bmj.com -- Press Releases

Press Releases Saturday 01 August 1998
No 7154 Volume 317

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the source BMJ article (URLs are given under titles).

(1) PAYING FOR THE RIGHT ANSWERS: SHOULD INDUSTRY SPONSOR RESEARCH?

(2) PASSING OVER THE EVIDENCE ON PASSIVE SMOKING?

(3) COGNITIVE BEHAVIOUR THERAPY REDUCES PSYCHOTIC SYMPTOMS

(4) CRIME AND POVERTY ARE CAUSES OF HEALTH CRISIS IN RUSSIA

(5) SHIFT IN CARE OF ELDERLY IS FALLING ON SHOULDERS OF GPS

(1) PAYING FOR THE RIGHT ANSWERS:
SHOULD INDUSTRY SPONSOR RESEARCH?

This week�s BMJ focuses on the debate about "conflict of interest"
within the world of medical research - should industry (such as the
tobacco, alcohol and infant formula manufacturers) sponsor research
or educational material? Can the results of studies be scientifically
robust or are they inevitably tainted if they have been funded by a
company with a vested interest in the results?

Dr Christopher Proctor is a high profile doctor who works for
British American Tobacco, defending the tobacco industry�s
position amidst the ever increasing anti-tobacco lobby. This
week�s BMJ carries an interview with him in which he answers
the question "Haven�t you sold your soul to the devil?".

In the Education and Debate section doctors, researchers and pressure
groups argue the pros and cons of industry funded research and among
this week�s letters are several that consider the evidence for and
against the link between smoking and the risk of lung cancer and heart
disease.

(Tobacco industry research: collaboration, not confrontation, is the best approach)
http://www.bmj.com/cgi/content/full/317/7154/333#resp1

(Tobacco company sponsorship discredits medical, but not all, research)
http://www.bmj.com/cgi/content/full/317/7154/333#resp2

Professor Tim Sorell of the University of Essex writes that "as soon as the
source of the funding is known the research is discredited. The tobacco
industry has only itself to blame...". He argues that a strategy of scientific
publication to raise questions rather than answer them has been adopted
by the tobacco industry to try and discredit evidence of a health risk from
smoking. Professor Sorell concludes that a particularly troubling example is
the funding of leisure research by BAT, which "...seems calculated to
associate smoking with an area of life in which smoking may be made to
seem (incorrectly) to be a harmless occasional indulgence rather than a
health hazard".

Dr Christopher Proctor, who is head of science and regulation at British
American Tobacco defends industry involvement in research and writes
that British Governments have supported the industry funding of
biomedical research, which has led to a greater understanding of
smoking behaviour and mechanisms of disease. The author stresses,
however, that "...science is yet to ascertain precise biological mechanisms
whereby prolonged exposure to constituents of tobacco smoke causes
[...]diseases...".

Dr Proctor argues against the claim that funded research may be "presented
in a skewed manner" by underlining the value of the peer review process
(whereby published research is checked over by a third party) and
highlighting the trust that we must always place in the integrity of scientific
researchers. (See also interview with Dr Proctor in the News Section of
this week�s BMJ).

Contact:

Dr Christopher Proctor, Head of Science and Regulation, British American
Tobacco, Millbank, Knowle Green, Staines, Middlesex
email: Christopher_Proctor{at}britamtob.com

Professor Tim Sorell, Professor of Philosophy, University of Essex,
Wivenhow Park, Colchester
email: tsorell{at}essex.ac.uk

(Condemning the drinks industry rules out potentially useful research)
http://www.bmj.com/cgi/content/full/317/7154/333#resp3

(If the drinks industry does not clean up its act, pariah status is inevitable)
http://www.bmj.com/cgi/content/full/317/7154/333#resp4

Professor Hurst Hannum from Tufts University in the US says that the
"...condemnation of the drinks industry and [...] elimination of potentially
useful research because of moralistic ideology should be rejected by
anyone who claims to serve the interests of science." He argues that almost
all funding comes with "strings attached" and he ponders whether funding
from the drinks industry should be "...any more corrupting than money
from the pharmaceutical, food, car or chemical industries, each of which
also has profit making as its primary corporate goal". The author states
that the response to concerns about funding should not be to prohibit
research, but instead to develop ethical principles to protect the integrity
of donors and recipients - such as those that have been established in the
Principles of Cooperation among the Beverage Alcohol Industry,
Governments, Scientific Researchers and the Public Health Community.

Griffith Edwards from the National Addiction Centre in London writes that
the drinks industry is in danger of joining the tobacco industry in "pariah status".
He says that the multinational drinks industry is "targeting young people with
alcopops" and denying research evidence "in a way highly reminiscent of the
tobacco manufacturers". Funding from the drinks industry should therefore
only be taken by researchers at arm�s length.

Contact:

Professor Hurst Hannum, Professor of International Law, Fletcher School of
Law and Diplomacy, Tufts University, Medford, MA 02155, USA
email: hannum{at}tufts.edu

Professor Griffith Edwards, Editor in Chief, Addiction,
National Addiction Centre, London
email: spjepad{at}iop.bpmf.ac.uk

(Collaborative research with infant formula companies should not always be censored)
http://www.bmj.com/cgi/content/full/317/7154/333#resp5

(How much research in infant feeding comes from unethical marketing?)
http://www.bmj.com/cgi/content/full/317/7154/333#resp6

"The real conflict is that some still contend that manufacturers of infant formula
damagingly compete with breast feeding [...] and that company affiliations
affect the independence of health professionals. The counter view is that formula
manufacturers [...] answer a clinical need," argues Professor Alan Lucas of the
Institute of Child Health. He argues that research into infant nutrition is fast
moving and thus requires substantial investment. He believes that formula
companies "...provide a critical contribution to infant health care, health
education and high quality research."

On the other hand, Patti Rundall concludes that the world is facing many
nutritional problems and "...if sustainable solutions are to be found,
surely it is imperative that adequate public funds are set aside for this
purpose - instead of money that has already be allocated for an entirely
different purpose, namely marketing. "

Contact:

Professor Alan Lucas, MRC Childhood Nutrition Research Centre,
Institute of Child Health, London
email: a.lucas{at}ich.ucl.ac.uk

Patti Rundall, International and Policy Co-ordinator, Baby Milk Action,
St Andrew�s Street, Cambridge
email: babymilkacti{at}gn.apc.org

(Moving beyond conflict of interest. Progress is painfully slow)
http://www.bmj.com/cgi/content/full/317/7154/291

In an editorial in this week�s BMJ, editor Dr Richard Smith considers the
issue of conflict of interest and cites examples relating to research published
on tobacco related diseases by researchers affiliated to the tobacco
industry. In response to this growing problem and potential reasons for
non-disclosure, Dr Smith announces that from hereon in the BMJ will
abandon the term "conflict of interest" and instead talk about "competing
interests", which will relate to purely financial matters. Authors of papers,
editorials and review articles to be published in the BMJ, will be asked to
complete and sign a questionnaire and asked it they have competing interests
- if they say they have none then the BMJ will write "none declared" at the
end of the piece concerned. If it is subsequently found that authors had competing
interests then readers will be told.

Contact:

Dr Richard Smith, c/o Jill Shepherd, Press Office, BMJ,
BMA House, Tavistock Square, London
email: jshepherd{at}bma.org.uk

(2) PASSING OVER THE EVIDENCE ON PASSIVE SMOKING?

(Passive smoking and heart disease)
http://www.bmj.com/cgi/content/full/317/7154/344

(Passive smoking and lung cancer)
http://www.bmj.com/cgi/content/full/317/7154/346

(The hot air on passive smoking)
http://www.bmj.com/cgi/content/full/317/7154/348

A cluster of letters in this week�s BMJ respond to two studies published in the
BMJ in the 18 October 1997 edition, written by Law, Morris and Wald, into
the effects of passive smoking on heart disease and by Hackshaw, Law and
Wald into its effects on lung cancer. The letters argue that in their meta-analysis
the authors disregarded results that did not agree with their interpretation of the
data. In return, the authors of the studies respond to the accusations.

Contact:

(Authors need to analyse same data)
http://www.bmj.com/cgi/content/full/317/7154/344#resp1

Maurice LeVois, Senior Scientist, Layard and Associates,
2241 SanAntonio Avenue, Alameda, CA 94501 USA

(Evidence on passive smoking and heart disease needs re-evaluation)
http://www.bmj.com/cgi/content/full/317/7154/344#resp2

Peter Lee, Independent Consultant in Statistics and Epidemiology, Sutton, Surrey
email: peterlee{at}pnlee.demon.co.uk

(There must be better uses for money spent on vilifying passive smoking)
http://www.bmj.com/cgi/content/full/317/7154/344#resp3

Dr K W E Denson, Director,
Thame Thrombosis and Haemostasis Research Foundation,
Thame, Oxfordshire
email: kdenson{at}cix.co.uk

(Author�s Reply)
http://www.bmj.com/cgi/content/full/317/7154/344#resp4

Professor Malcolm Law, Reader, Department of Environmental
and Preventive Medicine, Wolfson Institute of Preventive Medicine,
St Bartholomew�s and the Royal London School of Medicine
and Dentistry, London

(Strength of evidence on passive smoking and lung cancer is overstated)
http://www.bmj.com/cgi/content/full/317/7154/346#art

Peter Lee, as above

(Risk Extrapolation overestimates risk)
http://www.bmj.com/cgi/content/full/317/7154/346#resp1

Gerhard Scherer, Biochemist, Analytisch-biologisches Forchungslabor,
D-80336, Munich, Germany

(Accumulated evidence on lung cancer and environmental tobacco smoke)
http://www.bmj.com/cgi/content/full/317/7154/346#resp2

Fredrik Nyberg, Resaercher, Division of Environmental Epidemiology,
Institute of Environmental Medicine, Karolinska Institute,
Stockholm, Sweden
email: fredrik.nyberg{at}imm.ki.se

(Author�s Reply)
http://www.bmj.com/cgi/content/full/317/7154/346#resp3

(Experts who evaluated studies seem not to have had relevant experience)
http://www.bmj.com/cgi/content/full/317/7154/348#art

Benoit Nemery, Professor, Katholieke Universiteit Leuven,
Department of Occupational Medicine
and Division of Pneumology, Leuven, Belgium

(American Tobacco has not tried to discredit data on passive smoking)
http://www.bmj.com/cgi/content/full/317/7154/348#resp1

Dr Christopher Proctor, Head of Science and Regulation,
British American Tobacco, Millbank, Knowle Green,
Staines, Middlesex
email: Christopher_Proctor{at}britamtob.com

(3) COGNITIVE BEHAVIOUR THERAPY REDUCES PSYCHOTIC SYMPTOMS

(Randomised controlled trials of intensive cognitive behaviour therapy for
patients with chronic schizophrenia)
http://www.bmj.com/cgi/content/full/317/7154/303

Despite the development of drug treatments, schizophrenia remains a
debilitating disorder. In this week�s BMJ, Professor Nicholas Tarrier from
the Department of Clinical Psychology at the University of Manchester
and colleagues, report on their study to ascertain the success of cognitive
behaviour therapy (a method of treating mental disorders based on the
concept that the way we perceive the world and ourselves influences
our emotions and behaviour).

The authors found that, compared with supportive counselling and routine
care, there was a greater reduction in psychotic symptoms in patients
receiving cognitive behaviour therapy, although supportive counselling
was also effective, but to a lesser extent. They conclude that further
research needs to be done to ascertain whether the benefits can be
maintained and psychological treatments can be used to treat acutely
ill patients.

Contact:

Professor Nicholas Tarrier, Department of Clinical Psychology,
School of Psychiatry and Behavioural Sciences,
University of Manchester, Withington Hospital, Manchester
email: ntarrier{at}fs1.with.man.ac.uk (best method of contact)

(4) CRIME AND POVERTY ARE CAUSES OF HEALTH CRISIS IN RUSSIA

(Economic change, crime and mortality crisis in Russia:
regional analysis)
http://www.bmj.com/cgi/content/full/317/7154/312

The scale of the health crisis facing the Russian people in recent years
is now well recognised - life expectancy in Russia fell by over five years
between 1990 and 1994. In this week�s BMJ Professor Martin McKee
from the European Centre on Health of Societies in Transition at the
London School of Hygiene and Tropical Medicine, along with colleagues
from Sweden and Russia, report that the decline in life expectancy in
Russia cannot be attributed solely to impoverishment.

The authors surprisingly found that the greatest falls in life expectancy
have been in some of the wealthiest regions and they argue that much
of the deterioration can be explained by labour force turnover, crime
rates (which indicate a breakdown in social cohesion) and income
inequality. Professor McKee et al also believe that alcohol is a major
factor in many of the additional deaths. They conclude that understanding
changes in mortality in central and eastern Europe during the transition
(following the collapse of communism) may shed light on some of the
determinants of health in the Western World.

Contact:

Professor Martin McKee,
European Centre on Health of Societies in Transition,
London School of Hygiene and Tropical Medicine,
London
email: m.mckee{at}lshtm.ac.uk

(5) SHIFT IN CARE OF ELDERLY IS FALLING ON SHOULDERS OF GPS

(The impact on general practitioners of the changing balance of care
for elderly people living in institutions)
http://www.bmj.com/cgi/content/full/317/7154/322

The number of institutional care places for elderly people in Britain
doubled to 563,000 between 1980 and 1995, with NHS beds
accounting for less than ten per cent of the total by the end of this
period. In this week�s BMJ Shane Kavanagh from the University
of Kent and Martin Knapp from the London School of Economics
consider the impact that this shift is having on general practice.
They find that the declining provision of NHS long term care for
elderly people has increased the workload of family doctors and
the predicted increase in demand for general practitioners in Britain
to cope with the transition in the future is equivalent to 160 full time
doctors.

Contact:

Mr Shane Kavanagh, Research Fellow, Personal Social Services,
Research Unit, University of Kent, Canterbury, Kent
email: S.M.Kavanagh{at}uk.ac.uk

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;jshepher{at}bma.org.uk)

and from:

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Advancement of Science
(http://www.eurekalert.org)