Releases Saturday 11 January 2003
No 7380 Volume 326
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(1) Possibility that up to a quarter of intimate examinations
performed by trainees are conducted without consent
(2) Most ecstasy-related deaths occur among white males
(3) Hip protectors can reduce fractures by 40%
(4) Racism is a public health issue
(1) Possibility
that up to a quarter of intimate examinations
performed by trainees
are conducted without consent
(The ethics of intimate
examinations - teaching tomorrow's
doctors)
http://bmj.com/cgi/content/full/326/7380/97
(Commentary: Respecting
the patient's integrity is the key)
http://bmj.com/cgi/content/full/326/7380/97#resp1
(Editorial: Intimate
examinations and other ethical challenges in
medical education)
http://bmj.com/cgi/content/full/326/7380/62
A survey of medical students
in this week's BMJ suggests that
as many as a quarter of
the intimate examinations, which they
performed on anaesthetised
patients, are carried out without
adequate consent from the
patient.
The study was conducted after
students at the University of
Bristol expressed concerns
that ethical guidelines requiring
consent for the teaching
of vaginal and rectal examinations
were not always being followed.
The authors contacted 452
second, third, and fourth year
students at an English medical
school and asked them how
many intimate examinations
they had done, when in their
training they had taken
place, and the level of consent that had
been obtained.
In a third of examinations
by second-year students and half of
those by third-years, students
had not obtained consent from
the patient and did not
know whether it had been obtained by
the supervising doctor.
Fourth-year students, who are required
to do more examinations,
were more likely to have obtained
consent personally. Almost
a quarter of examinations on
sedated or anaesthetised
patients had apparently been carried
out without consent.
The authors argue that this
is unlikely to be the only medical
school failing to meet ethical
standards. "Trust and respect are
essential to the doctor-patient
relationship, yet this study
suggests that these are
missing from students' experiences of
learning to do intimate
examinations," they conclude.
In an accompanying editorial,
University of Toronto bioethicist
Peter Singer praises the
authors for highlighting the problem,
describes model guidelines
for ethics in clinical teaching, and
calls on all medical schools
to implement guidelines to address
the ethical challenges of
medical education. His views are
echoed in a commentary by
Britt-Ingjerd Nesheim, who
stresses that "The patient
must be treated as the student's
teacher, not as a training
tool".
Contacts:
Paper: Clive Roberts, Medical
Clinical Dean, University of
Bristol Medical School
Email: c.j.c.roberts{at}bristol.ac.uk
Editorial: Peter Singer,
University of Toronto Joint Centre for
Bioethics, Toronto, Canada
Email: peter.singer{at}utoronto.ca
Commentary: Professor Britt-Ingjerd
Nesheim, Department of
Obstetrics and Gynaecology,
Ulleval University Hospital Oslo,
Norway
Email: b.i.nesheim{at}ioks.uio.no
(2) Most ecstasy-related deaths occur among white males
(Review of deaths related
to taking ecstasy, England and
Wales, 1997-2000)
http://bmj.com/cgi/content/full/326/7380/80
Most people who die after
taking ecstasy are white males in
their late twenties, finds
a study in this week's BMJ.
Researchers at St George's
Hospital analysed data on
drug-related deaths collected
for the National Programme on
Substance Abuse Deaths.
They identified 81 ecstasy-related
deaths occurring in England
and Wales between 1997 and
2000.
Most people who died from
taking ecstasy were white,
employed men in their late
twenties, half of whom were known
to services as drug addicts.
The deaths occurred mainly at
party times (weekends, summer,
and at New Year) and were
concentrated in urban industrial
areas in the north and
southeast.
In 62% of cases ecstasy had
been taken with other drugs,
both prescribed and non-prescribed,
possibly in an attempt to
modulate the effects. In
these cases, the authors argue, ecstasy
had at least a facilitating
role in causing death.
In a number of cases, however,
people had died after taking
ecstasy on its own, which
earlier studies had suggested was
unlikely.
The authors conclude that
more research into the incidence of
ecstasy use is necessary
for a better understanding of the
drug's dangers, and welcome
plans to extend the role of the
National Programme on Substance
Abuse Deaths.
Contact:
Fabrizio Schifano, Senior
Lecturer, Department of Addictive
Behaviour and Psychological
Medicine, St George's Hospital
Medical School, London
Email: f.schifano{at}sghms.ac.uk
(3) Hip protectors can reduce fractures by 40%
(Effect on hip fractures
of increased use of hip protectors in
nursing homes: cluster
randomised controlled trial)
http://bmj.com/cgi/content/full/326/7380/76
The use of hip protectors
in nursing homes can reduce hip
fractures by about 40%,
yet acceptance of hip protectors is
poor, according to a study
in this week's BMJ.
Researchers in Germany identified
42 nursing homes in
Hamburg. Homes were allocated
either to usual care (control
group) or an intervention
programme consisting of structured
education of staff, who
then taught residents, and provision of
free hip protectors (intervention
group).
Over a period of 14 months,
there were 21 hip fractures in 21
(4.6%) residents in the
intervention group and 42 hip fractures
in 39 (8.1%) residents in
the control group.
These findings suggest that
a structured education programme
and provision of free hip
protectors can increase use and
protect residents from hip
fracture, say the authors. They
suggest provision of hip
protectors on prescription for elderly
people at high risk of hip
fracture.
Contacts:
Gabriele Meyer or Ingrid
Mulhlhauser, Unit of Health
Sciences and Education,
University of Hamburg, Germany
Email: Ingrid_Muehlhauser{at}uni-hamburg.de
(4) Racism is a public health issue
(Editorial: Racism
and health)
http://bmj.com/cgi/content/full/326/7380/65
Racism may be important in
the development of illness and
countering it should be
considered a public health issue, argues
a senior psychiatrist in
this week's BMJ.
Studies in the United States
report associations between
perceived racial discrimination
and high blood pressure, birth
weight, and days off sick.
In a recent study from the United
Kingdom, victims of discrimination
were more likely to have
respiratory illness, high
blood pressure, anxiety, depression,
and psychosis. Stress responses
have been considered
possible mechanisms for
the effects of racism on health.
Considering racism as a cause
of ill health is an important step
in developing the research
agenda and response from health
services, says the author.
Yet despite general agreement that
racism is wrong, there is
little evidence of any concerted and
effective initiatives to
decrease its prevalence. This means that
in the United Kingdom the
science of investigating the effects
of racism on health and
the development of preventive
strategies are in their
infancy.
How can we have equity in
health if one of the major possible
causes of illness in minority
ethnic groups in the United
Kingdom does not have a
dedicated research effort or
prevention strategy? he
concludes.
Contact:
Kwame McKenzie, Senior Lecturer
in Transcultural
Psychiatry, Department of
Psychiatry and Behavioural
Sciences, Royal Free and
University College Medical School,
London, UK
Email: k.mckenzie{at}rfc.ucl.ac.uk
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