eBMJ -- Press Releases

BMJ Press Releases, Saturday 9 November 1996
Volume 313 No 7066

EMBARGO: Friday 8 November 00.01

On probation
[Newly licensed drugs: editorial]

A probation period for newly licensed drugs during which they would be scrutinised for side effects and relative efficacy before becoming available for all doctors to prescribe, is recommended in an editorial in this week's BMJ. In the same issue, a cluster of articles report on the performance of treatments such as Interferon beta 1b and the newer antiepileptic drugs.

Dr Robin Ferner Consultant Physician at City Hospital, Birmingham, writes: "More careful monitoring after a drug has been marketed would make it easier to detect 'rogue' drugs like benoxaprofen (Opren)."

Some newer drugs, like Interferon beta 1b used in Multiple Sclerosis treatment, are very expensive. Treatment for one patient costs around �10,000 a year. Dr Ferner writes :"The NHS should not be obliged to pay for new drugs unless they are at least as good as older ones, nor for expensive drugs whose benefits are uncertain. A good starting point would be a trial of the costs and benefits of interferon beta 1b before patients are exposed haphazardly to unknown risks, and before large sums of money are spent for poorly quantified benefits."

The newer antiepileptic drugs are cited by Dr Ferner as another example where licensed drugs "might have been treated more circumspectly by the NHS".

The Medicines Act 1968 set up a licensing authority that will grant a product license for a drug only if it is effective, safe and of good quality. Once licensed, a drug can usually be prescribed by any doctor under the NHS. Dr Ferner says this general use may be undesirable. Relative efficacy - how good the new drug is compared to other drugs - plays no part in licensing decisions.

Under a probation system for newly licensed drugs, the licensing authority would operate as before, but a separate decision would be needed for the medicine to be available within the NHS. Manufacturers will have to show on the basis of randomised clinical trials that the drug was at least as effective as standard treatments. The NHS might also want to see evidence of cost effectiveness, suggests Dr Ferner. Such a scheme would prevent drug companies "grabbing profits in the first few years after licensing."

Contact:
Dr Robin Ferner
Consultant Physician at Birmingham City Hospital

Other "new drugs" reports in this issue:
[Editorial: Interferon beta in multiple sclerosis]
[A purchaser experience of managing new expensive drugs: interferon beta] [New antiepileptic drugs: a systematic review of their efficacy and tolerability]
[Long term use of lamotrigine and vigabarin in severe refractory epilepsy: audit of outcome]

Removing the Queen's crest
[Letter: Queen should remove her crest from cigarette packets]

Many cigarette packets sold in Britain are adorned by the Queen's crest. Dr David Goldberg, a consultant in child and adolescent psychiatry, writing to the BMJ says the crest, coupled with the Government health warning, gives young people a mixed message about smoking: "The Queen supports some brands of cigarettes while her government opposes smoking of all brands."

Contact:
Dr David Goldberg

DEATH IN THE CIVIL SERVICE

[Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study]

A long term study of mortality in 18,000 male civil servants reported in this week's BMJ suggests that work itself - not just socioeconomic factors - may generate inequalities in health.

The study conducted by the International Centre for Health and Society at University College, London, looked at differences in death rates between men who were in high status and low status jobs. Grade of civil service employment was a strong predictor of death rates before retirement, with lower grades having higher mortality. The men were studied up to age 89 years, and, while the mortality differences persisted in retirement, they were less marked than other, non-work, measures such as car ownership.

Lack of ownership of a car was associated with a 57 per cent higher mortality before retirement and 34 per cent after retirement. Up to the age of 64, there was a 212 per cent higher mortality in the lowest civil service employment grades compared with the higher grades, but this difference was less marked after retirement. Nevertheless, post retirement there was still an 86 per cent higher mortality among men who had been in the lower grades compared with the top grades. The BMJ paper states: "Alongside other socio-economic factors, work itself may play an important part in generating social inequalities in health in men of working age."

Contact:
Professor M.G.Marmot
UCL Medical School

E-mail: ichs@publichealth.ucl.ac.uk

DIY samples reliable
[Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study]

Women at home can collect diy gynaecological samples (to be tested for a specific type of bacterial infection ) which are as good as samples taken by a doctor. This is one of the key messages of a Danish study reported in this week's BMJ.

Chlamydia trachomatis is a common, treatable, bacterial infection which although often without symptoms, can lead to fertility problems and other disorders. The diagnostic efficacy of samples obtained by women at home and mailed to the laboratory for examination was as good as for samples taken by a doctor.

Contact:
Dr Lars Ostergaard
Denmark

e-mail: segalt@post2.tele.dk

[Genital Chlamydia trachomatis infections in primary care]
[Postal survey of management of cervical Chlamydia trachomatis infection in English and Welsh general practices]

A study in Scotland, reported in the BMJ. Shows that only 13 per cent of patients diagnosed as infected with Chlamydia trachomatis were referred to a genitourinary medicine clinic (GUM) for treatment and contact tracing to prevent reinfection.. A further study in England and Wales shows that 30 percent of GPs would have referred a woman infected with this bacteria to a GUM clinic.

Contact:
Scotland:
Dr Jonathan Ross

England and Wales:
Dr Pippa Oakeshott

e-mail: poakeshott@SGHMS.ac.uk

GP practices in Lambeth - size and quality
[Catchment areas in general practice and their relation to size and quality of practice and deprivation: a descriptive study in one London borough]

A study of general practice catchment areas in Lambeth, London, reported in this week's BMJ showed large variations in size associated with variations in the quality of care: on average the quality of service was poorer in the larger catchment areas.

Sixty of the 71 general practices in Lambeth were included in the study. Catchment area size varied greatly between practices and substantial differences existed between practices in each of the four locally assigned quality bands. The weakest practices had catchment areas three times as large as those of the strongest practices. When corrected for medical staffing the difference was eight times as great.

Contact:
Clare Jenkins
John Campbell
Dept Gen Practice
United Medical Schools
Guys and St Thomas's Hospitals

E-mail: jls80umds.ac.uk

EMBARGO: 00.01 HRS FRIDAY 8 NOVEMBER 1996