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Press releases Saturday 25 September 2004

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(1) DOGS CAN 'SMELL' BLADDER CANCER

(2) PHYSIOTHERAPY NO BETTER THAN ADVICE FOR BACK PAIN

(3) ASIA MUST TACKLE HIV IN INJECTING DRUG USERS
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(1) DOGS CAN 'SMELL' BLADDER CANCER

(Olfactory detection of human bladder cancer by dogs: a proof of principle study)
http://bmj.com/cgi/content/full/329/7468/712

(Commentary: Teaching dogs new tricks)
http://bmj.com/cgi/content/full/329/7468/715

Dogs can be trained to detect bladder cancer by 'smelling' urine, concludes new research published in this week's BMJ.

Tumours are thought to produce volatile organic compounds with distinctive odours. Even when present in minute quantities, it is possible that they are detectable by dogs, with their exceptional sense of smell.

The study involved urine samples from 36 patients with bladder cancer and 108 control samples from diseased (non-cancerous) and healthy individuals; 63 of the samples were used exclusively in final testing of the dogs.

Six dogs of varying breeds and ages were trained over 7 months to discriminate between urine from patients with bladder cancer and that from control individuals.

For the final tests, each dog was offered a set of seven urine samples, comprising one bladder cancer sample and six sex-matched controls. Some controls were also age-matched and most had some form of non-malignant urological disorder. The dogs identified their chosen sample by lying next to it. Each dog performed a total of 9 separate tests.

Taken together as a group, the dogs correctly selected bladder cancer urine on 22 out of 54 occasions, an average success rate of 41% compared to 14% expected by chance alone. The dogs' capacity to recognise a characteristic bladder cancer odour was independent of other chemical aspects of the urine, such as the presence of blood.

"Our study provides the first piece of experimental evidence to show that dogs can detect cancer by olfactory means more successfully than would be expected by chance alone," say the authors.

"The results we achieved should provide a benchmark against which future studies can be compared, and it is to be hoped that our approach to training may assist others engaged in similar work."

"The study was carefully designed to include several features to minimise bias, and it is hard to fault the study in this respect," writes an expert in medical statistics in an accompanying commentary. "On balance the results are unambiguous. Dogs can be trained to recognise and flag an unusual smell in the urine of bladder cancer patients."

Contact:

Carolyn Willis, Director of Academic Research, Department of Dermatology, Amersham Hospital, Buckinghamshire, UK
Email: carolyn.willis@sbucks.nhs.uk

(2) PHYSIOTHERAPY NO BETTER THAN ADVICE FOR BACK PAIN

(Randomised controlled trial of physiotherapy compared with advice for low back pain)
http://bmj.com/cgi/content/full/329/7468/708

(Editorial: Back pain and physiotherapy)
http://bmj.com/cgi/content/full/329/7468/694

Routine physiotherapy for mild to moderate low back pain is no more effective than a single advice session with a physiotherapist, finds a study in this week's BMJ.

Physiotherapists in the British NHS treat around 1.3 million people for low back pain each year, but there is very little evidence for its effectiveness. International guidelines vary but generally recommend advice to remain active.

The study involved 286 patients with low back pain of more than six weeks' duration; 144 received therapy and 142 received advice only. Level of disability was measured at two, six, and 12 months. Patient perceived benefit of treatment was also assessed.

Patients in the therapy group were more likely to report benefits from treatment, but there was no evidence of a long term effect of physiotherapy. There were no differences in disability scores between the groups at 12 months.

Routine physiotherapy seems to be no more effective than one session of assessment and advice from a physiotherapist, conclude the authors.

Contact:

Sarah Stewart-Brown, Professor of Public Health, University of Warwick, UK

(3) ±ASIA MUST TACKLE HIV IN INJECTING DRUG USERS

(Editorial: HIV in injecting drug users in Asian countries)
http://bmj.com/cgi/content/full/329/7468/697

Asian countries must adopt strategies to slow the spread of HIV among injecting drug users, urge researchers in this week's BMJ.

More than 60% of injecting drug users in many Asian countries are HIV positive. China alone is estimated to have almost 900,000 injecting drug users and disturbingly large pockets of HIV infected injecting drug users exist in other populous Asian countries, such as India and Pakistan.

Although strategies to prevent the spread of HIV infection among and from injecting drug users can be effective, an unwarranted fear exists that these strategies will conflict with current drug policies.

Encouragingly pragmatic approaches to HIV infection among injecting drug users are being adopted. For example, Indonesia, Vietnam and China have recently shown promising signs of increasing interest in developing outreach, syringe exchange, and drug substitution programmes.

But the frightening fact remains that HIV continues to spread among and from injecting drug users much more rapidly than these programmes are adopted and expanded, say the authors.

HIV/AIDS is probably the most serious global health problem since the Great Plague more than half a millennium ago, they write. For the next few decades, the health and wellbeing of the most populous region of the world will depend a lot on the speed with which Asian countries adopt, adapt, and fully implement harm reduction interventions, especially needle and syringe programmes and drug substitution treatment for heroin users.

Contact:

Michael Farrell, Senior Lecturer in Addictions, Addictions Resource Centre, London, UK
Email: m.farrell@iop.kcl.ac.uk

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