BMJ Press Releases, Saturday 10 August 1996
Volume 313 No 7053

EMBARGOED 00.01 HRS 9 AUGUST 1996

STUDY IDENTIFIES LARGE NUMBER OF PATIENTS ON ORAL STEROIDS AT RISK OF OSTEOPOROSIS

[Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study]

More than 250,000 people in the UK take oral steroids but most of these take no extra precautions against osteoporosis, a study in this week's BMJ suggests.

A study of eight general practices covering more than 65,000 people found that 0.5 per cent, or one in 200, were currently taking oral corticosteroids and had been for longer than three months. This figure rose to 1.7 per cent among women over 55 years. The drugs were prescribed for conditions such as rheumatoid arthritis, polymyalgia or asthma.

Although oral corticosteroids can be life-saving, their long term use increases the risk of hip and vertebral fractures. Yet the researchers from Nottingham found only 14 per cent of the patients had received any treatment to prevent osteoporosis over the last four years. Hormone replacement therapy is recommended for postmenopausal women taking oral steroids but the number of women receiving this treatment appeared to be no higher than the rest of the population.

Contact:

Dr Lesley Walsh
Research fellow

Division of Respiratory Medicine
City Hospital
Nottingham NG5 1PB

Tel: 0115 960 3268
Fax: 0115 960 2140

If not available contact:
Prof. Anne Tattersfield
details as above

HRT: TAKE IT OR LEAVE IT?

[Education and Debate. Controversies in management]

In this week's BMJ experts lock horns over hormone replacement therapy (HRT) in two opposing articles looking at who should be taking it and whether or not the proven benefits (fewer heart attacks and fewer broken bones) outweigh the potential risks (breast cancer).

Philip Toozs-Hobson and Linda Cardozo from King's College Hospital, London, argue that all women should be offered HRT once they reach the menopause. They dismiss cancer scares as "unfounded" and say that HRT makes women feel good on top of other benefits.

Howard Jacobs from the Middlesex Hospital, London, urges doctors to be more cautious. Scientific evidence of benefit is still inconsistent, he says, and while a link with breast cancer may be weak, it's enough to make many women rightly wary about taking HRT. "In my opinion .... the best we can do is suggest treatment for those most at risk of osteoporosis and heart attacks, he concludes.

Contact:

Prof Linda Cardozo
Dept of Obstetrics and Gynaecology

King's College Hospital
Bessemer Road
London SE5 8RX

Tel: 0171 737 4000 xtn 4321/4303
Fax: 0171 346 3641

or

Prof. Howard Jacobs
Professor of reproductive endocrinology

Cobbold Laboratories
Middlesex Hospital
London, W1N 8AA

Tel: 0171 380 9451
Fax: 0171 636 9941
E-mail: H.Jacobs@UCL.AC.UK

BETTER COMMUNICATION NEEDED TO REASSURE PATIENTS THAT NOTHING IS WRONG

[Opening Pandora's box: the unpredictability of reassurance by a normal test result]

Many patients continue to be anxious about their hearts despite receiving normal test result, says a study in this week's BMJ.

The authors report that some patients in their study continued to doubt the results and be anxious about their heart despite receiving normal test results from an echocardiogram by their consultant.

They say that communication between doctors and patients seems to be to blame because it seemed to be widely assumed that explaining that the tests showed no abnormalities was enough to reassure. They call for better clinical skills in handling the problem of reassurance. There needs to be greater awareness that normal test results do not always resolve doubts and eliminate anxiety.

Contact:
Dr I McDonald

St Vincent's Hospital
Fitzroy
Melbourne 3065
Australia

Tel: 00613 9288 3027
Fax: 00613 9288 3019

STUDY HIGHLIGHTS WIDER PROBLEM

[Editorial: Telling patients there is nothing wrong]

An accompanying editorial looks at the difficulties of reassuring patients in more detail and blames poor communication for the problem. The author concludes that unless doctors can address the true fears of their patients diagnostic tests may leave them more anxious than before.

Contact:

Prof. Ray Fitzpatrick

Dept of Public Health and Primary Care
Radcliffe Infirmary
Oxford, OX2 HE

Tel: 01865 278565
Fax: 01865 278621/278557

EDITORIAL. PRIVATE FINANCE FOR THE PUBLIC GOOD

[Still no sign of evidence based policy making]

The private finance initiative (PFI) is an extension of the government's contracting out policy, where a hospital needing new operating theatres or a scanner has to seek competitive tenders from the private sector to build a run them. The NHS trust does not purchase the scanner, but merely contracts, at public expense, say, 1200 scans for ten years. This will only be 'value for money' if the private operation of the facility is more efficient than public provision. There is no evidence base to support this supposition: the PFI policy is based on hope rather than experience. A leader in this week's issue, by Prof Alan Maynard and Diane Dawson, expresses scepticism about the initiative, saying PFI creates genuine risk for the NHS that needs monitoring and evaluating and that the Treasury admits there is no central system for monitoring or control.

Contact:

Prof Alan Maynard
Secretary

Nuffield Provincial Hospitals Trust,
London W1M 7RD

Tel: 0171 485 6632/3
or

Diane Dawson
Research fellow

Corpus Christi College
University of Cambridge
CB2 1RH

Tel: 01223 337147
Fax: 01223 337130

DEBATE ON RESALE PRICE MAINTENANCE CONTINUES

[Letters. Resale price maintenance on medicines]

The debate about ending the resale price maintenance on medicines (where retailers cannot sell an item at a price below that recommended by the manufacturer) continues on the letters pages of the BMJ this week.

Supermarket giant Asda argue that 8,000 GPs and other health professionals have so far supported their campaign to end the resale price maintenance. They argue that "price matters" and in opposing resale price maintenance they are responding to customers needs. The Royal Pharmaceutical Society, on the other hand, is opposed to the move arguing that medicines like paracetamol are not "mundane products" and cannot be put into the same category as detergents and breakfast cereals. They say prices of medicines in Britain are kept low by competition and are widely available in pharmacies where their sale can be accompanied by sound advice from pharmacists.

Contact:

Archie Norman
Chief executive

Asda Group
Leeds LS11 5AD

Tel: 0113 243 5435
Fax: 0113 241 8666

or

John Ferguson

Secretary
Royal Pharmaceutical Society
London SE1 7JN

Tel: 0171 735 9141
Fax: 0171 735 7629

EMBARGO: 00.01 HRS FRIDAY 9 AUGUST 1996

Issued by: Public Affairs Division, British Medical Association, BMA House, Tavistock Square, London, WC1H 9JP Telephone: 0171 383 6254, (between 08.30 - 18.00), (After 6pm & at weekends): 01895 23 96 87, 01491 65 14 05, 01483 42 77 93

PLEASE STATE THE BMJ AS THE SOURCE OF ALL ARTICLES USED

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