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Press releases Saturday 21 August 2004

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(1) PUBLISHING SURGEONS' PERFORMANCE REMAINS CONTROVERSIAL

(2) NEW VACCINE IS AN IMPORTANT STEP FORWARD

(3) FAILURE TO PUBLISH RESEARCH KILLS PATIENTS

(1) PUBLISHING SURGEONS' PERFORMANCE REMAINS CONTROVERSIAL

(The legacy of Bristol: public disclosure of individual surgeons' results)
http://bmj.com/cgi/content/full/329/7463/450

Later this year, the performance of individual surgeons in the UK will be made publicly available, but the move remains controversial. Researchers in this week's BMJ discuss the issues in relation to cardiothoracic surgery.

The inquiry into cardiac deaths at Bristol Royal Infirmary recommended that patients must be able to obtain information on the performance of hospitals and individual surgeons. Since then, cardiothoracic surgeons have been voluntarily submitting figures for publication.

But the arguments for and against publication are finely balanced. Cardiac surgeons in the United States, where public reporting already exists, believe that the system is unfair, as the performance of a surgeon is highly dependent on his or her institution. It may also encourage surgeons to protect their results by avoiding high-risk patients.

The value of such publications also depends on whether the outcome usefully reflects quality of care, the ability to cater for differences in casemix, and whether the publication is designed to facilitate patient choice or show consistency of standards.

In the UK, surgeons have collected simple activity and mortality data for each surgeon for some years. The data is not detailed enough to cater for variations in casemix, so the surgeons have agreed for their results to be compared against statistically derived standards without compensation for casemix. Each surgeon will be measured to see whether or not they meet the agreed standard.

When these results are published later this year, medicine in the United Kingdom will have crossed a threshold into a new era, say the authors. This system is not perfect, but it is a first step towards transparent public accountability.

Contacts:

Bruce Keogh, President Elect, Society of Cardiothoracic Surgeons of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
Email: Bruce.Keogh@uclh.org

James Roxburgh, Secretary, Society of Cardiothoracic Surgeons of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
Email: James.Roxburgh@gstt.sthames.nhs.uk

(2) NEW VACCINE IS AN IMPORTANT STEP FORWARD

(Editorial: Misconceptions about the new combination vaccine)
http://bmj.com/cgi/content/full/329/7463/411

The new five-in-one vaccine is an important step forward in the United Kingdom's vaccination programme, say child health experts in this week's BMJ.

Newspaper headlines of chaos and panic are regrettable since the new vaccine offers children protection against the same five diseases but in a more acceptable formulation, write Helen Bedford and David Elliman.

This change is a natural progression in the light of the near elimination of polio worldwide and advances in vaccine technology. Many other European countries, as well as the United States and Canada, have already made the change to inactivated polio vaccine (IPV).

A trial in the United Kingdom, to be published later this year, will show that the new vaccine (Pediacel) produces notably fewer of the common, troublesome but minor side effects such as fever and soreness at the injection site than the current vaccine.

This should prove popular with parents who in one study said that they would prefer a vaccine that causes fewer reactions, say the authors.

Concerns that this vaccine could overload the immune system are misguided as the new vaccine actually contains 3,000 less antigens than the current vaccine, even though it protects against five instead of four diseases.

However, the benefits of the new vaccine do not outweigh the risks of delaying immunisation until its introduction. Parents should therefore be encouraged to have their children immunised according to the current schedule, until the new one is introduced, they conclude.

Contacts:

Helen Bedford, Lecturer in Children's Health, Institute of Child Health, London, UK
Email: hbedford@ich.ucl.ac.uk

David Elliman, Consultant in Community Child Health, Great Ormond Street Hospital for Children, London, UK

(3) FAILURE TO PUBLISH RESEARCH KILLS PATIENTS

(Letter: Government regulation is needed to prevent biased under-reporting of clinical trials)
http://bmj.com/cgi/content/full/329/7463/462

Failing to disclose the results of clinical trials kills patients and wastes money, and government regulation is needed to put a stop to it, argues Sir Iain Chalmers in a letter to this week's BMJ.

In 1996, Schering Healthcare published details of its ongoing clinical trials. Two years later GlaxoWellcome announced its decision to register and seek to report all its clinical trials.

But only now, and in response to accusations of biased under-reporting of research, has GlaxoSmithKline (GSK) announced that it intends to put in place some of the policies set out seven years ago by GlaxoWellcome.

It would be churlish not to welcome this, says the author. But the past record of the pharmaceutical industry, and the reactions of some other companies to GSK's announcement, prompt deep scepticism that the industry will ever voluntarily implement ethical trial registration and publication policies, he concludes.

Contact:

Iain Chalmers, Editor, James Lind Library, Oxford, UK
Email: ichalmers@jameslindlibrary.org

Online First
(4) SCHOOL RUN DOES NOT AFFECT CHILDREN'S ACTIVITY LEVELS

(Walking to school and total physical activity in schoolchildren: cross-sectional analysis within a cohort study)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38169.688102.F71

Whether children walk to and from primary school makes no difference to their total activity, finds new research published on bmj.com today.

The proportion of children travelling to school by car in the United Kingdom almost doubled from 16% in 1986 to 30% in 1998. Not walking to school is perceived as a compromise to physical activity.

The study involved 154 boys and 121 girls in their first year at 53 urban primary schools. The children wore monitors during waking hours for five consecutive schooldays and a weekend to measure physical activity. Height, weight, and body fat were also recorded.

Twice as many boys and girls walked to school as were driven by car. The average time taken to walk to school was six minutes and the average distance was 0.7km.

Although children who walked to and from school recorded more activity in the process, their total weekly activity was identical to non-walkers. Crucially, the additional activity recorded by walkers during the school journey was only 2% of the children's total weekly activity, say the authors.

There may be other benefits from walking children to their neighbourhood school, but physical activity does not appear to be one of them, they conclude.

Contact:

Terry Wilkin, Professor of Endocrinology and Metabolism, Derriford Hospital, Plymouth, Devon, UK
Email: t.wilkin@pms.ac.uk

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