Releases Saturday 12 April 2003
No 7393 Volume 326
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(1) ANTIBODIES CAN HALVE RISK OF
TRANSPLANT REJECTION
(2) WOMEN
WITH PRE-ECLAMPSIA AT HIGHER
RISK OF LATER
BLOOD CLOTS
(3) PRESCRIPTION EXERCISE IS EFFECTIVE
(4) HAVE
MEDICAL JOURNALS HELPED TO
JUSTIFY WAR?
(5) IMAGES OF WAR RAISE ETHICAL CONCERNS
(1) ANTIBODIES
CAN HALVE RISK OF
TRANSPLANT REJECTION
(Interleukin-2 receptor monoclonal
antibodies in renal
transplantation: meta-analysis of
randomised trials)
http://bmj.com/cgi/content/full/326/7393/789
Giving interleukin-2 receptor antibodies
to patients after
a kidney transplant can halve the risk
of rejection,
concludes a study in this week's BMJ.
Researchers in Birmingham reviewed eight
trials of
interleukin-2 receptor antibodies versus
placebo in
1,858 patients receiving standard immunosuppressant
drugs after kidney transplants.
Treatment with interleukin-2 receptor antibodies
reduced
the risk of acute rejection by 49% after
six months.
Patients receiving antibodies did not
have an increased
risk of infection, and there were no significant
differences
in the rate of graft loss or survival
after one year.
Reducing the rate of acute rejection is
important in
kidney transplantation, as patients who
have had one or
more episodes of acute rejection have
at least a 50%
reduction in long term graft survival,
say the authors.
Longer follow up studies are needed to
confirm whether
interleukin-2 receptor antibodies improve
long term graft
and patient survival, they conclude.
Contact:
Dwomoa Adu, Consultant Nephrologist, Department
of
Nephrology, Queen Elizabeth Hospital,
Birmingham, UK
Email: dwomoa.adu{at}uhb.nhs.uk
(2) WOMEN WITH
PRE-ECLAMPSIA AT HIGHER
RISK OF LATER BLOOD CLOTS
(Risk of subsequent thromboembolism
for patients with
pre-eclampsia)
http://bmj.com/cgi/content/full/326/7393/791
Women with pre-eclampsia have a small but
significantly
higher risk of subsequent blood clotting
(venous
thromboembolism) compared with women diagnosed
as
having other common obstetrical diseases,
finds a study
in this week's BMJ.
The study compared 12,849 women admitted
to hospital
with pre-eclampsia during their pregnancy
with 284,188
controls. All women were observed for
up to three years
after discharge from hospital.
Venous thromboembolism was more common
in the
pre-eclampsia group than in any of the
control groups.
Women with pre-eclampsia were more than
twice as
likely to be admitted to hospital with
venous
thromboembolism during the observation
period.
The absolute risk increase with pre-eclampsia
is too
small to warrant preventive treatment
for such patients,
say the authors. Instead, the signs and
symptoms of
venous thromboembolism should be reviewed
with
women who develop or have had pre-eclampsia
so that
they can seek appropriate medical care
if the need
arises.
Contact:
Carl van Walraven, Ottawa Health Research
Institute,
Ottawa, Canada
Email: carlv{at}ohri.ca
(3) PRESCRIPTION EXERCISE IS EFFECTIVE
(Effectiveness of counselling patients
on physical activity
in general practice: cluster randomised
control trial)
http://bmj.com/cgi/content/full/326/7393/793
Advising patients in general practice on
exercise (known
as the green prescription programme) is
effective in
increasing physical activity and improving
quality of life
over 12 months, without evidence of adverse
effects,
finds a study in this week's BMJ.
Researchers in New Zealand identified all
sedentary
40-79 year old patients visiting their
general practitioner
over a five-day period. A total of 878
patients were
enrolled in the study. Patients allocated
to the
intervention group received advice about
physical activity
and support from exercise specialists.
Patients in the
control group received usual care.
Physical activity during leisure time and
total energy
expenditure increased more in the intervention
group
than in the control group. Measures of
self-rated "general
health," "vitality," and "bodily pain"
also improved
significantly more in the intervention
group.
A trend towards decreasing blood pressure
became
apparent but no changes in the risk of
coronary heart
disease were observed.
This study has shown that brief advice,
coupled with
ongoing telephone support, can change
people's
behaviour with respect to physical activity
and improve
general health, vitality, and bodily pain
for at least a year,
say the authors.
If implemented widely, such a strategy
could result in
major health benefits for sedentary people,
they
conclude.
Contact:
C Raina Elley, Senior Lecturer, Department
of General
Practice and Primary Health Care, University
of
Auckland, New Zealand
Email: c.elley{at}auckland.ac.nz
(4) HAVE MEDICAL
JOURNALS HELPED TO
JUSTIFY WAR?
(Letter: Medical journals may have
had a role in
justifying war)
http://bmj.com/cgi/content/full/326/7393/820
Medical journals may have played an important
part in
providing the political justification
for attacking Iraq,
argues a public health expert in this
week's BMJ.
Professor Ian Roberts believes that most
people in the
United States and the United Kingdom would
have
preferred not to launch a military attack
on the people of
Iraq. To persuade them to do so, they
need to believe
that they are being attacked.
Medical journals have (unwittingly) had
an important
propaganda role in persuading the public
that it is being
attached, he writes.
To illustrate this point, he compared the
number of
articles on bioterrorism published in
five major medical
journals between 1999 and 2002 with the
number of
articles published on road traffic crashes
(which kill
about 3,000 people and disable about 30,000
each day
worldwide).
Articles on bioterrorism outnumbered articles
on road
traffic crashes in both 2001 and 2002.
Of the 124
articles on bioterrorism, 63% originated
in the United
States and the rest in the United Kingdom.
JAMA
published the largest proportion (47%),
followed by the
BMJ (21%), the Lancet (16%), and the New
England
Journal of Medicine (15%).
Compared with a health problem that kills
3,000 people
per day, the public health importance
of bioterrorism has
been over emphasised in the leading medical
journals, he
says.
"I am not implying that this is a deliberate
attempt to
alarm the population, but nevertheless
it may have had
this effect. As a result, medical journals
may have
unwittingly played an important political
part in justifying
war in Iraq," he concludes.
Contact:
Ian Roberts, Professor of Epidemiology
and Public
Health, London School of Hygiene and Tropical
Medicine, London, UK
Email: ian.roberts{at}lshtm.ac.uk
(5) IMAGES OF WAR RAISE ETHICAL CONCERNS
(Editorial: Images of war and medical
ethics)
http://bmj.com/cgi/content/full/326/7393/774
Graphic media images of Iraqi civilian
casualties raise
questions about the boundaries of media
ethics and,
more importantly, medical ethics, according
to an
editorial in this week's BMJ.
Law lecturer, Jerome Singh, and television
news
reporter, Tania DePellegrin, believe that
doctors owe
patients basic duties of care that should
not be
suspended during times of war.
Any decision that affects a patient should
be motivated
by what is in the patient's best interest
and should be
supported explicitly by that individual.
If this cannot be
achieved then cameras should not be permitted
into a
hospital room. "Doctors who permit footage
to be
captured fail in their legal and ethical
duty to protect their
patients," they write.
Doctors should be mindful that during a
war patients can
be used as propaganda tools. Governments
and the
media should refrain from using doctors
and patients to
further their own agendas, they add.
Publishing or broadcasting images of prisoners
of war is
illegal under international law, yet the
same protection is
not afforded to civilian casualties of
war. Addressing this
shortcoming would provide explicit guidance
to doctors
faced with scenarios such as those being
experienced by
the Iraqi doctors. Ethics should not be
lost in the war,
they conclude.
Contacts:
Tania DePellegrin, Television News Reporter,
Toronto,
Canada
Email: tania.depellegrin{at}utoronto.ca
Jerome Singh, Senior Lecturer, Howard College
School
of Law, University of Natal, Durban, South
Africa
Email: singhj9{at}nu.ac.za
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Association for the
Advancement of Science
(http://www.eurekalert.org)
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