Press releases Saturday 20 March 2004

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://bmj.com).

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(1) SUCCESS OF NICOTINE PATCHES LINKED TO GENETIC MAKE-UP

(2) WORRYING RISE IN USE OF ANTIDEPRESSANTS IN CHILDREN

(3) UNEASE OVER FUTURE REGULATION OF DOCTORS

(4) MORE EVIDENCE THAT STRESS MAKES MS SYMPTOMS WORSE

(1) SUCCESS OF NICOTINE PATCHES LINKED TO GENETIC MAKE-UP

(Effectiveness of nicotine patches in relation to genotype in women versus men: randomised controlled trial)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38050.674826.AE

The effectiveness of nicotine patches seems to be related to genetic make-up (genotype) in women, but not in men, finds new research.

It has been suggested that variants of the dopamine D2 receptor may be related to response to nicotine replacement therapy. This study will be available on bmj.com on Friday 19 March 2004.

Researchers examined abstinence from smoking among 752 people, eight years after they had taken part in a trial of nicotine patches. Blood samples were taken to record genotype and abstinence from smoking was confirmed by levels of cotinine (a by-product of nicotine) in the blood.

In women, the effectiveness of nicotine patches seemed to be related to genotype. Women with the variant T allele (CT or TT genotype) showed considerable benefit from patches, whereas those with the more common CC genotype did not. No significant relation between genotype and patch effectiveness was seen in men.

The authors therefore suggest that nicotine replacement therapy works through different processes and is subject to different genetic influences in men and women.

Contact:

Patricia Yudkin, Department of Primary Health Care, University of Oxford, UK
Email: pat.yudkin@dphpc.ox.ac.uk

(2) WORRYING RISE IN USE OF ANTIDEPRESSANTS IN CHILDREN

(Letter: Increase in non-evidence based use of antidepressants in children is cause for concern)
http://bmj.com/cgi/content/full/328/7441/711-c

The use of antidepressant drugs in children is increasing, although evidence for their effectiveness and safety in children and adolescents is scant and widely debated, particularly for selective serotonin reuptake inhibitors (SSRIs) argue researchers in a letter to this week's BMJ.

They analysed drug prescriptions written during 2002 to over 500,000 Italian patients under 18. A total of 1600 young people (2.8 per 1000) received at least one antidepressant, 1200 of them an SSRI. Two thirds of prescriptions were for adolescents (age 14-17), mostly girls.

These prescribing rates are lower than those reported for the United States (1-2%) and the Netherlands (4.4 per 1000), but nevertheless about 28,000 youths are exposed to treatment with antidepressants, 21,000 of them receiving SSRIs, say the authors.

They also found a 4.5-fold increase in the rate of prescriptions for SSRIs between 2000 and 2002.

Apart from sertaline for obsessive compulsive disorder, all the SSRIs prescribed are unlicensed for children. The occurrence of depressive syndrome and obsessive compulsive disorder in children must be determined, along with their therapeutic needs.

Appropriate, independently funded studies should also be planned to guarantee effective and safe evidence based therapeutic approaches for children, adolescents, and their families, they conclude.

Contact:

Antonio Clavenna, Senior Research Fellow, Mario Negri Institute for Pharmacological Research, Milan, Italy
Email: clavenna@marionegri.it

(3) UNEASE OVER FUTURE REGULATION OF DOCTORS

(Revalidation: the purpose needs to be clear)
http://bmj.com/cgi/content/full/328/7441/684

From 1 January 2005 every UK doctor will need a license to practice. Most will be able to secure revalidation of their license by annual appraisal. This has led to confusion and unease about whether revalidation is intended to detect poor performance, and if so, whether the process will suffice, argues an expert in this week's BMJ.

In 2001, Professor Tim van Zwanenberg analysed the development of policy for the revalidation of general practitioners. Negotiations involved the profession, the government, and the General Medical Council (the profession's regulator).

The purpose of revalidation was seen as securing public trust, promoting continuing professional development, and detecting poor performance.

None of the stakeholders objected to revalidation, but all identified the tension inherent in a single process, which was designed both to improve the many and to detect the few poor performers. In particular, would revalidation redress unacceptable variation in practice or prevent high profile medical failure?

It is difficult to escape the conclusion that the purpose of revalidation is as a form of professional regulatory enforcer, says the author. Whether patients and the government will be satisfied remains to be seen, particularly if (and predictably when) a recently revalidated doctor is found to have been a poor performer.

Ultimately it may be more sensible to separate revalidation from appraisal, he concludes.

Contact:

Tim van Zwanenberg, Professor of Postgraduate General Practice, Postgraduate Institute for Medicine and Dentistry, University of Newcastle, Newcastle upon Tyne, UK
Email: t.d.van-zwanenberg@ncl.ac.uk

(4) MORE EVIDENCE THAT STRESS MAKES MS SYMPTOMS WORSE

(Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38041.724421.55

Most patients with multiple sclerosis believe that stressful life events make their symptoms worse, but this theory remains controversial among care providers and academics.

However, new research to be published on bmj.com on Friday 19 March 2004, confirms the association between stressful life events and exacerbation in patients with multiple sclerosis.

Researchers at the University of California, San Francisco analysed data from 14 trials of stress and multiple sclerosis and found a modest but significant risk of exacerbation after non-traumatic stressful life events, such as job stress or financial problems.

However, these data did not allow the linking of specific types of stress to exacerbations, nor should they be used to infer that patients are responsible for their exacerbations, say the authors.

These findings will hopefully open investigation into new avenues of managing multiple sclerosis, either through stress management or through treatment of the physical responses to stress, they conclude.

Contact:

David Mohr, Associate Professor, Department of Psychiatry, University of California, San Francisco, USA
Email: dmohr@itsa.ucsf.edu

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