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Press releases Saturday 12 February 2005
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(1) HERBAL EXTRACT AS EFFECTIVE AS COMMONLY PRESCRIBED ANTI-DEPRESSANT
(2) OVERSEAS JUNIOR DOCTORS WARNED TO EXPECT UNEMPLOYMENT IN THE UK
(3) BRITISH CONSERVATIVES SHOULD BEWARE OF AUSTRALIAN HEALTH SERVICE REFORMS
(4) HIV INFECTION STILL ON THE RISE
(5) SIMPLE TREATMENT
COULD PREVENT MANY CHILD MALARIA DEATHS
(1) HERBAL EXTRACT AS EFFECTIVE AS COMMONLY PRESCRIBED
ANTI-DEPRESSANT
Online First
(Acute treatment of moderate to severe depression with hypericum extract
WS 5570 (St John's Wort): randomised controlled double blind non-inferiority
trial versus paroxetine)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38356.655266.82
A specially manufactured extract from the herb St John's Wort is at least as effective in treating depression as a commonly prescribed anti-depressant, according to new research published on bmj.com today.
St John's Wort* and the anti-depressant drug Paroxetine** were used in a trial to treat patients with moderate or severe depression. The researchers asked 301 participants of both sexes from German mental health centres to take part in the trial. The two drugs were taken by the patients aged 18-70 over a six week period during 2000 -2003.
At the end of the trial half (61 out of 122) of those who took St John's Wort found their symptoms in decline, whilst only a third (43 out of 122) of those taking Paroxetine went into remission.
Participants also suffered more side-effects by taking Paroxetine with 269 adverse effects being reported over the treatment period. Those taking St John's Wort reported 172 adverse effects, the most common in both cases being stomach disorders.
The authors support the use of St John's Wort as an alternative to treat depression and welcome more research in this area. * Clinical name hypericum extract WS 5570 ** Paroxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) drug — a class of anti-depressants
Contact:
Dr. Jochen Muehlhoff, Marketing
Information Manager, Dr. Willmar Schwabe Pharmaceuticals, Karlsruhe, Germany
Email: jochen.muehlhoff@schwabe.de
(2) OVERSEAS JUNIOR DOCTORS WARNED TO EXPECT UNEMPLOYMENT IN THE UK
(Career Focus: Warning all
junior overseas doctors)
http://careerfocus.bmjjournals.com/cgi/content/full/330/7487/63
So many junior overseas doctors are struggling to get jobs in the United Kingdom that they are now being warned to be prepared for long periods of unemployment, writes Peter Trewby, of the Royal College of Physicians in this week's BMJ Career Focus.
The move follows a recent survey by the College working group on international medical graduates showing that junior doctors from outside the European Union were coming to the UK in larger numbers than ever but many are unable to find posts.
The NHS is totally dependent on international medical graduates, who make up a third of the junior workforce. Yet, remarkably, it has no system for matching graduates to vacancies, nor any way of informing those thinking of coming to the UK of current job competition. Until around four years ago, supply and demand were roughly matched, but it seems no more.
The warning is part of a package of measures to provide accurate information on job prospects to help graduates decide whether or not to come to the UK.
"Doctors are coming to the United Kingdom from countries with greater health needs than ours, but far from gaining experience they are spending long periods unemployed," says the author. "The system reflects badly on the NHS and all of those who work in it."
For the future, he recommends moving away from the present ad hoc arrangements towards a central clearing house to which international graduates apply before leaving their posts at home.
Contact:
Peter Trewby, Consultant Physician
and Chair of the Royal College of Physicians' Working Group on International
Medical Graduates, Darlington Memorial Hospital, UK
Email: Peter.Trewby@cddah.nhs.uk
(3) BRITISH CONSERVATIVES SHOULD BEWARE OF AUSTRALIAN HEALTH SERVICE REFORMS
(Healthcare lessons from
Australia: what can Michael Howard learn from John Howard?)
http://bmj.com/cgi/content/full/330/7487/357
Australia is held up as a model of how to increase use of private health care in the United Kingdom. But experts in this week's BMJ warn that the effects of its reforms are not all beneficial and ask what can British and European conservatives learn from an Australian colleague who has deliberately sought to enhance the role of the private sector?
The Australian prime minister, John Howard, has engineered a major expansion of private health insurance alongside a universal, publicly funded health system. Various incentives and penalties have driven coverage up from 30% to 45% of the population, but the strategy of subsidising insurance premiums has been expensive and primarily benefited the wealthy.
Admissions to private hospitals have increased, but admissions to public hospitals have also increased, suggesting that the private insurance subsidies do not seem to have reduced pressure on Australian public hospitals as forecast by the government. This has led commentators to ask whether the funds injected into private insurance would be spent more effectively if invested directly in the public hospital system.
"The ideological focus of these reforms makes them attractive to those who prefer private institutions to fund health care," say the authors. "They show, however, that such policies create increased fiscal burdens for government, increase in equality in funding care, and have no observable effects on efficiency."
They conclude: "British and continental European conservatives should beware of the simple solutions used by their Antipodean colleagues. However, with John Howard being re-elected for a record fourth term in October 2004, they may also recognise that creating cost inflation and greater inequity in health care pays politically."
Contact:
Alan Maynard, Professor of Health
Economics, Department of Health Sciences, University of York, UK
Email: akm3@york.ac.uk
(4) HIV INFECTION STILL ON THE RISE
(Editorial: Rising rates
of HIV infection)
http://bmj.com/cgi/content/full/330/7487/320
Preventive measures are failing to stem the rising rate of HIV infection, warn two senior doctors in an editorial in this week's BMJ.
An estimated 38 million people worldwide, including over 2 million children, are now infected with HIV, and a record 4.8 million became infected in 2003.
The underlying reason for this continuing increase is socioeconomic, but the increase also represents a failure of prevention, write the authors.
For instance, the search for a vaccine against HIV has so far produced only negative results, while microbicides have proved disappointing. Although the ABC message (abstinence, be faithful, use a condom) is popular with the American government, its application in other parts of the world may not have the impact required.
In the face of this global catastrophe, the epidemic in the United Kingdom seems both small and parochial, say the authors. Nevertheless, the latest figures show a 20% increase in the prevalence of HIV in 2003 and 2004 compared with 2002, partly because of infections acquired abroad.
Furthermore, each newly diagnosed HIV patient consumes £12,500 in healthcare costs each year, while the lifetime costs of care for the current 50,000 infected individuals in the United Kingdom, with a life expectancy of 20 years, is at least £12.5bn.
"Prioritisation of sexual health with substantial investment is essential to avoid continuing deterioration in services, rising HIV transmission, and costly consequences for tax payers," they conclude.
Contact:
Brian Gazzard, Consultant Gastroenterologist,
Kobler Centre, Chelsea and Westminster Hospital, London, UK
(5) SIMPLE TREATMENT COULD PREVENT MANY CHILD MALARIA DEATHS
(Rectal artemether versus
intravenous quinine for the treatment of cerebral malaria in children in
Uganda: randomised clinical trial)
http://bmj.com/cgi/content/full/330/7487/334
(Editorial: Rectal artemether
and intravenous quinine for treating severe malaria)
http://bmj.com/cgi/content/full/330/7487/317
A simple drug, given to children with severe malaria before they reach hospital, has the potential to save many lives, say researchers in this week's BMJ.
Every year over a million children die of malaria in Africa. The majority of fatalities occur outside hospital, especially in rural areas. For those who do make it to hospital, half of deaths occur within 24 hours of admission.
Conventional treatment, given by injection, is not possible to administer outside hospital, so buying time by starting treatment which is easy to administer in the community is crucial.
Researchers in Uganda compared the effectiveness and safety of conventional treatment (intravenous quinine) with an alternative treatment (artemether, given as a suppository) in 103 children aged between 6 months and 5 years with severe malaria.
They found the two treatments broadly comparable and suggest that rectal artemether could be used to treat severe malaria where qualified staff and equipment for intravenous therapy is not available.
These are encouraging results, say experts in an accompanying editorial. Although a single trial of this size cannot alone be the basis for policy change, rectal artemisinins might be one safe and effective way to reduce the risk of children dying before reaching hospital.
Providing effective antimalarial treatment close to home to reduce delay has the potential to save many lives, they conclude.
Contacts:
Paper: James Tumwine, Associate
Professor, Department of Paediatrics and Child Health, Makerere Medical School,
Kampala, Uganda
Email: jtumwine@imul.com
Editorial: Christopher Whitty, Senior
Lecturer, Department of Infectious and Tropical Diseases, London School of
Hygiene and Tropical Medicine, London, UK
Email: christopher.whitty@lshtm.ac.uk
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