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Wednesday, 13 December 2017

Hippocrates Book of the Heart launched in Toronto

The Hippocrates Book of the Heart
Edited by Wendy French, Michael Hulse and Donald Singer

ISBN 978-0-9935911-1-2   UK: £12  Ireland: €15  US: $18  CAN: $24  AUS: $24  NZ: $30


Order a printed copy of the book            Order the eBook



 Art installation by Rochelle Rubinstein and Alisha Kaplan


This book, made possible by the generous support of the Cardiovascular Research Trust, brings together eighty contemporary poets of the English-speaking world and a dozen medical experts from around the globe to offer their perspectives on the heart.

Since ancient times, the heart has been understood as the seat of the emotions, of the will, even of the soul. Over time, a fuller medical understanding of the organ has gradually evolved too, with Harvey’s first complete account of the circulation of the blood and the heart’s role (1628) and Dr. Christiaan Barnard’s first successful heart transplant (1968) marking key moments in a history that has given us a much better understanding of our hearts – and how to ensure they stay healthy.

In compiling this book, the editors invited poets around the English-speaking world, both prominent and less well-known, to contribute poems about the heart, written from any perspective, whether clinical or fanciful, medical or metaphorical. Among the poets are Griffin Poetry Prize winners Roo Borson and David Harsent, Forward Prize winners Sean O’Brien, Hilary Menos and Nick Mackinnon, former New Zealand Poets Laureate Elizabeth Smither and C. K. Stead, former National Poet of Wales Gwyneth Lewis, and President of PEN International Jennifer Clement. They are joined by many other distinguished and rising poets, including Robert Gray, John Kinsella, Peter Goldsworthy, Stephen Edgar and Geoffrey Lehmann from Australia; Anna Jackson, Jenny Bornholdt and Chris Price from New Zealand; Grace Schulman, Rafael Campo, Matthew Thorburn, Debora Greger and Jeffrey Harrison from the US; Marilyn Bowering and Kenneth Sherman from Canada; Justin Quinn, Mary O’Donnell and John F. Deane from Ireland; and Jane Draycott, Philip Gross, Mimi Khalvati, Lawrence Sail and Penelope Shuttle from the UK.

Leading medical professionals whose practice and research has led them to a keen interest in the health of the heart contribute information and advice to the book. In clear, crisp mini-essays they illuminate the nature of heart disease, the key risk factors, the history of cardiac surgery, and the most important steps every one of us can take in trying to maintain a healthy heart. Our medical professionals, based in Russia, Finland, The Netherlands, France, the UK, Australia and Hong Kong, agree in their core message: maintaining a healthy heart is possible for every one of us, and is crucial to our overall health and well-being throughout our lives.
The result is that rare thing, a book that satisfies the Horatian dictum that writing should both delight and instruct.


Makom, Toronto, 16.11.17:
Donald Singer, Ron Charach, Kenneth Sherman, Roo Borson,
Kim Maltman, Ronna Bloom and Alisha Kaplan
The Canadian launch of the book was held at Makom in Toronto on Thursday 16th November. The programme included readings by Canadian poets Alisha Kaplan, Kenneth Sherman, Roo Borson and Kim Maltman. There was also a lively discussion panel on "More poetry: just what doctors and the public need?" In addition to the above poets the panel was joined by poet and psychotherapist Ronna and poet and psychiatrist Ron Charach, with a co-chairs: Alisha Kaplan and Donald Singer.
Ronna Bloom is the author of 5 collections of poetry including The More (Pedlar Press, 2017). Her poems have been translated into Spanish and Bengali, recorded by the CNIB, and used in films, by architects, in education and health care. Her work appears in "Poetry is Public" and in the Toronto Public Library Poetry Map. She is currently Poet in Community at the University of Toronto and Poet in Residence in the Sinai Health System in Toronto. In these roles she offers students, health care professionals, patients and visitors opportunities to articulate their experiences through reflective writing and poetry. A meditator and psychotherapist, she lives in Toronto. 

Roo Borson's work has received the Griffin Poetry Prize and the Governor General's Award. Her most recent book of poetry is Cardinal in the Eastern White Cedar (2017), published by McClelland and Stewart/Penguin Random House. With Kim Maltman, she writes under the pen name Baziju, whose first book, Box Kite, was published in 2016 by House of Anansi Press.

Ron Charach is a poet, essayist, novelist and practicing psychiatrist. Born in Winnipeg, he has lived in Toronto since 1980 with his wife Alice, who is also a psychiatrist and researcher. His medically related poems are featured in two world anthologies of physician poetry published by the University of Iowa Press, Blood & Bone and Primary Care. His most recent books of poetry are Forgetting the Holocaust and Prosopagnosia, the latter of which was published by Toronto’s Tightrope Books. His poetry draws from the twin streams of literature and the healing arts.

Alisha Kaplan: The daughter of a printmaker and a psychiatrist, Alisha is very interested in the convergence of art and medicine, and the healing possibilities of poetry. She is a Torontonian poet, an editor for Narrative Magazine, and the winner of the 2017 Hippocrates Prize in Poetry and Medicine. She taught creative writing at New York University, where she received an MFA in Poetry. Her writing has appeared in Fence, DIAGRAM, Carousel, PRISM, The New Quarterly, and elsewhere.

Kim Maltman is a poet and theoretical particle physicist who teaches mathematics at York University. A past winner of the CBC Prize for Poetry, he has published five solo collections of poetry and three collaborative books, including Introduction to the Introduction to Wang Wei, written under the pen name Pain Not Bread and published by Brick Books.

Born in Toronto, Kenneth Sherman is the author of three books of prose and ten books of poetry. His most recent publications are Wait Time: A Memoir of Cancer and the poetry collection Jogging with the Great Ray Charles.

Donald Singer and Michael Hulse co-founded the Hippocrates Initiative for Poetry and Medicine in 2009. Singer is a clinical pharmacologist who has published over 200 articles, chapters and books on medicines, on cardiovascular research, prevention and treatment, and public understanding of health. He is an editor and contributor to The Hippocrates Book of the Heart (Hippocrates Press, 2017). He co-authors the prescribing safety guide Pocket Prescriber (Taylor & Francis) now in its 8th edition since 2004. He is President of the Fellowship of Postgraduate Medicine. He is also on the Executive Committee of the European Association of Clinical Pharmacology and Therapeutics. 

Tuesday, 12 December 2017

Developing robust common data models to guide safety in medicines in Europe


The European Medicines Agency is holding a 2 day international workshop in London [11th -12th december 2017] to define the opportunities and challenges around implementation of a common health data model in Europe to support regulatory decision making. The expected outcome of the workshop is agreement of guiding principles for the development of a Common Data Model (CDM) in Europe, including key criteria for validation in the context of regulatory decision-making.

A common data model could help harmonise healthcare data across multiple data sets and provide a mechanism to conduct pan-European studies in a timely manner to address regulatory questions. At the same time, applying a common model to European data has multiple challenges. The meeting is bringing together regulators with academia, data holders and the pharmaceutical industry.

Sessions include talks from experts from North America (FDA, Harvard, Duke, Georgia Tech ...) and the European region (Erasmus, Utrecht, CBG-MEB, EMA ...) discussing lessons learned and current challenges in very large current clinical data resources, regulatory verification and related issues. Common data model case studies considered included Sentinel – the Harvard-based FDA system for accessing patient data from 16 health data partners across the USA and CNODES (the Canadian Network for Operational Drug Effect Studies) which can access data on 100 million patients – a similar scale to Sentinel.

The U.S. Food and Drug Administration's (FDA) Sentinel Initiative is a long term approach which uses a common health data model to improve the FDA’s ability to identify and explore safety issues for medical products. Sentinel actively surveys pre-existing electronic healthcare data from multiple sources.

Consistent themes include ensuring the relevance of evolving common data models to health policy, keeping timelines as short as practical, interoperability, consent and related ethical issues (data custodians, patient data protection and privacy), and careful internal and external validation of clinical definitions, data, software and analytical models.

From the perspective of health professionals, policy makers, regulators and the public, key questions include whether clinical outcomes from common data models are generalisable or only relevant to specific sub-populations based on geography, genetics, demographics and/or complex co-morbidity.  In the era of precision medicine there is the clear need is to avoid “right” answers from the wrong clinical populations and “wrong” answers from the right populations.

Further key points to consider include what is the cost of developing and maintaining validated CDMs; who should pay; whether updating existing databases is a sufficient approach or rather new more robust databases are needed.

Monday, 11 December 2017

London launch of the Hippocrates Book of the Heart: writing to delight and instruct

Slide1The Hippocrates Book of the Heart was launched in London on Wednesday 6th December 2017.

See the programme.


This book, published by the Hippocrates Press on behalf of the Hippocrates Initiative for Poetry and Medicine, was made possible by the support of the healthy heart charity the Cardiovascular Research Trust. The CVRT, founded in 1996, educates health professionals, policy makers and the public about effective ways to prevent and treat serious disorders of the heart and the circulation.
The book brings together eighty contemporary poets of the English-speaking world and a dozen medical experts from around the globe to offer their perspectives on the heart.
Many of the contributors were in London for the launch of the book.


ISBN 978-0-9935911-1-2 UK: £12 Ireland: €15 US: $18 CAN: $24 AUS: $24 NZ: $30

Order a printed copy of the book       Order the eBook

Since ancient times, the heart has been understood as the seat of the emotions, of the will, even of the soul. Over time, a fuller medical understanding of the organ has gradually evolved too, with Harvey’s first complete account of the circulation of the blood and the heart’s role (1628) and the 50th anniversary this week of Dr. Christiaan Barnard’s first successful heart transplant (1968) marking key moments in a history that has given us a much better understanding of our hearts – and how to ensure they stay healthy.

In compiling this book, the editors invited poets around the English-speaking world, both prominent and less well-known, to contribute poems about the heart, written from any perspective, whether clinical or fanciful, medical or metaphorical. Among the poets are Griffin Poetry Prize winners Roo Borson and David Harsent, Forward Prize winners Sean O’Brien, Hilary Menos and Nick Mackinnon, former New Zealand Poets Laureate Elizabeth Smither and C. K. Stead, former National Poet of Wales Gwyneth Lewis, and President of PEN International Jennifer Clement. They are joined by many other distinguished and rising poets, including Robert Gray, John Kinsella, Peter Goldsworthy, Stephen Edgar and Geoffrey Lehmann from Australia; Anna Jackson, Jenny Bornholdt and Chris Price from New Zealand; Grace Schulman, Rafael Campo, Matthew Thorburn, Debora Greger and Jeffrey Harrison from the US; Marilyn Bowering and Kenneth Sherman from Canada; Justin Quinn, Mary O’Donnell and John F. Deane from Ireland; and Jane Draycott, Philip Gross, Mimi Khalvati, Lawrence Sail and Penelope Shuttle from the UK.




Leading medical professionals whose practice and research has led them to a keen interest in the health of the heart contribute information and advice to the book. In clear, crisp mini-essays they illuminate the nature of heart disease, the key risk factors, the history of cardiac surgery, and the most important steps every one of us can take in trying to maintain a healthy heart. Our medical professionals, based in Russia, Finland, The Netherlands, France, the UK, Australia and Hong Kong, agree in their core message: maintaining a healthy heart is possible for every one of us, and is crucial to our overall health and well-being throughout our lives.

The result is that rare thing, a book that satisfies the Horatian dictum that writing should both delight and instruct.


Toronto Heart panel
Makom, Toronto, 16.11.17: Donald Singer, Ron Charach, Kenneth Sherman, Roo Borson, Kim Maltman, Ronna Bloom and Alisha Kaplan
The Canadian launch of the book was held at Makom in Toronto on Thursday 16th November. The programme included readings by Canadian poets Alisha Kaplan, Kenneth Sherman, Roo Borson and Kim Maltman. There was also a lively discussion panel on “More poetry: just what doctors and the public need?” In addition to the above poets the panel was joined by poet and psychotherapist Ronna Bloom and poet and psychiatrist Ron Charach and co-chairs Alisha Kaplan and Donald Singer.


See more about the Toronto launch of the Heart book

Saturday, 9 December 2017

Developing health policy to protect the heart and circulation

Diseases of the heart and circulation are the commonest preventable cause of disability and death in the UK and elsewhere in the developed world. Heart and circulatory disorders are also rapidly overtaking communicable diseases as serious health problems in less developed countries. Policy makers need to take an increasing interest in encouraging lifestyle approaches aimed at reducing the incidence and severity of these serious disorders of the heart and circulation.

This one day symposium, with speakers from Hong Kong, the Netherlands, Spain and the UK was organised by the healthy heart charity the Cardiovascular Research Trust in partnership with the Fellowship of Postgraduate Medicine.

David Slovick, Leslie Morgan OBE DL, Donald Singer, Wade Dimitri, Ken Redekop, Alison Halliday, Robin Poston
FPM President and CRT chair Donald Singer said: “Despite recent efforts, obesity and diabetes are increasing epidemics in the UK and internationally. Political leaders have a huge opportunity to improve both national health and wealth by a sustained increase in the effective public health measures needed to prevent and address the major risk factors for premature heart, stroke and other vascular disease.”

Speaker Professor Kornelia Kotseva from Imperial College in London said: “Cardiovascular disease (CVD) is a leading cause of mortality accounting for 17.5 million deaths every year globally and 4.3 million deaths every year in Europe. The proportion of all deaths attributable to CVD is greater among women (49%) than in men (40%), with large geographic inequalities between countries.”

Speaker Professor Alison Halliday from the University of Oxford and President of the European Society of Vascular Surgery added: “Stroke causes many thousands of deaths in the UK every year and is the country’s leading cause of disability. Billions of pounds are spent on treating the causes and the results of stroke – hypertension, heart disease, diabetes, smoking, but the greatest risk factor is age, and, despite attention to known modifiable risk factors, the numbers of new and recurrent strokes have not fallen significantly in recent years.”

Professor Bernard Cheung from the University of Hong Kong and Editor of the FPM’s journal the Postgraduate Medical Journal said: “The biggest news in the world of hypertension is the publication of the latest American guidelines (ACC/AHA) on the prevention, detection, evaluation and management of high blood pressure. The most controversial change is in the definition of hypertension, which now includes a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg. This change will, at a stroke, make a sizeable proportion of the general population hypertensive.”

Professor Ken Redekop from Erasmus University in Rotterdam and Editor-in-Chief of the FPM’s journal Health Policy and Technology noted that “Precision medicine (PM) refers to the separation of patients into more homogeneous subgroups, with the rationale being that patients who will benefit from a treatment should receive the treatment while patients who will not benefit should not.” He added: “When all factors (including cost-effectiveness) are considered, a precision medicine strategy may or may not be the best one in the effort to improve cardiovascular health, and health outcomes in general.”

Heart surgeon Wade Dimitri commented that: “heart surgery in the UK has led the development and refinement of many techniques and health technologies and has resulted in significant reduction in cardiovascular mortality and morbidity. Such progress and improvements have not followed in the developing world where mortality and morbidity remain high, approaching 60% in certain countries. Urgent efforts are needed to reverse this trend and improve outcomes of adults and children with heart disease undergoing heart surgery in less developed countries.”

Professor Ramon Estruch, Barcelona said: "The Mediterranean diet has strong research evidence as an effective healthy lifestyle approach to protect the heart and brain. Similar healthy diet cultures are found in other regions on the 40th parallel in both the north and southern hemispheres around the world."

Papers from the symposium will be published in the journals of the Fellowship of Postgraduate Medicine (Postgraduate Medical Journal and Health Policy and Technology.

Note for Editors
For more on the themes of the event,
email: fpm.chandos@gmail.com or call 07494 450 805.


Speaker abstracts and biographies

Meeting programme: Health policy for the heart and circulation

Wednesday, 22 November 2017

Impact of decision to move European Medicines Agency to Amsterdam

As one of many consequences of Brexit, following a very close vote by member states on Monday 20th November, Amsterdam has been confirmed as the new home for the European Medicines Agency. On current plans, the EMA will be operating in Amsterdam from April 2019, following a likely shadow hosting of the EMA there for some months before the formal date for completing the move of the agency.

The EMA's Patients and Consumers Working Party annual meeting
Meantime the EMA's Patients and Consumers Working Party (PCWP) is holding its annual meeting with all EMA eligible patient/consumer consumer organisations to consider relocation preparedness, patient and consumer involvement in EMA activities, highlights from major EMA committees and updates on pharmacovigilance, information on medicines and future work programmes in 2018 and 2019 for the PCWP and the EMA's Healthcare Professionals Working Party.

Effective medicines have both powerful therapeutic actions as well as the potential for serious unwanted adverse effects. The EMA was founded in 1995 with initial funding from the European Union and the pharmaceutical industry, and further support from EU member states. The European Medicines Agency is concerned with regulation, supply chain and pharmacovigilance for medicines and other advanced therapies for 28 countries across the European Union - from the Baltic countries to Ireland and from Scandinavia to the Balkans and the Mediterranean. All these roles concern balancing benefits and risks when it comes to patient safety with regard to medicines.

The EMA has established mechanisms for involving patients in regulatory assessment: patients’ value perception and value systems. The EMA also has an increasing remit to engage with stakeholder organisations and to improve transparency in its activities for the ~510 million citizens of the European Union. Furthermore the EMA has a major role in educating patients, carers and health care professionals about medicines. There have for example been recent workshops on
  • combating antibiotic resistance: a partnership with the European Centre for Disease Control 
  • biosimilars
  • personalised medicine initiatives
  • applying big data to improved regulation of medicines in Europe which raises important questions about clinical utility, quality, accessibility and systems for data mining
There remain many decisions and actions for the coming months needed to ensure continuity of the EMA's business. These involve the smooth relocation of the EMA to Amsterdam and either developing systems to retain UK expertise for the EMA or replacing that expertise from other EU member states. For the EMA, priorities include:

  • minimising the impact on staff of the move to maximise staff retention
  • maintaining capacity to continue the work of the EMA 
  • the resulting need to prioritise EMA core and planned further activities
  • continuing productive engagement with stakeholder groups: patients, carers, healthcare professionals ...
  • maintaining the capacity of the EMA to engage with the public
For the UK, there are pressing questions regarding the future regulation of medicines in the UK post-Brexit, the impact of loss of international influence of UK regulators and other experts on medicines and the impact of loss of biotech and pharmaceutical companies from London to Amsterdam.

The EMA has been based in London for over 20 years. Many staff have strong family and other personal ties in the UK - for example partners' work, children at school, dependent relatives ...  Adapting to a new country is no simple matter. The working language of the EMA is currently English however full integration within Amsterdam will need competency in the native language in the Netherlands. There will also be practical challenges arising from the simultaneous impact of the arrival of up to 800 families on the Amsterdam housing market and schools system.


© Donald Singer 



Tuesday, 21 November 2017

Global perspectives on the heart: Hippocrates Book of the Heart launched in Toronto

The Hippocrates Book of the Heart edited by Wendy French, Michael Hulse and Donald Singer
ISBN 978-0-9935911-1-2   UK: £12  Ireland: €15  US: $18  CAN: $24  AUS: $24  NZ: $30


Order a printed copy of the book            Order the eBook


Art installation by Rochelle Rubinstein and Alisha Kaplan
This book, made possible by the generous support of the Cardiovascular Research Trust, brings together eighty contemporary poets of the English-speaking world and a dozen medical experts from around the globe to offer their perspectives on the heart.
Since ancient times, the heart has been understood as the seat of the emotions, of the will, even of the soul. Over time, a fuller medical understanding of the organ has gradually evolved too, with Harvey’s first complete account of the circulation of the blood and the heart’s role (1628) and Dr. Christiaan Barnard’s first successful heart transplant (1968) marking key moments in a history that has given us a much better understanding of our hearts – and how to ensure they stay healthy.
In compiling this book, the editors invited poets around the English-speaking world, both prominent and less well-known, to contribute poems about the heart, written from any perspective, whether clinical or fanciful, medical or metaphorical. Among the poets are Griffin Poetry Prize winners Roo Borson and David Harsent, Forward Prize winners Sean O’Brien, Hilary Menos and Nick Mackinnon, former New Zealand Poets Laureate Elizabeth Smither and C. K. Stead, former National Poet of Wales Gwyneth Lewis, and President of PEN International Jennifer Clement. They are joined by many other distinguished and rising poets, including Robert Gray, John Kinsella, Peter Goldsworthy, Stephen Edgar and Geoffrey Lehmann from Australia; Anna Jackson, Jenny Bornholdt and Chris Price from New Zealand; Grace Schulman, Rafael Campo, Matthew Thorburn, Debora Greger and Jeffrey Harrison from the US; Marilyn Bowering and Kenneth Sherman from Canada; Justin Quinn, Mary O’Donnell and John F. Deane from Ireland; and Jane Draycott, Philip Gross, Mimi Khalvati, Lawrence Sail and Penelope Shuttle from the UK.
Leading medical professionals whose practice and research has led them to a keen interest in the health of the heart contribute information and advice to the book. In clear, crisp mini-essays they illuminate the nature of heart disease, the key risk factors, the history of cardiac surgery, and the most important steps every one of us can take in trying to maintain a healthy heart. Our medical professionals, based in Russia, Finland, The Netherlands, France, the UK, Australia and Hong Kong, agree in their core message: maintaining a healthy heart is possible for every one of us, and is crucial to our overall health and well-being throughout our lives.
The result is that rare thing, a book that satisfies the Horatian dictum that writing should both delight and instruct.

Makom, Toronto, 16.11.17: 
Donald Singer, Ron Charach, Kenneth Sherman, Roo Borson, 
Kim Maltman, Ronna Bloom and Alisha Kaplan
The Canadian launch of the book was held at Makom in Toronto on Thursday 16th November. The programme included readings by Canadian poets Alisha Kaplan, Kenneth Sherman, Roo Borson and Kim Maltman. There was also a lively discussion panel on "More poetry: just what doctors and the public need?" In addition to the above poets the panel was joined by poet and psychotherapist Ronna and poet and psychiatrist Ron Charach, with a co-chairs: Alisha Kaplan and Donald Singer.

See more about the Toronto launch of the Heart book


Ronna Bloom is the author of 5 collections of poetry including The More (Pedlar Press, 2017). Her poems have been translated into Spanish and Bengali, recorded by the CNIB, and used in films, by architects, in education and health care. Her work appears in "Poetry is Public" and in the Toronto Public Library Poetry Map. She is currently Poet in Community at the University of Toronto and Poet in Residence in the Sinai Health System in Toronto. In these roles she offers students, health care professionals, patients and visitors opportunities to articulate their experiences through reflective writing and poetry. A meditator and psychotherapist, she lives in Toronto. 

Roo Borson's work has received the Griffin Poetry Prize and the Governor General's Award. Her most recent book of poetry is Cardinal in the Eastern White Cedar (2017), published by McClelland and Stewart/Penguin Random House. With Kim Maltman, she writes under the pen name Baziju, whose first book, Box Kite, was published in 2016 by House of Anansi Press.

Ron Charach is a poet, essayist, novelist and practicing psychiatrist. Born in Winnipeg, he has lived in Toronto since 1980 with his wife Alice, who is also a psychiatrist and researcher. His medically related poems are featured in two world anthologies of physician poetry published by the University of Iowa Press, Blood & Bone and Primary Care. His most recent books of poetry are Forgetting the Holocaust and Prosopagnosia, the latter of which was published by Toronto’s Tightrope Books. His poetry draws from the twin streams of literature and the healing arts.

Alisha Kaplan: The daughter of a printmaker and a psychiatrist, Alisha is very interested in the convergence of art and medicine, and the healing possibilities of poetry. She is a Torontonian poet, an editor for Narrative Magazine, and the winner of the 2017 Hippocrates Prize in Poetry and Medicine. She taught creative writing at New York University, where she received an MFA in Poetry. Her writing has appeared in Fence, DIAGRAM, Carousel, PRISM, The New Quarterly, and elsewhere.

Kim Maltman is a poet and theoretical particle physicist who teaches mathematics at York University. A past winner of the CBC Prize for Poetry, he has published five solo collections of poetry and three collaborative books, including Introduction to the Introduction to Wang Wei, written under the pen name Pain Not Bread and published by Brick Books.

Born in Toronto, Kenneth Sherman is the author of three books of prose and ten books of poetry. His most recent publications are Wait Time: A Memoir of Cancer and the poetry collection Jogging with the Great Ray Charles.

Donald Singer and Michael Hulse co-founded the Hippocrates Initiative for Poetry and Medicine in 2009. Singer is a clinical pharmacologist who has published over 200 articles, chapters and books on medicines, on cardiovascular research, prevention and treatment, and public understanding of health. He is an editor and contributor to The Hippocrates Book of the Heart (Hippocrates Press, 2017). He co-authors the prescribing safety guide Pocket Prescriber (Taylor & Francis) now in its 8th edition since 2004. He is President of the Fellowship of Postgraduate Medicine. He is also on the Executive Committee of the European Association of Clinical Pharmacology and Therapeutics.

Friday, 29 September 2017

Global threat of antibiotic resistance

The European Medicines agency, in partnership with the ECDC (European Centre for Disease Prevention and Control), is holding a workshop on global challenges from antimicrobial resistance (AMR). 

Loss of effectivenss of powerful classes of antimicrobial treatment is a serious issue both for less developed countries and for very developed healthcare systems. These are interdependent. Cultural and medical tourism leads to rapid transmission of resistant micro-organisms across continents.

There are 3 major current approaches to tackling AMR: 
1. reducing selection pressure on microbes to reduce the chance of their developing AMR. This needs strategies to reduce overuse of antimicrobial medicines. 
2. reducing human/human and animal/human transmission microbes. This needs effective infection control measures
3. increasing the availability of new antibiotics through more R & D combined with limiting their use within evidence-based guidelines - ie effective antibiotic stewardship.

There needs to be an integrated approach combining a pipeline of effective new antimicrobial and careful stewardship of existing antimicrobials through their effective use. However from a recent international survey, 20% of the public who took part were unaware that overuse of antibiotics leads to antimicrobial resistance to treatment. Furthermore 44% were unaware that antibiotics are ineffective against colds and 'flu'.

The WHO has estimated that, without major global action, by 2050 there may be ~400,000 preventable deaths annualy in the European region alone, as a result of lack of effective antiobiotics for serious infections (Figure).

Martial Plantady from the European Commission opened the day by discussing the EU Action plan launched in 2011 and running until 2016 against the threats from antimicrobial resistance. He noted that many solutions were described within the plan however there remain major challenges to effective implementation of the Plan, including:
- widespread and worldwide antibiotic use for growth promotion in livestock
- resulting need to push strategy to ban antibiotic use in livestock beyond the EU
- availability of animal and human data across member states
- effective surveillance on appropriate and prudent use of antimicrobials in humans
Some solutions include 
- effective dissemination of guidelines on prudent use of antibiotics in animals and humans
- Antibiotic Awareness Days
- more effective coordination of R & D across industry and academic sectors on new antimicrobials, alternatives, vaccines and rapid diagnostic tests
- engagement with key health professional and patient stakeholder organisations
The new EU Action Plan on antibiotic resistance was published in June 2017, with 3 pillars supported by strengthened measures for infection prevention and control:
- making the EU Region a best practice region on AMR
- improving research and innovation
- shaping the global agenda on AMR

At the 68th World Health Assembly in May 2015, the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance, including antibiotic resistance, the most urgent drug resistance trend. Carmen Pessoa da Silva from the WHO underlined the key point that if AMR remains unresolved, the global threat would be enormous both for human health as well as for the world economy. She summarised 5 key elements of WHO strategy against AMR.
1. improved awareness and understanding (annual WHO awareness week)
2. strengthen knowledge through surveillance and research 9WHO Global AMR Surveillance System - GLASS - further report due in Jan 2018 - 47 countries are fully enrolled - 25% of member states)
3. reduce incidence of infection
4. optimise use of anti-microbial medicines
5. ensure sustainable investment for R & D

The Pharmaceutical Group of the European Union represents the ~400,000 community pharmacists who dispense medicines for the ~500 million population of the European Union. Around 46 million people visit a community pharmacist every day in Europe.
James Wilkinson discussed efforts of the PGEU to educate community pharmacists and the public in rational use of antimicrobial medicines.