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(2)
ACTION NEEDED TO AVOID HIV DRUG
RESISTANCE
IN AFRICA
(3) CONCERN
OVER THE FUTURE OF CLINICAL
TRIALS
(1) UK FACES ASBESTOS EPIDEMIC
(Radical surgery for mesothelioma)
http://bmj.com/cgi/content/full/328/7434/237
The United Kingdom is facing an epidemic
of
mesothelioma (a malignant tumour of the
lung lining)
among workers exposed to asbestos, warn
senior
doctors in this week's BMJ.
There are now over 1800 mesothelioma deaths
per year
in Britain (more than one in 200 of all
deaths in men and
almost one in 1000 in women) and the number
is still
increasing. As exposure in the UK continued
until 1980
the peak of the epidemic is still to come,
and we need a
strategy to manage these patients, they
write.
Some patients and their doctors desperately
seek radical
surgery as their only hope, but others
have doubts about
the evidence.
But irrespective of whether radical surgery
will be
considered, all doctors need to know how
to recognise
and diagnose this disease and what treatments
are
available.
This disease is increasing in frequency.
There is nothing
we can do now to prevent it in workers
exposed to
asbestos throughout the 1950s, 1960s,
and 1970s, say
the authors.
What we can do is recognise it early, treat
it actively,
and learn about best treatment with carefully
thought out
studies because we will be seeing many
more
mesotheliomas in the next 25 years. In
the developed
world alone 100,000 people alive now will
die from it,
they conclude.
Contact:
Professor Tom Treasure, Cardiothoracic
Unit, Guy's
Hospital, London, UK
Email: tom.treasure@gstt.sthames.nhs.uk
(2) ACTION NEEDED
TO AVOID HIV DRUG
RESISTANCE IN AFRICA
(Antiretroviral therapy in Africa)
http://bmj.com/cgi/content/full/328/7434/280
We should stop and think about the risks
of resistance,
and ways of minimising them, before increasing
access to
antiretroviral therapy in Africa, argue
researchers in this
week's BMJ.
They warn that, without due forethought
and planning,
antiretroviral therapy is likely to be
introduced to Africa
in a random and haphazard way, risking
rapid
transmission of drug resistance.
Resistance to every currently licensed
antiretroviral drug
has been observed. The only sure way to
avoid the
development of drug resistance is to adhere
strictly to
therapy. Yet evidence suggests that adherence
with drug
treatment in Africa is low compared with
that in
industrialised nations.
Several methods of increasing adherence
to treatment
have been tested throughout the developing
world, but
have so far had limited success.
Another major problem in introducing antiretroviral
therapy to Africa is the inadequate infrastructure
to deal
with the number of people infected, write
the authors.
"We cannot afford inconsistent prescribing
practices and
poor monitoring of therapy and adherence,"
they say. "A
rational approach is required in which
systematic delivery
and proved methods for maximising adherence
are as
important as procuring the drugs themselves."
Contact:
Warren Stevens, Health Economist, MRC Laboratories,
Banjul, Gambia, West Africa
Email: wstevens@mrc.gm
(3) CONCERN OVER
THE FUTURE OF CLINICAL
TRIALS
(Editorial: Implementing the European
clinical trials
directive)
http://bmj.com/cgi/content/full/328/7434/240
(Letter: Save European research campaign)
http://bmj.com/cgi/content/full/328/7434/286
A new European directive has prompted concerns
over
the future of publicly funded clinical
trials in the United
Kingdom, according to an editorial in
this week's BMJ.
The European Union's clinical trials directive
must be
implemented in UK law by May 2004. It
is intended to
simplify and harmonise the regulation
of trials across the
European Union. Yet some believe that
it will actually
impede and inhibit publicly funded trials,
writes Kent
Woods of the Medicines and Healthcare
products
Regulatory Agency
The main concerns include the role and
responsibilities of
trial sponsors, the delay and cost imposed
by additional
bureaucracy, and new requirements for
good clinical
practice.
The concern is such that researchers from
all over
Europe and the world are supporting a
campaign to save
European science (www.SaveEuropeanResearch.org).
In a letter in this week's issue, the campaigners
argue that
little was wrong with the processes of
academic or
investor led research in the European
Union in the first
place, and that many important medical
breakthroughs in
recent times have been a product of this
mechanism.
Compliance with the directive will challenge
us to review
many details of current practice. Can
we find ways of
streamlining the initiation of trials
without compromising
patient safety?
Contact:
Brian Moulton, Chief Executive Officer,
Irish Clinical
Oncology Research Group, Dublin, Republic
of Ireland
Email: brian.moulton@icorg.ie
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Advancement of Science
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