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(1) COMBINATION
NICOTINE REPLACEMENT THERAPIES ARE
THE MOST EFFECTIVE MEANS TO QUIT SMOKING
(2) STUDY
CONFIRMS MULTIPLE ILLNESSES CAUSE ILL HEALTH
IN GULF VETERANS
(3) STAFFING
CRISIS TO BE CAUSED BY RETIRING ASIAN GPs:
STATISTICAL EVIDENCE
(4) VIAGRA
PRESCRIBING WILL BE BASED ON FINANCIAL
RATHER
THAN CLINICAL REASONING
(1) COMBINATION
NICOTINE REPLACEMENT THERAPIES ARE
THE
MOST EFFECTIVE MEANS TO QUIT SMOKING
(Nicotine nasal spray with nicotine
patch for smoking cessation: randomised
trial with six year follow up)
http://www.bmj.com/cgi/content/full/318/7179/285
Combined methods of nicotine
replacement therapy are more effective than
using just one, says a study in this week�s
BMJ. Dr Thorsteinn Blondal and
colleagues from National
University Hospital in Iceland, along with
researchers from Pharmacia
and Upjohn in Sweden, found that patients
combining the use of nicotine patches
with nicotine nasal sprays were twice
as likely to still be abstaining
from smoking after five years than those
who had only used patches.
In their study of
237 smokers over a six year period, the authors found
that using a nicotine patch for
five months in conjunction with a nicotine
nasal spray and then continuing
to use the spray only for a further seven
months, was the most effective way
of stopping smoking. They believe that
this is because the patches
release nicotine slowly, with the nasal spray
delivering nicotine more rapidly,
as and when the smoker needs to respond
to any smoking urges.
Blondal et al conclude that by providing
nicotine in several combinations,
abstinence rates after
six years can be double those of using a single
method of nicotine replacement.
Contact:
Dr Thorsteinn Blondal,
Chest Physician,
Reykjavik Health Care Centre,
National University Hospital, Iceland
email: thorsteinn.blondal{at}hr.is
(2) STUDY CONFIRMS MULTIPLE
ILLNESSES CAUSE ILL HEALTH
IN GULF VETERANS
(Clinical findings of
the first 1000 Gulf War veterans in the Ministry of
Defence�s medical assessment
programme)
http://www.bmj.com/cgi/content/full/318/7179/290
(Gulf War syndrome.
There may be no specific syndrome, but troops suffer
after most wars)
http://www.bmj.com/cgi/content/full/318/7179/274
In this week�s BMJ, physicians working
in the Ministry of Defence�s Medical
Assessment Programme describe
their independent clinical findings on Gulf
War veterans coming forward
for assessment. These findings confirm other
recent work that suggests
no single physical or psychological cause is
responsible for the illnesses seen
in some Gulf War veterans. The authors
speculate that this
pattern of illness has been described after previous
conflicts and may be
another example of, what have been described as,
�postwar syndromes�.
Dr Bill Coker and
colleagues assessed 1000 Gulf War veterans who sought
medical treatment between October
1993 and February 1997. They found that
59 per cent of veterans had more
than one diagnosed condition; 39 per cent
had at least one condition for which no
physical or psychological diagnosis
could be given and
in nearly one in ten (nine per cent) patients, no
diagnosis could be made.
The conditions that were reported by veterans
were characterised by fatigue
in a quarter of cases
(24 per cent). At least one in five (19 per cent)
patients had psychiatric
conditions, of which half were attributable to
post-traumatic stress disorder.
Musculoskeletal disorders and respiratory
conditions were also found to be
relatively common (18 per cent and 16 per
cent respectively).
The authors conclude
that from a clinical standpoint, the variety and
multiplicity of symptoms
make it unlikely that any single cause will be
found to underlie the ill
health described in some veterans. However, in
light of a recent
study, which found that active service has often been
associated with illnesses
occurring in the post-war period, Coker et al
speculate that some
of the illnesses experienced by veterans
may be
explained by the phenomenon of �postwar
syndromes�.
In an accompanying editorial,
Dr Frances Murphy from the Department of
Veterans Affairs in
Washington agrees that although Gulf War veterans�
illnesses are real and can be disabling,
they do not appear to constitute a
unique illness. Dr
Murphy concludes by calling for better proactive
prevention strategies to reduce the burden
of postwar illnesses.
Contact:
Martin Flanagan,
Ministry of Defence Press Office,
London
Dr Frances Murphy,
Chief consultant,
Occupational and Environmental Health,
Department of Veterans Affairs,
Washington DC, USA
e-mail: murfra{at}mail.va.gov
(3) STAFFING CRISIS
TO BE CAUSED BY RETIRING ASIAN GPs:
STATISTICAL
EVIDENCE
(Retrospective analysis
of census data on general practitioners
who
qualified in South Asia: who will
replace them as they retire?)
http://www.bmj.com/cgi/content/full/318/7179/306
There has been a lot
of anecdotal evidence about the potential workforce
problems which may be
caused by the retirement of South Asian general
practitioners who came to the UK to practice
in the 1960s and 70s. In this
week�s BMJ Professor
Donald Taylor from Duke University in the US and
Professor Aneez Esmail from
Harvard Medical School report that one in six
(4,192 of 25, 333)
GPs currently practising in the NHS, qualified in a
South Asian medical school,
of whom two thirds are likely to have retired
by 2007.
Because there is a
large variation in the geographical distribution of
these doctors (ranging
from 0.9 per cent in Somerset to 55 per cent in
Barking and Havering)
Taylor and Esmail report that the impact of the
retirement of South
Asian doctors will be felt disproportionately. They
also note that the
areas in which these doctors are practising
are
concentrated in inner cities,
with large list sizes and a large number of
patients who generate deprivation
payments and therefore they believe that
the affected health authorities
will have the greatest difficulty filling
the vacancies.
The authors say that
owing to changes in the regulations of medical
licensure in the UK, doctors from South
Asian medical schools can no longer
be expected to fill
GP partnership posts in large numbers, if at all and
the promised increase in the number
of medical students will come too late
to have much impact on the potential recruitment
crisis. Taylor and Esmail
conclude that workforce
planners should be acting now to mitigate the
impact of South Asian retirements,
with a particular emphasis on debating
and making broad policy
decisions related to the immigration of doctors.
Contact:
Dr Aneez Esmail,
Head of School of Primary Care,
University of Manchester
email: aesmail{at}man.ac.uk
or
Professor Donald Taylor,
Assistant Research Professor,
Center for Health Policy,
Law and Management,
Duke University, Durham, USA
email: dtaylor{at}hpolicy.duke.edu
(4) VIAGRA PRESCRIBING
WILL BE BASED ON FINANCIAL RATHER
THAN
CLINICAL REASONING
(Viagra: a botched test case for
rationing. If it leads to a proper debate
over rationing the decision
on sildenafil will not be all bad)
http://www.bmj.com/cgi/content/full/318/7179/273
The secretary of state�s
proposals for the introduction of sildenafil
(Viagra) may be rationing but they
are not rational, says Dr John Chisholm
in an editorial in this week�s BMJ.
In dressing up a rationing decision as
a clinical one, the secretary
of state has ended up with the worst of all
possible worlds: a decision
that makes no sense on clinical, equity or
cost-effectiveness grounds. After months
of uncertainty over how sildenafil
would be made available
on the NHS, Dr Chisholm suggests that these
proposals may lead to a long-awaited public
debate about NHS rationing.
The secretary of state has effectively
admitted that the government can no
longer fund an
NHS according to its founding
principles of
comprehensiveness, universality
and access based on need, but has made a
decision that will at
least ensure consistent access across the UK.
Although the BMA has
campaigned vigorously for increased NHS funding, it
has also stated that if the
government and taxpayers do not provide these
financial resources, the
government should explicitly state what the NHS
can and cannot provide, rather
than �leaving such decisions to individual
doctors or to the accident of where patients
live�.
Contact:
Dr John Chisholm,
Chairman General Practitioners Committee,
via the BMA Press Office
email: pressoffice{at}bma.org.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;pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)