Science        
21 September 2012 vol 337, issue 6101, pages 1425-1572
http://www.sciencemag.org/current.dtl

News
Chronic Disease Vaccines Need Shot in the Arm
Bijal Trivedi*
It’s difficult enough to develop and obtain approval for a traditional vaccine against a bacterium or virus, let alone create one that rouses the immune system to target molecules that drive a chronic disease such as obesity. Potential vaccines for hypertension, asthma, Alzheimer’s disease, obesity, and smoking (because it is a risk factor for heart disease, cancer, stroke, and more) have all been hyped in recent years and then suffered high-profile failures. Vaccine developers also face the problem that society largely views addiction and obesity as moral failures rather than chronic diseases. It’s difficult to persuade drug companies and the general population to invest in treating something they view as a failure of willpower with an intervention like a vaccine. But researchers aren’t giving up.
http://www.sciencemag.org/content/337/6101/1479.summary

Review
Can Noncommunicable Diseases Be Prevented? Lessons from Studies of Populations and Individuals
Majid Ezzati*, Elio Riboli
MRC-HPA, Centre for Environment and Health and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK.
Noncommunicable diseases (NCDs)—mainly cancers, cardiovascular diseases, diabetes, and chronic respiratory diseases—are responsible for about two-thirds of deaths worldwide, mostly in low- and middle-income countries. There is an urgent need for policies and strategies that prevent NCDs by reducing their major risk factors. Effective approaches for large-scale NCD prevention include comprehensive tobacco and alcohol control through taxes and regulation of sales and advertising; reducing dietary salt, unhealthy fats, and sugars through regulation and well-designed public education; increasing the consumption of fresh fruits and vegetables, healthy fats, and whole grains by lowering prices and improving availability; and implementing a universal, effective, and equitable primary-care system that reduces NCD risk factors, including cardiometabolic risk factors and infections that are precursors to NCDs, through clinical interventions.
http://www.sciencemag.org/content/337/6101/1482.abstract

Perspective
Double Burden of Noncommunicable and Infectious Diseases in Developing Countries
I. C. Bygbjerg
Copenhagen School of Global Health, Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, 5 Øster Farimagsgade, DK-1014, Copenhagen K, Denmark. E-mail: iby@sund.ku.dk.

Abstract
On top of the unfinished agenda of infectious diseases in low- and middle-income countries, development, industrialization, urbanization, investment, and aging are drivers of an epidemic of noncommunicable diseases (NCDs). Malnutrition and infection in early life increase the risk of chronic NCDs in later life, and in adult life, combinations of major NCDs and infections, such as diabetes and tuberculosis, can interact adversely. Because intervention against either health problem will affect the other, intervening jointly against noncommunicable and infectious diseases, rather than competing for limited funds, is an important policy consideration requiring new thinking and approaches.
http://www.sciencemag.org/content/337/6101/1499.abstract

Editorial
Prevention and Cost Control
Ezekiel Emanuel
Ezekiel Emanuel is the Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, Philadelphia, PA.

Prevention is the key to cost control and improving the quality of health care in many nations. Most people think of prevention as vaccines and screening tests. But it is tertiary prevention—keeping people with established diseases from becoming worse—that holds the greatest promise for strengthening the health care system. Why? Health care costs are unevenly distributed across populations. In the United States, 50% of the population uses hardly any health care, whereas 10% consumes nearly two-thirds of all health care spending. The latter are patients with one or more chronic conditions, such as congestive heart failure, diabetes, or cancer. To control costs, we must prevent the conditions of this 10% of patients from worsening.
http://www.sciencemag.org/content/337/6101/1433.summary