bmj.com -- Press Releases

Press Releases Saturday 30 January 1999
No 7179 Volume 318

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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

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�.