Releases Saturday 20 May 2000
No 7246 Volume 320
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
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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) MODERNISING THE NHS
(2) ALCOHOL
AND HEART ATTACKS - IT'S NOT
WHAT YOU DRINK
BUT THE WAY THAT YOU
DRINK IT
(3) INTENSIVE
TREATMENT OF TYPE 2 DIABETES
REDUCES COSTS
OVERALL
(4) VACCINATIONS
AND ILL HEALTH IN GULF WAR
VETERANS
(Prevention and the reduction of
health inequalities)
http://bmj.com/cgi/content/full/320/7246/1399
In the second of seven BMJ articles on
the modernising of the
NHS, Sally Macintyre, Director of the
MRC Social and
Public Health Sciences Unit at the University
of Glasgow,
argues that the modernisation action team
dealing with health
inequality should review progress and
act on the existing
public health reports, notably the Acheson
report. Professor
Macintyre says that most of the factors
which exacerbate
health disadvantage, such as air pollution,
unemployment,
crime and disorder, poor housing, low
educational
achievement and poverty lie outside the
control of the NHS.
Some of the extra resources coming on
stream should
therefore be spent in partnership with
organisations outside
the NHS.
Professor Macintyre highlights the growing
health gap
between rich and poor. The healthy life
expectancy of rich
people is increasing faster than that
of the poor who may find
it more difficult to respond to health
promotion strategies on
smoking, diet and exercise. Dr Macintyre
says it would be
disappointing if the action team is confined
to exhorting
people to change their behaviour. "The
action team should
focus upstream on what is pushing people
into the river as
well as downstream, pulling drowning
people out of the
river."
Contact:
Sally Macintyre, MRC Social and Public
Health Sciences
Unit, University of Glasgow, Glasgow G12
8RZ Note:
Professor Macintyre is away from Weds
17 May, but
Graham Hart in the unit will take press
calls, or contact the
BMJ press office for help.
Email : sally{at}msoc.mrc.gla.ac.uk
(2) ALCOHOL AND
HEART ATTACKS - IT'S NOT
WHAT YOU DRINK BUT THE WAY THAT YOU
DRINK IT
(Effect of beer drinking on risk
of myocardial infarction:
population based case-control study)
http://bmj.com/cgi/content/full/320/7246/1378
A study of beer drinking men who had had
a heart attack
shows that men who drank daily or almost
daily and
consumed moderate amounts of beer a week
had the lowest
risk of heart attack according to a paper
in this week's BMJ.
Many studies have shown an inverse association
(one rises as
the other falls) between alcohol consumption
and coronary
heart disease with a possible flattening
of the effect at higher
consumption levels. It remains unclear
whether the protective
effect is confined to specific drinks
such as red wine, or
relates to the ethanol in alcoholic drinks.
Dr Martin Bobak and colleagues studied
men in the Czech
Republic, a predominantly beer drinking
country and
excluded those who drank other alcohol
such as wine or
spirits. They compared them with a control
sample of healthy
men of the same age (25 to 64 years) from
the Czech
population.
In conclusion the authors note the protective
effect was most
pronounced among men who drank almost
daily or daily, and
who consumed between four and nine litres
of beer per week
(approximately half to one litre per day).
There was a
suggestion that the protective effect
of the alcohol was lost in
men who drank twice a day or more. All
this is similar to
results of studies of other alcoholic
drinks.
Dr Bobak writes: "These results support
the view that the
protective effect of alcohol intake is
due to ethanol rather than
to specific substances present in different
types of
beverages."
Contact:
Dr Martin Bobak, Senior Lecturer, International
Centre for
Health and Society, University College
London
Email: martinb{at}public-health.ucl.ac.uk
(3) INTENSIVE
TREATMENT OF TYPE 2 DIABETES
REDUCES COSTS OVERALL
(Cost effectiveness of an intensive
blood glucose control
policy in patients with type 2 diabetes:
economic analysis
alongside randomised controlled
trial (UK prospective
diabetes study 41))
http://bmj.com/cgi/content/full/320/7246/1373
Conventional management of type 2 diabetes
(the non insulin
dependent type which develops mainly in
people over 40) is
through diet. A paper by Gray and colleagues
in this week's
BMJ shows that an alternative treatment
using intensive blood
glucose control in these patients significantly
increases
treatment costs but substantially reduces
the cost of
complications and gives increased time
free of complications.
The study was based on a long term clinical
trial involving
3,867 patients with type 2 diabetes in
23 clinics around the
UK. Results showed that the intensive
policy cost around an
extra £140 per year per patient,
but that about £100 of this
would be saved because of fewer complications.
The net cost
of intensive blood glucose control for
all type 2 diabetic
patients in a typical general practice
might be around £4000
to £9000 annually, says the paper.
The authors say the
cost-effectiveness of the policy - around
£1200 for an
additional year free of complications
- compares favourably
with many existing treatments, indicating
strong economic as
well as clinical grounds for its adoption.
Contact:
Dr Alastair Gray, Director, Health Economics
Research
Centre, Dept Public Health, University
of Oxford.
Email: alastair.gray{at}ihs.ox.ac.uk
(4) VACCINATIONS
AND ILL HEALTH IN GULF WAR
VETERANS
(Role of vaccinations as risk factors
for ill health in veterans
of the Gulf war : cross sectional
study)
http://bmj.com/cgi/content/full/320/7246/1363
(Shots in the desert and Gulf war
syndrome)
http://bmj.com/cgi/content/full/320/7246/1351
Vaccines have been implicated as a potential
cause of ill
health in veterans of the Gulf war. In
order to protect against
the threat of biological warfare, and
against tropical and other
infectious diseases, a vaccination programme
was instated in
UK service personnel in the months leading
up to, and during,
deployment. In this week's BMJ, Matthew
Hotopf et al of
the Gulf war Research Unit at Guy's, King's
and St
Thomas's School of Medicine, King's College,
London
present the findings of their investigation
into the relation
between ill health after the Gulf war
and vaccines received
before or during the conflict.
An editorial by Dr Seif Shaheen questions
the conclusiveness
of the findings.
Please note that this paper, will be released
at 10.30 am on
Thursday 18 May 2000 at a press conference
at BMA
House, Tavistock Square, London WC1. The
embargo for
this paper and the accompanying editorial
only will be lifted at
10.30 hours, Thursday 18 May to coincide
with the press
conference.
Contact:
Contact authors via Melanie Gardner in
the King's College,
London press office
Email: melanie.j.gardner{at}kcl.ac.uk
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)
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