Before hypertensive patients start on chocolate binges, it should be noted that cardiovascular experts warn that chocolate candies are also high in calories and fats and therefore not good for the heart. So as in all things, moderation in chocolate eating should also be observed.

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In the United States, infant deaths among blacks have been steadily falling over the last few decades. While still lagging behind the national average, infant mortality rate in this population group has dropped to acceptable levels through the end of the 20th century.

Recently however, neo-natologists in the state of Mississippi have noted a disturbing upward trend in infant deaths among black and mostly rural poor families.

The racial disparity is quite striking with the infant mortality rate among blacks at 14 per thousand live births compared to 6.6 for whites.

The New York Times reported that doctors in these communities have raised the possibility that this development may be linked to recent cuts in welfare and Medicaid. But more important, there also seems to be a link to the growing epidemics of obesity and diabetes among potential mothers who sometimes may weigh as much as 300 pounds.

For countries like the Philippines, where access to health care is severely limited among the poor, such reports confirm the fact that the so-called diseases of development (cancer, heart disease, diabetes, and stroke) are most harmful to those who are already disadvantaged by poverty. This should alert health policy makers to the urgent need to reduce inequities in access to health services.

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While the implementing rules and regulations for the Hospital Detention Law are still under study, private hospitals continue to practice abusive detention policies to force mostly poor families to pay their bills. These hospitals are quick to cite stringent government regulations as one of the factors for the increasing number of closures of private health care facilities. These groups are also the most resistant to transparent quality control measures such as public reporting of comparative mortality and morbidity as well as incidents of medical negligence or poor practices.

Unfortunately, quality assurance advocates are mostly also health professionals and therefore are hesitant to develop public accountability instruments for quality improvement in hospitals and other health facilities. The sad fact is that self-policing in enforcing health care quality regulations seems to be unworkable in an environment where profits and the bottom-line are the dominant values.

This is also the experience in developed countries where publicly disclosed hospital statistics were only recently introduced. The recent release by the United States Department of Health and Human Services of mortality rates for heart surgery caught many of the major cardiovascular centers in that country by surprise. Many of them responded by vehement denials, denouncing the report as flawed and unfair. Nevertheless, a good number took the report as an input to further strengthen their efforts to improve the quality of their services.

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Erythropoietin is a hormone produced by kidney cells to promote the production of red blood cells (aka erythrocytes) by the bone marrow. Deficiency of this substance results in anemia or a lack of functioning red blood cells to carry oxygen from the lungs to the different parts of the body. For this reason, patients who are in chronic kidney failure generally suffer from fairly severe anemia.

When injectable forms of erythropoietin were introduced in the late 80s and early 90s, it was readily adopted as part of the treatment for renal failure. Over the years evidence has mounted that the product was indeed quite helpful in maintaining dialysis patients’ functional status and improving their quality of life.

Erythropoietin-based branded products are sold world-wide by only two giant pharmaceutical firms – Aranest and Epogen from Amgen; Procrit from Johnson & Johnson. Combined sales of the products reached ten billion dollars last year.

Regrettably, these companies have been found to have engaged in unethical marketing practices by encouraging doctors to over-use erythropoietin to the detriment of patient’s health. These practices included withholding information about adverse effects of excessive erythropoietin use as well as cash payments to doctors or institutions with high prescription rates for these medicines.

Such incidents cast further doubts on the claims of drug giants that they are motivated by concerns for patients’ benefits in their quest for innovation and production of new medicines. The fact is that the two companies are also in the forefront of the international pharmaceutical lobby working weaken the effects of the Doha declaration on intellectual property rights that considers public health as having higher value than commercial gain.