Releases Saturday 15 February 2003
No 7385 Volume 326
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(1) GOVERNMENT MONEY FOR MULTIPLE
SCLEROSIS PATIENTS COULD BE BETTER
SPENT
(2) DEATHS
FROM FOODBORNE DISEASES ARE
UNDERESTIMATED
(3) CHILDREN
IN CARE LESS LIKELY TO GET
MENINGITIS
VACCINE
(4) LARGER
GP PRACTICES DO NOT PROVIDE
BETTER CARE
(5) PATIENTS
ARE WILLING TO ALLOW
PERSONAL DETAILS
TO BE USED FOR
RERSEARCH,
BUT WANT TO BE CONSULTED
FIRST
(6) LAVATORY
DISINFECTANTS MAY HINDER
COLON CANCER
PROGRAMME
(1) GOVERNMENT
MONEY FOR MULTIPLE
SCLEROSIS PATIENTS COULD BE BETTER
SPENT
(Problems with UK government's risk
sharing scheme
for assessing drugs for multiple
sclerosis)
http://bmj.com/cgi/content/full/326/7385/388
The National Institute for Clinical Excellence
(NICE) has
announced that neither interferon beta
nor glatiramer can
be recommended for multiple sclerosis
in the NHS.
However, the UK government plans to make
these
drugs available through a risk sharing
scheme, despite
limited evidence of clinical and cost
effectiveness.
Researchers in this week's BMJ argue that
the money
would be better spent on independent trials.
To reach their decision, NICE considered
data from
placebo controlled trials of interferon
beta and glatiramer
acetate, but did not assess azathioprine,
which has also
been widely tested in multiple sclerosis.
Trials show that
azathioprine (which is 20 times cheaper)
may be just as
effective, say the authors.
Uncertainty also remains about the clinical
and cost
effectiveness of interferon beta and glatiramer
(especially
over the long-term duration of the disease),
and the
government's proposed risk sharing scheme
is, according
to the authors, scientifically unsound
and impractical.
Any additional resources for patients with
multiple
sclerosis are welcome, but should be used
to provide
services that will benefit more than just
the minority of
patients eligible for interferon or glatiramer,
they argue.
Government money would be better spent
on a long
term trial comparing interferon beta or
glatiramer with
azathioprine and no treatment.
All patients with multiple sclerosis deserve
much better
than this. The government should consider
a more
appropriate use of this large amount of
public money,
they conclude.
Contacts:
Cathie Sudlow, Wellcome Clinician Scientist,
Department of Clinical Neurosciences,
University of
Edinburgh, Western General Hospital, Edinburgh,
Scotland
Email: csudlow{at}skull.dcn.ed.ac.uk
or
Carl Counsell, Senior Lecturer in Neurology,
Aberdeen
Royal Infirmary and University of Aberdeen,
Scotland
Email: cec{at}iahs.abdn.ac.uk
(2) DEATHS FROM
FOODBORNE DISEASES ARE
UNDERESTIMATED
(Short and long term mortality associated
with
foodborne bacterial gastrointestinal
infections: registry
based study)
http://bmj.com/cgi/content/full/326/7385/357
The number of deaths from foodborne diseases
is likely
to be underestimated, finds a study in
this week's BMJ.
Researchers in Denmark identified 48,857
people
infected with the bacteria Salmonella,
Campylobacter,
Yersinia enterocolitica or Shigella plus
487,138 controls
from the general population.
A total of 1,071 (2.2%) of people with
gastrointestinal
infections died within one year after
infection compared
with 3,636 (0.7%) of controls. Risk of
death was three
times higher among patients infected with
one of the four
bacteria.
Most foodborne gastrointestinal infections
are self
limiting, say the authors. However, in
a subset of patients
they can cause severe complications and
increased risk
of death.
Infections with all these bacteria were
associated with an
increased short term risk of death, even
after pre-existing
illnesses were taken into account. Salmonella,
Campylobacter, Yersinia enterocolitica
infections were
also associated with increased long term
mortality.
Current estimates of the burden of foodborne
diseases
underestimate the number of deaths from
bacterial
infections, they conclude.
Contact:
Kåre Mølbak, Senior Medical
Officer, Department of
Epidemiology, Statens Serum Institut,
Copenhagen,
Denmark
Email: krm{at}ssi.dk
(3) CHILDREN IN
CARE LESS LIKELY TO GET
MENINGITIS VACCINE
(Cross sectional survey of meningococcal
C
immunisation in children looked
after by local authorities
and those living at home)
http://bmj.com/cgi/content/full/326/7385/364
Children looked after by local authorities
are twice as
unlikely to receive meningococcal C vaccine
than
children at home, concludes a study in
this week's BMJ.
Researchers identified the immunisation
status of all
children in nine health districts in the
United Kingdom.
Because universal childhood meningococcal
C
vaccination was introduced in 1999, they
were able to
measure immunisation uptake in public
care, unbiased by
historical health neglect.
Overall, 33% of children in public care
did not receive
meningococcal C vaccine compared with
15% of
children at home. Uptake decreased with
age in both
groups.
The team did not examine the reasons for
failure to
immunise. However, during 2001, 16% of
children in
public care moved placement more than
three times.
"This instability creates potent risk
factors, including
missed school based immunisation and discontinuity
of
primary care," they say.
The authors suggest two ways forward. Firstly,
health
services should be made accountable for
immunisation
uptake as well as social services. Secondly,
effective
shared information systems between health
and social
services need to be introduced.
Together these measures would better protect
our most
vulnerable children from disease, they
conclude.
Contact:
Catherine Hill, Senior Lecturer in Community
Child
Health, University Child health, Southampton
General
Hospital, Southampton, UK
Email: cmh2{at}soton.ac.uk
(4) LARGER GP
PRACTICES DO NOT PROVIDE
BETTER CARE
(Association between practice size
and quality of care of
patients with ischaemic heart disease:
cross sectional
study)
http://bmj.com/cgi/content/full/326/7385/371
It is widely known that fewer patients
die in larger
hospitals that do more operations, but
does a similar
association between volume of treatment
and quality
exist in primary care? In this week's
BMJ, Azeem
Majeed and colleagues set out to test
whether large
general practices or those that treat
more people provide
better care.
They identified patients with ischaemic
heart disease in
62 general practices in southwest London.
Practice size
varied from 1,265 to 13,147 patients.
In total, 6,888
people had ischaemic heart disease. The
number of
cases in individual practices varied from
12 to 326.
Only recording of cholesterol concentrations
showed an
improvement with increasing number of
cases of
ischaemic heart disease. All other aspects
of
management were not associated with the
number of
cases managed. They also found no association
between
practice size and the quality of care.
This suggests that the trend in the NHS
towards larger
general practices by itself has little
impact on the quality
of chronic disease management in primary
care, say the
authors.
Although recent developments in the NHS
have cast
doubt on the future of smaller practices,
both patients
and the doctors seem happy with smaller
practices.
Smaller practices are often seen as more
accessible and
achieve higher levels of patient satisfaction.
The NHS should reconsider how it can improve
the
quality of care provided by general practitioners,
without
relying on the presumed benefits of consolidating
them
into larger units, they conclude.
Contact:
Azeem Majeed, Professor of Primary Care,
Primary
Care Research Unit, School of Public Policy,
University
College London, UK
Email: a.majeed{at}ucl.ac.uk
(5) PATIENTS ARE
WILLING TO ALLOW
PERSONAL DETAILS TO BE USED FOR
RERSEARCH, BUT WANT TO BE CONSULTED
FIRST
(Patients' consent preferences for
research uses
of information in electronic medical
records: interview
and survey data)
http://bmj.com/cgi/content/full/326/7385/373
Patients are willing to allow personal
information from
their medical records to be used for research
purposes,
but want to be actively consulted first,
finds a study in
this week's BMJ.
Researchers in Canada identified 123 patients
from
family practices in Southern Ontario.
Seventeen were
interviewed and 106 completed a survey
about their
opinions and concerns on use of information
from their
medical records and their preferred method
of consent.
Most interviewees were willing to allow
the use of their
information for research purposes, although
most
preferred to be asked for consent, either
verbally or in
writing. The seeking of consent was considered
an
important element of respect for the individual.
Most patients made little distinction between
identifiable
and anonymised data, and most preferred
a time limit for
their consent.
Research sponsored by private insurance
firms
generated the greatest concern, whereas
funding by
foundations evoked the least concern.
Sponsorship by
drug companies evoked relatively low concern.
It makes sense to engage the public more
generally in the
use of personal information for research
purposes, say
the authors. One approach would be to
develop an
"information directive" with patients
identifying in
advance the purposes for which information
may be
used.
Obtaining individual consent for research
studies
presents logistical challenges that call
for new
approaches, taking into account the varying
needs of the
public and the evolving uses of personal
information in a
broader context, they conclude.
Contact:
Donald Willison, Assistant Professor, Centre
for
Evaluation of Medicines, McMaster University
Faculty
of Health Sciences, Hamilton, Ontario,
Canada
Email: willison{at}mcmaster.ca
(6) LAVATORY DISINFECTANTS
MAY HINDER
COLON CANCER PROGRAMME
(Letter: Look before you flush)
http://bmj.com/cgi/content/full/326/7385/397/b
Coloured lavatory disinfectants might be
hindering the
national programme for early detection
of colon cancer,
suggests a letter in this week's BMJ.
The programme advises people "don't blush�look
before
you flush" to raise public awareness of
rectal bleeding�
often an early sign of colon cancer.
Yet Mourad Habib, a clinical research fellow
at St
James's University Hospital, says that
the lavatory
disinfectants now sold in supermarkets
are mostly blue in
colour and change the water blue, which
makes looking
for blood quite difficult.
He suggests that we stop selling colouring
agents and
replace them with colourless ones or even
use reagents
that turn a certain colour in the presence
of minor blood
amounts.
Contact:
Mourad Ibrahim Habib, Clinical Research
Fellow, St
James's University Hospital, Leeds, UK
Email: mouradhabib{at}hotmail.com
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(http://www.eurekalert.org)
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