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Press releases Saturday 29 October 2005
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(1) ABORTION DOES NOT RAISE RISK OF DEPRESSION
(2) MEETING MRSA TARGETS LARGELY DOWN TO CHANCE, SAYS EXPERT
(3) SHOULD DRUGS FOR RARE DISEASES BE GIVEN SPECIAL STATUS IN THE NHS?
(4) US HEALTH CARE CUTS ARE COSTING LIVES
(1) ABORTION DOES NOT RAISE RISK OF DEPRESSION
Online First
(Depression and unwanted first pregnancy: longitudinal cohort study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38623.532384.55
Claims that terminating an unwanted first pregnancy raises the risk of depression is called into question in a study published online by the BMJ today.
In fact, the authors suggest that abortion may be linked to a lower risk of depression through beneficial effects on education, income, and family size.
The study involved 1,247 US women who aborted or delivered an unwanted first pregnancy between 1970 and 1992. The women were interviewed over several years to examine the relation between pregnancy outcome and later depression.
Terminating compared with delivering an unwanted first pregnancy was not directly related to risk of depression. Instead, women who delivered before 1980 had a significantly higher risk of depression than all other groups.
The abortion group also had a significantly higher mean education and income and lower total family size, all of which were associated with a lower risk of depression.
These results cannot be explained by underreporting of abortion, say the authors, because findings did not vary in groups known to vary in underreporting. Furthermore, women with higher depression scores were more willing to provide confidential abortion card information.
Despite some study limitations, they conclude that there is no credible evidence that choosing to terminate an unwanted first pregnancy puts women at higher risk of subsequent depression.
They suggest that if the goal is to reduce women’s risk for depression, research should focus on how to prevent and ameliorate the effect of unwanted childbearing, particularly for younger women.
Contact:
Professor Nancy Russo, Department
of Psychology, Arizona State University, AZ, USA
Email: nancy.russo@asu.edu
(2) MEETING MRSA TARGETS LARGELY DOWN TO CHANCE, SAYS EXPERT
(Problems in assessing rates
of infection with methicillin resistant Staphylococcus aureus)
http://bmj.com/cgi/content/full/331/7523/1013
(Editorial: Improving surveillance
of MRSA bacteraemia)
http://bmj.com/cgi/content/full/331/7523/976
Chance makes it impossible to assess reliably whether hospitals are meeting government targets to reduce MRSA infections, argues a statistics expert in this week’s BMJ.
The UK government has set a national target for reducing the rate of MRSA infection by 50% by 2008, but David Spiegelhalter, a senior scientist at the MRC Biostatistics Unit Cambridge, warns that setting these targets for individual hospitals is fraught with difficulties.
The basic problem, he says, is that it is unclear whether the targets refer to an observed rate reduction or a true reduction in underlying risk: this ambiguity is unimportant at the national level but, for individual hospitals, chance variation can make the observed rates extremely volatile and make simplistic notions of ‘hitting targets’ unreliable.
MRSA is an infectious disease and so tends to occur in clusters, making the volatility even worse.
Using data for financial years 2001-4, he found far more variability in the figures than would be expected by simple chance alone. For example, Aintree Hospitals NHS Trust had 34 cases in 2001-2, rising to 66 cases in 2002-3, and falling to 48 in 2003-4.
He therefore suggests that any attempt at ranking trusts into a detailed league table of change would be “entirely spurious.”
He also shows that, since high or low rates are largely due to chance events that are unlikely to be repeated, rates in the subsequent year will tend to be closer to the overall average rate (a phenomenon known as regression to the mean). This immediately explains reports of hospitals slipping significantly down the league table from one year to the next.
He believes that, if MRSA rates are to be used to assess performance, further changes are needed.
Finally, the government needs to be more precise about what it means by the term target, he adds. When it comes to assessing whether a target has been met, it is vital to distinguish between observed reduction in numbers of cases and reduction in true underlying risk.
Even if the average trust is truly reducing the underlying risk at the government target of 20% per year, there is still only a 50:50 chance that the observed rate will drop by more than 20%. Underlying risk, though it cannot be precisely measured, is the appropriate interpretation when setting local targets, he concludes.
But an accompanying editorial says that, despite these limitations, mandatory surveillance of MRSA infection rates has raised the profile of infection control .
Contact:
David Spiegelhalter, Senior Scientist,
MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
Email: david.spiegelhalter@mrc-bsu.cam.ac.uk
(3) SHOULD DRUGS FOR RARE DISEASES BE GIVEN SPECIAL STATUS IN THE NHS?
(Orphan drugs and the NHS:
should we value rarity?)
http://bmj.com/cgi/content/full/331/7523/1016
(Commissioning for rare diseases:
view from the frontline)
http://bmj.com/cgi/content/full/331/7523/1019
The growing number and costs of drugs for rare diseases (orphan drugs) are straining healthcare budgets. Should the NHS continue to pay for them and how will this affect other health services, ask two articles in this week’s BMJ?
Orphan drugs are often expensive to produce and benefit only small numbers of patients. Historically, the NHS has paid for them because treatments for these diseases were so rare that the effect on health services was negligible.
But, as more and more orphan drugs come on to the market, the impact on other health services is becoming substantial.
In the first article, experts argue that the cost effectiveness of orphan drugs should be treated in the same way as for other healthcare technologies.
They believe that the costs of production and the value of innovation cannot justify special treatment, and that arguments about the measurement and valuation of health outcomes apply equally to orphan drugs and drugs for more common conditions. “Why should a person’s health be valued less simply because the condition is not rare?”
Special status for orphan drugs in resource allocation will avoid difficult and unpopular decisions, but it may impose substantial and increasing costs on the healthcare system, they write.. The costs will be borne by other patients with more common diseases who will be unable to access effective and cost effective treatment as a result.
The second article describes how a national decision to provide therapies for a group of rare disorders prevented local funding for other equally vital services in the West Midlands.
The new commissioning arrangement came with no extra funding. The cost to primary care trusts doubled from £3.2m to £6.7m, limiting budgets available to commission and develop other services.
It is time to educate ourselves, policy makers, and the public, say the authors. “We need to learn how to make trade-offs between equity and efficiency that are explicit, principled, and generalisable and how to admit openly when there are treatments and services that are not being funded.”
Contacts:
Paper 1: Christopher McCabe, Professor
of Health Economics, School of Health and Related Research, University of
Sheffield, UK
Email: c.mccabe@sheffield.ac.uk
Paper 2: Lou Thomas or Liz Abbiss,
LTA Communications Ltd, UK
(4) US HEALTH CARE CUTS ARE COSTING LIVES
(Personal View: How US health
care cuts could kill me)
http://bmj.com/cgi/content/full/331/7523/1030
Health care cuts in the US are costing lives, argues one American citizen in this week’s BMJ.
Lori Smith, a representative of the Poor People’s Economic Human Rights Campaign in Tennessee, believes that plans to dismantle national social programmes for sick and poor people throughout the US are leading to suffering and death.
There has been a tendency to believe that poverty, hunger, homelessness, and lack of health care are nearly non-existent in the US, she writes. After all, the US is the richest country in the world. However, human rights violations and suffering are prevalent and growing rapidly.
She describes how, after losing her job and accompanying health insurance through illness, she was one of 150,000 people removed from Tennessee’s medical programme (TennCare) under government plans to cut health spending.
These are the largest cuts in US history, and deaths have already occurred as a result, she says. For the 1.1 million who remain on the programme, only the cheapest medical care will be available, without regard to professional medical standards.
There is enough money to provide health care for all, she argues. The US government knows it, yet it is allowing this to happen at the expense of human lives, while the healthcare industry is reaping record profits.
She is committed to breaking the silence over these cuts and taking action. She calls on others around the world to join her in bringing national and international attention to human rights violations in the US.
Contact:
Lori Smith, The Tennessee Health
Care Campaign, Nashville, Tennessee, USA
Email: LLSmith36@aol.com
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