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Press releases Saturday 11 September 2004

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(1) Removing tonsils has little benefit

(2) Results of drug trials must be open to public scrutiny

(3) 'Secrecy and silence' clouds truth of AIDS related deaths among doctors in South Africa

Online First
(1) Removing tonsils has little benefit

(Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38210.827917.7C

Surgical removal of the tonsils and adenoids (adenotonsillectomy) in children with mild symptoms of throat infections or enlarged tonsils and adenoids has no major benefits over watchful waiting, finds a new study published on bmj.com today.

Adenotonsillectomy is a common procedure in children in western countries, yet evidence of its benefits in children with milder symptoms is lacking.

Researchers in the Netherlands monitored 300 children aged 2-8 years with recurrent throat infections or enlarged tonsils and adenoids. Half were allocated to surgery and half to watchful waiting. All children were monitored over two years.

During the first six months, surgery marginally reduced the number of episodes of fever, throat infections, and upper respiratory tract infections. But from six to 24 months, there was no difference between the groups.

The authors conclude that adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or enlarged tonsils and adenoids.

Contact:

Dr. Anne Schilder, Department of Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
email: A.Schilder@wkz.azu.nl

(2) Results of drug trials must be open to public scrutiny

(All clinical trials must be reported in detail and made publicly available)
http://bmj.com/cgi/content/full/329/7466/626-a

The results of all clinical trials - for new drugs and procedures - must be released publicly if people are to get the full facts about their medical treatment, says a letter in this week's BMJ.

Writing from Japan Professor Furukawa, a specialist in psychiatry, argues that if detailed results of trials are not published openly, the public and health professionals are forced to rely on the drug company involved to interpret the trial findings ? an interpretation which may not reflect the results fully, says the author.

Examining the trial results of a drug for treating depression in children, Professor Furukawa argues that the drug company has mislabelled some of the results, and wrongly categorized others. A child with symptoms of hopelessness and suicidal thoughts, who "punched pictures, broke glass and sustained lacerations that required six sutures", was categorized as a case of aggression, says Professor Furukawa - rather than the more serious diagnosis of emotional lability or suicidal tendencies. Without access to the data itself, a doctor or parent is not in a position to challenge the drug company's findings.

All clinical trials results - not just those from drug companies - should be publicly accessible and reported in detail, argues the author. If such a policy were adopted internationally, healthcare professionals and the public could at last make properly informed decisions.

Contact:

Professor Toshi A Furukawa, Department of Psychiatry, Nagoya City University Medical School, Nagoya, Japan
email: furukawa@med.nagoya-cu.ac.jp

(3) 'Secrecy and silence' clouds truth of AIDS related deaths among doctors in sub-Saharan Africa

(Doctors and nurses with HIV and AIDS in sub-Saharan Africa)
http://bmj.com/cgi/content/full/329/7466/584

A culture of 'secrecy and silence' clouds the true picture of AIDS related deaths among doctors in sub-Saharan Africa, says Dr Dan Ncayiyana, editor of the South African Medical Journal, in this week's BMJ.

Little data exists on HIV rates among doctors in South Africa, but a new study from Uganda - also published in this week's BMJ - shows a 30% mortality rate in doctors from AIDS related illness. In South Africa a shortage of nurses is critical, says Dr Ncayiyana, as many emigrate or succumb to AIDS related illness. A recent report from a hospital in Durban for instance revealed a climate of hopelessness, following the deaths of four nurses from the illness in as many months. Yet the issue continues to be obscured, and nothing is known about HIV and AIDS among the country's doctors, says Dr Ncyayina.

The possible disastrous impact of high mortality rates among doctors would be even more devastating for South Africa, which treats 10% of the world's AIDS victims. In a country and continent already desperately short of health workers, AIDS related mortality among health professionals must be addressed, argues the author.

Contact:

Dr Dan J Ncayiyana, Vice Chancellor, Durban Institute of Technology, Durban, South Africa
email: vice-chancellor@dit.ac.za

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