Online First articles may not be available until 09:00 (UK time) Friday.

Press releases Saturday 9 April 2005

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://bmj.com).

(1) MEDITERRANEAN DIET LEADS TO LONGER LIFE

(2) THE RIGHT TO LIVE GIVES US A RIGHT TO DIE

(3) DEPRESSION OVERTAKES BACK PAIN FOR INCAPACITY BENEFIT CLAIMS

(4) UK APPROVAL PROCEDURES WILL DRIVE RESEARCH OVERSEAS

(5) UNCHAPERONED EXAMINATIONS RISK MISCONDUCT ALLEGATIONS

(1) MEDITERRANEAN DIET LEADS TO LONGER LIFE

Online First
(Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38415.644155.8F

The Mediterranean diet is associated with longer life expectancy among elderly Europeans, finds a study published online by the BMJ today.

The Mediterranean diet is characterised by a high intake of vegetables, legumes, fruits, and cereals; a moderate to high intake of fish; a low intake of saturated fats, but high intake of unsaturated fats, particularly olive oil; a low intake of dairy products and meat; and a modest intake of alcohol, mostly as wine.

Current evidence suggests that such a diet may be beneficial to health.

The study involved over 74,000 healthy men and women, aged 60 or more, living in nine European countries. Information on diet, lifestyle, medical history, smoking, physical activity levels, and other relevant factors was recorded. Adherence to a modified Mediterranean diet was measured using a recognised scoring scale.

A higher dietary score was associated with a lower overall death rate. A two point increase corresponded to an 8% reduction in mortality, while a three or four point increase was associated with a reduction of total mortality by 11% or 14% respectively.

So, for example, a healthy man aged 60 who adheres well to the diet (dietary score of 6-9) can expect to live about one year longer than a man of the same age who does not adhere to the diet.

The association was strongest in Greece and Spain, probably because people in these countries follow a genuinely Mediterranean diet, say the authors.

Adherence to a Mediterranean type diet, which relies on plant foods and unsaturated fats, is associated with a significantly longer life expectancy, and may be particularly appropriate for elderly people, who represent a rapidly increasing group in Europe, they conclude.

Contacts:

Professor Antonia Trichopoulou, Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
Email: antonia@nut.uoa.gr

(2) THE RIGHT TO LIVE GIVES US A RIGHT TO DIE

(Editorial: The right to die)
http://bmj.com/cgi/content/full/330/7495/799

Human beings' inalienable right to life means we also have the right to die, says an editorial in this week's BMJ.

The right to life does not just mean the right to exist, but implies the right to a minimum level of life, says Professor of Philosophy Anthony Grayling. That minimum includes the right to be "as free as reasonably possible from distress and pain."

If an individual feels that their life is being lived below that minimum quality, they also have the right to end their life - and by extension to have medical assistance to achieve this painlessly, he argues.

In most countries people attempting suicide are not prosecuted if they fail an acknowledgement of an individual's freedom to end their lives. Capable patients refusing medical treatment or those who draw up living wills - advance directives for doctors should a patient become incapacitated - are also exercising a right to die, says Professor Grayling.

The same right becomes more difficult to apply when the decision to withdraw life prolonging treatment falls to a third party - for instance when the patient is incapacitated and there is no living will. If there is disagreement among third parties, the decision must be made by the courts as dispassionate adjudicators, says the author, since "political and religious sentiments may obscure the interests of the patients in such cases."

More problematic is an individual seeking medical help to end their lives. Doctors and lawyers distinguish between withholding treatment, which results in death, and giving treatment to cause death. But both involve the decision to end life, and so are effectively the same, argues Professor Grayling. Any distinction between the two is fictitious, he concludes.

Contact:

Professor A C Grayling, School of Philosopy, Birkbeck College, University of London, UK
Email: a.grayling@philosophy.bbk.ac.uk

(3) DEPRESSION OVERTAKES BACK PAIN FOR INCAPACITY BENEFIT CLAIMS

(Editorial: Long term sickness absence)
http://bmj.com/cgi/content/full/330/7495/802

Common mental disorders, such as depression and anxiety, now account for more incapacity benefit claims than musculoskeletal conditions like low back pain, say researchers in this week's BMJ.

Long term sickness absence is a major public health and economic problem. In 2003, 176 million working days were lost; up 10 million on the previous year. Each year, £13bn are spent on benefits, and the reduction of long term sick leave is now a top government priority.

Until recently, the most common causes of long term sickness absence were musculoskeletal disorders, in particular low back pain, but over the last decade, the contribution of psychiatric disorders has increased markedly. Since 1995, the number of people reporting stress that was caused or made worse by their work has doubled, and common mental disorders are now the leading cause of sickness absence.

These disorders are managed almost entirely in primary care, but with limited capacity for psychological therapies, waiting times are often long. The United Kingdom also has very poor provision of occupational physicians (one specialist for every 43,000 workers) compared with the rest of Europe.

Both employers and patients require a speedier response than is currently delivered, as the longer an individual remains off work, the more difficult a return becomes.

If the government is serious about tackling the consequences of common mental disorders then innovative policies, including a major expansion in occupational health and psychological therapy services in primary care, will be required alongside research into the most effective and cost effective methods of delivering service, say the authors.

This would be a wise investment given the substantial economic and social costs engendered by the current service framework, they conclude.

Contacts:

Max Henderson, Clinical Research Fellow, Institute of Psychiatry, Department of Psychological Medicine, Weston Education Centre, London, UK
Email: m.henderson@iop.kcl.ac.uk

or

Nicholas Glozier, Consultant Occupational Psychiatrist, Department of Occupational Health and Safety, King's College Hospital NHS Trust, London, UK

(4) UK APPROVAL PROCEDURES WILL DRIVE RESEARCH OVERSEAS

(Letter: Ethics and research governance in a multicentre study: add 150 days to your study protocol)
http://bmj.com/cgi/content/full/330/7495/847

Approval procedures for UK research will "accelerate the migration of clinical studies to other parts of the world," warn researchers in a letter to this week's BMJ.

They describe the problems experienced by a research team that wanted to assess the impact of modernising endoscopy services in 20 NHS trusts in England.

Substantial variation occurred in the application procedures. Some trusts gave approval authority to one person while others relied on research and development committees, which typically sat monthly, resulting in delays. Documentation was "lost" in two trusts.

Obtaining research governance approval for all 20 trusts required 103 days. With the addition of the 47 days taken to obtain ethical approval, this resulted in a total delay of 150 days.

Research studies requiring multiple NHS sites should build in substantial lag times before research processes can be initiated, say the authors.

"We anticipate that failure to address this new obstacle to health service research will block evaluation work and accelerate the migration of clinical studies to other parts of the world," they conclude.

Contact:

Professor Glyn Elwyn, University of Wales, Swansea, Wales
Email: glyn.elwyn@btinternet.com

(5) UNCHAPERONED EXAMINATIONS RISK MISCONDUCT ALLEGATIONS

(Letters: Use of chaperones in general practice)
http://bmj.com/cgi/content/full/330/7495/846

Doctors who continue performing intimate examinations unchaperoned risk allegations of misconduct, warn researchers in a letter to this week's BMJ.

However, a recent study found that nearly half of male general practitioners never and rarely used chaperones when intimately examining women, while another found only 37% of general practitioners had a chaperoning policy.

The authors carried out a survey on patients' preferences for chaperones at genitourinary medicine (GUM) clinics, where intimate examinations are routine.

A total of 252 patients took part in the survey during June and December 2003. Ninety two percent (232) were offered a chaperone before an intimate examination, 22% (52) accepted, 12% (27) expressed no preference, and 66% (153) declined.

Patients declined chaperones because they trusted the doctor, felt it unnecessary, wished privacy, felt embarrassed, or were not bothered.

Significantly fewer male patients accepted chaperones than female patients and significantly more female patients accepted chaperones from male doctors than from female doctors.

"Chaperones are there for the protection of both parties," say the authors. "Perhaps further guidance will arise for other healthcare professionals, who until now may see patients unaccompanied."

Contact:

Charlotte Cohen, Specialist Registrar in GU/HIV Medicine, Chelsea & Westminster Healthcare NHS Trust, London, UK
Email: cemcohen@hotmail.com

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs DivisionBMA HouseTavistock SquareLondon WC1H 9JR
(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for theAdvancement of Science(http://www.eurekalert.org)