bmj.com -- Press Releases

Releases Saturday 11 November 2000
No 7270 Volume 321

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://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) ASPIRIN, EVEN AT LOW DOSE, CARRIES RISK OF
GASTROINTESTINAL BLEEDING

(2) NEW STUDY RE-OPENS THE DEBATE ON THIRD
GENERATION PILLS AND VENOUS CLOTTING

(3) WET COMBING IS FAR MORE EFFECTIVE IN
DETECTING HEAD LICE THAN TRADITIONAL
SCALP INSPECTION

(4) MEDIA IMAGES MAY DETER WOMEN FROM
BREAST FEEDING

(5) GENETICS LIKELY TO BE A MAJOR FACTOR IN
OSTEOATHRITIS OF THE HIP

(6) GMC REVALIDATION PROPOSALS ARE
INAPPROPRIATE

(1) ASPIRIN, EVEN AT LOW DOSE, CARRIES RISK OF
GASTROINTESTINAL BLEEDING

(Risk of gastrointestinal haemorrhage with long term use of
aspirin: meta-analysis)
http://bmj.com/cgi/content/full/321/7270/1183

(Editorial: Aspirin, like all other drugs, is a poison)
http://bmj.com/cgi/content/full/321/7270/1170

Long term use of aspirin to prevent heart problems carries an
increased risk of gastrointestinal bleeding, according to a
study in this week's BMJ. Furthermore, no evidence exists
that reducing the dose or using expensive "modified release"
formulations of aspirin would reduce the likelihood of
bleeding.

Researchers at the Radcliffe Infirmary in Oxford analysed 24
previous studies of aspirin, involving almost 66,000 patients,
to establish the risk of gastrointestinal bleeding from long term
treatment with aspirin. There were two main results. Firstly,
bleeding occurred, on average, in 2.5% of patients taking
aspirin compared with 1.4% who were not; this difference
was statistically significant. Secondly, there was no evidence
to suggest that switching to a low dose or modified release
formulation of aspirin would reduce the problem.

Given the widespread use of aspirin for the prevention of
heart problems, these findings have important implications for
everyday practice, say the authors. Patients and doctors need
to consider the trade-off between the benefits and harms of
long term treatment with aspirin, they conclude.

In an accompanying editorial, Martin Tramr argues that we
do not know who should be given what dose of aspirin and
for how long. Physicians have been treating their patients with
low dose aspirin on the understanding that they did more
good than harm, yet innovative research is needed to estimate
rare events with confidence, he concludes.

Contacts:

[Paper]: Yoon Kong Loke, University of Oxford, Radcliffe
Infirmary, Oxford, UK
Email: yoon.loke{at}clinpharm.ox.ac.uk

[Editorial]: Martin Tramr, Division of Anaesthesiology,
Geneva University Hospitals, Switzerland

(2) NEW STUDY RE-OPENS THE DEBATE ON THIRD
GENERATION PILLS AND VENOUS CLOTTING

(Risk of venous thromboembolism among users of third
generation oral contraceptives compared with oral
contraceptives with levonorgestrel before and after the 1995
warning: cohort and case-control analysis)
http://bmj.com/cgi/content/full/321/7270/1190

(Editorial: Pitfalls of pharmacoepidemiology)
http://bmj.com/cgi/content/full/321/7270/1171

A study in this week's BMJ finds that the third generation oral
contraceptive pills are associated with around a two-fold
increased risk of clots in the veins. These findings are
consistent with previous studies, but conflict with a study
published recently in the BMJ surrounding the 1995 'pill
scare.'

Using data from UK general practices between January 1993
and December 1999, researchers at Boston University in the
USA evaluated the overall incidence and risks of venous
clotting in users of third generation oral contraceptive pills and
oral contraceptive pills containing the hormone levonorgestrel,
before and after the scare. They found that the risk of venous
clotting is around twice as high among users of third
generation pills than it is among users of pills with
levonorgestrel, and the difference is significant.

They also found that a shift away from the use of third
generation pills after the scare was more pronounced among
younger women (who have a lower risk of venous clotting)
than among older women. Had the use of third generation
pills remained unchanged after the warning, the authors
estimated that about 26% more cases of venous clotting
would have occurred. If more older women had shifted away
from use of third generation pills, the authors suggest there
would have been an even greater decrease in venous clotting.

Several reasons may explain why these conclusions differ
from the recent study by Farmer and colleagues, say the
authors. These include the methods used to exclude women
from the analysis who were at risk of clots for other reasons,
and taking into account other risk factors for clots, such as
obesity and smoking.

Contact:

Hershel Jick, Boston University School of Medicine,
Lexington, USA
Email: hjick{at}bu.edu

(3) WET COMBING IS FAR MORE EFFECTIVE IN
DETECTING HEAD LICE THAN TRADITIONAL
SCALP INSPECTION

(Wet combing versus traditional scalp inspection to detect
head lice in children: observational study)
http://bmj.com/cgi/content/full/321/7270/1187

Traditional scalp inspection is a poor technique for detecting
head lice, as 30 per cent of its "positive" results and 10 per
cent of its "negative" results are false according to an
observational study of 260 primary school children in
Belgium.

False results are a worry since they lead to non-infested
children being treated unnecessarily and infested children
missing out on effective eradication treatment. The study, in
this week's BMJ, suggests that despite the extra effort
involved, wet combing is the gold standard for detecting head
lice.

Contact:

Jan De Maesener, Department of General Practice and
Primary Health Care, Ghent University, Belgium
Email: jan.demaeseneer{at}rug.ac.be

(4) MEDIA IMAGES MAY DETER WOMEN FROM
BREAST FEEDING

(Representing infant feeding: content analysis of British media
portrayals of bottle feeding and breast feeding)
http://bmj.com/cgi/content/full/321/7270/1196

Breast and bottle feeding are portrayed very differently in UK
mass media and may have a negative impact on women's
decisions about breast feeding, according to a study from
Brunel University in this week's BMJ.

Bottle feeding was shown on television and in newspapers
more frequently than breast feeding and was presented as
less problematic. Bottle feeding was associated with
"ordinary" families whereas breast feeding was associated
with middle class or celebrity women according to an analysis
of more than 200 TV and newspaper mentions in March
1999, conducted by Henderson and Kitzinger of the Centre
for Communications Research at Brunel.

The authors warn that the health risks of formula milk and the
health benefits of breast feeding were rarely mentioned and
health professionals should be aware of the potential impact
on women's choices about breast versus bottle feeding.

Contact:

Lesley Henderson, Centre for Media and Communications
Research, Department of Human Sciences, Brunel University,
London, UK
Email: lesley.henderson{at}brunel.ac.uk

(5) GENETICS LIKELY TO BE A MAJOR FACTOR IN
OSTEOATHRITIS OF THE HIP

(Assessment of a genetic contribution to osteoarthritis of the
hip: sibling study)
http://bmj.com/cgi/content/full/321/7270/1179

Siblings have a five fold increased risk of developing
osteoarthritis of the hip compared with unrelated individuals,
which suggests a strong genetic influence on susceptibility to
the disease, according to research from Nottingham in this
week's BMJ.

Peter Lanyon and colleagues from Nottingham University
contrasted 392 patients with osteoarthritis and 604 of their
siblings against a control group of 1,718 other patients.

Other research has already demonstrated a family link for
osteoarthritis of the hand and knee but this large-scale study
now confirms earlier research suggesting a link in
osteoarthritis of the hip. The Nottingham research shows that
the risk to siblings is even greater than previously thought, at
around three to eightfold the rate of prevalence in unrelated
people.

Contact:

Professor Michael Doherty, Queens Medical Centre,
Nottingham, UK

(6) GMC REVALIDATION PROPOSALS ARE
INAPPROPRIATE

(GMC's proposals for revalidation would not be accurate,
economical, or fair)
http://bmj.com/cgi/content/full/321/7270/1220

The General Medical Council's proposal for a five-year
assessment to identify potentially inadequate doctors would
be unfair, inaccurate and very expensive, according to a letter
in this week's BMJ.

The proposed system - based on an individual group of
assessors for each doctor's review - will suffer from assessor
bias and a lack of serious training, making it unreliable and
inaccurate, argues Richard Wakeford. Furthermore,
estimates of the time needed for the review suggest a cost of
at least £50 million a year. A paper based assessment
exercise, with a maximum one-day's duration, could be
devised as an accurate, economical and fair alternative for
predicting clinical performance, he concludes.