Releases Saturday 23 November 2002
No 7374 Volume 325
Please remember to credit the BMJ as source when publicising
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(1) CANNABIS INCREASES RISK OF DEPRESSION AND
SCHIZOPHRENIA
(2) FOLIC ACID COULD PREVENT HEART DISEASE
(3) DELIBERATE
SELF HARM IS COMMON IN
ADOLESCENTS
(4) BANERJEE
CASE HIGHLIGHTS INSTITUTIONAL
CORRUPTION
IN MEDICINE
(5) VERY
LONG TERM EFFECTS OF BOTOX STILL
UNKNOWN
(1) CANNABIS INCREASES
RISK OF DEPRESSION AND
SCHIZOPHRENIA
(Cannabis use and mental health in
young people: cohort
study)
http://bmj.com/cgi/content/full/325/7374/1195
BMJ Volume 325, pp 1195-8
(Self reported cannabis use as a
risk factor for schizophrenia
in Swedish conscripts of 1969: historical
cohort study)
http://bmj.com/cgi/content/full/325/7374/1199
(Cannabis use in adolescence and
risk for adult psychosis:
longitudinal prospective study)
http://bmj.com/cgi/content/full/325/7374/1212
(Editorial: Cannabis and mental health)
http://bmj.com/cgi/content/full/325/7374/1183
Frequent cannabis use increases the risk
of developing
depression and schizophrenia in later
life, according to three
studies in this week's BMJ.
In the first study of 1,600 students from
44 secondary schools
in Australia, frequent cannabis use predicted
later depression
and anxiety, particularly in teenage girls.
Some 60% of participants had used cannabis
by the age of 20
and 7% were daily users. After adjusting
for use of other
substances, daily use in young women was
associated with a
more than fivefold increase in the odds
of later depression and
anxiety. Weekly or more frequent use as
a teenager predicted
a twofold increase in later risk.
Given recent increasing levels of cannabis
use, measures to
reduce frequent and heavy recreational
use seem warranted,
suggest the authors.
The second study clarifies earlier findings
that cannabis is
associated with later schizophrenia and
that this is not
explained by use of other psychoactive
drugs or personality
traits. The results show that use of cannabis
increases the risk
of schizophrenia by 30%.
The weight of evidence is that occasional
use of cannabis has
few harmful effects overall, say the authors.
Nevertheless,
these results indicate a potentially serious
risk to the mental
health of people who use cannabis particularly
in the presence
of other risk factors for schizophrenia.
Such risks need to be
considered in the current move to liberalise
and possibly
legalise the use of cannabis in the United
Kingdom and other
countries, they conclude.
In the third study, researchers found that
using cannabis in
adolescence increases the likelihood of
experiencing
symptoms of schizophrenia in adulthood,
with the youngest
cannabis users (by age 15) at greatest
risk. These findings
suggest that cannabis use among psychologically
vulnerable
adolescents should be strongly discouraged,
while policy and
law makers should concentrate on delaying
onset of cannabis
use, say the authors.
The shown dose-response relation for both
schizophrenia and
depression highlights the importance of
reducing the use of
cannabis in people who use it, write two
psychiatry experts in
an accompanying editorial.
Contacts:
Paper 1: George Patton, Professor of Adolescent
Health,
Centre for Adolescent Health, Murdoch
Children's Research
Institute, Victoria, Australia
Email: gpatton{at}cryptic.rch.unimelb.edu.au
Paper 2: Stanley Zammit, MRC Clinical Research
Fellow,
Depatment of Psychosocial Medicine, University
of Wales
College of Medicine, Cardiff, UK
Email: zammits{at}cardiff.ac.uk
Paper 3: Louise Arseneault, Lecturer, SGDP
Research
Centre, King's College, London, UK
Email: l.arseneault{at}iop.kcl.ac.uk
Editorial: Joseph Rey, Professor of Child
and Adolescent
Psychiatry or Christopher Tennant, Professor
of Psychiatry,
University of Sydney, New South Wales,
Australia
Email: jrey{at}doh.health.nsw.gov.au
/
tennant{at}doh.health.nsw.gov.au
(2) FOLIC ACID COULD PREVENT HEART DISEASE
(Homocysteine and cardiovascular
disease: evidence on
causality from a meta-analysis)
http://bmj.com/cgi/content/full/325/7374/1202
Folic acid could dramatically reduce the
risk of heart disease,
deep vein thrombosis, and stroke if levels
of homocysteine (an
amino acid) were reduced, according to
researchers in this
week's BMJ.
Their conclusion rests on strong evidence
that a raised
homocysteine concentration is a cause
of cardiovascular
disease. Homocysteine can be lowered by
folic acid.
Over 100 studies on the association between
serum
homocysteine and cardiovascular disease
were analysed.
Some looked at the prevalence of a genetic
mutation, which
increases homocysteine (genetic studies),
and some looked at
homocysteine and disease risk (prospective
studies).
The genetic studies and the prospective
studies did not share
the same potential sources of error but
both yielded similar
results - strong evidence that the association
between
homocysteine and cardiovascular disease
is causal. On this
basis, the researchers estimate that folic
acid could reduce the
risk of ischaemic heart disease by 16%,
deep vein thrombosis
by 25%, and stroke by 24%.
The folic acid could be taken as tablets
by people at high risk
(those with existing cardiovascular disease
or anyone above
age 55), or possibly supplied to the general
public through
food fortification or a combination of
both, as a simple and
safe means of prevention, they conclude.
Folic acid food fortification has already
been introduced in
America to prevent the birth defect spina
bifida. This research
shows that such fortification will also
help prevent heart
attacks and strokes.
Contact:
David Wald, Specialist Registrar in Cardiology,
Department
of Cardiology, Southampton General Hospital,
Southampton,
UK
Email: davidwald{at}hotmail.com
(3) DELIBERATE
SELF HARM IS COMMON IN
ADOLESCENTS
(Deliberate self harm in adolescents:
self report survey in schools
in England)
http://bmj.com/cgi/content/full/325/7374/1207
Deliberate self harm is common in adolescents,
especially
females, finds a study in this week's
BMJ.
Researchers surveyed over 6,000 pupils
aged 15 and 16
years from 41 schools in England. The
questionnaire was
anonymous and sought information about
lifestyle, deliberate
self harm, suicidal thoughts, and self
esteem. Reported acts of
self harm were assessed according to specific
criteria.
Overall, 398 pupils (7%) had carried out
an act of deliberate
self harm in the previous year that met
study criteria.
However, only 13% of episodes had resulted
in presentation
to hospital. Deliberate self harm was
nearly four times more
common in females than in males.
In females, the factors associated with
deliberate self harm
included recent self harm by friends or
family members, drug
misuse, depression, anxiety, impulsivity,
and low self esteem.
In males the factors were suicidal behaviour
in friends and
family members, drug use, and low self
esteem.
These findings support the need for school
based mental
health initiatives, targeting self esteem
issues, depression,
anxiety, and impulsivity, say the authors.
Further potential
approaches could include educating school
pupils about
mental health problems and routine screening
for those at risk.
Contact:
Keith Hawton, Professor of Psychiatry,
Centre for Suicide
Research, University Department of Psychiatry,
Warneford
Hospital, Oxford, UK
Email: keith.hawton{at}psychiatry.ox.ac.uk
(4) BANERJEE CASE
HIGHLIGHTS INSTITUTIONAL
CORRUPTION IN MEDICINE
(Institutional corruption in medicine)
http://bmj.com/cgi/content/full/325/7374/1232
The finding by the General Medical Council
that Mr Anjan
Kumar Banerjee and Professor Timothy John
Peters were
guilty of serious professional misconduct
for research fraud
committed a decade earlier is not just
a case of one doctor
covering up for another but of corruption
at a senior level in
academic institutions, argues Consultant
Cardiologist, Peter
Wilmshurst in this week's BMJ.
He describes how senior academics and managers
at King's
College, the University of London, and
the Royal College of
Surgeons concealed serious professional
misconduct by
doctors for a decade. These institutions
are among the bodies
that directly appoint non-elected members
to the GMC.
Some were aware that Banerjee had falsified
his research but
failed to bring this to the attention
of the GMC, the funding
bodies, or the journal that had published
the falsified research.
Others allowed Banerjee to gain a qualification
and an honour
dishonestly.
The case of Banerjee and Peters is not
an isolated one, writes
the author. "I am aware of other cases
under investigation by
the GMC in which academic institutions,
which appoint
members to the GMC, refused to cooperate
with the GMC's
investigations into research fraud and
other forms of
misconduct by doctors employed in their
institutions."
It is difficult to believe that the decision
not to cooperate with
the GMC is made at a junior level, he
adds. It seems likely
that in some cases appointed members of
the GMC are
involved in the decision of their institution
not to cooperate
with the GMC's inquiries.
At a time when there is restructuring at
the GMC, the role of
GMC members needs to be considered, he
concludes.
Contact:
Peter Wilmshurst, Consultant Cardiologist,
Royal Shrewsbury
Hospital, Shrewsbury, UK
Email: peter.wilmshurst{at}rsh.nhs.uk
(5) VERY LONG
TERM EFFECTS OF BOTOX STILL
UNKNOWN
(Editorial: The changed image of
botulinum toxin)
http://bmj.com/cgi/content/full/325/7374/1188
The use of botulinum toxin for facial cosmetic
enhancement
has established its new image as a glamour
drug, but its
unlicensed use is increasing dramatically
for certain conditions,
ahead of clear scientific evidence. Although
negative side
effects are few, its very long term effects
are still unknown,
warns a neurology expert in this week's
BMJ.
Botulinum toxin is reported to be useful
in more than 50
conditions, but is licensed for only a
few. For instance, in the
United Kingdom it is an effective and
safe treatment for facial
spasms and excessive sweating, with few
side effects. It may
also be useful in several conditions for
which it does not yet
have a licence. In the United States the
toxin was licensed this
year for facial lines or wrinkles.
The revenue for the global sales of Botox
has increased from
$25m in 1993 to $310m in 2001 and is estimated
to be
$430m in 2002, writes the author. The
biggest area of growth
has been in dermatology ? the use of the
toxin for facial lines
has increased by 1500% in the United States
over the past
four years.
Popular magazines and newspapers regularly
report its use by
celebrities from the film, television,
and music industries. Given
such hype it is unsurprising that a recent
study found that 23%
of patients seeking treatment with botulinum
toxin at a
dermatology clinic had body dysmorphic
disorder, and
psychotherapy was considered the more
appropriate
treatment for them.
In this atmosphere of "Botox parties,"
it is easy to forget that
botulinum toxin is a potent neurotoxin
and that its very long
term effects are still unknown, he concludes.
Contact:
Peter Misra, Consulant Clinical Neurophysiologist,
National
Hospital for Neurology and Neurosurgery,
London, UK
Email: peter.misra{at}uclh.org
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
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BMA House
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London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
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Advancement of Science
(http://www.eurekalert.org)
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