This week in the BMJ
Volume 331, Number 7516, Issue of 10 Sep 2005Treatment options for alcoholism haven't advanced
Treatment options for alcoholism haven't advanced
Social behaviour and network therapy—a new approach to treating alcoholism—seems to be as good as the proved method of motivational enhancement therapy, but it doesn't seem to offer additional benefits. In a pragmatic randomised trial that included 742 clients with alcohol problems and followed them up for 12 months, the UKATT Research Team (p 541) found no significant differences between the groups in alcohol consumption, alcohol dependence, and alcohol related problems. Although the new treatment was on average more expensive, the cost effectiveness of the two treatments also did not show any significant differences (p 544).
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Chronic stress protects from breast cancer
Exposure to chronic stress protects women from breast cancer, probably by impairing endogenous synthesis of oestrogen. A prospective cohort study by Nielsen and colleagues (p 548), involving 6689 women, a follow-up of 12 years, and loss to follow-up of less than 0.1%, showed that women with high levels of stress had a 40% lower risk of getting first time primary breast cancer. Moreover, the researchers found a dose-response relation, and the protective effect of stress was more pronounced in women receiving hormone therapy. Still, the cumulative consequences of stress on health may be disadvantageous, authors warn.
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Did cardiovascular prevention guidelines go over the top?
According to 2003 European guidelines on prevention of cardiovascular disease, more than one in five women and almost nine out of 10 men in Norway are at high risk of cardiovascular disease at age 40. In a modelling study based on the Nord-Tröndelag health study, Getz and colleagues (p 551) used the guidelines to estimate the high risk group in the Norwegian population—one of the world's longest living and healthiest. At the same age, one out of 10 women and no men would be classified as having a low risk.
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Extension studies need tighter ethical scrutiny
Open label extension studies, which enable physicians to continue prescribing unlicensed drugs to trial participants after a randomised trial is over, should provide information on long term safety and tolerability of potential new drugs. However, they seem particularly prone to the pressures of marketing rather than good research methods and research ethics, say Taylor and Wainwright (p 572). The authors argue that it is unclear who benefits most from these studies—patients or drug companies. Patients should be better informed when deciding whether to participate, and tighter ethical criteria need to be applied, say the authors.
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Women doctors are challenging entrenched attitudes in the UK
The proportion of women entering medical schools in the UK rose from about a quarter in the 1960s to 61% in 2003. On page 569, Allen explores the position that women have today in hospital medicine and in general practice in the UK. Based on a series of focus groups, she also reports views of women consultants working in a London hospital. The discussions included topics such as stress at work, the importance of time management, role models and mentors, flexible training, full time employment, and academic careers.
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