Online First articles may not be available until 09:00 (UK time) Friday.
Press releases Saturday 18 March 2006
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) COMMERCIAL INTERESTS DRIVING STANDARDS FOR FORMULA MILK
(2) GRIEVING PARENTS AT INCREASED SUICIDE RISK
(3) IS SOCIETY
LOSING CONTROL OF THE MEDICAL RESEARCH AGENDA?
(1) COMMERCIAL INTERESTS DRIVING STANDARDS FOR FORMULA MILK
(Editorial: Standards for
infant milk formula)
http://bmj.com/cgi/content/full/332/7542/621
Commercial interests may be the strongest driver of what goes into formula milk, warn child health experts in this week’s BMJ.
Professors Berthold Koletzko and Raanan Shamir describe a meeting in Bonn, Germany in November 2005 to revise the standard on infant formula. The meeting involved government delegations, non-governmental organizations, and other groups with commercial interests in infant formula.
Infant formula must meet very high quality standards. The Codex Alimentarius Commission, part of both the Food and Agriculture Organisation of the United Nations and the World Health Organisation, develops standards and guidelines on food to protect consumers’ health and to ensure fair trade practices globally.
Three scientific reviews all agree that the safe level of infant formula protein should be based on a recognised nitrogen conversion factor. In Bonn, however, the International Dairy Federation demanded that the proportion of protein in formula derived from cows’ milk should be based on a larger nitrogen conversion factor.
Even though no scientific arguments were put forward to justify the federation’s request, and it would falsely indicate that cow's milk protein is superior to human milk protein, it got support from several member states with strong dairy industries.
While the industry argues that using the lower nitrogen conversion factor would lead to a loss of some €80m (£55m; $96m) for the dairy industry in Europe alone, this is clearly not the case if the appropriate factor is applied to infant feeding products.
Another controversial issue was the approach to setting maximum values for nutrients. The scientific expert report recommended that the contents of water soluble vitamins in infant formulas should not exceed five times the minimum level unless there are data to justify other decisions.
But, contrary to this strong scientific advice, some member states requested that the maximum values should be established only for levels of nutrients with documented adverse effects in infants, while in all other cases only interim upper values should be established which would not be binding for manufacturers.
Moreover, the US delegation requested that both maximum values and guidance values should not be lower than values used for formulas already on the market, even if such levels have not been subjected to systematic evaluation of their biological effects and safety.
The worldwide medical community might question the basis of these decisions and might rise to reject such commercial pressures, suggest the authors.
Doctors should choose and recommend only those infant formulas with compositions based on current scientific knowledge and on the nutritional requirements of infants, they conclude.
Contact:
Berthold V Koletzko, Professor of
Paediatrics, Dr von Haunersches Kinderspital, Munich, Germany
Email: berthold.koletzko@med.uni-muenchen.de
(2) GRIEVING PARENTS AT INCREASED SUICIDE RISK
(Parental suicide after the
expected death of a child at home)
http://bmj.com/cgi/content/full/332/7542/647
(Editorial: Grieving the
death of a child)
http://bmj.com/cgi/content/full/332/7542/620
Parents who have cared for a dying child at home may be at higher risk of suicide after the child dies, by overdosing on the powerful painkillers used to ease the child’s condition, say two papers in this week’s BMJ.
Little research has been done on suicide rates for bereaved parents, say the authors. But there is substantial evidence that parents who have lost a child suffer deeper and more long-lasting grief than others suffering bereavements.
And one recent study showed that the death of a young child in particular put parents at heightened suicide risk - especially in the month following the death.
Recent advances in caring for the terminally ill - palliative care - mean that more and more of these patients are being cared for in the home. After the loved one has died, parents or other carers are encouraged to return any unused morphine or other painkillers (opioids) to the pharmacy for safe disposal. But despite the best efforts of medical staff, this may not happen - resulting in powerful drugs being left in the hands of grieving loved ones.
Currently there is no official guidance on what to do about leftover drugs remaining in carers’ homes, say the authors, and if the misuse of opioids continues the situation must be addressed.
An accompanying editorial describes the immense distress suffered by parents caring for dying children. Once the child has died, many child cancer units provide bereavement support for families, with surveys suggesting this is generally to a high standard.
But there is very little guidance or research on how healthcare staff can best give this support, says the author. Looking after the carer before, during and in the aftermath of death is essential. Much more research is needed on how these families can best be supported at this difficult time, she concludes.
Contacts:
For the paper: Dawn Davies Assistant
professor, Department of Paediatrics, University of Alberta, Edmonton, Canada,
out-of-hours contact: Joanne Nugent at University of Alberta press
office at JoanneNugent@cha.ab.ca
Email: dawn.davies@ualberta.ca
For the editorial: Beverley Raphael
Professor of Population Mental Health and Disasters, University of Western
Sydney, New South Wales, Australia
Email: b.raphael@uws.edu.au
(3) IS SOCIETY LOSING CONTROL OF THE MEDICAL RESEARCH AGENDA?
Online First
(Origin and funding of the most frequently cited papers in medicine:
database analysis)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38768.420139.80
Is society losing control of the medical research agenda? ask experts in a study published online by the BMJ today (17 March 2006) .
Medical research depends on funding from the private sector, in particular from biotechnology and drug companies, but this funding may lead to conflicts of interest about the results of medical research.
To measure the potential impact of public funding compared to industry funding, researchers analysed the affiliations of authors and the funding sources of the most frequently cited medical research papers from 1994 to 2003. Top-cited papers have a major impact on scientific thinking.
Of the 289 most frequently cited articles, most had at least one author with a university (76%) or hospital (57%) affiliation.
Government or public funding was most common (60% of articles), followed by industry (36%). However, the proportion of articles funded by industry increased over the decade and by 2001, more than 50% of funding came from industry, surpassing funding from government or public sources.
Sixty five of the 77 top-cited randomised controlled trials received funding from industry, whereas government and public sources funded only 32 trials. The proportion of trials funded by industry also increased significantly over time. Eighteen of the 32 most cited trials published after 1999 were funded by industry alone.
Participation of academics in influential medical research has remained strong, despite the perceived crisis in academic medicine, say the authors. Yet industry funds an increasing proportion of this research, especially randomised controlled trials, most of which are now funded exclusively by industry.
They suggest that the role of industry should be scrutinised further. They also believe that medical research should reflect public needs more closely and the efforts of all those involved (government, industry, and academia) should be better coordinated.
Contact:
Professor John Ioannidis, Department
of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina,
Greece
Email: jioannid@cc.uoi.gr
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)