Category Archives: Public Health

CLUELESS! doctors are confused of each others responsibility in cancer treatment, study found

When it comes to their respective responsibilities in patient care with breast cancer, doctors may be as clueless as the next person, according to a study conducted on Metro Manila doctors.

Researchers underlined the need for multidisciplinary guidelines for patient care in breast cancer .

The study surveyed doctors from tertiary hospital in Metro Manila with regards to division of labor among health practitioners in various aspects of Human Epidermal Growth Factor Receptor-2 (HER2) Testing, an important diagnostic exam for breast cancer.

HER-2 testing is widely recommended diagnostic procedure for all primary breast cancers. From patient education, to collection of specimen, and and overall patient care, the procedure involved a team of medical practitioners with with varying tasks and responsibilities.

The study, done in collaborations between researchers at the University of the Philippines – College of Medicine and Cardinal Santos Medical Center,   revealed that more than half (54%) of the surveyed answered that surgeons and staff at the operating room are responsible for the breast tissue collection, while 23% answered it is the pathologist’s responsibility. Varying answers include staff at the operating room only (13%), medical technicians (7%), medical oncologist (1%), and  whomever was in charge of the patient (1%).

As for the primary responsibility of requesting for HER-2 testing, 69% answered the medical oncologist or whomever the patient saw first, 13% answered surgeons, 12% medical oncologist only, 4% pathologists, and 1% said it should be the patient.

With regard to patient education, 59% of the surveyed answered the responsibility is in the hands of medical oncologists or whomever sees the patient first. Other answered medical oncologists only (28%), surgeons (9%), nurses (1%), and any oncologist or practicing physician (15).

With the varying answers, researchers lamented, “Though the differences are minor, these may reveal a lack of interdisciplinary awareness.”

Researchers explained that the awareness of interdisciplinary roles played by members of the medical team is essential for the well-being of both the patient and the medical practitioners. Patients get more efficient service while the medical team increase morale and work satisfaction.

The lack of interdisciplinary awareness can only be sufficiently addressed through strong compliance to international accepted guidelines with patient care. The researchers discussed that guidelines on HER-2 testing has been set up by the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP). However, the Philippines currently have no central body that will help with the adoption of a similar guidelines for HER-2 testing in the country. Until the Philippines has find away to successfully set up guidelines for HER-2 testing, cohesive and efficient medical service for Filipino breast cancer patient will remain a challenge.

Urban slums report the highest death rates for children under five

Children in world’s urban slums are twice as likely to die before they reach the age of five than their richer counterpart, according to the State of the World’s Mothers 2015 report released by the Save the Children Foundation last 5 May 2015.

The first-ever assessment of disparities in health among the the rich and the poor in cities worldwide, the report warned of the widening gaps in child survival rates among the rich and poor in almost half of the 40 developing nations surveyed.

Death among newborns in cities is common, the report revealed. However, in some cities, such as in Brazil and India, death rates among newborns could be 50% higher in urban slums than in the richer neighborhoods.

Malnutrition increases susceptibility of children in slum areas to diarrheal diseases and respiratory infections, further increasing chances of  dying among children in slums. For instance, in Bangladesh, 50% of children living slums under the age of five are stunted, while 43% are underweight. The figures are 33% and 26% respectively in wealthier areas in the country.

Lack of access to medical and health services was cited as a major factor in the skewed death rates among rich and poor children in cities worldwide.

For instance, mothers giving births at home without the attendance of trained medical personnel can result to late recognition of newborn illnesses, inadequate newborn care, and delay in appropriate medical interventions.

“While urbanization in and of itself not inherently problematic, the pace and the sheer scale of urbanization has, in many places, far exceeded local government’s ability to provide essential services, including water, sanitation, and health care,” the report discussed.

Amidst the grim statistics, Dr. Carolyn Miles, President and CEO of Save the Children, found hope in cities such as Addis Ababa and Manila. “There is no simple solution to creating more equitable cities, but a number of cities cited in the report – such as Addis Ababa in Ethiopia and Manila in the Philippines – have been successful in addressing the health needs of the poorest families, and these examples could serve as models for other cities to follow,” she said.

Manila and Addis Ababa were among the major cities that were found to be making significant gains for the poorest children, which also includes Cairo, Guatemala City, Kampala and Phnom Penh. Dr. Miles explained that while these cities have conducted various programs to address the inequity in access to health care services, three major strategies were found to be consistent. These are 1) better care for mothers and babies before, during and after childbirth; 2) increased use of modern contraception to prevent or postpone pregnancy; and 3) effective strategies to provide free or subsidized quality health services for the poor.

Dr. Miles stressed that cities have the advantage of technology, highly skilled partners, and presence of health care services to address the growing divide in survivability of children in cities of the world. What must be done is to provide enough resources to fuel life saving programs to make health services accessible to everyone.


Toxic wastes take toll on ‘healthy years of life’ of people in India, Indonesia and the Philippines

More than 8 million people in India, Indonesia and the Philippines live under constant exposure to toxic wastes, a study found.

Focusing on the impact to health of 373 toxic wastes sites researchers found that the economic opportunities lost because of premature deaths or disabilities incurred by the people due to the hazardous wastes is comparable, if not higher, to those caused by well-known diseases and other environmental risk factors.

By calculating the disability-adjusted life years (DALY), a measure of overall disease burden used by the World Health Organization (WHO), researchers were able to determine healthy years of life lost due to illness, disability or premature death. One DALY is equivalent to one year of healthy life loss by a person, which represents opportunities in life destroyed forever due to failing health or death.

The study revealed that toxic wastes sites are responsible to 828,722 DALYs or 828,722 years of life full health lost due the effects of toxic wastes exposures.

Furthermore, children or women of childbearing age constituted for 60% of the affected population. With many toxic chemicals affecting brain development in children and unborn babies, researchers insisted that children and women of childbearing age are considered to be most vulnerable. Heavy metals such as lead and cadmium, pollutants found to be of high concentration in the sites tested, are known to affect brain development in children and unborn babies. Other chemicals have debilitating effects on kidneys and livers, while several others, such as chromium and asbestos, cause cancer.

Result of the study emphasized the need for a concrete step to control the ill effects of pollution to human health, researchers said. Environmental remediation of toxic waste sites was recommended in order to remove the pollutants and rehabilitate the environment. While completely eliminating exposure to toxic wastes may be impossible, remediation of would help minimize amount of toxic chemicals on these site and reduce exposure.

Toxic wastes sites around the world are not only detrimental to the environment, but also to health. While global concern is growing, assessments on how these sites affect the health of communities around them is still limited or lacking in many developing countries. The study provided a rich resource for policymakers on how to manage toxic wastes sites and help affected communities.


Reference:Chatham-Stephens K, Caravanos J, Ericson B, Sunga-Amparo J, Susilorini B, Sharma P, Landrigan PJ, Fuller R. (2013). Burden of disease from toxic waste sites in India, Indonesia, and the Philippines in 2010. Environmental Health Perspectives. 121(7):791-6.

Filipino poor are more at risk of hepa B, study says

If two Filipinos are to be tested for hepatitis B, the one who is getting less annual salary is more likely to be tested positive than his richer counterpart, according to a study.

People usually measure the gap between the rich and poor in terms of what they can readily observe. One drives a car while the other commutes. One buys a house while the other rents. One dines at fine dining; the other boils instant noodles for dinner.

But a collaborations of researchers from various academic and medical institutions explained that evidence of gap between the two social classes may not be as obvious as the examples above, such as in the prevalence of hepatitis B.

A seroprevalence study of 2,150 randomly selected participants nationwide showed that poor Filipinos are disproportionately infected by hepatitis B as compared to others who have bigger annual income.

Describing annual income as the only predictor of the likelihood to testing positive in hepatitis B test, the researchers explained that the phenomenon reflects inequity in the access of healthcare.

Researchers discussed that health care services such as preventive vaccination are often neglected by or inaccessible for people at the lower socioeconomic levels. Poor Filipinos are more likely to miss or delay the hepatitis B vaccination (HBV), giving a window of opportunity of contracting the hepatitis B infection.

In a country where people living below the poverty line hovers around 27%, researchers insisted on the importance of government-subsidized actions that focuses on prevention of the disease.

Treatment and management of a patient with liver cirrhosis due to hepa B infection can range from US$185-1,321 in Asian countries like the Philippines. The cost can skyrocket to US$49,000-66,000 if the patient needs a liver transplant. Researchers lamented that the staggering cost of treatment, management and liver transplant usually falls in the shoulder of the patient with very little government assistance.

Arguing with the old adage that “prevention is always better than cure,” researchers insisted that focusing on preventive measures such as immunization programs would be more cost-effective to implement than coverage for treatment on full blown liver diseases.

Citing the success of immunization programs in decreasing the prevalence of hepatitis B infection in Northeast China and South Korea, researchers expressed their support to the Philippines’ Expanded Program on Immunization (EPI), which include universal infant vaccination with HBV.


Wong, S., Ong, J., Labio, M., Cabahug, O., Daez, M., Valdellon, E., Sollano, J., & Arguillas, M. (20013). Hepatitis B infection among adults in the Philippines: a national seroprevalence study. World Journal of Hepatology, 5(4), 214–219.