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Press releases Saturday 3 September 2005

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(1) AVOID ANIMALS WHEN VISITING DEVELOPING COUNTRIES, WARN EXPERTS

(2) CORONARY HEART DISEASE IS UNDER-DIAGNOSED AND UNDER-TREATED IN WOMEN

(3) PRICEY NEW VERSIONS OF OLD DRUGS FUELLING HUGE RISE IN DRUG SPENDING

(1) AVOID ANIMALS WHEN VISITING DEVELOPING COUNTRIES, WARN EXPERTS

(Paralytic rabies after a two week holiday in India)
http://bmj.com/cgi/content/full/331/7515/501

(Avoiding rabies)
http://bmj.com/cgi/content/full/331/7515/469

In this week’s BMJ, experts warn travellers to get vaccinated and avoid animals when visiting areas such as Africa, Asia, Latin America, and the Middle East, where rabies is common. They should also seek urgent help if they are bitten or scratched.

Their warning comes after the recent death of a British woman, bitten by a dog during a two week holiday in Goa, India.

Rabies is an acute viral infection of the central nervous system. The virus is usually transmitted through a dog bite, and results in at least 40,000 deaths worldwide every year.

Around 90% of deaths occur in the developing world, particularly in India, where dogs that roam freely are largely responsible. Rabies is rare in the UK, where just 12 cases have been reported since 1977, 11 contracted abroad and one rare case acquired from a bat in the UK.

A team of researchers describe the case of a woman in her late 30s who was admitted to hospital with shooting pain in her lower back and left leg. Three and a half months earlier, she had been bitten by a puppy on a lead during a two week holiday in Goa.

It left a slight graze, but she did not seek medical help, and she had not received a vaccination before travelling. She was diagnosed with rabies and died after 18 days in hospital.

This case serves as an important reminder of the risk of rabies for any traveller to a country where rabies is endemic, even tourists on a short visit to a holiday resort, say the authors.

Travellers need to know whether they are visiting a country where rabies is endemic, and that any dog bite must be taken seriously, even an apparently innocuous bite from a pet.

The risk can also be reduced by avoiding contact with animals that might be susceptible to rabies, adds Professor Derrick Pounder in an editorial. Ignoring freely roaming dogs and cats may go against the instincts of animal loving travellers to developing countries, but it is a necessary precaution. Wildlife should be appreciated at a distance.

Contacts:

Dr Anthony Fooks, Head of the Rabies and Wildlife Zoonoses Group, Veterinary Laboratories Agency, Weybridge, UK
Email: matt.radley@defra.gsi.gov.uk

Derrick Pounder, Professor of Forensic Medicine, Department of Forensic Medicine, University of Dundee, Scotland
Email: d.j.pounder@dundee.ac.uk

(2) CORONARY HEART DISEASE IS UNDER-DIAGNOSED AND UNDER-TREATED IN WOMEN

(Editorial: Coronary heart disease in women)
http://bmj.com/cgi/content/full/331/7515/467

Coronary heart disease is under-diagnosed, under-treated, and under-researched in women, says a senior doctor in this week’s BMJ.

Cardiovascular disease remains the leading cause of death in men and women worldwide, exceeding the number of deaths from all cancers combined. In Europe, cardiovascular disease kills a higher percentage of women (55%) than men (43%). Yet it is still considered a disease of men.

Many women are unaware that coronary heart disease is their main killer; their biggest fear is breast cancer, writes cardiologist Ghada Mikhail. Even more worrying is the apparent lack of awareness of cardiovascular disease in women among healthcare professionals.

Women and men with heart disease tend to differ in their presenting symptoms, their access to investigations and treatment, and their overall prognosis. For example, women may have less common symptoms, are less likely to seek medical help, and tend to present late in the process of their disease.

They are also less likely to have appropriate investigations, which can delay the start of effective treatment.

Women also continue to be under-represented in research on heart disease, making it difficult to draw conclusive evidence on managing cardiovascular disease. To remedy this, the author suggests that participants’ sex must be considered in the design and analysis of cardiology studies.

Better awareness and education, earlier and more aggressive control of risk factors, and appropriate access to diagnosis and treatment are desperately needed to tackle this potentially fatal disease, she concludes.

Contact:

Ghada Mikhail, Consultant Cardiologist, North West London Hospitals and St Mary’s Hospital Trusts, London, UK
Email: g.mikhail@btopenworld.com

(3) PRICEY NEW VERSIONS OF OLD DRUGS FUELLING HUGE RISE IN DRUG SPENDING

Online First
(“Breakthrough” drugs and growth in expenditure on prescription drugs in Canada)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38582.703866.AE

Newly patented versions of old drugs are driving the rapid growth in expenditure on prescription drugs in most developed countries, without offering substantial improvements over existing products, finds a study published online by the BMJ today.

The rising cost of using these “me-too” drugs at prices far exceeding those of time-tested competitors deserves careful scrutiny, say the authors, based at the University of British Columbia in Canada, where spending on drugs doubled between 1996 and 2003.

They used classifications from the Canadian Patented Medicine Prices Review Board to examine which drugs drove this expenditure growth.

Between 1990 and 2003, the board appraised 1147 newly patented drugs. Of these, 68 (5.9%) met the regulatory criterion of being a breakthrough drug (defined as the first drug to treat effectively a particular illness or which provides a substantial improvement over existing drug products).

The balance of the newly patented drugs did not provide a substantial improvement over existing products, so were classified as “me-to” drugs. Older drugs (available before 1990) were classified as “vintage brand” or “vintage generic” drugs.

Breakthrough drugs accounted for 6% of expenditure and 1% of use in 1996, and 10% of expenditure and 2% of use in 2003.

Vintage brand and vintage generic drugs combined accounted for 75% of total use in 1996 and 54% in 2003, but only 53% and 27% of total annual expenditure. In contrast, me-too drugs accounted for 44% of use and 63% of expenditure by 2003. Their average cost per day of treatment was twice that of vintage brand drugs and four times that of vintage generic drugs.

Given that the list of top 20 drugs in global sales includes newly patented versions of older drugs, me-too drugs probably dominate spending trends in most developed countries, conclude the authors.

Contact:

Steven Morgan, Assistant Professor, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
Email: morgan@chspr.ubc.ca

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