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Press releases Saturday 9 October 2004

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(1) CHILD HEART DEATHS AT BRISTOL FALL BELOW NATIONAL AVERAGE

(2) RADIOLOGICAL RISKS ARE NOT EXPLAINED WELL

(3) TAR MEASUREMENTS ON CIGARETTE PACKETS ARE MISLEADING

(4) GMC IS RIGHT TO APPEAL OVER LIFE PROLONGING TREATMENT

(5) SHOULD MEDICAL STUDENTS HAVE EARLIER CONTACT WITH PATIENTS?

(1) CHILD HEART DEATHS AT BRISTOL FALL BELOW NATIONAL AVERAGE

(Paediatric cardiac surgical mortality in England after Bristol: descriptive analysis of hospital episode statistics 1991-2002)
http://bmj.com/cgi/content/full/329/7470/825

Child heart deaths at the Bristol Royal Infirmary have fallen markedly, to below the national average, finds a study in this week's BMJ.

The Bristol inquiry between 1991 and 1995 showed that Bristol had a much higher death rate for open heart surgery in children aged under 1 year than other major centres. Since then, there have been major changes in the child cardiac surgery service.

Researchers at Imperial College London analysed data on the performance of United Bristol Healthcare Trust and that of the other major centres in England since 1991. They identified over 8,000 open operations between April 1991 and March 2002 in children under 1 year and over 11,000 in children aged 1-15 years.

Mortality for all centres combined fell from 12% between April 1991 and March 1995 to 4% between April 1999 to March 2002. Mortality in children under 1 year at Bristol fell from 29% to 3% over the same time period, below the national average. The fall in mortality did not seem to be due to fewer high risk procedures or an increase in the numbers of low risk cases.

Mortality at Bristol has fallen markedly after the changes there, say the authors. Nationally, mortality has also fallen. "Improved quality of care may account for the drop in mortality, through new technologies or improved perioperative and postoperative care, or both," they conclude.

Contact:

Tony Stephenson, Press Office, Imperial College London, UK

(2) RADIOLOGICAL RISKS ARE NOT EXPLAINED WELL

(Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno)
http://bmj.com/cgi/content/full/329/7470/849

Radiological examinations, such as chest x-rays and CT scans, confer a definite (albeit low) long term risk of cancer, but patients undergoing such examinations often receive no or inaccurate information about theses risks.

Such practices disregard patients' rights and violate basic principles of modern medical practice, argues an expert in this week's BMJ.

Assessing radiological risk is certainly complicated, but some key information should be shared between patients and doctors, writes the author.

He suggests that risk might easily be communicated by expressing the dose as multiples of a chest x-ray and the risk of cancer as number of extra cases in the exposed population. This method has been suggested by the UK College of Radiologists and endorsed by the European Commission's guidelines on imaging. Explanation of dose should also be mandatory for the higher risk investigations, he adds.

Better knowledge of risks will help us to avoid small individual risks translating into substantial population risks, he concludes.

Contact:

Eugenio Picano, Clinical Cardiologist, Institute of Clinical Physiology, National Research Council, Pisa, Italy
Email: picano@ifc.cnr.it

(3) TAR MEASUREMENTS ON CIGARETTE PACKETS ARE MISLEADING

(Editorial: Publishing tobacco tar measurements on packets)
http://bmj.com/cgi/content/full/329/7470/813

Labelling cigarette packets with tar, nicotine and carbon monoxide measurements is misleading and should be stopped, argue cancer experts in this week's BMJ.

The tar delivery of cigarettes is routinely measured with a machine and, with the exception of the United States, stated on every packet as a legal requirement in almost every country in the world. It is accompanied by measurement of nicotine and often carbon monoxide.

Yet these measurements are now known to be misleading for two reasons. Firstly, human smoking patterns vary greatly and are not mimicked by the machine. Secondly, modern cigarette design encourages over-inhalation, which may lead to the smoker taking in much greater amounts of tar and nicotine than are measured by the machine.

The tobacco industry has also modified cigarette design, making the modern cigarette at least as dangerous as its predecessor, despite a dramatic lowering of tar delivery.

Tar measurement and labelling has served the tobacco industry well, say the authors. It has underpinned claims that cigarettes were light or ultralight and has seemingly, and falsely reassured many smokers who might otherwise have quit the habit.

They believe that machine measured figures for tar, nicotine, and carbon monoxide should be removed from the packet, and a realistic measure must be established for regulatory purposes.

The current health warnings deal qualitatively with the risks of smoking very well, and misleading figures on the packet can only do harm, they conclude.

Contact:

Nigel Gray, Scientist, International Agency for Research on Cancer, Lyon, France
Email: nigel@uicc.org

(4) GMC IS RIGHT TO APPEAL OVER LIFE PROLONGING TREATMENT

(Editorial: Why the GMC is right to appeal over life prolonging treatment)
http://bmj.com/cgi/content/full/329/7470/810

The General Medical Council, Britain's regulatory body for doctors, is right to appeal against a high court ruling that its current guidance on withholding and withdrawing life prolonging treatment is unlawful, says a professor of medical ethics in this week's BMJ.

The GMC's guidance was recently challenged by Mr Oliver Burke, a patient with a serious degenerative disorder who argued that it would allow doctors to withdraw artificial nutrition and hydration from him if he lost mental capacity. In July 2004, Mr Justice Munby ruled in Mr Burke's favour.

Emeritus Professor Raanan Gillon warns that, if not overturned, the judgement is likely to skew medical care by tilting the balance of medical practice towards non-beneficial and wasteful provision of life prolonging treatment in general and of artificial nutrition and hydration in particular.

He believes that the judgement itself extends far beyond this particular case and will inexorably lead to prioritisation of resources towards artificial nutrition and hydration and other life prolonging treatments for all legally incompetent patients who have not rejected them in advance.

"If it is not overturned, the ruling will delight vitalists, he says. "The rest of us ? patients, doctors, and society in general ? should be appalled by it. We should hope that the appeal court overturns the judgement," he concludes.

Contact:

Raanan Gillon, Emeritus Professor of Medical Ethics, Imperial College Medical Ethics Unit, Department of Primary Care and Social Medicine, London, UK
Email: raanan.gillon@imperial.ac.uk

(5) SHOULD MEDICAL STUDENTS HAVE EARLIER CONTACT WITH PATIENTS?

(What can experience add to early medical education?)
http://bmj.com/cgi/content/full/329/7470/834

Allowing medical students to interact with patients earlier in their medical course would better prepare them for their future role as a doctor, suggest researchers in this week's BMJ.

Traditionally, the foundation years of medical education have grounded students in biomedical sciences but offered little, if any, clinical exposure.

A group of 64 medical students, staff, and curriculum leaders from three UK medical schools discussed the question: "What can experience add to early medical education?" *

Without early experience, students felt the curriculum was socially isolating and divorced from clinical practice. Students described entering the clinical environment in year 3 as "being thrown in at the deep end."

Both staff and students agreed that interacting with people would give them a better understanding of "the human condition," and would relieve their "tunnel vision" in a way problem based learning did not.

Other likely benefits of early experience included greater motivation and confidence, greater social and self awareness, and more rounded and practically relevant theoretical understanding.

Viewing medical education as a process of socialisation ? into the population that the future doctors will serve, and the profession they will join ? helps redefine the task of medical education in the 21st century, conclude the authors.

Contact:

Tim Dornan, Consultant Physician, Hope Hospital, Salford, Manchester, UK
Email: tim.dornan@man.ac.uk

* "Experience" defined as "authentic human contact in a social or clinical context that enhances learning of health, illness or disease, and the role of the health professional."

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