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(2) UNDISCLOSED
PAYMENTS TO DOCTORS
RECRUITING
TRIAL PATIENTS IS UNETHICAL
(3) TRADITIONAL
HEALING MAY RELIEVE
SYMPTOMS OF
MENTAL ILLNESS
(4) SOUTH
ASIAN PATIENTS ARE MISSING OUT
ON CHOLESTEROL
DRUGS
(5) STUDIES
OFTEN IGNORE DOMESTIC
VIOLENCE COMMITTED
BY WOMEN
(1) NEW SCREENING
METHODS FOR DOWN'S
SYNDROME QUESTIONED
(Retrospective audit of different
antenatal screening
policies for Down's syndrome in
eight district general
hospitals in one health region )
http://bmj.com/cgi/content/full/325/7354/15
New screening techniques for Down's syndrome
are less
effective than previously supposed, despite
a government
initiative to offer all pregnant women
the new tests by
2004, finds a study in this week's BMJ.
Researchers identified all cases of Down's
syndrome in
eight district general hospitals in the
Wessex region
between 1994 and 1999. During these six
years,
155,501 babies were delivered 335 cases
of Down's
syndrome were identified.
Across the region, seven different screening
policies were
used, in three principal groups: - serum
screening -
screening by maternal age plus serum or
nuchal screening
- screening by maternal age (35 years
or more) combined
with routine anomaly scans
Fifteen per cent of pregnant women were
aged over 35
years at delivery - more than double the
5-7% presumed
in statistical models of screening - and
58% of infants
with Down's syndrome were born to women
in this age
range.
The team found no evidence that serum and
nuchal
screening improves antenatal detection
rates or reduces
rates of invasive procedure, such as amniocentesis.
The
districts that used serum screening detected
57% of
cases, those using maternal age plus serum
or nuchal
screening detected 52%, and those using
a maternal age
of 35 or more and anomaly scans detected
54%.
Their findings also suggest that the recently
announced
government initiative to introduce universal
serum
screening from 2004 - to increase detection
rates and
reduce the need for invasive procedures
such as
amniocentesis - will not achieve its stated
objectives.
"To avoid continuing the confusion that
Down's screening
currently causes in pregnant women, we
believe that new
screening methods should be offered only
as part of a
controlled study until their benefit is
proved," they
conclude.
Contacts:
Diana Wellesley, Associate Specialist in
Clinical
Genetics, Wessex Clinical Genetics Service,
Princess
Anne Hospital, Southampton, UK
Email: dgw@soton.ac.uk
or
David Howe, Consultant in Fetomaternal
Medicine,
Wessex Fetal Medicine Unit, Princess Anne
Hospital,
Southampton, UK
(2) UNDISCLOSED
PAYMENTS TO DOCTORS
RECRUITING TRIAL PATIENTS IS UNETHICAL
(Ethics of undisclosed payments to
doctors recruiting
patients in clinical trials)
http://bmj.com/cgi/content/full/325/7354/36
Doctors are often paid to recruit patients
to clinical trials
sponsored by pharmaceutical companies,
yet such
payments are often not disclosed to the
patients.
Researchers in this week's BMJ argue that
this practice is
unethical and damages efforts to involve
patients more
fully in clinical trials.
Over the years, payments have soared to
thousands of
pounds per completed patient, and well-
organised
British general practices can earn an
extra £15,000
annually for three hours' work a week,
write the authors.
As a result, trials designed by non-commercial
sponsors
aiming to answer clinically important
questions, but
without the funding available to pay recruiters,
fail to
attract doctors.
Although guidelines insist that such payments
are divulged
to a research ethics committee, commercial
sponsors
regularly flout these recommendations,
they add.
Patients believe that such payments are
wrong and that
they have a right to be told about them,
say the authors.
Furthermore, a change to the regulatory
framework
making full disclosure mandatory would
not meet with
opposition.
"Consent obtained on the basis of withholding
information
on an issue that patients consider important
is not fully
informed consent. If we are ever to reach
the ideal of
involving patients in the design and conduct
of clinical
trials then we could do worse than treat
patients as equal
partners by making full and frank disclosure
of payments
that trial sponsors make to doctors for
recruiting their
patients," they conclude.
Contact:
Jammi N Rao, Director of Public Health,
North
Birmingham Primary Care Trust, Birmingham,
UK
Email: jammi@bharat.demon.co.uk
(3) TRADITIONAL
HEALING MAY RELIEVE
SYMPTOMS OF MENTAL ILLNESS
(Traditional community resources
for mental health: a
report of temple healing from India)
http://bmj.com/cgi/content/full/325/7354/38
Temple healing practices may help to improve
the
symptoms of people with mental illnesses,
according to
researchers in this week's BMJ.
The study was conducted at the temple of
Muthuswamy
in South India, known as a source of help
for people with
serious mental disorders. From June to
August 2000,
everyone who came for help was assessed
by a trained
psychiatrist on the first day of their
stay in the temple and
again on the day they left to return home,
using
recognised psychiatric rating scale scores.
Family
caregivers were also asked to assess satisfaction
with
their experience at the temple.
A total of 31 people sought help and stayed
at the
temple. Twenty three were diagnosed with
paranoid
schizophrenia, six with delusional disorders,
and two with
bipolar disorder. No specific ceremonies
to promote the
recovery of patients are performed at
the temple. Instead
the patient is encouraged to take part
in the daily
maintenance routines of the temple.
The researchers found a reduction of nearly
20% in
psychiatric rating scale scores, representing
a level of
clinical improvement that matches that
achieved by many
psychotrophic drugs. Family caregivers
also thought that
most of the patients had improved during
their stay.
In the absence of any specific healing
rituals, the
observed benefits appeared to result from
a supportive,
non-threatening environment, say the authors.
They
suggest that these institutions may have
a role in providing
community mental health care.
Contact:
R Raguram, Professor of Psychiatry, National
Institute of
Mental Health and Neurosciences, Bangalore,
India
Email: raguram@nimhans.kar.nic.in
(4) SOUTH ASIAN
PATIENTS ARE MISSING OUT
ON CHOLESTEROL DRUGS
(Prescribing of lipid lowering drugs
to South Asian
patients: ecological study)
http://bmj.com/cgi/content/full/325/7354/25
Patients in general practices with a greater
South Asian
population are less likely to be prescribed
cholesterol
lowering drugs, despite being at a higher
risk of coronary
heart disease than white patients, finds
a study in this
week's BMJ.
Researchers identified the proportion of
South Asian
patients at 62 general practices in one
health authority in
England. They then determined the number
of daily doses
of all cholesterol lowering drugs prescribed
to these
patients.
They found that patients in practices with
a greater South
Asian population were less likely to receive
cholesterol
lowering drugs.
It was not possible for the authors to
ascertain the
incidence of coronary heart disease in
the practices
studied. However, this finding is surprising,
they say,
given the higher level of cardiovascular
illness and death
among South Asian people in the UK, and
an equal if not
greater need for cholesterol lowering
treatment than the
white population.
Further analysis is needed to ascertain
the effects of
subsequent prescribing guidelines and
recent government
strategies promoting the use of cholesterol
lowering
drugs, say the authors. Assessment to
determine the
extent of unmet need and risk profiles
at the level of the
individual patient, with particular reference
to South Asian
patients, is also required.
Contacts:
Mahendra Patel, Research Assistant in Pharmacy
Practice, School of Pharmacy, University
of Bradford,
Bradford, UK
Email: m.g.patel@bradford.ac.uk
or
David Wright, Lecturer in Pharmacy Practice
or
Paramijit Gill, Clinical Senior Lecturer,
Department of
Primary Care and General Practice, University
of
Birmingham, Birmingham, UK
(5) STUDIES OFTEN
IGNORE DOMESTIC
VIOLENCE COMMITTED BY WOMEN
(Letters: Domestic Violence)
http://bmj.com/cgi/content/full/325/7354/44
It's not only men who commit domestic violence,
yet
scientific studies rarely look at female-to-male
violence,
according to two letters in this week's
BMJ.
Responding to a recent editorial on domestic
violence, Dr
Mark Horner argues that the clear implication
is that men
are the oppressors and women suffer. Sadly
this is often
true, but it is far from being the whole
picture, he writes.
According to the 1996 British crime survey
on the extent
of domestic violence in England and Wales,
4.2% of
women and 4.2% of men said that they had
been
physically assaulted by a current or former
partner in the
past year.
Indeed, when one considers that most violence
against
children is committed by women, in terms
of gender it is
women who are most likely to be perpetrators
of
domestic violence, says the author. Why
is domestic
violence so often portrayed in such a
partisan and
unscientific way?
The justification for this slant in the
domestic violence
literature has been that female victims
vastly outnumber
male victims, writes Dr Chris Carlsten
in an
accompanying letter. Many data however
suggest
otherwise.
For example, one study found that 86% of
marital
aggression was reported as reciprocal
between husbands
and wives. Another found that female-to-male
violence
was reported to be higher than male-to-female.
Such reporting bias ignores many thousands
of male
victims and alienates those who demand
a more balanced
presentation, says the author. "Let's
keep working to get
better data, but let's recognise the bi-gender
nature of this
societal ill," he concludes.
Contact:
Chris Carlsten, Resident in Internal Medicine,
Department of Medicine, University of
Washington,
Seattle, USA
Email: carlsten@u.washington.edu
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