BMJ Press Releases, Saturday 30 November 1996
Volume 313 No 7069

EMBARGO: Friday 29 November 00.01

CAFETIERE COFFEE AND CORONARY RISK

[Comparison of effect of cafetiere and filtered coffee on serum concentrations of liver aminotransferases and lipids: six months randomised controlled trial]
Five or six cups of strong cafetiere coffee a day have an effect on a liver enzyme for at least six months and raise potentially harmful cholesterol concentrations, but filter coffee has no effect, claims a paper in this week's BMJ.

In a randomised controlled study, Rob Urgert and colleagues from Wageningen Agricultural University, The Netherlands, studied the effects of prolonged intake of cafetiere coffee on serum concentrations of alanine aminotransferase (a liver enzyme) and LDL ('bad') cholesterol, and found that both of these were raised. Serum concentrations were still raised after six months of daily intake of strong cafetiere coffee, but filter coffee had no effect. The authors predict that the cafetiere findings would also apply to Turkish coffee, but instant and percolated coffee would have negligible effects because of their low concentrations of the key substances "cafestol" and "kahweol". A devotee of Italian espresso coffee would need to drink about 25 cups a day to get the same effect as five to six cups of strong cafetiere coffee - because of the small espresso cup sizes.

The increase in liver enzyme activity could be innocuous, say the authors, but the increase in cholesterol concentration may increase coronary risk and could be a reason to drink filtered coffee. Contact:
Dr Rob Ugert
Tel: (w) 0031 317 484 298
Tel: (h) 0031 317 413 509
Fax: 0031 317 483 342
e-mail: rob.urgert@et3.voed.wau.nl

CAFFEINE AND PREGNANCY

[Relation of caffeine intake and blood caffeine concentrations during pregnancy to fetal growth: prospective population based study]

A separate paper , Dr Derek Cook and colleagues examines the effects of caffeine intake during pregnancy on fetal growth. In a study of 1500 women attending St. George's Hospital, they found, although intake did not change, blood caffeine concentrations rose by 75 per cent during pregnancy. Cigarette smokers in the study consumed 50% more caffeine than non-smokers, but metabolised it faster, resulting in lower blood concentrations.

Although blood caffeine concentrations during pregnancy showed no association with birth weight, a higher caffeine intake was associated with lower birth weight among cigarette smokers. It seems reasonable, say the authors, to advise women who smoke to reduce their caffeine intake as well as stop smoking during pregnancy.

Contact:
Dr Derek Cook
Tel: 0181 725 5490
Fax:0181 725 3584
e-mail: d.cook@sghms.ac.uk

UNETHICAL BEHAVIOUR BY ETHICS COMMITTEES

[Are research ethics committees behaving unethically? Some suggestions for improving performance and accountability]

Research ethics committees are behaving unethically by approving proposals for unnecessary research and failing to insist that even disappointing results are published. Julian Savulescu of the Clinical Ethics Project at Oxford Radcliffe Hospitals, Iain Chalmers Director of the UK Cochrane Centre and Jennifer Blunt of Salford and Trafford Health Authority, writing in the BMJ, propose some suggestions for improving the accountability of research ethics committees.

The authors argue that patients may be denied treatment which has already been shown to be effective because they are put into unnecessary further placebo controlled trials. They also warn that if research ethics committees do not insist on publication, patients may be expected to accept the harmful side effects of ineffective forms of care simply because a research study has proved disappointing or embarrassing to its sponsors.

Contact:
Dr Julian Savulescu
Tel: 01865 222621
Fax:01865 222777
e-mail: julian.savulescu@philosophy.ox.ac.uk

or Jennifer Blunt
Tel: 0161 766 5197

USING HUMAN TISSUE FOR RESEARCH

[Ownership and uses of human tissue: Does the Nuffield bioethics report accord with opinion of surgical inpatients?]
Patients are generally happy to allow tissue removed during their treatment to be used for medical education, treatment and research according to a Sheffield research team reporting in this week's BMJ. This means that patients' views are in harmony with recommendations from the Nuffield Council of Bio-ethics that such tissue should be viewed as "abandoned". Its potential use should be explained to patients and included in the general patient consent procedures for medical and surgical treatment.

The research team questioned 384 post-operative surgical patients and found that one third believed that the hospital owned any tissue which was surplus to sampling requirements. A similar number thought that no one owned the tissue and a minority, 37 patients, thought that they had personal ownership. Even those who thought they owned their tissue were likely to support its use in teaching and research. Many respondents believed that the proper use of the tissue was more important than who owned it.

Contact:
Dr Simon Cross
Tel: 0114 271 2683
Bleeper 538 at 0114 271 1900
Fax: 0114 278 0059
e-mail: s.cross@sheffield.ac.uk

TELEMEDICINE: A CAUTIOUS WELCOME

Face to face contact is fundamental to health care and telemedicine is never likely to be as good as the real thing, says an article in this week's BMJ. Nevertheless, telemedicine has the potential to produce major efficiencies in the diagnostic process . The aim should be producing a system that delivers an acceptable service at an appropriate price.

Obvious examples of the value of telemedicine - eg when doctor and patient are in different places - are emergencies in remote places, on ships, aircraft or on the battlefield. But it has useful applications even in urban situations: South Westminster Health Centre, London, effected savings when it installed a telemedicine link in its minor injuries clinic. Professor Richard Wootton, Director of the Institute of Telemedicine and Telecare at Belfast City Hospital, warns of the danger of commercial pressures and unbridled curiosity forcing the widespread introduction of telemedicine before the time is right.

Contact:
Prof Richard Wootton
Tel:01232 263 596
Fax:01232 238 400
e-mail: r.wootton@qub.ac.uk

NO EVIDENCE OF WIDESPREAD INAPPROPRIATE PRESCRIBING

[Prevalence of potentially inappropriate long term prescribing in general practice in the UK, 1980-95: systematic literature review]

There is no evidence of widespread inappropriate prescribing in general practice according to a paper in this week's BMJ. A review of studies spanning 15 years says that though such prescribing has occurred, the scale of the problem is unknown and the evidence base to support allegations of such practice on a large-scale is unsound. The authors conclude that contrary to the claims of the Audit Commission, the scope for cost savings and effectiveness gains is unknown. Indicators applicable to individual patients could yield evidence of prescribing appropriateness.

Contact:
Dr Stephen Buetow
Tel: 0161 275 7602
Fax: 0161 275 7600
e-mail: sbuetow@fs1.cpcr.man.ac.uk

EMBARGO: 00.01 HRS FRIDAY 29 NOVEMBER 1996

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