Press Releases Saturday 30 January 1999
No 7179 Volume 318

Please remember to credit the BMJ as source when publicising an
article and to tell your readers that they can read its full text on the
journal's web site (http://www.bmj.com).

If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).


(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)
 
 




Access jobs at BMJ Careers
Whats new online at Student 

BMJ