Releases Saturday 26 January 2002
No 7331 Volume 324

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(1) SURGICAL ADVANCES PREVENT DEATHS
IN OLDER HEART BYPASS PATIENTS

(2) AIDS SURPASSES BLACK DEATH AS
DEADLIEST DISEASE IN HISTORY

(3) AN HIV VACCINE IS WITHIN REACH

(4) COULD DRUG COMPANIES HELP WIN THE
FIGHT AGAINST AIDS?



(1) SURGICAL ADVANCES PREVENT DEATHS
IN OLDER HEART BYPASS PATIENTS

(Time trends in survival and readmission following
coronary artery bypass grafting in Scotland,
1981-96: retrospective observational study)
http://bmj.com/cgi/content/full/324/7331/201

The age of patients undergoing heart bypass
operations has risen sharply, yet the risk of death
within two years of the operation has declined,
finds a study in this week's BMJ.

Researchers in Scotland identified all 25,229
coronary artery bypass operations performed in
Scottish NHS hospitals from 1981 to 1996. The
percentage of operations performed on patients
aged over 65 increased from 2% to 30% in men
and from 16% to 45% in women.

After adjusting for age, they found that the risk of
death up to two years after the operation and the
need for readmission to hospital declined
significantly in men. Similar time trends were seen
in women, but were not significant. However, this
may simply reflect the fact that fewer procedures
are carried out in women, say the authors.

These improvements are likely to reflect advances
in surgical and anaesthetic techniques, they
conclude.

Contact:

Jill Pell, Honorary Clinical Senior Lecturer,
Department of Public Health, Greater Glasgow
Health Board, Glasgow, Scotland
Email: jill.pell@gghb.scot.nhs.uk

(2) AIDS SURPASSES BLACK DEATH AS
DEADLIEST DISEASE IN HISTORY

(Reducing heterosexual transmission of HIV in
poor countries)
http://bmj.com/cgi/content/full/324/7331/207

In terms of illness and death, AIDS is worse than
the Black Death of the 14th century. Ninety five
per cent of new infections of HIV are in the world's
poor countries and heterosexual transmission is
responsible for most of these, reports Peter
Lamptey, in this week's BMJ.

Programmes to change behaviour and promote
condoms and treatment of sexually transmitted
infections are effective in preventing the spread of
HIV. However, large scale prevention efforts have
been successful in only a few countries, mainly
because of inadequate resources and lack of
international commitment, argues the author.

HIV/AIDS is likely to surpass the Black Death as
the worst pandemic ever, as without access to
drugs, most of the 40 million people currently living
with HIV will die, writes the author. We urgently
need an effective and safe vaccine, an affordable
cure, and intensified prevention, care, and support
programmes, he concludes.

Contact:

Peter Lamptey, President, Family Health
International AIDS Institute, Arlington, USA
Email: Plamptey@fhi.org

(3) AN HIV VACCINE IS WITHIN REACH

(The search for an HIV vaccine)
http://bmj.com/cgi/content/full/324/7331/211

An effective, affordable, and accessible HIV
vaccine is 7-10 years away, according to scientists
at the Medical Research Council of South Africa,
in this week's BMJ. However, its success depends
on a complex interplay of politics, science, and
public-private partnerships.

Equitable public-private partnerships between
researchers, manufacturers, and distributors and
partnerships between rich and poor countries are
the best strategy for the development of the
vaccine, say the authors. Successful vaccine
development also entails adequate investment in the
countries that carry the burden of the HIV/AIDS
pandemic.

Vaccines are the only hope for the control and
possible elimination of HIV infection. How we
distribute the vaccine will also be a test of our
international ethics and humanitarian objectives,
they write.

If we fail to provide the world with an effective
HIV vaccine, future generations will judge us
harshly, because this failure will not be due to lack
of ability or resources but to politics, they
conclude.

Contact:

Malegapuru William Makgoba, President, Medical
Research Council of South Africa, Cape Town,
South Africa
Email: malegapuru.makgoba@mrc.ac.za

(4) COULD DRUG COMPANIES HELP WIN THE
FIGHT AGAINST AIDS?

("We all have AIDS": case for reducing the cost of
HIV drugs to zero)
http://bmj.com/cgi/content/full/324/7331/214

Drug companies could influence the fight against
the AIDS epidemic by reducing the cost of HIV
drugs in poor countries to zero, writes Donald
Berwick in this week's BMJ.

He argues that modern drugs can improve the lives
of people with HIV by years, even decades, yet
their high costs are often used as an excuse for
poor countries not to develop effective
infrastructures for the care of patients.

Richard Sykes, chairman of GlaxoSmithKline, says
that it is easy ± although misguided ± to assume that
cost is the main barrier to people in poor countries
having greater access to effective drugs. His
company offers its medicines to poor countries at
prices up to 90% lower than those charged in rich
countries, yet he has not seen a considerable
uptake in the use of these medicines.

The international community's lack of political will
to provide drugs to people with HIV and AIDS is
a greater danger than the South African President's
belief that poverty is the cause of AIDS, argues
Zackie Achmat of South Africa's Treatment Action
Campaign.

He believes that a global health fund will be a start
in providing treatment, supporting HIV prevention
efforts, demonstrating political commitment, and
reaffirming the principle that everyone has the rights
to life, freedom, dignity, and equality.

Contacts:

Donald Berwick, President and Chief Executive
Officer, Institute for Healthcare Improvement,
Boston, USA
Email: dberwick@ihi.org

Richard Sykes, Chairman, GlaxoSmithKline,
Middlesex, UK
Email: tft28919@glaxowellcome.co.uk

Zackie Achmat, Chairperson, Treatment Action
Campaign, Cape Town, South Africa
Email: zackie@pixie.co.za


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