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Press Releases Saturday 10 October 1998
No 7164 Volume 317

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(1) DOBSON MUST QUIT DENIAL OF RATIONING

(2) HOW DO WE ASCERTAIN OUR PRIORITIES IN HEALTH CARE?

(3) CELEBRITY DEATHS FROM DISEASE CAN CAUSE PUBLIC ANXIETY

(4) PREVENTING SUICIDE IN PATIENTS WITH STROKE

(5) DOES INITIAL MANAGEMENT AFFECT THE RATE OF REPETITION OF
DELIBERATE SELF HARM? COHORT STUDY

(6) MILBURN�S MOVE WILL UNDERMINE THE GENERAL MEDICAL COUNCIL

To coincide with the second international conference on priorities in health
care (8-10 October 1998 in London), this week�s BMJ publishes a series
of papers to be presented at the conference, each illustrating in a different
way how priority setting in health care has developed over recent years.

(1) DOBSON MUST QUIT DENIAL OF RATIONING

(Puzzling out priorities. We must acknowledge that rationing
is a political process)
http://www.bmj.com/cgi/content/full/317/7164/959

In his editorial in this week�s BMJ Professor Rudolf Klein from the King�s
Fund calls on the British government to acknowledge that setting priorities
in health care is inescapably a political process. He argues that Frank
Dobson, the Secretary of State for Health, will only make himself "look
foolish and undermine his credibility" if he continues to ban the word from
ministerial vocabulary. Professor Klein writes that once the inevitability
of rationing is finally accepted "we can get down to the serious business
of discussing how to devise the appropriate mechanisms... involved".

The author proposes that a National Council for Health Care Priorities
would provide a forum and a focus for the rationing debate in the UK.
However, he ponders the role of such a body and concludes that this
reflects the general dilemma about how to develop the way we think
about rationing, which in turn reinforces the case for more debate.
He believes that rationing decisions, no matter who they are made by,
should have to pass the test of being reasonable (whereby most people
would regard them as being relevant and fair, without necessarily
agreeing with the decision).

Contact:

Professor Rudolf Klein, Senior Associate, King�s Fund, London

(2) HOW DO WE ASCERTAIN OUR PRIORITIES IN
HEALTH CARE?

(The second phase of priority setting)
http://www.bmj.com/cgi/content/full/317/7164/1000

Drawing on his own experiences, in this week�s BMJ Professor Jim
Sabin from Harvard Medical School writes a moving account of the
quandary clinicians find themselves in when involved in a rationing
process. He believes that patients are able to understand the need
for priority setting if the case is presented simply and honestly to
them. By using simple common sense terms that make fundamental
human sense, the author says that patients can understand the
concept of rationing just as they can understand interrupting their
appointment to tend to an emergency with another patient.

Sabin concludes that resolving the inherent conflict between acting
for the good of the individual and acting for the benefit of the
community requires more of the heart than the brain. He believes
that the US experience of rationing to date has been adversarial
and argues that patients and society need clinicians and managers
to join with them in deliberating about solutions to "this painful but
ultimately unavoidable conflict of the heart".

In his paper Dr Søren Holm from the University of Copenhagen
describes how priority setting in Scandinavia has passed through
two phases. He explains that the first phase was based on the idea
that it is possible to devise a rational priority setting system that
will produce legitimate decisions. The second stage realised that
the concept of devising a simple set of rules to govern rationing is
fundamentally flawed. He concludes that current thinking is now
focussed on the priority setting process itself and methods to
ensure its transparency.

Dr David Chinitz et al report that Israel�s 1995 National Health
Insurance law included an explicit rationing process which, under
pressures for cost control, was carried out implicitly. Their analysis
of the development of this process concludes that explicit and
implicit approaches to rationing and priority setting are not exclusive
alternatives but rather complementary tools which support each other.

Contacts:

The following authors will all be in London from 8 - 10 October at
the second international conference on priorities in health care and
contactable through Jill Shepherd in the BMJ press office
email: jshepherd{at}bma.org.uk

Professor Jim Sabin, Associate Clinical Professor of Psychiatry,
Centre for Ethics in Managed Care, Harvard Pilgrim Health Care
and Harvard Medical School, Boston, USA
email: Jim_Sabin{at}HPHC.org

Dr Søren Holm, Department of Medical Philosophy
and Clinical Theory, University of Copenhagen, Denmark

Dr David Chinitz, Lecturer, Hebrew University-Hadassah,
School of Public Health, Jerusalem, Israel

(3) CELEBRITY DEATHS FROM DISEASE CAN CAUSE
PUBLIC ANXIETY

(Celebrity�s death from cancer resulted in increased
calls to CancerBACUP)
http://www.bmj.com/cgi/content/full/317/7164/1016

The death of a celebrity from a disease can cause the public to face up
to their own mortality, which can lead them to seek emotional support
and reassurance, say CancerBACUP and researchers from the Royal
Free NHS Trust and the Cancer Public Health Unit at the London
School of Hygiene and Tropical Medicine.

In their letter in this week�s BMJ the authors report that people were
substantially affected by the death of Linda McCartney in April of this
year. The daily calls to the CancerBACUP telephone information
service about breast cancer rose by 64 per cent at the time of Ms
McCartney�s death. The authors conclude that the death of a celebrity
from a disease which is so publicly explored, may well force women
to face their own mortality. They say that, perhaps, no matter how
well a woman copes with a diagnosis of breast cancer, anxiety is
never far from the surface.

Contact:

Anne-Marie Jones, Press Officer, CancerBACUP, London
email: amj{at}cancerbacup.org

Jean Mossman, Chief Executive, CancerBACUP, London
email: jean{at}cancerbacup.org

(4) PREVENTING SUICIDE IN PATIENTS WITH STROKE

(Depression may be caused by symptoms affecting lower
urinary tract)
http://www.bmj.com/cgi/content/full/317/7164/1016/b

It is well known that stroke patients are prone to depression and this
can sometimes lead to suicide. In this week�s BMJ, Ms Katherine
Brittain and Professor Mark Castleden from Leicestershire claim that
stroke survivors with urinary symptoms (such as incontinence) are
twice as likely to report depression than stroke survivors without them.
They argue that symptoms affecting the lower urinary tract should not
be discounted when assessing survivors of stroke in the community
because they can be treated and this could help reduce cases of
depression and therefore suicide.

Contact:

Ms Katherine Brittain, Research Associate,
Division of Medicine for the Elderly, University of Leicester
email: krb{at}leicester.ac.uk

(5) (Does initial management affect the rate of repetition of
deliberate self harm? Cohort study)
http://www.bmj.com/cgi/content/full/317/7164/985

Patients who inflict self harm and discharge themselves from hospital
before they have undergone a psychiatric assessment are more likely
to repeat their actions, says a report in this week�s BMJ. The authors,
Dr Mike Crawford and Professor Simon Wessely, studied 308 cases
of patients inflicting self harm in the region of Southwark, south London,
over a period of 18 months. 54 of these patients repeated self harm
within this period. The authors conclude that their findings emphasise
the importance of optimising the psychosocial management of self
harm patients by staff in A & E departments during the initial stages
of treatment. They also believe there is a need for further understanding
of the reasons why so many patients choose to discharge themselves
from hospital before their treatment is complete.

Contact:

Dr Mike Crawford, Research Fellow, Section of Epidemiology
and General Practice, Institute of Psychiatry, London
email: sphamjc{at}iop.bpmf.ac.uk

(6) MILBURN�S MOVE WILL UNDERMINE THE GENERAL
MEDICAL COUNCIL

(Repositioning self regulation. The influence of the GMC
is leaking away)
http://www.bmj.com/cgi/content/full/317/7164/964

In an editorial in this week�s BMJ, editor Dr Richard Smith writes that
the timing of British government�s proposal to modify the legislative
procedure governing professional regulatory bodies is suspicious. The
announcement has been made with little or no consultation with the
profession. The author believes that in the wake of the Bristol case
and in advance of the public enquiry next year, the government is
strengthening its ability to respond to any public outrage, by quickly
changing the legislation governing the General Medical Council (GMC).
Dr Smith concludes that even though the government insists that its
proposals are benign and simply a "tidying up exercise" of a lengthy
process, the temptation to use the new legislation in the future to
reduce the power of the GMC "may one day prove irresistible".