This week in the BMJ
Volume 331,
Number 7524,
Issue of 5 Nov 2005
Prepare for flu pandemic
Role of folate in preventing CHD may be in doubt
Oral anticoagulation can safely be self managed
Chimneys reduced COPD in China
Paternalism can stand in the way of best treatment
Prepare for flu pandemic
Now is the time for general practitioners to plan their response to an influenza pandemic, says Fleming on page 1066. He revisits the characteristics of the H5N1 virus that could cause the illness, its transmission properties, and how it affects humans. As general practice is likely to carry the major burden of disease in the community if the pandemic occurs, Fleming offers advice for organising the practice and managing patients. He also explores commercial and ethical issues, including supply shortages of vaccines and antiretroviral drugs.
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Credit: BOGDAN CRISTEL/AP/EMPICS
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Role of folate in preventing CHD may be in doubt
The protective role of folate—through lowering serum homocysteine concentrations—against coronary heart disease may not be as strong as previously thought. Lewis and colleagues (p 1053) carried out an updated meta-analysis of observational studies that included 26 000 cases and more than 30 000 controls—twice the size of previous meta-analyses. Using rigorous statistical techniques, they show there is little evidence of homocysteine affecting the risk of coronary heart disease. Only studies conducted in the Middle East and Japan seem to suggest the causal relationship, but this could also be a result of publication bias.
Oral anticoagulation can safely be self managed
Appropriately trained, patients taking oral anticoagulants long term can safely and effectively use a point of care device to manage their own anticoagulation. In a multicentre open randomised trial of more than 600 patients taking warfarin, Fitzmaurice and colleagues (p 1057) found that the percentage of time spent within the therapeutic range and the incidence of adverse events were similar in patients who self managed and those who received routine care provided by anticoagulation clinics. The intervention also improved management of patients with initially poor control.
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Credit: ANDREW SYRED/SPL
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Chimneys reduced COPD in China
The incidence of chronic obstructive pulmonary disease was markedly reduced in one Chinese county after chimneys were installed in households with previously unvented coal stoves. Chapman and colleagues (p 1050) followed up for 16 years a cohort of more than 20 000 people who were born into homes with unvented coal stoves. More than 80% subsequently changed to stoves with chimneys and, when compared with people still without chimneys, their risk for developing COPD almost halved. The reduction in risk became unequivocal about 10 years after the introduction of chimneys.
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Credit: MARK HENLEY/PANOS
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Paternalism can stand in the way of best treatment
It is unethical and paternalistic to withhold information about potentially beneficial unsubsidised drugs because of concerns about a patient's capacity to pay, say Jefford and colleagues on page 1075. A survey of Australian oncologists found that about two thirds would not discuss an effective but unsubsidised new cancer drug with a patient who might benefit from it, because of its cost. It is difficult for doctors to know the financial capacity of individual patients and their families, argue the authors. If doctors judge that patients would want the drug if it were free, they should inform them of the unsubsidised drug.
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Credit: GEORGE MARKS/HULTON/GETTY
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