Paul Garner | |
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| Born | 25 August 1955 |
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Paul Garner is a British epidemiologist and public health professional, known for his work in systematic reviews and evidence-informed policy. He is currently an Emeritus Professor, Evidence Synthesis in Global Health, at the Liverpool School of Tropical Medicine. [1] Previously he was a member of the WHO malaria treatment guidelines group from 2004-18.
Paul Garner attended Spalding Grammar School in Lincolnshire, England. He received an MB BS from University College London in 1979, and MD from the University of London in 1990.
He started his career in as a physician in Papua New Guinea. From 1982 to 1984 he ran the Aitape Health Center in West Sepik Province, a 100-bed hospital with a catchment area of 200,000 people. From 1984 to 1988 he worked as a researcher at the Papua New Guinea Institute of Medical Research branch in Madang. [2]
Between 2004 and 2022, he was a full time Professor of Evidence Synthesis at the Liverpool School of Tropical Medicine (LSTM) and the Director of the Center for Evidence Synthesis in Global Health. He is now an emeritus professor at LSTM. He has also been an honorary research fellow at St. George's University School of Medicine, Grenada since 1997, and honorary Professor at the University of Stellenbosch since 2013. He has also directed a series of UK Government research and development programmes in evidence synthesis related to problems of the tropics and low- and middle-income countries, the most recent being READ-It from 2018 to 2024. He is a Fellow of the Faculty of Public Health. [1]
In 1992, Paul Garner played a key role in the development of the Cochrane Collaboration after its founding. He led the Cochrane Infectious Diseases Group, whose reviews have helped underpin policy changes across the world.
Garner directly contributed to change in the formulation of oral rehydration solution and global policies related to its use in treatment of diarrheal diseases. At the time the World Health Organization (WHO) used a 311mOsm/L solution as the standard and Garner's systematic review clearly showed that lower osmolarity of 240mOsm/L is more effective. [3] [4] [5]
Garner worked closely with the WHO in the development of malaria treatment guidelines from 2004 to 2018, organizing evidence synthesis for the three editions in 2006, 2010, and 2015. He played a key role in the introduction of Artemisinin-based combination treatments for malaria around the world. [6]
His systematic reviews have also challenged global dogmas, including Directly Observed Therapy for tuberculosis, [7] and routine de-worming of soil transmitted helminths in schoolchildren living in endemic areas in middle- and low-income countries. [8]
Drawing from personal experience, Garner worked to highlight the occurrence of the post-COVID-19 syndrome and health concerns related to it. [9] [10] He advocated that the involvement of communities of people who have recovered from post-viral illnesses would be helpful in management and treatment approaches. Over time, Garner rejected the notion of a purely biomedical cause of his own post-COVID illness and attributed his full recovery to psychological training including techniques of meditation and visualisation. [11] His statements created huge controversy among post-COVID and ME/CFS activist groups, resulting in Garner receiving death threats while others thanked him for opening a path to recovery for them. [12]
Malaria is a mosquito-borne infectious disease that affects humans and other vertebrates. Human malaria causes symptoms that typically include fever, fatigue, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. Symptoms usually begin 10 to 15 days after being bitten by an infected Anopheles mosquito. If not properly treated, people may have recurrences of the disease months later. In those who have recently survived an infection, reinfection usually causes milder symptoms. This partial resistance disappears over months to years if the person has no continuing exposure to malaria.
Diarrhea, also spelled diarrhoea or diarrhœa, is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.
Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Typically, only one ear is affected initially, but over time, both ears may become involved. Episodes generally last from 20 minutes to a few hours. The time between episodes varies. The hearing loss and ringing in the ears can become constant over time.
Cochrane is a British international charitable organisation formed to synthesize medical research findings to facilitate evidence-based choices about health interventions involving health professionals, patients and policy makers. It includes 53 review groups that are based at research institutions worldwide. Cochrane has approximately 30,000 volunteer experts from around the world.
Sore throat, also known as throat pain, is pain or irritation of the throat. Usually, causes of sore throat include:
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities, gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits (tartar) not removed by routine cleaning. Those with dentures and natural teeth may supplement their cleaning with a denture cleaner.
Artemisinin and its semisynthetic derivatives are a group of drugs used in the treatment of malaria due to Plasmodium falciparum. It was discovered in 1972 by Tu Youyou, who shared the 2015 Nobel Prize in Physiology or Medicine for her discovery. Artemisinin-based combination therapies (ACTs) are now standard treatment worldwide for P. falciparum malaria as well as malaria due to other species of Plasmodium. Artemisinin is extracted from the plant Artemisia annua a herb employed in Chinese traditional medicine. A precursor compound can be produced using a genetically engineered yeast, which is much more efficient than using the plant.
Oseltamivir, sold under the brand name Tamiflu, is an antiviral medication used to treat and prevent influenza A and influenza B, viruses that cause the flu. Many medical organizations recommend it in people who have complications or are at high risk of complications within 48 hours of first symptoms of infection. They recommend it to prevent infection in those at high risk, but not the general population. The Centers for Disease Control and Prevention (CDC) recommends that clinicians use their discretion to treat those at lower risk who present within 48 hours of first symptoms of infection. It is taken by mouth, either as a pill or liquid.
Ivermectin is an antiparasitic drug. After its discovery in 1975, its first uses were in veterinary medicine to prevent and treat heartworm and acariasis. Approved for human use in 1987, it is used to treat infestations including head lice, scabies, river blindness (onchocerciasis), strongyloidiasis, trichuriasis, ascariasis and lymphatic filariasis. It works through many mechanisms to kill the targeted parasites, and can be taken by mouth, or applied to the skin for external infestations. It belongs to the avermectin family of medications.
Artemether is a medication used for the treatment of malaria. The injectable form is specifically used for severe malaria rather than quinine. In adults, it may not be as effective as artesunate. It is given by injection in a muscle. It is also available by mouth in combination with lumefantrine, known as artemether/lumefantrine.
Artesunate (AS) is a medication used to treat malaria. The intravenous form is preferred to quinine for severe malaria. Often it is used as part of combination therapy, such as artesunate plus mefloquine. It is not used for the prevention of malaria. Artesunate can be given by injection into a vein, injection into a muscle, by mouth, and by rectum.
Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydration therapy can also be given by a nasogastric tube. Therapy can include the use of zinc supplements to reduce the duration of diarrhea in infants and children under the age of 5. Use of oral rehydration therapy has been estimated to decrease the risk of death from diarrhea by up to 93%.
A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on the topic, then analyzes, describes, critically appraises and summarizes interpretations into a refined evidence-based conclusion. For example, a systematic review of randomized controlled trials is a way of summarizing and implementing evidence-based medicine.
Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are an important cause of chronic wounds, affecting 1% of the population. Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.
Iron supplements, also known as iron salts and iron pills, are a number of iron formulations used to treat and prevent iron deficiency including iron deficiency anemia. For prevention they are only recommended in those with poor absorption, heavy menstrual periods, pregnancy, hemodialysis, or a diet low in iron. Prevention may also be used in low birth weight babies. They are taken by mouth, injection into a vein, or injection into a muscle. While benefits may be seen in days, up to two months may be required until iron levels return to normal.
Sir Iain Geoffrey Chalmers is a British health services researcher, one of the founders of the Cochrane Collaboration, and coordinator of the James Lind Initiative, which includes the James Lind Library and James Lind Alliance.
Dihydroartemisinin is a drug used to treat malaria. Dihydroartemisinin is the active metabolite of all artemisinin compounds and is also available as a drug in itself. It is a semi-synthetic derivative of artemisinin and is widely used as an intermediate in the preparation of other artemisinin-derived antimalarial drugs. It is sold commercially in combination with piperaquine and has been shown to be equivalent to artemether/lumefantrine.
Peter Christian Gøtzsche is a Danish physician, medical researcher, and former leader of the Nordic Cochrane Center at Rigshospitalet in Copenhagen, Denmark. He is a co-founder of the Cochrane Collaboration and has written numerous reviews for the organization. His membership in Cochrane was terminated by its Governing Board of Trustees on 25 September 2018. During the COVID-19 pandemic, Gøtzsche was criticised for spreading disinformation about COVID-19 vaccines.
The Centre for Evidence-Based Medicine (CEBM), based in the Nuffield Department of Primary Care Health Sciences at the University of Oxford, is an academic-led centre dedicated to the practice, teaching, and dissemination of high quality evidence-based medicine to improve healthcare in everyday clinical practice. CEBM was founded by David Sackett in 1995. It was subsequently directed by Brian Haynes and Paul Glasziou. Since 2010 it has been led by Professor Carl Heneghan, a clinical epidemiologist and general practitioner.
Mass deworming, is one of the preventive chemotherapy tools, used to treat large numbers of people, particularly children, for worm infections notably soil-transmitted helminthiasis, and schistosomiasis in areas with a high prevalence of these conditions. It involves treating everyone – often all children who attend schools, using existing infrastructure to save money – rather than testing first and then only treating selectively. Serious side effects have not been reported when administering the medication to those without worms, and testing for the infection is many times more expensive than treating it. Therefore, for the same amount of money, mass deworming can treat more people more cost-effectively than selective deworming. Mass deworming is one example of mass drug administration.
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