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(2) EUROPE
BECOMING COMPLACENT OVER HIV
PREVENTION
(3) UNLICENSED
AND OFF-LABEL PRESCRIBING IN
CHILDREN MUST
IMPROVE
(4) SAFETY
CLAIMS OF NEW ARTHRITIS DRUGS
MAY BE MISLEADING
(5) DO
CELEBRITIES HELP SELL NEW MEDICINES?
(1) SCREENING
FAMILIES WITH A HISTORY OF
HIGH CHOLESTEROL IS MOST COST EFFECTIVE
WAY TO CUT HEART DEATHS
(Cost effectiveness analysis of different
approaches of
screening for familial hypercholesterolaemia)
http://bmj.com/cgi/content/full/324/7349/1303
Screening relatives of people with high
cholesterol levels is
the most cost effective way to reduce
deaths from
coronary heart disease, yet no recommended
screening
strategy currently exists in the United
Kingdom , according
to researchers in this week's BMJ.
High cholesterol which runs in families
is known as familial
hypercholesterolaemia. About 110,000 people
in the UK
are thought to have the condition, and
at least 75% of them
are undiagnosed. Without identification
and treatment, over
half of these people will have a fatal
or non-fatal coronary
heart disease event by the age of 50 (men)
or 60 (women).
Using computer modelling, the research
team assessed the
costs and benefits of different screening
strategies in the
UK. They found that screening family members
of people
with familial hypercholesterolaemia was
the most cost
effective way of detecting cases across
the whole
population for all age groups.
This represents good value for money compared
with
common medical interventions, say the
authors. As no
recommended screening strategy currently
exists for this
condition in the UK, they suggest that
pilot evaluation
programmes should be conducted.
Contacts:
Margaret Thorogood, Reader in Public Health
and
Preventative Medicine, or Dalya Marks,
Research Fellow,
London School of Hygiene and Tropical
Medicine,
London, UK
Email: Margaret.Thorogood@lshtm.ac.uk
(2) EUROPE BECOMING
COMPLACENT OVER HIV
PREVENTION
(Are trends in HIV, gonorrhoea, and
syphilis worsening in
western Europe?)
http://bmj.com/cgi/content/full/324/7349/1324
Rising levels of gonorrhoea and syphilis
across western
Europe since 1995 imply that complacency
over HIV
prevention efforts may have set in among
individuals and
some governments, argue researchers in
this week's BMJ.
Angus Nicoll and Francoise Hamers examined
national
trends in diagnosed HIV infections, gonorrhoea,
and
infectious syphilis from 1995 to 2000.
They found the numbers of new diagnoses
of sexually
acquired HIV infections increased by 20%
in western
Europe. Rates of gonorrhoea increased
in France, the
Netherlands, Sweden, Switzerland, and
the United
Kingdom, while outbreaks of syphilis have
recently been
reported in several countries, especially
among men who
have sex with men, including men already
infected with
HIV.
These preliminary data show that sexual
health has
deteriorated in parts of western Europe
in recent years, say
the authors. Increasing numbers of people
are living with
HIV, levels of sexually transmitted infections
that facilitate
HIV transmission are rising, and sexual
behaviour is getting
more risky. The danger is that HIV transmission
rates
could increase again.
AIDS campaigns from the late 1980's and
early 1990's
seem to have been forgotten and efforts
to prevent the
transmission of HIV need to be strengthened,
they say. In
addition to prevention measures, consistent
surveillance
needs to be established across Europe
to monitor trends in
key sexually transmitted infections, resistance
of
gonorrhoea, and likely incidence of HIV
transmission.
Contact:
Public Health Laboratory Service Press
Office, London,
UK
Email: ecollins@phls.org.uk,
sgregor@phls.org.uk
(3) UNLICENSED
AND OFF-LABEL PRESCRIBING IN
CHILDREN MUST IMPROVE
(Off-label prescribing to children
in primary care in
Germany: retrospective cohort study)
http://bmj.com/cgi/content/full/324/7349/1311
(Unlicensed and off-label drug use
by children in the
community: cross sectional study)
http://bmj.com/cgi/content/full/324/7349/1312
(Unlicensed and off-label drug use
by children in the
community: population based cohort
study)
http://bmj.com/cgi/content/full/324/7349/1313
(Editorial: Off label prescribing
in children)
http://bmj.com/cgi/content/full/324/7349/1290
Many drugs prescribed to children in general
practice are
either not licensed for use in children
("unlicensed") or are
prescribed outside the terms of the product
licence
("off-label").
Three studies in this week's BMJ show that
unlicensed and
off-label prescription of drugs to children
is common and
carries a high risk of adverse drug reactions.
In the first study, researchers in Germany
found 13% of
prescriptions for a group of children
in primary care were
off-label. The proportion of off-label
prescriptions was
highest for 1-2 year olds and included
drugs for heart
conditions, genitourinary disorders, and
anti-inflammatory
agents. The authors conclude that efforts
to improve the
quality of drug treatment in children
should not exclude
widely marketed and firmly established
drugs.
A second study by a team of Dutch researchers
found over
22% of prescriptions for children aged
0-16 years were
used off-label. Drug groups with the highest
proportion of
off-label use included oral contraceptives,
and drugs for
eye and skin conditions. They argue that
many licensed
drugs used by children in the community
are poorly
labelled for use in children, resulting
in high rates of
off-label use. Therefore labelling for
children needs to be
improved.
Although unlicensed and off-label prescribed
drugs do not
necessarily carry an actual threat to
the health of a child,
the risk of adverse drug reactions is
high, as adequate
dosing schemes have often not been assessed,
according
to a third study. The authors conclude
that this situation is
highly unsatisfactory, and efforts should
be made to
improve it.
Contacts:
Lolkje de Jong-van den Berg, Professor
of Social
Pharmacy and Pharmaco-epidemiology, University
of
Groningen, Netherlands
Email: l.t.w.de.jong-van.den.berg@farm.rug.nl
or
Bruno Stricker, Professor of Pharmaco-epidemiology,
Erasmus Medical Center, Rotterdam, Netherlands
Email: stricker@epib.fgg.eur.nl
(4) SAFETY CLAIMS
OF NEW ARTHRITIS DRUGS
MAY BE MISLEADING
(Editorial: Are selective COX 2 inhibitors
superior to
traditional non steroidal anti-inflammatory
drugs?)
http://bmj.com/cgi/content/full/324/7349/1287
(Editorial: Potential alternatives
to COX 2 inhibitors)
http://bmj.com/cgi/content/full/324/7349/1289
Popular arthritis drugs, known as selective
COX 2
inhibitors, may not be superior to traditional
non-steroidal
anti-inflammatory drugs, conclude researchers
in this
week's BMJ.
A study published in September 2000 concluded
that the
COX 2 inhibitor, celecoxib, was associated
with a lower
rate of stomach and intestinal ulcers
than two older drugs
for arthritis. However, only data for
the first six months of
the study were published. When all the
data were
considered, the published results appeared
to be clearly
flawed.
Two issues cause concern, say the researchers.
The
authors' explanations for these serious
irregularities were
inadequate, and the flawed findings published
in the original
article appear to be widely distributed
and believed by
many physicians.
They believe that an "industry independent"
analysis of all
trials of selective COX 2 inhibitors must
be performed to
include both published and unpublished
data. They also call
for the wide dissemination of the misleading
results of the
trial has to be counterbalanced by the
equally wide
dissemination of the findings of the reanalysis
according to
the original protocol.
"If this is not done, the pharmaceutical
industry will feel no
need to put the record straight in this
or any future
instances," they conclude.
The failure of this study may have more
to do with the
design of the trial than with inadequacies
of COX 2
inhibitors, suggest researchers at Queen's
Medical Centre,
Nottingham in a second editorial. "Although
it is extremely
important to highlight distortion of information,
it is equally
important to recognise that the more information
there is
the more issues can arise, and a lack
of information can
easily nurture as many illusions as partial
publication."
Contacts:
Editorial 1: Peter Juni, Senior Research
Fellow,
Departments of Rheumatology, and Social
and Preventive
Medicine, University of Berne, Switzerland
Email: peter.juni@bristol.ac.uk
Editorial 2: Professor C J Hawkey, Division
of
Gastroenterology, University Hospital
Nottingham,
Queen's Medical Centre, Nottingham, UK
Email: cj.hawkey@nottingham.ac.uk
(5) DO CELEBRITIES HELP SELL NEW MEDICINES?
(Reviews: Celebrity selling)
http://bmj.com/cgi/content/full/324/7349/1342
Last month, Camilla Parker Bowles made
her first big
public speech on behalf of the National
Osteoporosis
Society to raise awareness of the bone
condition. In this
week's BMJ, journalist Ray Moynihan suggests
that by
spreading the word about osteoporosis,
she is
inadvertently helping to expand markets
for new medicines.
The trend of using high profile personalities
to raise
awareness about diseases is growing. In
the US, Frasier
star Kelsey Gramer and his wife appeared
publicly to raise
awareness of irritable bowel syndrome,
while film and
television star Cybill Shepherd recently
talked about the
menopause. Both campaigns were a huge
success in the
American healthcare market.
Unlike the television stars, Camilla Parker
Bowles is not
being paid by a drug or supplement company,
but her
recent appearances talking about osteoporosis
have
nevertheless attracted media attention,
says the author.
They also appear somehow to be synchronised
with a
much larger global campaign being underwritten
by the
world's biggest pharmaceutical companies,
he adds. The
commercial sponsor for the meeting at
which Mrs Parker
Bowles spoke was Lilly, the manufacturer
of a new
osteoporosis drug, and her "call to action"
for early
diagnosis and prevention is based on a
report sponsored
by eight global pharmaceutical companies.
Lilly is the
"Gold Sponsor."
Intuitively, early diagnosis and prevention
make perfect
sense, but the debate within the medical
literature about
osteoporosis is far more complicated than
these simple
measures reveal, says the author.
Although Mrs Parker Bowles paid her own
way to the
meeting, by spreading the word about osteoporosis,
she is
inadvertently raising awareness about
the latest trend in
global drug promotion, he concludes.
Contact:
Ray Moynihan, Journalist, Australian Financial
Review,
Sydney, Australia
Email: ray_128@hotmail.com
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