by Dr. Iain Corness
WHO sounds a warning
The WHO Director-General, Dr
Margaret Chan, published a statement on the first meeting of the
International Health Regulations (2005) Emergency Committee on Zika
virus and observed increase in neurological disorders and neonatal
Dr Chan convened an Emergency Committee, under the International Health
Regulations, to gather advice on the severity of the health threat
associated with the continuing spread of Zika virus disease in Latin
America and the Caribbean. The Committee met in February by
In assessing the level of threat, the 18 experts and advisers looked in
particular at the strong association, in time and place, between
infection with the Zika virus and a rise in detected cases of congenital
malformations and neurological complications. The experts agreed that a
causal relationship between Zika infection during pregnancy and
microcephaly is strongly suspected, though not yet scientifically
proven. All agreed on the urgent need to coordinate international
efforts to investigate and understand this relationship better.
The experts also considered patterns of recent spread and the broad
geographical distribution of mosquito species that can transmit the
The lack of vaccines and rapid and reliable diagnostic tests, and the
absence of population immunity in newly affected countries were cited as
further causes for concern.
After a review of the evidence, the Committee advised that the recent
cluster of microcephaly cases and other neurological disorders reported
in Brazil, following a similar cluster in French Polynesia in 2014,
constitutes an “extraordinary event” and a public health threat to other
parts of the world.
In their view, a coordinated international response is needed to
minimize the threat in affected countries and reduce the risk of further
Members of the Committee agreed that the situation meets the conditions
for a Public Health Emergency of International Concern.
Dr Chan has now declared that the recent cluster of microcephaly cases
and other neurological disorders reported in Brazil, following a similar
cluster in French Polynesia in 2014, constitutes a Public Health
Emergency of International Concern.
A coordinated international response is needed to improve surveillance,
the detection of infections, congenital malformations, and neurological
complications, to intensify the control of mosquito populations, and to
expedite the development of diagnostic tests and vaccines to protect
people at risk, especially during pregnancy.
The Committee found no public health justification for restrictions on
travel or trade to prevent the spread of Zika virus.
At present, the most important protective measures are the control of
mosquito populations and the prevention of mosquito bites in at-risk
individuals, especially pregnant women.
This shows the way public health is being monitored in the world by the
WHO (World Health Organization) and I commend them for their attention
to this latest public health threat, without hysteria, as has sometimes
been the case in the past. It certainly does look as if there is an
association with this Zika virus and microcephaly (small head).
Zika, usually mild and rarely fatal with symptoms often mistaken for
other mosquito-borne viruses such as dengue and chikungunya, has
“widespread distribution” across Thailand, according to an article last
year in the American Journal of Tropical Medicine and Hygiene. But
Thailand has only reported one case this year. But that does not mean
there has only been one case -
Zika virus is spread by the Aedes aegypti mosquito, the culprit
responsible for dengue, yellow fever and other tropical diseases. Since
we have not been that successful in combating Aedes aegypti which breeds
in standing water (and there has been plenty of water recently), the
potential for an epidemic is quite obviously there.
The big problem here, and one where the WHO is sliding down a knife
edge, is if the microcephaly issue turns out not to be a Zika effect,
the WHO becomes accused of scaremonger tactics for having brought
attention to it. If however it is shown to be a vector in the condition,
the WHO becomes accused of not giving the world enough of a warning!
Damned if you do and damned if you don’t!
Does EBM mean increased ‘benefits’ for you?
The practice of Medicine is a
fascinating story over thousands of years. “Healers” have been part of most
societies, and in ancient China, for example, you paid the doctor to remain
well, not for treatment of your ailment. Now there’s an incentive bonus for
Then there are different kinds of “medicine” given such names as
“conventional”, “alternative” and “complementary”.
These different ways at looking at the same subject (making you well) can be
quite confusing, and for me much hangs on the term EBM, which stands for
Evidence Based Medicine.
Mind you, it has also always been the case where people like to throw stones
at conventional clinical medicine. Claims of over-servicing,
over-prescribing and downright fraudulent practices are thrown about, citing
someone whose uncle/friend/mother (delete that which is inappropriate)
suffered at the hands of “bad” doctors who misdiagnosed the illness and the
Now, there are certainly some “bad” doctors out there, just as there are
“bad” lawyers, “bad” real estate agents, “bad” mechanics and just about any
profession you would like to think of. But they’re not all “bad”.
And me? I am a conventionally trained British/Australian style medical
practitioner who has spent a lifetime practicing EBM. Practices that have
been proven to work. Call it “good” medicine, if you like.
I am also proud of my final exams taken in the Royal Colleges of Physicians
and Surgeons in London. I have the honor to have my name listed in the
‘great book’ with luminaries such as Hunter, Jenner and Lister. I am also
indebted to my tutors during the 12 months of ‘pre-registration’, where you
apply your knowledge under the supervision of accredited specialists. An
arduous road, but one that is a safeguard for you, the general public.
The ‘powers that be’ are also ensuring that we keep up to date with a
process called Continuous Medical Education (CME). That medical education
continues through to today, with CME lectures being attended by my
hospital’s doctors, and myself. Fortunately for me, the slides are in
Those ‘powers that be’ also try to ensure that we prescribe drugs that are
efficacious, that have been tested, and the evidence points to this. It is
not anecdotal evidence, but true scientific evidence shown by research in
many countries, with hundreds of thousands of patients. It is following that
type of evidence, that I can recommend with all good faith, that 100 mg of
aspirin a day is “good” medicine. I also know that if you are prescribed a
‘statin’ drug it will lower your cholesterol levels. They have been tested.
I am also the first to admit that we have sometimes managed to get it wrong.
The Thalidomide story still has living examples of this. However, the
medical world-wide network is cohesive enough to ensure that this drug was
withdrawn. It is the checks and balances system that has kept conventional
I am often asked my opinion on “alternative” medicine, and I try to avoid
direct confrontation over this. If devotees have found that they can
diagnose tumors by looking at patient’s auras through their third eye in the
middle of their foreheads, then I am genuinely pleased, in fact delighted,
provided that they have subjected the method to scientific scrutiny.
If various groups can actually cure cancer, epilepsy, halitosis or lock-jaw
by inserting dandelions into a fundamental orifice, then again I am
delighted. This is a medical break-through, but as such, must be subjected
to medical scrutiny. If the method stands true scientific examination (not
to be confused with anecdotal ‘evidence’) then it will be adopted by
everyone, complete with thanks to those clever people who picked the
dandelions in the first place. Ignore the claims that “Big Pharma” is
suppressing cancer treatments. If someone has the answer, they will be
As far as the majority of ‘folk’ remedies is concerned, I work on the
principle that if you ‘think’ it is doing you good, then it probably is. But
don’t ask me to endorse something that has not been scientifically tested.
When the ‘alternative’ group spends more time proving their methods, instead
of complaining about non-acceptance, EBM practitioners will give them more