This week in the BMJ
Volume 331, Number 7520, Issue of 8 Oct 2005Postcards can save lives
Postcards can save lives
Sending postcards (asking about wellbeing and offering an invitation to contact the hospital) to people who have tried to poison themselves reduces the number of repeated attempts—but doesn't reduce the proportion making repeated attempts. Carter and colleagues (p 805) randomised 772 patients who were treated in a hospital for deliberate self poisoning to receive eight postcards during the year after the incident, plus standard care, or to standard care only. The people who were sent the postcards made only half as many repeat attempts to poison themselves as the controls. Subgroup analysis showed that the intervention predominantly reduced the number of attempts made by women.
![[To top]](/icons/back.gif){kind=icon}
Optimal therapy after kidney transplantation varies
Whether tacrolimus or ciclosporin is the optimal choice for initial immunosuppression after kidney transplantation depends on the patient. Webster and colleagues (p 810) performed a meta-analysis and meta-regression of 30 randomised controlled trials to compare the positive and negative effects of the two drugs. Treatment with tacrolimus halved the risk of graft loss at six months compared with ciclosporin but almost doubled the risk of developing type 1 diabetes. Other side effects of tacrolimus included tremor, headache, diarrhoea, dyspepsia, and vomiting, whereas ciclosporin caused significantly more constipation and cosmetic side effects.
|
"Me-too" drugs drive the rise in drug expenditure
Drug expenditure in the Canadian province of British Columbia doubled between 1996 and 2003, and 80% of this increase was due to me-too drugs (drugs that don't offer substantial improvements over less expensive alternatives). Morgan and colleagues (p 815) analysed the use of prescription drugs and expenditure per capita by the Canadian Patented Medicine Prices Review Board's product classification, which distinguishes between breakthrough drugs (the first to treat effectively a particular illness or provide a substantial improvement over existing drugs) and me-too drugs. Me-too drugs probably dominate spending trends in most developed countries, say the authors.
|
Safer homes may cut falls in elderly people with poor vision
Home safety assessment and modification programmes may reduce the number of falls and injuries in elderly people with poor vision who live at home. Campbell and colleagues (p 817) randomised 391 people aged 
75 years to one of four groups: a home safety programme, an exercise programme plus vitamin D supplementation, both these interventions, or social visits. The incidence of falls fell by 40% among those randomised to receive the home safety programme compared with those not receiving the home safety programme; the exercise programme failed to reduce the number of falls, possibly because of poor adherence.
|
Pioglitazone may not reduce macrovascular events
On page 836, Freemantle challenges the interpretation of a new trial on the oral antidiabetic drug pioglitazone. Members of the trial's steering committee presented the results of the trial last month at a conference in Athens. The committee members claimed that the trial showed that pioglitazone, which lowers blood glucose concentration, can prevent macrovascular events. Freemantle says that this interpretation is based on secondary outcomes (the primary outcome remained neutral), and he explains why the conclusions presented may be statistically unsound and unsafe.
|
UK drug regulatory body describes attempts to ensure independence
On page 834, Breckenridge and Woods from the Medicine and Healthcare Products Regulatory Agency discuss the relation between the UK drug regulatory system and the pharmaceutical industry. They describe the steps being taken to ensure that the regulatory agency is independent in its assessment even though it is funded entirely by user fees. Members of staff must disclose any potential competing interests (such as having shares in a pharmaceutical company), and other measures are used to increase transparency while protecting commercial confidentiality and secrecy.
|
Adequate dietary folate may reduce alcohol related breast cancer
Adequate folate supplementation may protect against alcohol related increased risk of breast cancer. In a prospective cohort study of more than 17 000 Australian women for 10 years, Baglietto and colleagues (p 807) found that women who regularly consumed more than 40 g (5 units) a day of alcohol had a 40% greater risk of invasive breast cancer than lifetime abstainers. A daily folate intake of 400 µg in this drinking group, however, was associated with a significant reduction in risk compared with a daily intake of 200 µg (hazard ratios of 0.77 and 2.00 respectively).
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
