- Email: [email protected]
Why a Youth Commission on Global Governance for Health?
Correspondence
Science Photo Library
and 2008 (373). As we have suggested, and Economou and colleagues agree, attempts and reported attempts or suicidal thoughts are quite different from completed suicides. Although it is good news that so far there is no increase in completed suicides, it is important to note that Greece experienced extreme indices of crisis (eg, unemployment rate above 17%) only after late 2011, so any conclusions might be immature. Although we think that it might take years before one can confirm or reject an increase in the suicide rate, we agree with Economou and colleagues that by then it might be too late and there is an urgent need for intensive screening, follow-up, and treatment of people with suicidal ideation. Often caring for public health might imply forecasting rather than confirmation of statistics since human lives and not numbers are at risk. A substantial decline in suicide rates throughout Europe, the USA, and Canada has happened in the past two decades;2 however, with the global economic crisis, the future of these rates is unknown. Targeted interventions of proven efficacy should be applied, including specific psychoeducational programmes.3 They should use long-term and repeated interventions as well as community networking, and should not be restricted to gatekeepers’ training and general (theoretical) education of the public. We declare that we have no conflicts of interest.
*Konstantinos N Fountoulakis, Melina Siamouli, Ilias A Grammatikopoulos, Sotirios A Koupidis, Pavlos N Theodorakis [email protected] 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 54634 Thessaloniki ,Greece (KNF, MS); Private Practice, Thessaloniki, Greece (IAG); Evaggelismos General Hospital, Athens, Greece (SAK); Social Cooperative, “New Horizons”, Corfu Mental Health Sector, Corfu, Greece (SAK); and Social Cooperative, 8th Athens Mental Health Sector, Athens, Greece (PNT)
338
1
2
3
Hellenic Statistical Authority. Vital statistics: deaths. http://www.statistics.gr/portal/page/ portal/ESYE/PAGE-themes?p_param=A1605 (accessed July 10, 2012). Henriques GR, Brown GK, Berk MS, Beck AT. Marked increases in psychopathology found in a 30-year cohort comparison of suicide attempters. Psychological Med 2004; 34: 833–41. Fountoulakis KN, Gonda X, Rihmer Z. Suicide prevention programs through community intervention. J Affect Disord 2010; 130: 10–16.
The interleukin 6 pathway and atherosclerosis Two Articles (March 31, pp 1205 and 1214)1,2 showed that the single nucleotide polymorphism (SNP) rs7529229 of the interleukin 6 receptor (IL-6R D358A), which results in higher serum concentrations of the soluble IL-6R (sIL-6R), is connected to a lower risk of coronary heart disease. As an explanation, the accompanying Comment3 states that the point mutation led to increased cleavage of the IL-6R from the cell surface of hepatocytes, monocytes, and macrophages and concomitantly to less interleukin-6-induced signalling by these cells. We would like to put forward an alternative explanation. Interleukin 6 is present in the blood at a concentration of 1–5 ng/L, the sIL-6R at a concentration of around 50 μg/L, and a soluble form of gp130 (sgp130) at a concentration of 100–200 μg/L.4 Secreted interleukin 6 will bind to sIL-6R, and the interleukin-6/ sIL-6R complex will bind to sgp130, which is the natural inhibitor of this complex.4 An increase in sIL-6R caused by the SNP will lead to increased buffer capacity for secreted interleukin 6 and therefore to reduced interleukin 6 activity. Interleukin 6 acts on cells such as hepatocytes, monocytes, and macrophages via the membrane-bound IL-6R and the ubiquitously expressed receptor gp130. Alternatively, by a mechanism called trans-signalling, interleukin 6 can bind
to the sIL-6R and this complex can stimulate all cells of the body via gp130 alone.4 Specific inhibition of interleukin 6 trans-signalling by an sgp130-Fc fusion protein is sufficient to block the development of atherosclerosis in mice, underlining the proinflammatory role of interleukin 6 trans-signalling via the sIL-6R.5 We therefore think that the decreased risk of coronary heart disease in homozygous carriers of the rs7529229 SNP is not necessarily due to reduced interleukin 6 signalling on hepatocytes, monocytes, and macrophages but to a more efficient buffering of secreted interleukin 6 by the sIL-6R/sgp130 system and consequently to lower overall interleukin 6 activity. We declare that we have no conflicts of interest.
Jürgen Scheller, *Stefan Rose-John [email protected] Institute of Biochemistry and Molecular Biology II, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany (JS); and Institute of Biochemistry, Medical Faculty, Christian-AlbrechtsUniversity, 24098 Kiel, Germany (SR-J) 1
2
3
4
5
IL6R Genetics Consortium Emerging Risk Factors Collaboration. Interleukin-6 receptor pathways in coronary heart disease: a collaborative meta-analysis of 82 studies. Lancet 2012; 379: 1205–13. The Interleukin-6 Receptor Mendelian Randomisation Analysis (IL6R MR) Consortium. The interleukin-6 receptor as a target for prevention of coronary heart disease: a mendelian randomisation analysis. Lancet 2012; 379: 1214–24. Boekholdt SM, Stroes ES. The interleukin-6 pathway and atherosclerosis. Lancet 2012; 379: 1176–78. Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. J Clin Invest 2011; 121: 3375–83. Schuett H, Oestreich R, Waetzig GH, et al. Transsignaling of interleukin-6 crucially contributes to atherosclerosis in mice. Arterioscler Thromb Vasc Biol 2012; 32: 281–90.
Why a Youth Commission on Global Governance for Health? The University of Oslo and The Lancet is announcing a Youth Commission on Global Governance for Health. The initiative follows The Lancet– University of Oslo Commission on www.thelancet.com Vol 380 July 28, 2012
Correspondence
Global Governance for Health, in collaboration with the Harvard Global Health Institute, whose mandate is to “examine aspects of governance, at both national and global levels, with the aim of making recommendations for improving global governance for health”.1 The open-mindedness and innovative thinking that young people often display will accentuate the work of the Commission, and provide valuable perspectives. Besides, young people have for long shown enthusiasm and progressive action in the field. First, there has been a growing interest from students, with numerous calls for more and better global health education,2 and advocacy for increased global health research at universities.3 Second, student involvement is increasingly becoming multidisciplinary. Collaboration across a range of disciplines, such as with the People’s Health Movement Students Coalition, acknowledges that reducing health inequities and achieving social justice require health to be dealt with by decision makers outside the health sector. Finally, students have already done cross-disciplinary and innovative analyses and policy proposals for improving global health. Students at McMaster University, Hamilton, ON, Canada, have produced analyses of 13 proposals for global health governance reform,4 and the studentled advocacy group Universities Allied for Essential Medicines have for long advocated for equitable access to medicines and medical innovations.5 Through such efforts, students are claiming their place in global health debates and establishing themselves as stakeholders. The enthusiasm and energy of students will be vital for the success of future work in global health. At the initiative of young academics themselves, the University of Oslo and The Lancet therefore decided to establish this Youth Commission on Global Governance for Health. The 16 young academics and professionals represent a wide variety www.thelancet.com Vol 380 July 28, 2012
of disciplines and regions. The Youth Commission will work as an independent entity, analysing governance mechanisms, institutions, and decision-making processes that affect global health. Youth and social movements will be consulted for their diverging experiences of global governance. Furthermore, they will act as an advisory group to the main Commission. Through dialogue and feedback they will challenge it to move beyond conventional wisdom. During the course of The Lancet–University of Oslo Commission, the Youth Commission thus seeks to make a valuable contribution to the future debates on global governance for health. We declare that we have no conflicts of interest.
*Unni Gopinathan, Lotte Danielsen, Ann Louise Lie [email protected] Institute of Health and Society, Faculty of Medicine, University of Oslo, PO Box 1130 Blindern, 0318 Oslo, Norway (UG, ALL); and Centre for Environment and Development, University of Oslo, Blindern, Oslo, Norway (LD) 1
2
3
4
5
Ottersen OP, Frenk J, Horton R. The LancetUniversity of Oslo Commission on Global Governance for Health, in collaboration with the Harvard Global Health Institute. Lancet 2011; 378: 1612–13. Johnson O, Bailey SL, Willott C, et al. Global health learning outcomes for medical students in the UK. Lancet 2012; 379: 2033. Kishore SP, Tavera G, Hotez PJ. The global health crisis and our nation’s research universities. PLoS Negl Trop Dis 2010; 4: e635. Hoffman SJ, ed. Student voices 2: assessing proposals for global health governance reform. http://www.mcmasterhealthforum.org/ images/docs/student-voices-2-assessingproposals-for-global-health-governancereform.pdf (accessed March 12, 2012). Chokshi DA. Improving access to medicines in poor countries: the role of universities. PLoS Med 2006; 3: e136.
Physics and medicine in the life and work of Božo Metzger I was delighted to see The Lancet dedicate a Series to, as Peter Knight put it, the “long and happy marriage between physics and medicine”.1 I recently worked on a series of papers on a similar topic, resulting in a book,
The Meeting Points: Physics and Medicine in the Life and Work of Professor Božo Metzger (1913–2012).2 Allow me to share some of the book’s highlights. Božo Metzger was born on March 3, 1913, in Karlovac, central Croatia. After finishing high school in 1928, he enrolled in the physics programme at the University of Zagreb. He graduated in 1936, and completed his doctoral dissertation in 1939. Metzger applied for the position of assistant professor at the School of Veterinary Medicine and began working there in 1942. In 1945, Metzger joined the Zagreb School of Medicine where he taught medical physics. The subject consisted of 6 h of lectures and 2 h of practical sessions weekly. The development of nuclear medicine in Zagreb began in the 1950s. The first cobalt treatment in Croatia took place in 1958, at the Dr Mladen Stojanović Hospital. Metzger joined this hospital in the same year and so became the first Croatian clinical physicist. He worked on dosimetry, cobalt bomb calibration, and resolution of physics-related problems in telecobalt therapy; introduced dosimetry in telegamma therapy and sealedsource radiotherapy; participated in introducing a range of radioisotopebased diagnostic procedures; and was in charge of radiation protection. He remained in the same hospital until his retirement in 1978. One of Metzger’s legacies is radiation protection, the promotion of which he was at the forefront in Croatia. His lifelong commitment to radiation protection was motivated largely by the tragic fate of his uncle, physician Stjepan Metzger, who died as a victim of his own work with high doses of radiation. Božo Metzger was deeply involved in the field of radiation protection until the end of his life, and, in 2009, at the age of 96 years, he became the first honorary member of the Croatian Radiation Protection Association. At the time of the book’s completion, Metzger was almost 99 years old and
For more on The Lancet– University of Oslo Youth Commission see http://www. med.uio.no/helsam/english/ research/global-governancehealth/youth-commission/
For the People’s Health Movement Students Coalition see https://sites.google.com/ site/phmsc2011/home/
For the Series on physics and medicine see http://www. thelancet.com/series/physicsand-medicine/
339
Science Photo Library
and 2008 (373). As we have suggested, and Economou and colleagues agree, attempts and reported attempts or suicidal thoughts are quite different from completed suicides. Although it is good news that so far there is no increase in completed suicides, it is important to note that Greece experienced extreme indices of crisis (eg, unemployment rate above 17%) only after late 2011, so any conclusions might be immature. Although we think that it might take years before one can confirm or reject an increase in the suicide rate, we agree with Economou and colleagues that by then it might be too late and there is an urgent need for intensive screening, follow-up, and treatment of people with suicidal ideation. Often caring for public health might imply forecasting rather than confirmation of statistics since human lives and not numbers are at risk. A substantial decline in suicide rates throughout Europe, the USA, and Canada has happened in the past two decades;2 however, with the global economic crisis, the future of these rates is unknown. Targeted interventions of proven efficacy should be applied, including specific psychoeducational programmes.3 They should use long-term and repeated interventions as well as community networking, and should not be restricted to gatekeepers’ training and general (theoretical) education of the public. We declare that we have no conflicts of interest.
*Konstantinos N Fountoulakis, Melina Siamouli, Ilias A Grammatikopoulos, Sotirios A Koupidis, Pavlos N Theodorakis [email protected] 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 54634 Thessaloniki ,Greece (KNF, MS); Private Practice, Thessaloniki, Greece (IAG); Evaggelismos General Hospital, Athens, Greece (SAK); Social Cooperative, “New Horizons”, Corfu Mental Health Sector, Corfu, Greece (SAK); and Social Cooperative, 8th Athens Mental Health Sector, Athens, Greece (PNT)
338
1
2
3
Hellenic Statistical Authority. Vital statistics: deaths. http://www.statistics.gr/portal/page/ portal/ESYE/PAGE-themes?p_param=A1605 (accessed July 10, 2012). Henriques GR, Brown GK, Berk MS, Beck AT. Marked increases in psychopathology found in a 30-year cohort comparison of suicide attempters. Psychological Med 2004; 34: 833–41. Fountoulakis KN, Gonda X, Rihmer Z. Suicide prevention programs through community intervention. J Affect Disord 2010; 130: 10–16.
The interleukin 6 pathway and atherosclerosis Two Articles (March 31, pp 1205 and 1214)1,2 showed that the single nucleotide polymorphism (SNP) rs7529229 of the interleukin 6 receptor (IL-6R D358A), which results in higher serum concentrations of the soluble IL-6R (sIL-6R), is connected to a lower risk of coronary heart disease. As an explanation, the accompanying Comment3 states that the point mutation led to increased cleavage of the IL-6R from the cell surface of hepatocytes, monocytes, and macrophages and concomitantly to less interleukin-6-induced signalling by these cells. We would like to put forward an alternative explanation. Interleukin 6 is present in the blood at a concentration of 1–5 ng/L, the sIL-6R at a concentration of around 50 μg/L, and a soluble form of gp130 (sgp130) at a concentration of 100–200 μg/L.4 Secreted interleukin 6 will bind to sIL-6R, and the interleukin-6/ sIL-6R complex will bind to sgp130, which is the natural inhibitor of this complex.4 An increase in sIL-6R caused by the SNP will lead to increased buffer capacity for secreted interleukin 6 and therefore to reduced interleukin 6 activity. Interleukin 6 acts on cells such as hepatocytes, monocytes, and macrophages via the membrane-bound IL-6R and the ubiquitously expressed receptor gp130. Alternatively, by a mechanism called trans-signalling, interleukin 6 can bind
to the sIL-6R and this complex can stimulate all cells of the body via gp130 alone.4 Specific inhibition of interleukin 6 trans-signalling by an sgp130-Fc fusion protein is sufficient to block the development of atherosclerosis in mice, underlining the proinflammatory role of interleukin 6 trans-signalling via the sIL-6R.5 We therefore think that the decreased risk of coronary heart disease in homozygous carriers of the rs7529229 SNP is not necessarily due to reduced interleukin 6 signalling on hepatocytes, monocytes, and macrophages but to a more efficient buffering of secreted interleukin 6 by the sIL-6R/sgp130 system and consequently to lower overall interleukin 6 activity. We declare that we have no conflicts of interest.
Jürgen Scheller, *Stefan Rose-John [email protected] Institute of Biochemistry and Molecular Biology II, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany (JS); and Institute of Biochemistry, Medical Faculty, Christian-AlbrechtsUniversity, 24098 Kiel, Germany (SR-J) 1
2
3
4
5
IL6R Genetics Consortium Emerging Risk Factors Collaboration. Interleukin-6 receptor pathways in coronary heart disease: a collaborative meta-analysis of 82 studies. Lancet 2012; 379: 1205–13. The Interleukin-6 Receptor Mendelian Randomisation Analysis (IL6R MR) Consortium. The interleukin-6 receptor as a target for prevention of coronary heart disease: a mendelian randomisation analysis. Lancet 2012; 379: 1214–24. Boekholdt SM, Stroes ES. The interleukin-6 pathway and atherosclerosis. Lancet 2012; 379: 1176–78. Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. J Clin Invest 2011; 121: 3375–83. Schuett H, Oestreich R, Waetzig GH, et al. Transsignaling of interleukin-6 crucially contributes to atherosclerosis in mice. Arterioscler Thromb Vasc Biol 2012; 32: 281–90.
Why a Youth Commission on Global Governance for Health? The University of Oslo and The Lancet is announcing a Youth Commission on Global Governance for Health. The initiative follows The Lancet– University of Oslo Commission on www.thelancet.com Vol 380 July 28, 2012
Correspondence
Global Governance for Health, in collaboration with the Harvard Global Health Institute, whose mandate is to “examine aspects of governance, at both national and global levels, with the aim of making recommendations for improving global governance for health”.1 The open-mindedness and innovative thinking that young people often display will accentuate the work of the Commission, and provide valuable perspectives. Besides, young people have for long shown enthusiasm and progressive action in the field. First, there has been a growing interest from students, with numerous calls for more and better global health education,2 and advocacy for increased global health research at universities.3 Second, student involvement is increasingly becoming multidisciplinary. Collaboration across a range of disciplines, such as with the People’s Health Movement Students Coalition, acknowledges that reducing health inequities and achieving social justice require health to be dealt with by decision makers outside the health sector. Finally, students have already done cross-disciplinary and innovative analyses and policy proposals for improving global health. Students at McMaster University, Hamilton, ON, Canada, have produced analyses of 13 proposals for global health governance reform,4 and the studentled advocacy group Universities Allied for Essential Medicines have for long advocated for equitable access to medicines and medical innovations.5 Through such efforts, students are claiming their place in global health debates and establishing themselves as stakeholders. The enthusiasm and energy of students will be vital for the success of future work in global health. At the initiative of young academics themselves, the University of Oslo and The Lancet therefore decided to establish this Youth Commission on Global Governance for Health. The 16 young academics and professionals represent a wide variety www.thelancet.com Vol 380 July 28, 2012
of disciplines and regions. The Youth Commission will work as an independent entity, analysing governance mechanisms, institutions, and decision-making processes that affect global health. Youth and social movements will be consulted for their diverging experiences of global governance. Furthermore, they will act as an advisory group to the main Commission. Through dialogue and feedback they will challenge it to move beyond conventional wisdom. During the course of The Lancet–University of Oslo Commission, the Youth Commission thus seeks to make a valuable contribution to the future debates on global governance for health. We declare that we have no conflicts of interest.
*Unni Gopinathan, Lotte Danielsen, Ann Louise Lie [email protected] Institute of Health and Society, Faculty of Medicine, University of Oslo, PO Box 1130 Blindern, 0318 Oslo, Norway (UG, ALL); and Centre for Environment and Development, University of Oslo, Blindern, Oslo, Norway (LD) 1
2
3
4
5
Ottersen OP, Frenk J, Horton R. The LancetUniversity of Oslo Commission on Global Governance for Health, in collaboration with the Harvard Global Health Institute. Lancet 2011; 378: 1612–13. Johnson O, Bailey SL, Willott C, et al. Global health learning outcomes for medical students in the UK. Lancet 2012; 379: 2033. Kishore SP, Tavera G, Hotez PJ. The global health crisis and our nation’s research universities. PLoS Negl Trop Dis 2010; 4: e635. Hoffman SJ, ed. Student voices 2: assessing proposals for global health governance reform. http://www.mcmasterhealthforum.org/ images/docs/student-voices-2-assessingproposals-for-global-health-governancereform.pdf (accessed March 12, 2012). Chokshi DA. Improving access to medicines in poor countries: the role of universities. PLoS Med 2006; 3: e136.
Physics and medicine in the life and work of Božo Metzger I was delighted to see The Lancet dedicate a Series to, as Peter Knight put it, the “long and happy marriage between physics and medicine”.1 I recently worked on a series of papers on a similar topic, resulting in a book,
The Meeting Points: Physics and Medicine in the Life and Work of Professor Božo Metzger (1913–2012).2 Allow me to share some of the book’s highlights. Božo Metzger was born on March 3, 1913, in Karlovac, central Croatia. After finishing high school in 1928, he enrolled in the physics programme at the University of Zagreb. He graduated in 1936, and completed his doctoral dissertation in 1939. Metzger applied for the position of assistant professor at the School of Veterinary Medicine and began working there in 1942. In 1945, Metzger joined the Zagreb School of Medicine where he taught medical physics. The subject consisted of 6 h of lectures and 2 h of practical sessions weekly. The development of nuclear medicine in Zagreb began in the 1950s. The first cobalt treatment in Croatia took place in 1958, at the Dr Mladen Stojanović Hospital. Metzger joined this hospital in the same year and so became the first Croatian clinical physicist. He worked on dosimetry, cobalt bomb calibration, and resolution of physics-related problems in telecobalt therapy; introduced dosimetry in telegamma therapy and sealedsource radiotherapy; participated in introducing a range of radioisotopebased diagnostic procedures; and was in charge of radiation protection. He remained in the same hospital until his retirement in 1978. One of Metzger’s legacies is radiation protection, the promotion of which he was at the forefront in Croatia. His lifelong commitment to radiation protection was motivated largely by the tragic fate of his uncle, physician Stjepan Metzger, who died as a victim of his own work with high doses of radiation. Božo Metzger was deeply involved in the field of radiation protection until the end of his life, and, in 2009, at the age of 96 years, he became the first honorary member of the Croatian Radiation Protection Association. At the time of the book’s completion, Metzger was almost 99 years old and
For more on The Lancet– University of Oslo Youth Commission see http://www. med.uio.no/helsam/english/ research/global-governancehealth/youth-commission/
For the People’s Health Movement Students Coalition see https://sites.google.com/ site/phmsc2011/home/
For the Series on physics and medicine see http://www. thelancet.com/series/physicsand-medicine/
339