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Press releases Saturday 1 April 2006

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(1) UK PLANS FOR PANDEMIC FLU DON’T GO FAR ENOUGH

(2) NHS CASH CRISIS WILL DELAY NATIONAL BOWEL SCREENING PROGRAMME, WARNS EXPERT

(3) REAL BATTLE OVER MENTAL HEALTH LAW ABOUT TO BEGIN

(4) BMJ EDITOR CALLS FOR INDEPENDENCE FOR THE NHS

(5) AUSTRALIAN SCIENTISTS DISCOVER NEW DISEASE

(1) UK PLANS FOR PANDEMIC FLU DON’T GO FAR ENOUGH

(Using lessons from the past to plan for pandemic flu)
http://bmj.com/cgi/content/full/332/7544/783

(An iatrogenic pandemic of panic)
http://bmj.com/cgi/content/full/332/7544/786

(A slippery disease: a microbiologist’s view)
http://bmj.com/cgi/content/full/332/7544/789

(Hard decisions will have to be made: view from intensive care)
http://bmj.com/cgi/content/full/332/7544/790

(Dealing with uncertainty: perspective from primary care)
http://bmj.com/cgi/content/full/332/7544/791

The UK’s contingency plans for pandemic flu don’t go far enough, argues a director of public health in this week’s BMJ.

Plans for pandemic flu in the United Kingdom are said to be among the best in the developed world, but important lessons from the past have been missed, writes Hilary Pickles. These include the need to prepare for high death rates, being open with the public, and understanding population behaviour. Clear and appropriate accountability and communications are also needed, she concludes.

In response, David Salisbury, Director of Immunisation at the Department of Health, argues that preparedness has been strengthened through cross government working, enhanced communications, and international cooperation.

In a second article, public health experts in Belgium discuss the risks of a pandemic and ask whether stockpiling antiviral drugs is the best response. They argue that, in a climate of fear, the perception of risk is easily distorted from the actual risk, making us over-react to hypothetical dangers. This has led to stockpiling of antiviral drugs of no clear use, and following mindlessly the advice of disease experts with undeniable interests.

They believe that the energy unleashed by the fear of a pandemic should be directed at tackling real health problems.

“Intensive care resources are unlikely to be able to meet the extra demand of an influenza pandemic, warns critical care specialist, Richard Marsh. Based on data from influenza patients admitted to hospital in Asia, he predicts that between four and five times the number of intensive care beds available in most general hospitals in the UK would be required to meet demand at the peak of the epidemic.

Decisions will be difficult and will require an unprecedented degree of cooperation between everyone caring for these patients, he concludes.

In terms of primary care, preparation is key, says Anthony Harnden. It is not sufficient for practices to rely on government or primary care trust plans. Current guidance is voluminous and general practitioners are in danger of not being able to see the wood for the trees. He believes that practices should develop straightforward plans that are applicable to local circumstances.

Whether H5N1 becomes pandemic, no one can say. The only certainty is that there will be a flu pandemic, some time, warns leading microbiologist Hugh Pennington. “The lesson from history is that making predictions about the virus is a fool’s game. It will go on evolving whatever we do.” He suggests that the best way forward is to focus on vaccines: to improve their immunogenicity, their breadth of protection, and the speed of manufacture.

Contacts:

Hilary Pickles, Director of Public Health, Hillingdon Primary Care Trust, West Drayton, Middlesex, UK
Email: hilary.pickles@hillingdon.nhs.uk

David Salisbury, Director of Immunisation, Department of Health, London, UK
Email: Vicky.Wyatt@dh.gsi.gov.uk

Professor Wim Van Damme, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
Email: wvdamme@itg.be

Richard Marsh, Consultant in Anaesthesia and Critical Care, Northampton General Hospital NHS Trust, Northampton, UK
Email: richard.marsh@doctors.org.uk

Hugh Pennington, Emeritus Professor of Bacteriology, University of Aberdeen, Scotland
Email: t.h.pennington@abdn.ac.uk

(2) NHS CASH CRISIS WILL DELAY NATIONAL BOWEL SCREENING PROGRAMME, WARNS EXPERT

(Editorial: Impending or pending? The national bowel cancer screening programme)
http://bmj.com/cgi/content/full/332/7544/742

The NHS financial crisis will delay the government’s bowel cancer screening programme, which is due to begin this week, warns a senior doctor in this week’s BMJ.

The government has said that, from April 2006, it will provide £37.5m to screen men and women aged 60-69 every two years. But this deadline cannot be met, argues Professor Wendy Atkin, because it will take around six months to commission the screening centres, and no funding has yet been provided.

Last week, Cancer Research UK’s chief executive, Professor Alex Markham, accused the Department of Health of “unacceptable prevarication” and said he feared the delay will lead to people dying unnecessarily from bowel cancer.

The case for screening is clear, writes Professor Atkin of Cancer Research UK’s Colorectal Cancer Unit at St Mark's Hospital, London. Bowel cancer is second only to lung cancer as a cause of cancer deaths in the United Kingdom. In 2004 the number of deaths from bowel cancer (16 148) exceeded the number from breast cancer (12 347) and cervical cancer (1093), diseases for which there are already effective, well run screening programmes. Five year survival rates for bowel cancer, although increasing, remain below 50%.

This programme will be an important opportunity to reverse the low ranking of our bowel cancer survival rates in comparison with the US and several European countries, she says.

There is still time to introduce the programme in 2006, she adds, but doubts about the speed of introducing the programme risks harming the professional goodwill and motivation that have driven service improvements.

“The government’s short term financial difficulties should not be permitted to erode national confidence in its commitment to tackling bowel cancer death rates,” she concludes.

Contact:

Nick Stewart, Press Office, Cancer Research UK, London, UK
Email: nick.stewart@cancer.org.uk

(3) REAL BATTLE OVER MENTAL HEALTH LAW ABOUT TO BEGIN

(Editorial: Reforming mental health law in England and Wales)
http://bmj.com/cgi/content/full/332/7544/737

The UK government’s climb down on reform of mental health legislation is not a victory – the real battle is about to begin, warns a senior doctor in this week’s BMJ.

The UK government’s announcement that it has abandoned its eight year attempt to achieve a new Mental Health Act for England and Wales is an apparent victory for patients, professionals, and liberal democracy, writes Professor Nigel Eastman of St George’s Hospital, London.

But faced with almost unanimous opposition from those with an interest in mental health care, the government has stated that it will instead introduce a shortened and streamlined bill amending the 1983 Mental Health Act.

This amending legislation will replace the Draft Mental Health Bill that had been described as a “Public Order Act” which would be “unethical, unworkable, and also ineffective,” even in enhancing public safety.

The bill’s most contentious proposals included widening the criteria for compulsory detention and treatment, and removing the “treatability test” for personality disorder (so that those with dangerous and severe personality disorder could be detained by doctors when not capable of being sentenced by criminal courts). It’s uncertain whether the legal amendments now being proposed will be any less controversial, says Eastman.

The government’s climb down on reform of mental health legislation is, almost certainly, merely a prelude to climbing up by another route, he warns.

Crucially, amendments should include introducing guiding principles into the act, including those of autonomy and reciprocal rights, in order to enhance consistent and ethical operation of the legislation. Unsurprisingly, this is resisted by the government.

He urges professionals working in mental health care, including general practitioners, to be vigilant in scrutinising the detail of the proposed amending legislation.

“There is a grave danger of being lulled into a false sense of security through having apparently won the seven year phoney war. The real parliamentary battle is about to begin,” he concludes.

Contact:

Nigel Eastman, Professor of Law and Ethics in Psychiatry, Division of Mental Health, St George’s Hospital Medical School, London, UK
Email: neastman@sghms.ac.uk

(4) BMJ EDITOR CALLS FOR INDEPENDENCE FOR THE NHS

(Editor’s Choice: Time to leave home)
http://bmj.com/cgi/content/full/332/7544/0

In this week’s BMJ, Editor Fiona Godlee calls for independence for the NHS.

These are bad times for the NHS, she writes. The words “crisis” and “meltdown” are flying around and few people say these are exaggerations. Record spending has delivered record deficits and uncertain value for money. For the first time in anyone’s memory, sizeable numbers of NHS staff are losing their jobs. How has this happened and what’s to be done?

Last week’s edition of the BBC’s Panorama roundly blamed the government. But government ministers blame managers. On Panorama health secretary Patricia Hewitt spoke of “a few bad apples” - incompetent managers who have failed to balance their books - and a culture of overspending. The managers interviewed on the programme cried foul. They said they had done what the government asked.

"If this crisis tells us anything it is that health care is too important to be left to politicians," she writes. "If the NHS is to stop being a political football kicked from one party’s version of an internal market to another’s, it needs to be protected from party politics."

"An independent NHS authority (or four authorities for England, Scotland, Wales, and Northern Ireland) could do this. Each would be run by a board of governors responsible for managing health care within a set budget and a broad political framework. The analogy to that other great British institution, the BBC, is obvious."

"Gordon Brown’s first act as chancellor was to give the Bank of England independence to set interest rates. His first act as prime minister should be to give independence to the NHS," she concludes.

Contact:

Via Emma Dickinson, BMJ Press Officer, BMA, London, UK
Email: edickinson@bma.org.uk

(5) AUSTRALIAN SCIENTISTS DISCOVER NEW DISEASE

(News: Australian scientists find new disease: motivational deficiency disorder)
http://bmj.com/cgi/content/full/332/7544/745

Extreme laziness may have a medical basis, say a group of Australian scientists in this week’s BMJ, as they describe a new condition called motivational deficiency disorder (MoDeD).

The condition is claimed to affect up to one in five Australians and is characterised by overwhelming and debilitating apathy. Neuroscientists at the University of Newcastle in Australia say that in severe cases motivational deficiency disorder can be fatal, because the condition reduces the motivation to breathe.

Neurologist Leth Argos is part of the team that has identified the disorder. “This disorder is poorly understood,” he says. “It is underdiagnosed and undertreated.”

Trials of indolebant, a drug to help combat this condition, are underway and initial results are promising. “Indolebant is effective and well tolerated,” adds Professor Argos. “One young man who could not leave his sofa is now working as an investment adviser in Sydney.”

But some doctors are concerned that ordinary laziness is being medicalised, and have organised a conference on “disease mongering” at Newcastle University on 11-13 April 2006 (www.diseasemongering.org).

A study of the economic impacts of motivational deficiency disorder estimates the condition may be costing the Australian economy $A2.4bn (£970m; €1.4bn; $1.7bn) a year in lost productivity. This has prompted calls from industry and advocacy groups for a fast tracking of the regulatory assessment of indolebant in Australia and world wide.

Contact:

Ray Moynihan, Journalist, Sydney, Australia
Email: raymond.moynihan@verizon.net

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)