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

Press releases Saturday 24 September 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) AIRPORT SCREENING UNLIKELY TO PREVENT SPREAD OF SARS OR INFLUENZA

(2) TREAT STUTTERING BEFORE CHILDREN START SCHOOL, SAY EXPERTS

(3) SHOULD THE LAW ON EUTHANASIA AND PHYSICIAN ASSISTED SUICIDE BE CHANGED?

(4) SCRAPPING BCG VACCINATION IN BRITISH SCHOOLS IS JUSTIFIED

(1) AIRPORT SCREENING UNLIKELY TO PREVENT SPREAD OF SARS OR INFLUENZA

Online First
(Entry screening for severe acute respiratory syndrome (SARS) or influenza: policy evaluation)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38573.696100.3A

Screening passengers as they arrive at UK airports is unlikely to prevent the importation of either SARS or influenza, finds a study published online by the BMJ today.

In the event of a new SARS or influenza epidemic, air travel would represent the principal route of international spread. Although airport entry screening has been advocated, its benefit is currently unknown.

Using the incubation periods for influenza and SARS, researchers at the Health Protection Agency estimated the proportion of passengers with latent infection who would develop symptoms during any flight to the UK.

For SARS, they found that the incubation period was too long to allow more than a small proportion of infected individuals to develop symptoms during a flight to the UK (0-3% for European flights and a maximum of 21% for the longest flights from East Asia).

Although influenza has a much shorter incubation period than SARS, the average predicted proportion of people infected with influenza and progressing during any flight was still less than 10%.

Because the proportion of individuals detected is highest from cities with the longest flight duration, screening passengers from the Far East and Australasia derives the most benefit. But, even then, the sensitivity for cities in these areas would still be low, explain the authors.

Early screening is unlikely to be effective in preventing the importation of either SARS or influenza, they conclude.

Although adopting a policy of quarantining all exposed passengers on the detection of a single case could substantially increase the benefit of entry screening, this still leaves the problem that the sensitivity of entry screening is low.

Contact:

Emily Collins, Health Protection Agency Press Office, London, UK
Email: hqpress@hpa.org.uk

(2) TREAT STUTTERING BEFORE CHILDREN START SCHOOL, SAY EXPERTS

(Randomised controlled trial of the Lidcombe programme of early stuttering intervention)
http://bmj.com/cgi/content/full/331/7518/659

Stuttering is best treated early, before children start school, according to new evidence published in this week’s BMJ.

About 5% of children begin to stutter, usually in the third and fourth years of life. The consensus is that early intervention in the preschool years is necessary, but evidence to support this is currently lacking.

Researchers tested a new behavioural treatment (the Lidcombe programme) developed specifically for stuttering in preschool children to see whether its effects were significantly and clinically greater than those of natural recovery.

Fifty-four children aged 3-6 years took part. Each child was diagnosed with a frequency of at least 2% syllables stuttered. Twenty-nine received the Lidcombe programme and 25 acted as controls. Over nine months, 517 speech samples were collected for analysis.

Before the study, severity of stuttering was similar in the two groups. After nine months, the control group had reduced their frequency of stuttering by an average of 43% but only 15% of children had attained a minimum level of stuttering (1% of syllables stuttered).

In contrast, the treatment group had reduced their stuttering by 77% and over half (52%) of children had attained a minimum level of stuttering.

The Lidcombe programme is a significantly and clinically more effective treatment for stuttering than natural recovery in children of preschool age, say the authors.

Several reasons support implementing the programme in the preschool years. For example, the programme seems to be less effective once children reach school age, while delaying treatment until school age risks exposing children to the serious social and psychological effects of stuttering at this age, they conclude.

Contact:

Mark Onslow, Director, Australian Stuttering Research Centre, University of Sydney, Lidcombe, NSA, Australia
Email: m.onslow@fhs.usyd.edu.au

(3) SHOULD THE LAW ON EUTHANASIA AND PHYSICIAN ASSISTED SUICIDE BE CHANGED?

(Taking the final step: changing the law on euthanasia and physician assisted suicide)
http://bmj.com/cgi/content/full/331/7518/681

(Legalised euthanasia will violate the rights of vulnerable Patients)
http://bmj.com/cgi/content/full/331/7518/684

(Changes in BMA policy on assisted dying)
http://bmj.com/cgi/content/full/331/7518/686

(Moral dimensions)
http://bmj.com/cgi/content/full/331/7518/689

(Dutch experience of monitoring euthanasia)
http://bmj.com/cgi/content/full/331/7518/691

Next month’s debate in the House of Lords could begin the process of changing the law on euthanasia and physician assisted suicide. To help doctors decide where they stand, this week’s BMJ publishes a range of opinions.

People who want assisted suicide should have the same rights as patients who can end their lives by refusing life sustaining treatment, argues retired barrister Margaret Branthwaite.

She points out that public support for legislation to permit assisted dying has grown from 69% in 1976 to 82% in 2004, and that most professional bodies have now adopted a neutral stance.

Data from countries where assisted dying has been legalised also answer some of the concerns expressed by opponents of the proposed legislation, she adds. For example, in the US state of Oregon, the number of assisted suicides has changed little under Oregon’s Death with Dignity Act.

These views are echoed in an ethical analysis by Professor Torbjorn Tannsjo, who argues that a system for euthanasia would mean that people could approach the terminal phase of their lives without fear. “They would know that, if, when their turn comes, and things turn out to be terrible, they have a way out,” he writes.

But in another article, senior palliative care doctors warn that legalised euthanasia would leave vulnerable groups open to therapeutic killing without consent.

Rob George and colleagues argue that assisted suicide cannot be separated from euthanasia, and reject the arguments that legalised euthanasia promotes autonomy of the dying in general or that any safeguards are ethically sustainable.

Before another bill is laid before parliament, doctors must consider all the moral and practical implications of legalisation, they write.

The adequacy of safeguards in any proposed legislation will also be a priority for the British Medical Association, which has recently adopted a neutral policy on assisted dying. From the BMA’s perspective, a neutral position entails a campaign for better palliative care, robust safeguards for patients, training and support for health professionals, and clear conscientious objection clauses.

Finally, research among doctors in the Netherlands shows that, although with the introduction of review procedures for euthanasia and physician-assisted suicide the public oversight and legal control has increased, almost half of all euthanasia and physician assisted suicide are still not reported.

Contacts:

Margaret Branthwaite, Retired Barrister, London, UK
Email: mab.clf@doctors.org.uk

Rob George, Centre for Bioethics and Philosophy of Medicine, University College London, UK
Email: rob@palliativecare.org.uk

Professor Torbjorn Tannsjo, Department of Philosophy, Stockholm University, Sweden
Email: torbjorn.tannsjo@philosophy.su.se

Bregje Onwuteaka-Philipsen, Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, Netherlands
Email: b.philipsen@vumc.nl

(4) SCRAPPING BCG VACCINATION IN BRITISH SCHOOLS IS JUSTIFIED

(Editorial: Stopping routine vaccination for tuberculosis in schools)
http://bmj.com/cgi/content/full/331/7518/647

From autumn 2005, the long running routine programme to vaccinate school children against tuberculosis with BCG vaccine will stop. This decision brings the UK into line with much of the rest of the world and is well justified, writes Professor Paul Fine in this week’s BMJ.

The spread of tuberculosis in the United Kingdom has changed greatly over the years since the BCG programme began. The annual risk of infection has declined from about 2% a year in 1950 to less than 1 per 1,000 today, and the disease has become restricted to segments of the population, in particular immigrant communities. The number of cases in people born in the United Kingdom reached an all time low in 2003.

Although the criteria set by the International Union against Tuberculosis and Lung Disease for shifting away from routine BCG vaccination were achieved in the 1990s, policy makers were reluctant to stop the programme in schools because of lingering concerns that increases in the prevalence of HIV and tuberculosis internationally might increase the risk of tuberculosis in the UK general population, explains the author.

This has not occurred, and it is clear that the risk of tuberculosis among immigrant communities declines over time once they have settled in the United Kingdom, and that the imported disease has not led to increases in the risk of disease for the indigenous population.

Under the new policy, BCG vaccination will be offered to infants in communities with an average incidence of tuberculosis of at least 40 per 100,000 and to unvaccinated individuals who come from, or whose parents or grandparents come from countries where the incidence exceeds 40 per 100,000.

BCG vaccination will continue to have an important role in protecting children in high risk populations from tuberculosis, says the author. Coupled with vigorous efforts to identify and treat cases, and to ascertain and offer prophylaxis to people with latent infection, the new policy should allow more efficient control of tuberculosis in the entire UK population.

Contact:

Professor Paul Fine, Professor of Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
Email: paul.fine@lshtm.ac.uk

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)