This week in the BMJ
Volume 329, Number 7457, Issue of 10 Jul 2004Are atypical neuroleptics better than the old drugs?
Are atypical neuroleptics better than the old drugs?
Newer "atypical" neuroleptic drugs may not be better than typical neuroleptics in the management of the behavioural and psychological symptoms of dementia. Lee and colleagues (p 75) reviewed five trials including 1570 patients, evaluating the four oral atypical antipsychotic therapies in patients with the disorder. They found that atypical antipsychotic drugs were superior to placebo, but not to typical antipsychotic drugs. Adverse events were common even with the new drugs and included extrapyramidal symptoms, somnolence, and abnormal gait.
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Too few trials report on the ethnicity of participants
People from different ethnic groups may respond differently to treatments, but trials often do not report the ethnic profile of participants. Sheikh and colleagues (p 87) studied a random sample of 200 trials from 2002 listed in Medline. Although reporting of ethnicity was poor, trials from the United States were five times more likely than European trials to report on the ethnicity of participants. The authors say that European governments should consider the American model for promoting inclusion of ethnic minority participants in research.
Narrowed retinal arterioles predict development of hypertension
People with narrowed retinal vessels are more likely to develop hypertension. Following up 2451 people who had normal blood pressure and had had the diameter of retinal arterioles and venules measured at baseline, Wong and colleagues (p 79) found that, at 10 years, people with the smallest vessel ratio had three times the risk of developing hypertension than did those with the highest ratio. Small vessel disease may be linked with the development of hypertension, say the authors, and it may be a target for antihypertensive treatment.
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Doctors look after the interests of the patients first
Doctors retained a high degree of professionalism as a recent healthcare crisis developed. In interviews with 14 doctors from Toronto who looked after patients with SARS, Straus and colleagues (p 83) found that they felt a professional obligation to care for these patients and acted with professionalism, but professional behaviour was occasionally strained. Medical educators and professional organisations need to focus on exploring the balance between clinicians' personal safety and the needs of the patients, on professional respect and collaboration, and role modelling of professionalism to trainees, say the authors.
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Early stimulation helps children's development
Integrating early psychosocial stimulation of undernourished children into primary care may improve their development. Powell and colleagues (p 89) randomised 139 undernourished children and their mothers in Jamaica to an intervention consisting of a weekly session discussing parenting issues and play activities for one year, or to standard care. Children in the intervention group had better developmental quotients, hearing and speech, hand and eye coordination, and scores on a performance scale than children in the control group; their mothers had gained a better knowledge of childrearing practices.
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Informed consent could sometimes be postponed
When informed consent would let participants know what intervention they are receiving, patients may accept receiving information after the trial is over. Boter and colleagues (p 86) evaluated a modified consent procedure in which full disclosure was delayed until after data collection. The delay did not reduce the recruitment of patients, their trust in doctors, or willingness to take part in future studies. A modified procedure should be considered when the additional treatment entails no risk, and when this treatment seems attractive to patients, they say. In a commentary (p 87), Dawson says that no ethical principle should be absolute; a requirement for full informed consent may prevent beneficial studies from being done. Informing participants in advance that some information may be withheld may increase their anxiety, and to say nothing may be preferable.
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