bmj.com -- Press Releases

Releases Saturday 11 December 1999
No 7224 Volume 319

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(1) BUDGET FOR INTERFERON BETA FOR MS
SUFFERERS WOULD BE BETTER SPENT ON
IMPROVED SUPPORTIVE CARE

(2) HYPERICUM EXTRACT AS EFFECTIVE AS
COMMON ANTI-DEPRESSANT MEDICATION

(3) OVERREACTION TO PADDINGTON DISASTER
WILL ULTIMATELY DRIVE MORE PEOPLE ON TO
THE ROADS AND INCREASE DEATHS

(1) BUDGET FOR INTERFERON BETA FOR MS
SUFFERERS WOULD BE BETTER SPENT ON
IMPROVED SUPPORTIVE CARE

(Population based cost utility of interferon beta-1b in
secondary progressive multiple sclerosis)
http://www.bmj.com/cgi/content/full/319/7224/1529

Prescribing of the multiple sclerosis (MS) drug interferon
beta-1b should be restricted and the funds saved should be
redirected into improved supportive care for MS sufferers,
say researchers in this week's BMJ.

Dr Raeburn Forbes from Ninewells Hospital and Medical
School in Dundee along with colleagues from Argyll and
Clyde Health Board and the Scottish Health Purchasing
Information Centre studied 132 people with secondary
progressive multiple sclerosis and the estimated effect of
treating them with interferon beta-1b against existing best
practice without this drug.

Treating a patient with interferon beta-1b costs over £9,600 a
year, say the authors and in their study they find that this cost
would be high in the context of the duration and quality of life
gained owing to the modest clinical effects of the drug.

Forbes et al report that a recent trial showing the benefit from
interferon beta-1b in secondary progressive multiple sclerosis
sufferers has led to the call for the treatment to be made
available to all patients with that form of the disease. The
authors argue however that despite the need for improvement
in the care of people with MS, their analysis shows that
treatment with interferon beta-1b has a significant opportunity
cost and resources could probably be better spent on other
ways of improving quality of life for patients.

Contact:

Dr Robert Swingler, Consultant Neurologist, Department of
Neurology, Ninewells Hospital and Medical School, Dundee
Email: roberts@tuht.scot.nhs.uk

(2) HYPERICUM EXTRACT AS EFFECTIVE AS
COMMON ANTI-DEPRESSANT MEDICATION

(Hypericum extract versus imipramine or placebo in patients
with moderate depression: randomised multicentre study of
treatment for eight weeks)
http://www.bmj.com/cgi/content/full/319/7224/1534

Hypericum extract, manufactured from the herb St John's
Wort, is just as efficacious as the prescribed drug imipramine
in treating moderate depression, claim researchers from
Germany in this week's BMJ.

Professor Michael Philipp from Landshut Bezirkskrankenhaus
[district hospital] along with colleagues from Nuremberg and
Berlin studied the efficacy and safety of hypericum extract as
compared with imipramine (which is a commonly prescribed
anti-depressant in Germany) and placebo in 263 patients with
moderate depression.

They found that hypericum extract was more effective for
reducing depression than placebo and just as effective as
imipramine. Patients taking hypericum extract had the same
range of side-effects as those taking placebo and less than
those being treated with imipramine. Using an internationally
recognised questionnaire, the authors found that quality of life
(both mentally and physically) was significantly improved by
taking hyeperium extract.

The authors conclude that since many depressed patients
receive either no treatment or inadequate treatment after their
first bout of depression, hypericum extract may be considered
as an alternative first choice treatment in most cases of mild to
moderate depression.

Contact:

Dr Karl-O Hiller, Senior Research Fellow, Steiner
Arzneimittel, Berlin, Germany
Email: kohiller.steiner@t-online.de

(3) OVERREACTION TO PADDINGTON DISASTER
WILL ULTIMATELY DRIVE MORE PEOPLE ON TO
THE ROADS AND INCREASE DEATHS

(Overreaction to the Paddington rail disaster may not be
beneficial in the long run)
http://www.bmj.com/cgi/content/full/319/7224/1578

The public reaction to the tragic Paddington rail disaster might
make those running railways so fearful of accidents and
subject to such severe controls that they are no longer able to
do their job well enough to compete with far more dangerous
and polluting modes of transport, writes Dr Kevin Connolly
from Darlington in this week's BMJ.

Connolly comments that "public opinion cannot put disasters
into their proper context, resulting in distortion and
expenditure on accident prevention". He says that,
irrespective of the source of finance, the conflict [which is
inherent in running a railway system] is between safety and the
other interests of passengers (such as punctuality, speed and
economy) and that both sides of the equation "have
implications for life and limb".

Even if absolute safety were achieved on rail, he says, it
would be made at the expense of passengers and other legitimate
interests. This would shift them back to the road which would
lead to an increased loss of life through traffic accidents and
pollution, says Connolly. He concludes that consideration
should be given to prioritising structural changes to railways
which reduce the likelihood and consequences of accidents.
He says these measures might be far cheaper, cost effective
and less disruptive than the introduction of inflexible control
systems that cannot be overridden.