Adapting to climate change

Adapting to climate change

Editorial Science Photo Library Probiotics or con? See Comment page 634 See Articles page 651 For the paper by Pyne et al see the British Journal ...

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Science Photo Library

Probiotics or con?

See Comment page 634 See Articles page 651

For the paper by Pyne et al see the British Journal of Sports Medicine 2008; published online Feb 13. DOI:10.1136/ bjsm.2007.044628

Online publication during the past week of two randomised trials of probiotics will intensify debate about their role as nutritional supplements. In the largest study of probiotics to date, the Dutch Acute Pancreatitis Study Group, writing in The Lancet, showed that a combination of lactobacilli and bifidobacteria more than doubled mortality compared with placebo in 298 patients with predicted severe acute pancreatitis. By contrast, David Pyne and colleagues report in the British Journal of Sports Medicine, that another species of lactobacillus halved the frequency of respiratory infections in 20 high-performance distance runners. How these findings translate to the 2 million people who consume probiotics regularly in the UK and who are neither world-class athletes, nor have acute pancreatitis is not clear. Though many studies have attributed benefit to probiotics, most have involved specific illnesses in hospital settings. The benefits of different strains and their mechanisms of action in typical consumers are uncertain. Indeed, the validity of advertised health

benefits is being examined by a court in California, USA. Regulation of the worldwide US$4 billion probiotic market is disjointed, since substantiation of claims must satisfy different local criteria depending on whether the products are considered foods, supplements, or drugs. Since July, 2007, the European Union requires scientific evidence to support claims of benefit. But labelling is often incomplete and misleading, despite recommendations by the Food and Agriculture Organization in 2002 to specify strain details, number of viable bacteria, storage conditions, and consumer information. For instance, a UK survey in 2006 found that half of 50 probiotics tested did not contain the specified strain or stated concentration. By raising questions of safety and efficacy, the above trials should generate further probiotic research, which concerned consumers will want extended to community studies. Meanwhile, the WHO definition that probiotics confer a health benefit on the host might need revision, because after the Dutch group’s results, it is no longer tenable to regard probiotics as risk-free. ■ The Lancet

Adapting to climate change


The printed journal includes an image merely for illustration

For the Department of Health report see uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyA ndGuidance/DH_080702


Much of the global discussion about climate change has focused on mitigating its effects by reducing emissions of greenhouse gases. Although preventing climate change is crucial, countries also need to prepare for temperature variations and their accompanying health risks. An updated report on the health effects of climate change in the UK, published last week by the Department of Health and the Health Protection Agency, is therefore welcome. Written by an independent expert panel, the report details the health consequences for the UK if no action is taken to mitigate climate change this century. These outcomes include 3000 heat-related deaths from a serious heatwave by 2012, 14 000 more cases of food-poisoning, an increase in skin cancers and floodrelated health problems, and 1500 extra deaths and hospital admissions from air pollution each year. Predictions of the health risks of climate change are not fatalistic. The global climate is projected to increase by 0·4°C over the next two decades, according to the Intergovernmental Panel for Climate Change. And premature deaths from extreme temperature events are

already occurring. The devastating heatwave in Europe in 2003 caused around 30 000 excess deaths. The Department of Health report makes several publichealth recommendations, which include the promotion of measures to avoid dehydration in hot weather, clearer advice on how the public can maintain vitamin D levels while avoiding the adverse consequences of exposure to sunlight, and the implementation of health-risk assessments after flooding. The report is an important planning document for health organisations in the UK. The UK is in a privileged position to have had the data and the means to produce this report. Less-developed countries, where climate change is likely to have a far bigger effect on health and which are already burdened with other serious health concerns, need financial and technical assistance to develop adaptive strategies to temperature variations. Reducing morbidity and mortality related to climate change in these countries will be the global community’s defining challenge as it faces one of the biggest known threats to health and human survival. ■ The Lancet Vol 371 February 23, 2008