Releases Saturday 22 September 2001
No 7314 Volume 323
Please remember to credit the BMJ as source when publicising
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(1) WIDESPREAD BODY PAIN SEEMS TO DOUBLE
RISK OF DEATH FORM CANCER
(2) NEW
GENERATION ANTIDEPRESSANTS
INCREASE RISK
OF GASTROINTESTINAL
BLEEDS
(3) LEARNING LESSONS FROM CHERNOBYL
(1) WIDESPREAD
BODY PAIN SEEMS TO DOUBLE
RISK OF DEATH FORM CANCER
(Widespread body pain and mortality:
prospective
population based study)
http://bmj.com/cgi/content/full/323/7314/662
(Commentary)
http://bmj.com/cgi/content/full/323/7314/662
Widespread body pain seems to double the
risk of
dying from cancer, reports a study in
this week's BMJ.
The research team at the University of
Manchester's
Chronic Disease Epidemiology Unit monitored
the rates
and causes of death among 6569 adults
up to the age of
85 for eight years. All of them had taken
part in two
pain surveys in 1991-2. They were asked
if and where
they had felt body pain in the preceding
month, whether
they smoked, and what their levels of
psychological
distress were.
Just under half of respondents had pain
in one area of
their bodies and just over a third reported
no pain at all.
A further 15 per cent complained of pain
all over their
bodies. And this group included more women
and more
older people than the other two groups.
Over the eight years of monitoring, 654
people died.
Heart disease accounted for four out of
10 of the
deaths, followed by cancer, which killed
almost one in
three. Most of the remaining deaths were
attributable to
respiratory disease.
Death rates were not only higher among
people with
widespread and regional pain, but they
were also much
more likely to die of cancer. Regional
pain sufferers
were significantly more likely to have
died of cancer,
while those with widespread pain were
twice as likely
to have done so. The risk remained even
after
accounting for a diagnosis of cancer at
the time of the
survey and other influential factors,
such as age, sex,
and smoking. The number of accidental,
suicidal, or
violent deaths was small at 2 per cent,
but people with
widespread pain were five times as likely
to die this way
as people who reported no pain.
The authors suggest that perhaps the same
factors
underlying heightened pain perception
may also be
involved in an increased risk of cancer,
or that
widespread pain may shorten survival in
people who go
on to develop the disease.
An accompanying commentary speculates on
the
possible reasons for the "unexplained
but potentially
important finding," one of which relates
to undiagnosed
cancer.
Contacts:
Professor Gary Macfarlane, Unit of Chronic
Disease
Epidemiology, University of Manchester.
Email: G.Macfarlane{at}man.ac.uk
(Commentary) Professor Iain Crombie, Epidemiology
and Public Health, University of Dundee,
Scotland
Email: i.k.crombie{at}dundee.ac.uk
(2) NEW GENERATION
ANTIDEPRESSANTS
INCREASE RISK OF GASTROINTESTINAL
BLEEDS
(Inhibition of serotonin re-uptake
by antidepressants
and upper gastrointestinal bleeding
in elderly patients:
retrospective cohort study)
http://bmj.com/cgi/content/full/323/7314/655
New generation antidepressant drugs, known
as SSRIs,
increase the risk of gastrointestinal
bleeding, shows
research in this week's BMJ.
Canadian researchers monitored hospital
admissions for
gastrointestinal bleeding among almost
314,000 people,
aged 65 and above, who had been prescribed
antidepressants between 1992 and 1998.
Antidepressant drugs were grouped according
to what
extent they inhibited serotonin re-uptake.
There were 974 gastrointestinal bleeds
during the study.
The higher the inhibition of serotonin
re-uptake, the
higher was the risk of a bleed. This was
especially true
of older patients in whom the risk increased
by over 10
per cent for each more powerful grade
of inhibitor drug,
and those who had already had a bleed,
in whom the
risk increased by almost 10 per cent.
For patients in their 80s, bleeding rates
increased from
10.6 per 1000 person years for drugs with
the lowest
inhibition to 14.7 with the highest. This
equals an
additional bleed for every 244 patients
treated with the
highest inhibiting drugs for a year. The
data also showed
that the numbers of 80 year olds prescribed
SSRIs rose
from 892 in 1192 to 11,179 in 1997.
Among patients who had had peptic ulcers,
bleeding
rates increased from over 28 to over 40
per 1000
person years. This equates to an additional
bleed for
every 85 patients treated with the highest
inhibiting
drugs for a year.
The authors conclude that the extent to
which
antidepressants inhibit serotonin re-uptake
should be
considered before prescribing these drugs
to very
elderly patients or those who have had
a bleed before.
Contact:
Dr Carl van Walraven, Ottawa Health Research
Institute, Ottawa Hospital, Ontario, Canada.
Email: carlv{at}ohri.ca
(3) LEARNING LESSONS FROM CHERNOBYL
(Editorial: lessons from Chernobyl)
http://bmj.com/cgi/content/full/323/7314/643
Our response to international disasters
needs to be
better coordinated, if we are to maximise
the benefit to
the country affected and the world as
a whole, says an
editorial in this week's BMJ.
Dillwyn Williams, joint director of the
Thyroid
Carcinogenesis Group at Strangeways Research
Laboratory, University of Cambridge, writes
his
comments in light of the 15th anniversary
of Chernobyl,
the world's worst nuclear disaster to
date.
The international response to the need
to study the long
term health consequences was initially
uncoordinated
and continues to be inadequate, he says.
He documents
an array of separate studies by international
agencies,
individual countries and various organisations,
with
duplicated results on the same tumours,
and the use of
tissue samples sometimes without governmental
agreement.
Personality clashes and an initial unwillingness
to fund
collaborative studies, played their part
in the confusion,
he writes. And a reluctance at first to
accept the
evidence of an increase in thyroid cancer
also hampered
a coordinated response. "In some cases
the reluctance
appeared to be an example of the general
rule that the
degree of proof needed to accept a causal
link is
strongly correlated with the vested interests
of the
individual or organisation in the outcome."
But he warns that an international study
of all the long
term health effects of Chernobyl is needed
now.
Thyroid cancer is unlikely to be the only
consequence,
and claims of immune impairment, birth
defects and
various other cancers need to be properly
investigated.
This will be of value not only help in
terms of helping the
sick, but will also inform the debate
on the merits and
disadvantages of nuclear power.
Chernobyl occurred in a country that has
a history of
scientific isolation and has subsequently
undergone
radical political and economic change,
making such a
study all the more difficult, says professor
Williams. But
unless we can coordinate our responses
more
effectively and impartially, we will not
be able to
improve our ability to prevent future
disasters and to
deal with the consequences when they do
occur.
Contact:
Professor Sir Dillwyn Williams, Joint Director,
Thyroid
Carcinogenesis Groupl Strangeways Research
Laboratory, University of Cambridge.
Email: edw1001{at}cam.ac.uk
FOR ACCREDITED JOURNALISTS
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London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
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Association for the
Advancement of Science
(http://www.eurekalert.org)
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