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Press releases Saturday 7 May 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) Politicians bury their heads in the sand while global flu threat mounts

(2) Decline in major heart disease offset by rise in diagnosed angina among British men

(3) Drug combinations improve survival for patients with heart disease

(4) Doctor voices concerns over new NHS IT system

(1) Politicians bury their heads in the sand while global flu threat mounts

(Letter: Sit up and take notice about avian flu)
http://bmj.com/cgi/content/full/330/7499/1087

Governments around the world must stop burying their heads in the sand over the growing threat of a global epidemic of avian flu, argues a GP in this week's BMJ.

Disasters like the Asian Tsunami "pale into insignificance" compared to the human cost of an influenza pandemic, says Dr Higson, which will wipe out "hundreds of millions" of lives if it is not prevented.

A recent report in the BMJ showed that avian flu (called H5N1) is beginning to jump from human to human - as opposed to transmission from bird to human only, as happened initially. This vastly increases the potential for spreading the virus across the population, as infection no longer depends on direct contact with diseased birds.

Governments must fund the rapid development of vaccines against H5N1, and build up sufficient stocks of anti-viral drugs such as zanamivir or olsetamivir, the best treatment for anyone infected, says Dr Higson.

Pharmaceutical companies should also expand the manufacture and supply of relevant drugs, he argues, and GPs and other prescribing practitioners must prepare for the practicalities of dealing with an epidemic or pandemic of influenza.

Avian flu is now a true threat to the world's population, Dr Higson concludes. Planning from world leaders to prevent it and deal with its consequences is now vital.

Contact:
Dr Nigel Higson, General Practitioner, Goodwood Court Medical Centre, Hove, UK Email: surgery@goodwoodcourt.org

(2) Decline in major heart disease offset by rise in diagnosed angina among British men

(Trends in rates of different forms of diagnosed coronary heart disease, 1978 to 2000: prospective, population based study of British men)
http://bmj.com/cgi/content/full/330/7499/1046

Rates of heart attack and coronary death among British middle aged men have fallen steadily since the late 1970s, but this has been largely offset by an increase in the rate of diagnosed angina, finds a study in this week's BMJ.

These results emphasise the ongoing need for health service resources for angina, say the researchers.

The study involved 7,735 men, aged 40-59 in 1978-80, who were randomly selected from one general practice in 24 different British towns. The men were monitored over a 20 year period to examine trends in rates of diagnosed (medically recorded) coronary heart disease.

The rate of major coronary events fell substantially over the 20 year period by an average of 3.6% per year. In contrast, the rate of first diagnosed angina increased by an average of 2.6% per year, resulting in no apparent change in the overall incidence of diagnosed coronary heart disease.

The trend in angina may well be due to changes in diagnostic practices, rather than a real increase in disease incidence, say the authors. Nevertheless, the trend raises concerns for health service resources for angina and suspected angina.

The results also highlight the need for continued emphasis on the prevention of coronary heart disease, they conclude.

Contact:
Fiona Lampe, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK Email: f.lampe@pcps.ucl.ac.uk

(3) Drug combinations improve survival for patients with heart disease

(Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis)
http://bmj.com/cgi/content/full/330/7499/1059

(Editorial: The polypill and cardiovascular disease)
http://bmj.com/cgi/content/full/330/7499/1035

Patients with coronary heart disease who take a combination of three specific drugs have a better chance of survival than those taking single drugs, finds a study in this week's BMJ.

This is the first large scale, long term trial to report the effect of different combinations of drugs to prevent deaths in patients with heart disease,

The study involved over 13,000 patients who were diagnosed with ischaemic heart disease between 1996 and 2003. Cases were patients with heart disease who died, while controls were patients with heart disease who were matched for age, sex, and year of diagnosis and were alive at the time their matched case died.

Treatments associated with the greatest reduction in deaths (83%) were statins (cholesterol lowering drugs), aspirin, and beta-blockers (a type of blood pressure lowering drug). Adding another type of blood pressure lowering (an angiotensin converting enzyme inhibitor) conferred no additional benefit.

Treatments associated with the smallest reduction were beta-blockers alone (19%) and angiotensin converting enzyme inhibitors alone (20%).

Combinations of statins, aspirin, and beta-blockers improve survival in high risk patients with cardiovascular disease, say the authors.

It has previously been proposed that these three treatments, along with folic acid, be combined into a "polypill" to be taken daily by everyone from age 55. These results support the synergic action of the polypill for people with pre-existing heart disease, but provide no evidence that it should be prescribed to all patients over 55, they conclude.

Contacts:
Emma Thorne or Tim Utton, Press Office, University of Nottingham, UK Email: emma.thorne@nottingham.ac.uk / tim.utton@nottingham.ac.uk

(4) Doctor voices concerns over new NHS IT system

(Choose and book? whose choice is it anyway?)
http://bmj.com/cgi/content/full/330/7499/1093

The political drive to implement the NHS's national programme for information technology is failing to take account of professionals' anxieties, argues a GP in this week's BMJ.

Dr Nigel de Kare-Silver describes his experience of workshops to introduce the new system to users. "We were shown screens of a third rate computer program lifted from the existing system of US hospital administrators," while further meetings produced "lame presentations by various strategic health authority IT leaders."

He goes on to describe problems with the "choose and book" system, in which doctors will select from a list of local hospitals and book an appointment while the patient waits. This has a national implementation date of the end of December 2005.

"The application screens are slow, and the computers often fail to pick up the programs. There is no integration with existing clinical systems or with Microsoft Outlook," he writes.

But the "really frightening module" is the inability of the software to retain advice by either the consultant or the GP, or to integrate it with clinical results. "This is a major clinical governance issue, he adds.

While the ambition of the NHS agenda for IT change should be applauded, it is unfortunate that the contractors show no ability to deliver a system that is an advance on existing services, says the author. "It is frightening that the political drive to implement the system is failing to take account of professionals' anxieties."

Before allowing its delivery, clinicians from all backgrounds must demand a service that is rigorous in terms of clinical governance, friendly in its user interface, fast, and relevant to the needs of clinicians and patients, he concludes.

Contact:
Nigel de Kare-Silver, General Practitioner, Gladstone Medical Centre, London, UK Email: intellidoc@nhs net

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