Research on carcinogens in the environment led to tobacco laws that helped to decrease the number of smokers in South Africa.
Research on carcinogens in the environment led to tobacco laws that helped to decrease the number of smokers in South Africa.

E-cigarettes should not yet be trusted, says Council Against Smoking
The headline "E-cigarettes: 'cancer risk close to zero'" (September 6) is both misleading and dangerous.  It is misleading because there is no scientific evidence to show that e-cigarettes are harmless. It is dangerous because it might encourage smokers who might otherwise have quit to instead use e-cigarettes, and so continue to put their health at risk. 

In the 1970s some health authorities promoted so-called 'light' and 'low-tar' cigarettes in the false belief that these were safer than regular cigarettes. Decades later, research showed that 'mild' and 'light' cigarettes cause cancer and heart disease just as ordinary cigarettes do. Millions of smokers who switched to these products, to lower the health risks, were not only offered false hope but suffered the consequences of not quitting. The public health community does not want to repeat this mistake, and is thus understandably cautious about promoting 'less harmful' products.

The views of the National Council Against Smoking include: 

1) E-cigarettes deliver considerably less nicotine than ordinary cigarettes so are unlikely to satisfy the smoker's cravings and they may not be able to switch to using e-cigarettes exclusively. Smokers may instead use e-cigarettes where smoking is not allowed and smoke their usual brand at other times.  Such dual use will increase their exposure to nicotine and the other toxins in e-cigarettes.

2) E-cigarette users cannot be sure of what they are inhaling.  There are multiple manufacturers and no regulatory standard controlling the purity of the products. So poisons like chromium, acrolein, formaldehyde, etc will be found to varying extents in different products.

3) Lack of scientific data about its safety for users, and the effects of secondhand vapour on non-users.

4) Just like other cigarette companies, the e-cigarette manufacturers are breaking the law so as to increase sales and profits.  Legally, e-cigarettes should only be available on prescription from a pharmacist.  Yet manufacturers are promoting its sale by ordinary retailers.

There is clearly a need for solid, independent research on which to base policy. – Dr Yussuf Saloojee, National Council Against Smoking

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On the contrary, cancer research is still a priority
Cancer researcher Carl Albrecht's comment piece "Death knell for cancer research" (June 7) on the lack of Medical Research Council (MRC) support for cancer research is unfortunate and inaccurate. 

The MRC is repositioning itself to rise to the challenge of building a healthy nation through research. In this context, cancer research is a priority area for the MRC. Indeed, the MRC announced last week that it is expanding its cancer research funding, including a new five-year, R100-million initiative on cancer research in South Africa through a new partnership with the United States National Cancer Institute.

This more than doubles the amount of money the MRC spends on cancer research. Some of the best opportunities for cancer research, including studies on new ways to treat and prevent it, are those undertaken with cancer patients. 

Since the MRC does not provide any patient care or treatment for cancer, it behoves us to relocate cancer research to the hospitals and medical schools where cancer patients are being cared for. Hence, the MRC is reducing its in-house cancer research to expand the funding available for cancer research in medical schools across the country. 

This approach of co-locating cancer research with cancer care in the country's leading cancer treatment facilities has been successfully applied by government research funding agencies in Canada (Canadian Institute for Health Research), Australia (National Health and Medical Research Council) and the United Kingdom, where the British MRC is transferring all its in-house research units to universities and medical schools. 

The increased funding and the relocation of the MRC's cancer research to university-based scientists, doctors and carers is designed to ensure our country maintains a position of pre-eminence in this area of medical science. This exciting opportunity heralds a promising new era for cancer research in South Africa. – Professor Salim S Abdool Karim, president: Medical Research Council

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Criminal law unfit to judge medical issues 
The recent ordeal that Professor Cyril Karabus was subjected to in the United Arab Emirates has brought to the fore the debate on the correctness of the criminalisation of medical practice.

Recently we have seen an increase around the world in the number of medical practitioners being charged with (and in some cases convicted of) serious criminal offences as a result of alleged negligence in their professional activities.

Numerous efforts have been made by governments to regulate physicians' practice of medicine. Criminal penalties have been imposed on physicians for various aspects of medical practice, including medical errors, despite the availability of adequate noncriminal redress. In times of war and civil strife, there have also been attempts to criminalise compassionate medical care to those injured as a result of conflicts.

A core concern is not only about the apparent increase in such charges but also their appropriateness in the healthcare context. The criminalising of medical decision-making is a gross disservice to patients and is contrary to the very principles and tenets of the profession. 

Medical negligence is an act or omission by a doctor that fails to meet the appropriate standard of care but that is rendered without any deliberate intent to harm the patient.

One of the significant challenges associated with the using of criminal law against healthcare professionals for negligence in professional practice is that criminal law is ill-equipped to address the complexities facing health professionals.

The modern healthcare system is an often complex and demanding environment with multiple interacting healthcare providers, treatment options, numerous patients with multiple co-morbidities and advanced technology. This may be compounded by an increasing burden of disease, inadequate facilities and high-pressure environments.

This context is not always acknowledged or appreciated and can primarily only be understood by a peer review system. Hence, the available mechanism to address alleged medical malpractice is through professional regulatory bodies. This process should only then be followed by civil or criminal processes where necessary.

It is wholly inappropriate for governments to intrude into the practice of medicine and professional decision-making in defining what they deem as appropriate medical care through the imposition of criminal penalties. – Dr Mzukisi Grootboom, chairperson, South African Medical Association

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Break silence around terminal depression
Thank you to the Mail & Guardian for dedicating the health supplement of April 12 to the occurrence of fatal depression, namely suicide, among teens.

We need to break the silence and stigma regarding depression and its fatal outcomes that are still experienced through the "memes" instilled in us by means of religious and cultural conditioning from previous eras. 

In more than 90% of cases, suicide is the result of a biological illness, namely depression. "This terrible disease", as Virginia Woolf described it in her last letter to her husband before she walked into the river Ouse.

Society tends to see the fatal result of terminal depression in isolation from the mental illness that caused it. But it does not occur in a vacuum; it is the result of humankind's most cruel illness, one we have not yet begun to understand, either in terms of its psychological or psychiatric pathologies.

An American professor of ­psychiatry, Kay Redfield Jamison, who is herself bipolar, wrote about depression: "The disease that has, on several occasions, nearly killed me, does kill tens of thousands of people every year: most are young, most die unnecessarily, and many are among the most imaginative and gifted that we as a society have. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that … brings in its wake almost unendurable suffering and, not infrequently, suicide. I am fortunate that I have not died from my illness."

She even referred to her illness during her teen years as "wounds". "It was impossible to avoid quite terrible wounds to both my mind and heart, the shock of having been so unable to understand what had been going on around me […] the realization that I had been so depressed that I wanted only to die — and it was several months before the wounds could even begin to heal. […] I aged rapidly during those months, as one must with such loss of one's self, with such proximity to death, and such distance from shelter."

In the biography of the German goalkeeper Robert Enke, who also lost his life to depression, the author writes: "Robert's death reminded most of us how little we understand of the illness that is depression. The rest of us, in shockingly large numbers, were reminded of how difficult it is to speak about depression. Just like Robert, we had always thought we had to keep the illness or the illnesses of our families a secret."

I support with all my heart calls for more funding for research into psychiatric diseases in order for us to understand depression in its various manifestations and to break the silence, so that symptoms can be recognised and acted upon quicker in order to have more victors and fewer victims.

Knowledge will set us free and will also free us from the bonds of societal stigma and cultural taboos surrounding the tragic deaths owing to biological illness of too many. – Professor Lizette Rabe is founder of the Ithemba Foundation, www.ithembafoundation.org.za, an organisation dedicated to raising awareness of depression 

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Baby bins the best of bad options
The statements of Margot Davids of the department of social development, and Child Welfare South Africa, a consortium of organisations working with children, beggar belief ("But when the bough breaks", Mail & Guardian, Health, March 8). They claim that baby bins, or hole-in-the-wall facilities, where mothers can safely and anonymously leave babies they cannot or do not want to keep, encourage infant abandonment and prevent any future reunification of the family.

A mother taking her child to a hospital is required to give personal details, laying herself wide open to being charged with child abandonment, as explained in the article. Who is going to risk a jail sentence by following this option? 

A woman already stressed by the birth of a child she may not be able to support is unlikely to contact the "authorities".

As for the second statement, it would seem to me that a baby dumped in a rubbish bin, drain or pit toilet would stand little or no chance of "reunification of a family unit", as it would probably be dead.

Baby bins allow distressed mothers a viable option for their children's survival and future care.

Bless all those people who have provided a loving service for moms and babies with baby bins.

And, to those that object to them, here's a question: If you had been one of those babies, which option would you have preferred your mother to have chosen? – Elizabeth Stiekema, Sandton

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An accomplished mission
The reason why McCord Hospital in Overport Durban is being taken over by the state ("McCord Hospital: Defending a legacy of healthcare integrity", Mail & Guardian, Health, February 8) was made clear in an article in the Mercury on February6, in which the MEC for health, Sibongiseni Dhlomo, said that mission hospitals and hospitals funded with international money to serve KwaZulu-Natal's most disadvantaged communities during apartheid would be "gradually absorbed" by the public health sector.

In addition to McCord and St Aidan's Mission Regional Hospital in the city centre, Dhlomo is quoted as saying that there are at least 12 hospitals in the province that would be "absorbed" by the public health sector, including St Mary's in Marionhill and St Mary's in Melmoth.

Why does the government want to take over all these hospitals? It is far less costly to continue to give McCord its provincial subsidy than to take over the full cost of the hospital and the huge responsibility of running it. McCord is and has been very well run. In the Mercury, Dhlomo himself acknowledges that these mission hospitals are hospitals "whose histories are exceptional". 

KwaZulu-Natal is struggling to keep Addington Hospital up and running. Why take on extra financial and managerial burdens? The provincial budget has been slashed because of the 2012 census, in which the KwaZulu-Natal population numbers are shown to have dropped.

The hospital's staff members have to be congratulated for their dedication and massive contribution to healthcare in the Durban region – and for the training of nurses. 

James McCord, after whom the hospital was named, wrote an inspirational and historically interesting autobiography, My Patients Were Zulus. When he retired at the age of 70, after 40 years of incredible service at McCord, he said: "It is natural for a man to feel a dismaying sense of loss when the time comes to pass his life work over to other hands. The time came to me on April 5 in 1940. I still had zest for my work when that day came. I still had the vigour to see a large number of dispensary patients every week … In leaving a country in which you've lived and worked for 40 years, it is though a part of you were dying."

It is to be hoped that the policy of "absorption" by the state will be re-evaluated. 

The mission hospitals still have a vital role to play in healthcare in the province and they should be valued and supported rather than dismantled and absorbed. – Beverly Muller, Durban