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Press releases Saturday 31 July 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) COMMON OSTEOARTHRITIS DRUGS ARE INEFFECTIVE AFTER TWO WEEKS

(2) NEW REGULATIONS HINDER RESEARCH

(3) FAILED ASYLUM SEEKERS MUST NOT BE DENIED HEALTH CARE

Online First
(1) COMMON OSTEOARTHRITIS DRUGS ARE INEFFECTIVE AFTER TWO WEEKS

(Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38159.639028.7C

Using topical non-steroidal anti-inflammatory drugs (NSAIDS) to relieve the pain of osteoarthritis is only beneficial for the first two weeks, finds a study available on bmj.com today.

This challenges current guidelines from Europe and America that topical NSAIDS are an effective treatment for osteoarthritis, the most common form of arthritis.

Researchers in Nottingham analysed 13 trials comparing topical NSAIDS with placebo or oral NSAIDS in osteoarthritis. The trials lasted up to four weeks and involved 1,983 patients.

Topical NSAIDS were superior to placebo in relieving pain due to osteoarthritis only in the first two weeks of treatment. Trials lasting four weeks showed no benefit. A similar pattern was found for function and stiffness. Topical NSAIDS were inferior to oral NSAIDS in the first week of treatment and were associated with more local side effects such as rash, itch, or burning.

Evidence to support the long term use (more than one month) of topical NSAIDS in osteoarthritis is absent, say the authors. Current recommendations for their use in osteoarthritis need to be revised, they conclude.

Contact:

Weiya Zhang, Senior Lecturer in Epidemiology, Academic Rheumatology, University of Nottingham, City Hospital, Nottingham, UK
Email: weiya.zhang@nottingham.ac.uk

(2) NEW REGULATIONS HINDER RESEARCH

(Education & Debate)
http://bmj.com/cgi/content/full/329/7460/277

(Editorial: Clinical research under the cosh again)
http://bmj.com/cgi/content/full/329/7460/241

New ethics committee regulations impede and delay clinical research, sometimes to the extent that conclusions are flawed and patients damaged, according to several articles in this week's BMJ.

Hester Ward and colleagues report how data protection rules hampered their study of CJD so much that their results are likely to be unreliable. They call for further debate on how to strike an appropriate balance between an individual's rights and freedoms and the right of the community or society to answer important questions.

Others describe their frustration with the unnecessary bureaucracy of ethics applications. David Wald's application took two weeks and 44 hours to complete, at a cost of £850. "Action is urgently needed to reduce a research bureaucracy that has largely lost sight of the patient, advancing medical knowledge, and improving medical care," he writes.

Konrad Jamrozik also believes that the ethical approval process is too long and cumbersome. He argues for training and certification of research investigators and for simplifying the process of approval of new projects.

Finally, Michael Parker and co-authors describe the difficulties of ethical review of research into rare genetic disorders. "Ethics committees need to take into account the special problems of consent, anonymity, and method in research into rare diseases," they say.

"Rightly or wrongly, clinical researchers are exhausted by the demands of ethics committees who seem more concerned with the science which they cannot necessarily judge, than with ethics," writes Professor Charles Warlow in an accompanying editorial.

He suggests that researchers should make plain which scientifically inappropriate aspects of the methodology were forced on them by ethics committees, and how their findings may be biased as a result. "If nothing is done, clinical research will wither, and that is not to anyone's advantage," he concludes.

Contacts:

Hester Ward, Consultant Epidemiologist, National Creutzfeldt-Jakob Disease Surveillance Unit, Edinburgh, UK
Email: h.ward@ed.ac.uk

David Wald, Clinical Research Fellow, Wolfson Institute of Preventive Medicine, London, UK
Email: d.s.wald@qmul.ac.uk

Konrad Jamrozik, Professor of Primary Care Epidemiology, Imperial College, London, UK
Email: k.jamrozik@imperial.ac.uk

Michael Parker, Reader in Medical Ethics, University of Oxford, UK
Email: michael.parker@ethox.ox.ac.uk

Charles Warlow, Professor of Medical Neurology, Western General Hospital, Edinburgh, UK
Email: charles.warlow@ed.ac.uk

(3) FAILED ASYLUM SEEKERS MUST NOT BE DENIED HEALTH CARE

(Why failed asylum seekers must not be denied access to the NHS)
http://bmj.com/cgi/content/full/329/7460/298

It is unethical to deny failed asylum seekers access to the NHS, argues a doctor in this week's BMJ.

New rules state that failed asylum seekers are not entitled to free NHS treatment from the day their asylum claim failed, yet failed asylum seekers are not bogus asylum seekers, writes Paul Williams, a general practitioner in North East England.

Each day he sees people who have been imprisoned, tortured or raped but carry "only" psychological scars that do not convince decision makers of their suffering. Some have physical scars but their stories are not accepted. "The culture of disbelief and cynicism within the system places intimidating and often insurmountable barriers in the path towards being granted status," he writes.

Although the UK government has no obligation to people whose asylum applications have failed, to systematically deny them health care is unnecessary, unethical, and impractical, says the author. Even though the immigration system has passed judgement, the NHS should not.

There is no hard evidence that health tourism exists, and plenty of evidence that failed asylum seekers are desperate and needy, and have physical and psychological needs, he adds. "Healthcare professionals should not allow denial of care to failed asylum seekers to be used as a tool by which the government can beat these already broken people."

Contact:

Paul Williams, General Practitioner, Arrival, the general practice for new refugees, Stockton-on-Tees, UK
Email: paul.williams2@nhs.net

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