Releases Saturday 13 July 2002
No 7355 Volume 325
Please remember to credit the BMJ as source when publicising
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(1) RECOGNISING MENTAL ILLNESS IN YOUNG
PEOPLE COULD PREVENT SUICIDES
(2) POSTCODE
PRESCRIBING IS ALIVE AND WELL
IN SCOTLAND
(3) STRONGEST
MEDICAL EVIDENCE SELDOM
CONSIDERED
NEWSWORTHY
(4) CAN
LONGER CONSULTATIONS REALLY SAVE
TIME AND RESOURCES?
(1) RECOGNISING
MENTAL ILLNESS IN YOUNG
PEOPLE COULD PREVENT SUICIDES
(Familial, psychiatric, and socioeconomic
risk factors for
suicide in young people: nested
case-control study)
http://bmj.com/cgi/content/full/325/7355/74
Recognising mental illness in young people
and dealing with
it appropriately could help prevent suicides,
concludes a
study in this week's BMJ.
Researchers in Denmark identified 496 cases
of suicide
during 1981-97 in young people aged 10-21
years. They
matched each case to a random sample of
50 people of
the same age and sex, to act as controls.
They found that suicide is more likely
among young people
if a parent commits suicide or there is
a history of mental
illness in the individual and their parents
and siblings.
Dysfunctional family backgrounds and socioeconomic
factors, such as unemployment, low income,
and poor
schooling, seem to be less important.
When all factors were considered, the strongest
risk factor
was mental illness in the young people,
say the authors.
Preventive strategies should therefore
be aimed at the early
recognition and treatment of mental illness,
they conclude.
Contact:
Esben Agerbo, Assistant Professor, National
Centre for
Register-based research, University of
Aarhus, Denmark
Email: ea{at}ncrr.dk
(2) POSTCODE PRESCRIBING
IS ALIVE AND WELL
IN SCOTLAND
(Letter: Postcode prescribing is
alive and well in Scotland)
http://bmj.com/cgi/content/full/325/7355/101/a
Drug availability in Scotland continues
to depend on local
health board decisions, despite one of
the intentions of the
National Institute for Clinical Excellence
(NICE) being to
ensure that NHS patients have equitable
access, argue
doctors from Lothian in this week's BMJ.
For example, Imatinib (for the treatment
of chronic
leukaemia) is available to patients in
Fife, yet Lothian
Health Board's drug evaluation panel has
rejected it, write
David Cameron and Michael Dixon of the
Western
General Hospital in Edinburgh.
Irinotecan (licensed for the treatment
of colorectal cancer)
was approved by NICE and the Health Technology
Board
for Scotland, but has also been rejected
in Lothian.
Patients in the west of Scotland can receive
it, and in
Aberdeen, doctors are allowed to prescribe
it but without
any additional funding, so that expenditure
on Irinotecan
competes with that on other drugs, add
the authors.
The current system seems no more equitable
than
previously; extra layers of central committees
exist, and
drug availability continues to depend
on local health board
decisions, say the authors.
"We would advocate a streamlined approach,
with
centralised decision making bodies, such
as NICE and the
Scottish Health Consortium. Any decisions
in favour of a
new drug should result in automatic top-sliced
funding
going direct to the departments dispensing
the drugs, so
that clinicians do not have to apply locally
for approval and
funding," they conclude.
Contacts:
David Cameron, Senior Lecturer in Medical
Oncology,
University of Edinburgh and Edinburgh
Breast Unit,
Western General Hospital, Edinburgh, Scotland
or
Michael Dixon, Consultant Breast Surgeon,
Edinburgh
Breast Unit, Western General Hospital,
Edinburgh,
Scotland
(3) STRONGEST
MEDICAL EVIDENCE SELDOM
CONSIDERED NEWSWORTHY
(What is newsworthy? Longitudinal
study of the reporting
of medical research in two British
newspapers )
http://bmj.com/cgi/content/full/325/7355/81
The strongest medical evidence is seldom
regarded as
newsworthy and is underreported in British
newspapers,
according to researchers in this week's
BMJ.
A team at Bristol University and the University
of Berne,
Switzerland examined two stages on the
path to
newspaper coverage ? selection by medical
journal editors
of studies for press releases and selection
of newsworthy
articles by journalists. They identified
all original research
articles published in the Lancet and BMJ
during 1999 and
2000, then assessed the characteristics
of articles that
were press released and subsequently reported
in the
Friday and Saturday issues of the Times
and Sun
newspapers.
Of 1193 original research articles, 517
(43%) were
highlighted in a press release and 81
(7%) were reported
in one or both newspapers. All articles
covered in
newspapers had been press released. The
pattern of
reporting was similar in the Times and
Sun.
Selection processes acted at both stages,
but not always in
the same direction. For example, newspapers
underreported findings from randomised
trials, even though
they provide the strongest evidence and
were more likely
to be included in press releases. Instead,
they tended to
emphasise results from observational studies,
which are
more prone to bias, say the authors.
Good news and bad news were equally likely
to be
released to the press, but bad news was
more likley to
appear in the newspapers. Studies of women's
health,
reproduction, and cancer were more likely
to be press
released and covered in newspapers, and
research from
developing countries was ignored.
Although press releases might have been
compiled, to
some extent, in anticipation of popular
tastes, the selective
process introduced by newspaper journalists
is stronger
than that operating in the issuing of
press releases, say the
authors.
"We are concerned that many aspects of
medical research
are not well represented in newspapers."
Given that
newspapers are an important source of
information about
the results of medical research, these
findings have
important implications for policy makers,
consumers of
health services, and the population in
general.
Contact:
Matthias Egger, Professor of Clinical Epidemiology
and
Public Health, Department of Social and
Preventive
Medicine, University of Bern, Switzerland
Contactable at
Department of Social Medicine, University
of Bristol, UK
Email: egger{at}bristol.ac.uk
(4) CAN LONGER
CONSULTATIONS REALLY SAVE
TIME AND RESOURCES?
(Letters: Evolving general practice
consultation in Britain )
http://bmj.com/cgi/content/full/325/7355/104
It has been argued that increasing the
length of general
practice consultations will save time
and resources. Yet
two letters in this week's BMJ suggest
that longer
consultations may lead to higher health
service costs and
might necessitate redeployment of pharmacists.
Phil Wilson and colleagues carried out
a pilot study with
six general practitioners in Glasgow to
assess the effect of
increased consultation time on patients'
psychological
distress. Each doctor's surgery was randomised
to either
10 minutes per patient (the normal booking
interval) or 15
minutes. After the consultation, patients
completed a
general health questionnaire.
Although the consultation interval increased
by 50%,
consultation length increased by only
12%. This raises the
question of what the doctors did with
the extra time, say
the authors. When the doctors had longer
booking
intervals, they performed more tests and
asked more
patients to make return appointments.
Perhaps doctors
given more time with patients simply uncover
more
problems, they suggest.
The results of this short-term study must
be interpreted
with caution, say the authors. "Our data
suggest, however,
that longer consultation intervals may
cost more than
remuneration for extra general practitioners'
time."
The only way for doctors to have more time
is for them to
stop doing things, argue Arnold Zermansky
and colleagues
in an accompanying letter. For instance,
a move from
repeat prescribing to repeat dispensing
would probably
save the average general practitioner
about an hour a day.
The extended roles of practice nurses and
nurse
practitioners are a move in this direction,
but there are so
many calls on nurses that we are probably
close to the limit
of available staff.
The largest untapped source of underused
skill is
community pharmacists, say the authors.
The potential
exists to redeploy pharmacists into general
practices to
review patients and supervise drugs, making
best use of
their knowledge and developing skills.
This would free up general practitioners
and enable them
to extend consultations and improve the
depth and breadth
of care, they conclude.
Contact:
Phil Wilson, General Practitioner, Glasgow,
Scotland
Email: p.wilson{at}clinmed.gla.ac.uk
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)
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