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Press releases Saturday 2 April 2005

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(1) BRITISH HOSPITALS NEED CLINICAL ETHICISTS

(2) NOT ENOUGH EVIDENCE THAT MULTIVITAMINS PREVENT INFECTIONS IN THE ELDERLY

(3) WOLFOWITZ IS THE WRONG CHOICE FOR THE WORLD BANK

(1) BRITISH HOSPITALS NEED CLINICAL ETHICISTS

(Editorial: Meeting the ethical needs of doctors)
http://bmj.com/cgi/content/full/330/7494/741

"We need to introduce clinical ethicists in hospitals in the United Kingdom," says a researcher in medical ethics in this week's BMJ.

A sound knowledge of medical ethics is essential to the good practice of medicine, yet conclusive evidence exists that doctors need help with ethical problems, writes Daniel Sokol of Imperial College London.

About a fifth of NHS acute trusts currently have a clinical ethics committee. Although these provide a valuable service in drafting hospital policies and helping doctors resolve ethical dilemmas, most are ill suited to respond to the immediate problems that doctors encounter in their daily work.

In contrast, many hospitals in North America have full time clinical ethicists as well as clinical ethics committees, who can be called on by staff or patients for help in medico-ethical matters.

Studies have shown that ethics consultations are associated with reductions in time spent on ventilators and days in hospital, and that most doctors and nurses who have used the service find it helpful. Clinical ethicists could also contribute to the continuing medical education of healthcare staff in medical ethics through lecturing and private consultations, adds the author.

In light of all the evidence, we now need to introduce clinical ethicists in hospitals in the United Kingdom, he says. Doctors cannot possibly deal with all the ethical problems they encounter in their professional lives, nor can they be expected to analyse complex ethical issues, and to know how similar cases were handled elsewhere.

"Clinical ethics committees cannot alone cope with the demands of ethically troubled doctors at the coalface. The use of clinical ethicists would represent an important step forward," he concludes.

Contact:

Daniel Sokol, Doctoral Candidate in Medical Ethics, Medical Ethics Unit, Department of Primary Health Care and General Practice, Imperial College London, UK
Email: daniel.sokol@talk21.com

(2) NOT ENOUGH EVIDENCE THAT MULTIVITAMINS PREVENT INFECTIONS IN THE ELDERLY

Online First
(Role of multivitamins and mineral supplements in preventing infections in elderly people: systematic review and meta-analysis of randomised controlled trials)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38399.495648.8F

There is currently not enough evidence to suggest that multivitamin and mineral supplements prevent infections in elderly people, finds a study published online by the BMJ today.

Ageing is associated with an increased risk of infection. So, as the number of elderly people in developed nations continues to rise, there has been great interest in the use of supplements to help prevent infections.

Researchers identified eight trials evaluating the effect of multivitamin and mineral supplements on infections in elderly people. Although three studies reported fewer days spent with infection, overall the evidence was weak and conflicting.

The evidence does not support a policy recommending the routine use of such supplements in all elderly people, say the authors. However, the results are sufficiently encouraging to warrant further and more expansive studies in this area of considerable public health importance.

Contact:

Alia El-Kadiki, Specialist Registrar, Chemical Pathology Department, Royal Hallamshire Hospital, Sheffield, UK
Email: alia@elkadiki.fsnet.co.uk

(3) WOLFOWITZ IS THE WRONG CHOICE FOR THE WORLD BANK

(Editorial: A wolf in sheep's clothing)
http://bmj.com/cgi/content/full/330/7494/744

The nomination of Paul Wolfowitz to head the World Bank is the wrong choice and should be rejected, says an editorial in this week's BMJ.

Wolfowitz's reputation as the chief mover for the war on Iraq ? a development disaster ? sits uncomfortably with a job whose main role is multilateral international development, writes Kamran Abbasi, BMJ Deputy Editor. Many countries that Wolfowitz will be required to help are critical of America's war on Iraq and its motives.

But is this to misjudge Wolfowitz? Does he fit in with the World Bank in a way that is not immediately obvious?

Following his reputation as "the leading neoconservative hawk in George Bush's regime" Wolfowitz has begun by saying that his focus will be on economics, not politics. But he must achieve effectiveness through sound, evidence informed, policy making ? not brazen ideology, says Abbasi.

In the end, the Wolfowitz situation boils down to how the United States wants to be perceived by the world. His nomination, and that of John Bolton as US ambassador to the United Nations, has done little more than reinforce concerns that the current US administration is hell bent on disseminating its political ideology through control of international and non-governmental organisations. This is an abuse of power. Wolfowitz has some merits, but not enough to justify his appointment, he argues.

"He may well be skilled at managing a large organisation, but his is an inflammatory nomination to head the world's most influential multilateral development organisation, a post that requires acute political sensitivity and cultural awareness. His is a nomination that the World Bank's executive board would do well to reject," he concludes.

Contact:

Kamran Abbasi, Deputy Editor, BMJ, London, UK
via Emma Dickinson, (BMJ Press Office)
Email: edickinson@bmj.com / kabbasi@bmj.com

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