying "fatigue" is too broad a term.

Prof Michael Sharpe, of the University of Oxford, said: "The concepts of CFS and ME have been conflated as CFS/ME. That may be right but it may be a bit like an apple/banana - we need to be clearer what we are talking about."

In 2002, then chief medical officer Prof Sir Liam Donaldson described it as a "disease in the wilderness". He was presenting a report which said CFS/ME was a "genuine illness and imposes a substantial burden on the health of the UK population".

It is thought to affect about a quarter of a million people in the UK.

The main symptom is severe fatigue, made worse by exertion, which does not go away after resting. Muscle pains, headaches, memory problems and depression can also be involved. In some cases it can be completely debilitating, resulting in patients being unable to leave their beds.

Understanding of the disease is largely led by those symptoms. There is no test for CFS/ME, instead it is diagnosed by ruling out other conditions which might produce the same symptoms.

The underlying cause, or indeed causes, have been more elusive.

Uncertain origins

One of the issues in the field is that there is an emerging consensus that CFS/ME is not one illness.

Continue reading the main story

Victoria said she used to be a "mega-fit, mega-healthy" fell walker with a job she loved, and was "incredibly happy".

She collapsed in 2005. Two years later a neurologist diagnosed her with ME.

"I just feel incredibly ill all the time, I have no strength to even wash my face, I very rarely leave the house.

"I think people have a perception of what fatigue is, but not ME at this level."

She says she considers herself lucky that she can still get out of bed and make a cup of tea.

"I literally cannot do anything, it's an illness that takes your life, but it doesn't kill you."

Prof Stephen Holgate, chair of the Medical Research Council group on CFS/ME, told the BBC: "I think the problem with it is the term is used as a bit of a dustbin."

In children there are thought to be three sub-groups, and even more in adults, all given the label CFS/ME.

Prof Peter White, of Barts and the London School of Medicine and Density, said: "Most specialist doctors and scientists agree that it is more than one illness. It may be three to five separate illnesses.

"Like kidney failure, it has lots of different causes, but looks the same."

There was a brief moment of hope and optimism that a specific virus - XMRV - was the cause, however, that link has been largely discredited.

Viruses may have a role as a trigger for the illness, with many patients reporting that their symptoms started after infection.

Yet this has further levels of complication, as Prof White argues: "If glandular fever is a trigger but a patient has symptoms five years later, then it is no longer the Epstein-Barr virus, its something else."

While there have been suggestions that patients with CFS/ME have differences in their immune systems, pain perception and hormones, it is not known whether these are a cause or symptom of a chronic condition.

There has also been suspicion of a genetic or family element.

In Nature Reviews Neuroscience, Prof Holgate argued: "One is left with a strong sense that post-viral events are a common trigger of Chronic Fatigue Syndrome, but how they lead to chronic persistent disease remains unresolved."

Continue reading the main story The National Institute of Health and Clinical Excellence recommends doctors consider diagnosing with CFS/ME when: Fatigue is new, persistent and/or recurrent, unexplained by other conditions, [and] has resulted in a substantial reduction in activity level characterised by post-exertional malaiseAnd a least one of: difficulty with sleeping, muscle and/or joint pain, headaches, sore throat, difficulty thinking, exertion makes the symptoms worse, general "flu-like" symptoms or dizzinessThe symptoms have been present for at least four months in an adult or three months in a child. The search for a cure So far, a cure does not exist.

Prof Michael Sharpe, of the University of Oxford, said: "A pill that made you better would be great." However, he added, medicine fell well short of that: "The best shot right now is various forms of rehabilitation."

The PACE trial, which published results earlier this year, attempted to find out what the best therapies were.

It examined the use of both cognitive behavioural therapy, which alters the way people think and cope with their symptoms, and graded exercise therapy, a gradual and supervised increase in activity levels.

The trial suggested that patients using these therapies showed lower levels of fatigue and greater physical function.

Prof Holgate said: "Combining graded exercise therapy and cognitive behavioural therapy has undoubted benefit.

"Yes you can improve, but it mustn't be confused with the underlying cause."

He said these therapies might only be treating secondary symptoms.

However, the study has generated controversy with patients' groups and charities saying the findings were exaggerated and went against their own evidence. In Action for ME's 2008 survey of patient experiences, more than one in three said graded exercise therapy actually made them worse. They prefer a method known as "pacing" - or learning to live within limits - which the PACE trial concluded was not effective.

The ME Association's Dr Charles Shepherd said: "We consistently find pacing is the most effective. I'm not convinced graded exercise therapy is the answer to this disease, it is something more fundamental which cannot be reversed, an overly simplistic solution to an extremely complex problem."

Some people do, however, get much better.

Dr Ester Crawley, who specialises in children with the illness, said: "The prognosis for adults is poor, but for children it is really good, up to 94% get better."

She said the reason for this was unclear, but theories included "neuronal plasticity" - as children's brains are not fully developed, they can heal better - and "the adult lifestyle being predicated against recovery".

It is easier to adjust a child's lifestyle, such as doing two hours of school a day and gradually building it up, which is harder to do with adults who are in work.

A deeper understanding of the illness is desired by all involved. Delving into the sub-types of the condition may help in finding causes, which could also have implications for treating each sub-type.

One hope is that the new biobank of blood samples of CFS/ME patients being set up at London's Royal Free Hospital will help provide the answers.

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Scientists Back Down From Viral Cause of Chronic Fatigue Syndrome

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A new paper published online in Science on Thursday has failed to confirm a link between a mouse retrovirus called XMRV and chronic fatigue syndrome. Along with the new study, the authors of the controversial original study that first associated the virus with the illness in 2009 published a partial retraction of that work.

For the new study, conducted by the Blood XMRV Scientific Research Working Group, researchers analyzed blood samples from 15 people who had previously tested positive for XMRV or a similar mouse leukemia virus; 14 of these people had chronic fatigue syndrome (CFS) and one person had contact with a patient with the disease. The researchers also looked at 15 blood samples from healthy donors who did not have XMRV or CFS.

The samples were blinded and sent to nine different labs — including the Whittemore Peterson Institute lab and a National Cancer Institite lab, which participated in the 2009 study — for testing for XMRV. Seven labs could not find XMRV or any related viruses in the blood samples. The two labs that were involved in the original research did find the retroviruses, but they didn't find them in the same people and they were equally likely to find the viruses in controls as well as those who had earlier tested positive. Neither lab was able to replicate its own findings.

The origins of chronic-fatigue syndrome, which causes severe pain, exhaustion and memory and concentration problems, and has no cure, have long been a mystery. Studies have fingered immune system inflammation, the herpes virus and the Epstein-Barr virus as possible culprits. But there is no definitive cause, and many sufferers of the disease say that doctors don't always believe they're sick.

When the 2009 paper was published in Science, it came as a great relief to people with CFS — an estimated 1% of the world population — and to the scientists who study it. If a cause could be identified, then it could open the door to potential treatment.

But since that time, the original research has repeatedly come under fire. Seventeen studies have been published since the 2009 paper, showing no link between XMRV and chronic fatigue. One particularly damning study published in May found that the retrovirus found in the original blood samples got there by laboratory contamination.

All 13 of the authors of the 2009 study signed the partial retraction published in Science on Thursday. However, Judy A. Mikovits of the Whittemore Peterson Institute in Reno, Nev., which led the original research team, said the initial work deserved continued follow-up study. The Wall Street Journal reported:

Dr. Mikovits said she stood by the theory that there was a retrovirus associated with chronic-fatigue syndrome, though not necessarily XMRV. "We have to dig in to find the right viruses. We need to keep looking," she said.

Many other experts, including Kim McCleary, president and CEO of the Chronic Fatigue and Immune Dysfunction Syndrome Association of America, said they thought it was time to move on to other lines of research.

"We share the deep disappointment of many CFS patients and scientists that the initial data did not hold up. Whether you have been diagnosed recently or have been ill for decades, this news comes as a blow to hope for rapid advances in the care available to CFS patients," McCleary said in a statement.

Meredith Melnick is a reporter at TIME. Find her on Twitter at @MeredithCM. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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What causes Chronic Fatigue Syndrome?

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24 September 2011 Last updated at 03:22 GMT By James Gallagher Health reporter, BBC News When it comes to controversy and heated debate, few illnesses come close to Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis (ME).

There have been arguments about whether it exists, the cause, the best treatments and even the name itself.

These disagreements have reached the level of abuse and death threats.

The disease itself, however, remains poorly understood - or as one doctor put it: "The whole thing is surrounded by uncertainty".

Does it exist?

For a long time, the existence of CFS/ME was widely dismissed and labelled as "yuppie flu". That opinion has largely been reversed in the past decade.

Continue reading the main story

Should the illness be called CFS, ME or CFS/ME?

Doctors prefer the term CFS as the main symptom is fatigue, while ME has a specific meaning related to inflammation of the brain and spinal cord.

However, this is not popular with some patients' groups or charities, which talk about ME as a specific disease, saying "fatigue" is too broad a term.

Prof Michael Sharpe, of the University of Oxford, said: "The concepts of CFS and ME have been conflated as CFS/ME. That may be right but it may be a bit like an apple/banana - we need to be clearer what we are talking about."

In 2002, then chief medical officer Prof Sir Liam Donaldson described it as a "disease in the wilderness". He was presenting a report which said CFS/ME was a "genuine illness and imposes a substantial burden on the health of the UK population".

It is thought to affect about a quarter of a million people in the UK.

The main symptom is severe fatigue, made worse by exertion, which does not go away after resting. Muscle pains, headaches, memory problems and depression can also be involved. In some cases it can be completely debilitating, resulting in patients being unable to leave their beds.

Understanding of the disease is largely led by those symptoms. There is no test for CFS/ME, instead it is diagnosed by ruling out other conditions which might produce the same symptoms.

The underlying cause, or indeed causes, have been more elusive.

Uncertain origins

One of the issues in the field is that there is an emerging consensus that CFS/ME is not one illness.

Continue reading the main story

Victoria said she used to be a "mega-fit, mega-healthy" fell walker with a job she loved, and was "incredibly happy".

She collapsed in 2005. Two years later a neurologist diagnosed her with ME.

"I just feel incredibly ill all the time, I have no strength to even wash my face, I very rarely leave the house.

"I think people have a perception of what fatigue is, but not ME at this level."

She says she considers herself lucky that she can still get out of bed and make a cup of tea.

"I literally cannot do anything, it's an illness that takes your life, but it doesn't kill you."

Prof Stephen Holgate, chair of the Medical Research Council group on CFS/ME, told the BBC: "I think the problem with it is the term is used as a bit of a dustbin."

In children there are thought to be three sub-groups, and even more in adults, all given the label CFS/ME.

Prof Peter White, of Barts and the London School of Medicine and Density, said: "Most specialist doctors and scientists agree that it is more than one illness. It may be three to five separate illnesses.

"Like kidney failure, it has lots of different causes, but looks the same."

There was a brief moment of hope and optimism that a specific virus - XMRV - was the cause, however, that link has been largely discredited.

Viruses may have a role as a trigger for the illness, with many patients reporting that their symptoms started after infection.

Yet this has further levels of complication, as Prof White argues: "If glandular fever is a trigger but a patient has symptoms five years later, then it is no longer the Epstein-Barr virus, its something else."

While there have been suggestions that patients with CFS/ME have differences in their immune systems, pain perception and hormones, it is not known whether these are a cause or symptom of a chronic condition.

There has also been suspicion of a genetic or family element.

In Nature Reviews Neuroscience, Prof Holgate argued: "One is left with a strong sense that post-viral events are a common trigger of Chronic Fatigue Syndrome, but how they lead to chronic persistent disease remains unresolved."

Continue reading the main story The National Institute of Health and Clinical Excellence recommends doctors consider diagnosing with CFS/ME when: Fatigue is new, persistent and/or recurrent, unexplained by other conditions, [and] has resulted in a substantial reduction in activity level characterised by post-exertional malaiseAnd a least one of: difficulty with sleeping, muscle and/or joint pain, headaches, sore throat, difficulty thinking, exertion makes the symptoms worse, general "flu-like" symptoms or dizzinessThe symptoms have been present for at least four months in an adult or three months in a child. The search for a cure So far, a cure does not exist.

Prof Michael Sharpe, of the University of Oxford, said: "A pill that made you better would be great." However, he added, medicine fell well short of that: "The best shot right now is various forms of rehabilitation."

The PACE trial, which published results earlier this year, attempted to find out what the best therapies were.

It examined the use of both cognitive behavioural therapy, which alters the way people think and cope with their symptoms, and graded exercise therapy, a gradual and supervised increase in activity levels.

The trial suggested that patients using these therapies showed lower levels of fatigue and greater physical function.

Prof Holgate said: "Combining graded exercise therapy and cognitive behavioural therapy has undoubted benefit.

"Yes you can improve, but it mustn't be confused with the underlying cause."

He said these therapies might only be treating secondary symptoms.

However, the study has generated controversy with patients' groups and charities saying the findings were exaggerated and went against their own evidence. In Action for ME's 2008 survey of patient experiences, more than one in three said graded exercise therapy actually made them worse. They prefer a method known as "pacing" - or learning to live within limits - which the PACE trial concluded was not effective.

The ME Association's Dr Charles Shepherd said: "We consistently find pacing is the most effective. I'm not convinced graded exercise therapy is the answer to this disease, it is something more fundamental which cannot be reversed, an overly simplistic solution to an extremely complex problem."

Some people do, however, get much better.

Dr Ester Crawley, who specialises in children with the illness, said: "The prognosis for adults is poor, but for children it is really good, up to 94% get better."

She said the reason for this was unclear, but theories included "neuronal plasticity" - as children's brains are not fully developed, they can heal better - and "the adult lifestyle being predicated against recovery".

It is easier to adjust a child's lifestyle, such as doing two hours of school a day and gradually building it up, which is harder to do with adults who are in work.

A deeper understanding of the illness is desired by all involved. Delving into the sub-types of the condition may help in finding causes, which could also have implications for treating each sub-type.

One hope is that the new biobank of blood samples of CFS/ME patients being set up at London's Royal Free Hospital will help provide the answers.

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More doubt on virus, chronic fatigue connection

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WASHINGTON (AP) — There is more evidence that a virus once thought to be linked to chronic fatigue syndrome was a false alarm. A U.S. study released Thursday concluded lab tests used to make that link are unreliable.

Also Thursday, the journal Science said researchers were withdrawing part of the original study that suggested the connection — although not its conclusions — because a laboratory that contributed to the work discovered contamination in some of its samples.

In 2009, researchers in the state of Nevada announced they had found a mouse-related virus named XMRV in the blood of chronic fatigue patients, fueling hopes that a cause of the mysterious illness might have been found. Blood banks began turning away donations from people diagnosed with chronic fatigue. Yet numerous other studies failed to confirm the findings. Last spring, Science declared any link "seriously in question" as genetic tracing suggested it was the result of laboratory contamination.

The newest study, also reported in Science, was part of government efforts to see if XMRV or related viruses might affect the safety of the blood supply. It concluded there's no reason to worry.

Nine laboratories re-tested blood samples from 30 people, some chronic fatigue patients previously reported to have XMRV and some healthy people known to be virus-free. Only the two labs that previously reported an XMRV link could find any signs of the virus in some samples — but some of those were from healthy people, and additional testing couldn't confirm the findings.

"There does not seem to be any evidence of an association of XMRV with chronic fatigue syndrome," said Dr. Harvey Klein, who was not part of the new research but monitors it for the international blood-banking association AABB. Still, blood banks may continue turning away chronic fatigue patients out of concern about their own health after losing blood, he added.

The controversy is not over. In a statement, researchers at Nevada's Whittemore Peterson Institute said, "We want to make it very clear that we are continuing the important work" of studying the virus, despite the partial retraction of their 2009 study.

Associated Press

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Leaders vow to cut deaths from chronic disease

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UNITED NATIONS (AP) — World leaders have pledged to take wide-ranging action to prevent millions of deaths from cancer, diabetes, and heart and lung disease by tackling the key causes — smoking, excessive drinking, lack of exercise and unhealthy diets dominated by fast food.

But the 13-page political declaration approved at the first-ever General Assembly meeting on chronic diseases which ended Tuesday left unanswered the question of coordinating an international response to what the leaders called "a challenge of epidemic proportions."

The declaration notes "with profound concern" that according to the World Health Organization, an estimated 36 million of the 57 million global deaths in 2008 were due principally to cancer, diabetes and heart and lung diseases — including about 9 million men and women below the age of 60. WHO said 80 percent of these deaths were in developing countries.

At a final round-table discussion, Prime Minister Denzil Douglas of St. Kitts and Nevis said, "Our response must be urgent, it must be comprehensive, and it has to be fully coordinated at the national, regional and local levels."

Douglas, who chairs the Caribbean Community known as CARICOM, said priority must be given to international coordination so there can be effective monitoring of the diseases and effective measures to reduce the risk factors and strengthen health care systems, especially in developing countries where cases of the four diseases are increasing rapidly.

The only other high-level General Assembly meeting on a health issue, in 2001, led to creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, with billions of dollars provided by governments and private groups such as the Bill & Melinda Gates Foundation.

At the round-table, many speakers proposed that the global fight against non-communicable diseases follow the same model. Some proposed a coordinating body, possibly under the World Health Organization, and Poland said an international network of organizations specializing in chronic diseases would be valuable.

The declaration asks U.N. Secretary-General Ban Ki-moon to submit options to strengthen and facilitate global action to combat these diseases to the General Assembly by the end of 2012.

"Non-communicable diseases can be prevented and their impacts reduced, with millions of lives saved and untold suffering avoided," the declaration said.

To achieve this, the leaders pledged to accelerate implementation of WHO's anti-smoking treaty and its global strategies to promote healthy diets and physical activity, and reduce the harmful use of alcohol.

They also pledged to promote cost-effective measures to reduce salt, sugar and saturated fats and eliminate industrially produced transfats in foods and to encourage policies that support the production and consumption of foods that contribute to healthy diets.

The leaders also pledged to promote increased access to cost effective cancer screening programs, help improve "access and affordability for medicines and technologies" to prevent and control chronic diseases, and try to identify and mobilize sustained funding.

Many countries said they were already taking action to address the crisis.

South Africa said it had just passed regulations to reduce the use of trans fats and is drawing up regulations to reduce salt content in processed food. Kenya said its parliament has banned smoking in all public places and prohibited tobacco advertising and the sale of tobacco products to anyone under the age of 21. Australia announced it is giving $25 million to help Pacific island countries tackle non-communicable diseases — and starting next year it will require all tobacco products sold in Australia to have the same "unattractive dark brown" packaging covered by graphic health warnings to discourage smoking.

WHO Director General Margaret Chan, who urged world leaders to stand up to the tobacco and fast food industries in a keynote speech Monday, applauded efforts in Australia, Uruguay and elsewhere to counter tobacco company advertising campaigns.

But she urged vigilance, telling Tuesday's round-table participants: "Watch out. Even an old dog like the tobacco industry can learn some dirty new tricks."

Associated Press

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HEALTH MANAGEMENT. Analysis: Forecast bad for UN chronic disease meeting

LONDON (Reuters) - ten years to commit to the fight against AIDS, the United Nations takes on an even bigger pile of Mörder--common chronic ailments-in what design is up for a bruising battle between big business, Western Governments and the world's poor.
Tobacco, food and drink companies are in the firing line for peddling products, accused in connection with cancer, diabetes and heart disease while politicians in the rich world, in the absence of a fixed goals or means the appropriate against provide.
"This is an opportunity generation." Rebecca Perl the World Lung Foundation (WLF) we have millions of life here, and it said is a disgraceful and immoral could save that industry lobbying short-term profits to a public health disaster has put, "told of Reuters." WLF participates in irritable preliminary talks for several months.
The fear is that the large company has successfully lobbying rich Governments only half-heartedly in non-communicable diseases or NCDs, fight despite predictions that they paralyze the health systems of developing countries could be.
A bit a short-term financial requires such as climate change, prevention and treatment of non-communicable diseases affluent Nations and multinational companies hours to prevent that overwhelmed poor countries in the future.
Fears grow in these strict times already, that a high-level UN Conference in New York on September 19-20-only the second in the Centre of the disease after an AIDS in the year 2001-could be a flop.
The collection includes scores of delegates of the UN Member States, including about 20 head of Government as well as representatives of the public health groups, non-governmental organizations, the private sector and science.
After a draft of political declaration, that are the foundation of the United Nations think many platitudes but few concrete commitments on NCDs contains close to the negotiations.
Ann Keeling, Chairman of the NCD Alliance, which groups of 2,000 health organizations from which all over the world, said "There is no strong and temporally fixed commitments there," the news agency of Reuters. "It's a big disappointment from this point of view."
NOT ROCKET SCIENCE
The extent of the problem is immense. Some 36 million people die each year from NCDs--about 80% of them in poor countries where prevention programmes are virtually non-existent, and access to diagnosis and treatment is extremely limited.
As a result, death of NCDs are almost twice as high in poor countries as in the industrialized world.
Prevent that outrun this Todesfälle-- or at least a good part - is not rocket. A simple improvement enables proven measures such as the reduction of smoking, diet, drugs available and promote the use could tap a huge hole in this number.
"It is a common history, the cancer, cardiovascular, diabetes and respiratory medicine to tobacco, alcohol, diet and General-links and that's where we have the most cost-effective impact", says David Kerr, President of the European society for medical oncology.
The key points are money, goals and control.
Complete a billion people from lighting, or to prevent every day cheap medications such as aspirin and Statins, heart attacks and strokes may be less expensive, but the repayment does not quickly and it is unlikely that many votes to win.
"The time horizon for return on investment is very long and many political horizon." So it is difficult to require people to this kind of resources, ", says Gordon Tomaselli, President of the American Heart Association."
The NCD Alliance says spending $9 billion a year on tobacco control, food risks would advice and treatment for people with heart avert millions of premature deaths in this decade.
That's a lot? Compared to care for HIV patients in developing countries already costs by 13 billion per year.
In contrast to combat AIDS, which UN focus was ten years ago, the price of drugs of less is a problem here, as many as cheap generic drugs are available, although there are disputes about the costs for some more products expensive such as insulin.
STUBBING FROM TOBACCO
The sharpest concentrated themselves this time on fatty foods, sugary drinks and--in allem-- the tobacco industry, the World Health Organization Director General Margaret Chan was described as "an industry that has lots of money and no scruples, for use in the insidious as possible."
With tobacco, if the development however, that public health lobby says nothing else does the UN session, it should be predicted to kill more than one billion people of this century at least a smoke-free world of one of its central objectives.
Smoke alone causes one of three cases of pulmonary diseases, one of four cases of cancer and in 10 cases of heart disease, says Perl. "So what a bang, get for your money there, to look for."
Conflicts Governments find it hard. Japan tobacco is of, for example, 50 percent owned by the Japanese Government, and the massive profits U.S. cigarette to strengthen the US economy manufacturers.
China, the world's male smokers, the combination of taxes and sale of China national tobacco houses a third-all State Office-account for about 9 percent of annual tax revenue of the Government.
This is one reason more, according to Paul Lincoln of UK National Heart Forum and Jaakko Tuomilehto, an epidemiologist at the University of Helsinki, hiking tobacco taxes, advertising to put the brakes and insist on health warnings graphic.
"There are no excuses," Lincoln said. "We have the know-how." "The challenge for public health as ever and ever is to overcome the ideological and vested interests."
Tuomilehto is more stump: "it is a crazy thing to have a product in the shops, the every second consumer-it kills is madness."

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