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(2) NEW
APPROACH TO INSULIN TREATMENT
IMPROVES PATIENTS'
LIVES
(3) SMALL
BABIES ARE MORE LIKELY TO BE
STRESSED ADULTS
(4) SHOULD
WE HELP TO CREATE DISABLED
BABIES?
(1) MEN WITH PROSTATE
CANCER WANT
SCREENING DESPITE DOUBTS OVER
EFFECTIVENESS OF TREATMENT
(Why men with prostate cancer want
wider access to
prostate specific antigen testing:
qualitative study)
http://bmj.com/cgi/content/full/325/7367/737
(Natural experiment examining impact
of aggressive
screening and treatment on prostate
cancer mortality in
two fixed cohorts from Seattle area
and Connecticut)
http://bmj.com/cgi/content/full/325/7367/740
(Editorial: Prostate specific antigen
testing for prostate
cancer)
http://bmj.com/cgi/content/full/325/7367/725
Most men with prostate cancer strongly
advocate routine
testing for prostate specific antigen
(PSA), despite
evidence that aggressive screening and
treatment does not
reduce deaths, according to two studies
in this week's
BMJ.
In the first study, researchers at the
University of Oxford
interviewed 52 men with suspected or confirmed
prostate
cancer.
All but four men were keen to see others,
including their
own friends and sons, have a PSA test.
Their reasons
included the belief that early diagnosis
would reduce
death, improve quality of life, and save
the NHS money.
The four men who opposed screening knew
that treatment
had not been proved effective and accepted
that this was
a deterrent to screening.
Screening for prostate cancer has serious
disadvantages,
say the authors. As such, general practitioners
in the UK
have been advised to ensure that men who
have a PSA
test are making an informed choice. Policy
makers,
politicians, and doctors need to understand
why people
want wider access to PSA testing so that
they can find
better ways of communicating information
about risk, they
conclude.
In the second study, researchers in the
United States
compared the Seattle-Puget Sound region,
where
intensive screening and treatment for
prostate cancer were
adopted early, and Connecticut, where
adoption was
slower.
During 1987-90, men in Seattle were five
times as likely
to undergo PSA testing and twice as likely
to undergo
biopsy. Rates of radical surgery and radiotherapy
were
also substantially higher. However, over
11 years of
follow up, prostate cancer death rates
were similar in the
two areas.
Longer follow up may be necessary to fully
assess the
outcome of this natural experiment, say
the authors.
Meanwhile, ongoing trials assessing the
effectiveness of
screening and treatment for prostate cancer
should be
supported.
Contacts:
Alison Chapple, Senior Research Fellow
Department of
Primary Health Care, University of Oxford,
Oxford, UK
Email: alison.chapple@dphpc.ox.ac.uk
Michael Barry, Associate Professor of Medicine,
Harvard
Medical School, USA
Email: mbarry@partners.org
(2) NEW APPROACH
TO INSULIN TREATMENT
IMPROVES PATIENTS' LIVES
(Training in flexible, intensive
insulin management to enable
dietary freedom in people with type
1 diabetes: dose
adjustment for normal eating (DAFNE)
randomised
controlled trial)
http://bmj.com/cgi/content/full/325/7367/746
Training patients with diabetes to adjust
their insulin doses
to match their food choices, improves
diabetes control
and quality of life, finds a study in
this week's BMJ.
This approach has been developed in Germany,
but has
not been widely adopted elsewhere. Patients
in the UK
often have impaired quality of life and
a high risk of
diabetic complications. Researchers in
Sheffield, London
and North Tyneside set out to test this
approach in the
UK with the dose adjustment for normal
eating (DAFNE)
trial.
They identified 169 adults with type 1
diabetes attending
hospital clinics in Sheffield, Northumbria,
and London.
Patients either attended a five day training
course, or
continued to receive usual care for six
months as controls
and then attend a course.
The course trained patients to adjust their
insulin doses to
match their food choices, rather than
being expected to
sacrifice dietary preferences to fit in
with prescribed insulin
doses. Participants in DAFNE had improved
glycaemic
control and, despite intensified insulin
treatment, reported
greater satisfaction with treatment, general
wellbeing, and
quality of life.
The personal importance of these improvements
are
illustrated by patient's comments. One
said, "I now feel
able to travel abroad without worry about
not eating or
eating on time." Another said, "I have
found my whole
lifestyle and outlook on life has improved."
Skills training enables patients to fit
diabetes into their lives
rather than their lives into diabetes,
and can be applied
successfully across different healthcare
systems, say the
authors. This approach has the potential
to enable more
people to adopt intensive insulin treatment
and is worthy
of further investigation, they conclude.
Contacts:
Simon Heller, Clinical Sciences Centre,
Northern General
Hospital, Sheffield, UK
Email: s.heller@sheffield.ac.uk
or
Jane Speight, Health Psychologist, Royal
Holloway,
University of London, UK
Email: j.speight@rhul.ac.uk
(3) SMALL BABIES
ARE MORE LIKELY TO BE
STRESSED ADULTS
(Association between psychological
symptoms in adults
and growth in early life: longitudinal
follow up study)
http://bmj.com/cgi/content/full/325/7367/749
Small size at birth and slow growth in
early childhood are
associated with higher levels of psychological
distress in
adults, finds a study in this week's BMJ.
Cheung and colleagues studied the psychological
health of
over 9,000 British adults born in 1958
until age 42 years.
Birth weight and growth in childhood was
measured and
factors such as father's social class
and maternal smoking
were accounted for.
They found that people who had a higher
birth weight and
a faster weight gain from birth to 7 years
old had a lower
level of psychological distress into middle
age.
Previous studies could only demonstrate
such a relation up
to the age of 26 years, they conclude.
Contact:
Y B Cheung, Biostatistician, Division of
Clinical Trials and
Epidemiological Sciences, National Cancer
Centre,
Singapore
Email: ctecyb@nccs.com.sg
(4) SHOULD WE
HELP TO CREATE DISABLED
BABIES?
(Deaf lesbians, "designer disability,"
and the future of
medicine)
http://bmj.com/cgi/content/full/325/7367/771
Should genetic tests be offered to couples
seeking to have
a child to allow them to select for disability?
Many would
see deliberately creating disabled babies
as the most
perverse manifestation of creating designer
babies but, in
this week's BMJ, Julian Savulescu argues
that there may
be good reasons for acceding to such requests.
We offer genetic tests to couples to allow
them to select
the child ? from the possible children
they could have ?
with the best opportunity of having the
best life. But how
should we decide what constitutes "the
best life
prospects?"
Each couple makes its own decision about
whether or not
to have a child with Down's syndrome.
"But my value
judgement should not be imposed on couples
who must
bear and rear the child. Nor should the
value judgement of
doctors, politicians, or the state be
imposed directly or
indirectly (through the denial of services)
on them," he
says.
There are good reasons to engage people
in dialogue
about their decisions, to try to persuade
them with
arguments, but in the end we should respect
their
decisions about their own lives.
Reproduction should be about having children
who have
the best prospects, but we must give individual
couples
the freedom to act on their own value
judgement of what
constitutes a life of prospect. That includes
the freedom to
do what others disapprove of or judge
wrong, provided
the exercise of freedom does not harm
others, he writes.
As rational people, we should all form
our own ideas
about what is the best life. But to know
what is the good
life and impose this on others is at best
overconfidence ?
at worst, arrogance, he concludes.
Contact:
Professor Julian Savulescu, Oxford Centre
for Applied
Ethics, Oxford, UK (Currently in Japan,
but available via
two email addresses)
Email: julian.savulescu@philosophy.oxford.ac.uk
OR
savulesj@aol.com
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