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Press releases Saturday 29 April 2006

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(1) British public supports use of personal data for health research

(2) Blood clots may hold key to treating dementia

(3) Early diagnosis key to melanoma cure

(4) Should we screen people for depression?

(5) Britain must embrace psychological therapy for mental health problems

BMJ Online First
(1) British public supports use of personal data for health research
(Importance of relative measures in policy on health inequalities)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38805.473738.7C

The British public supports the use of personal medical data, without consent, for public health research, finds a study published on bmj.com today. Most people also think that cancer registration should be required by law.

Health research and surveillance is vital for the delivery of effective health services and public health interventions. But since the introduction of the Data Protection Act, research has been disrupted because of concern about the ethics and legality of using identifiable data from patient records.

The NHS code of practice on confidentiality states that it cannot be assumed that patients are happy for information about them to be used for purposes other than direct care, but there is currently little evidence on public opinion.

So researchers set out to assess the views of the British public on the acceptability of personal information being used by the National Cancer Registry for public health purposes.

A total of 2,872 people answered a series of questions on cancer registration and personal privacy in face-to-face interviews. Of these, 81% said that holding details of their name and address in the registry would not be an invasion of their privacy, 88% said that they had no objection to their postcode being held, and 87% said that being invited to take part in a research study on the basis of their inclusion in the registry would not be an invasion of privacy. Only 2% considered all of these to be an invasion of privacy, and 72% were happy with all three.

81% of respondents also said that they would support a law making cancer registration statutory.

Most likely to be concerned about invasion of privacy were those whose ethnicity was not ±white British,± those of lower socioeconomic status, and those living in rented accommodation.

These results show that the British public supports the use of identifiable cancer data without consent for public health research, provided the information is kept confidential and secure, say the authors.

Research across the European Union has also shown that doctors and medical services are highly trusted with regard to their use of individuals± personal information, much more so than tax authorities, banks, employers, and insurance and credit card companies.

±Our findings provide a direct insight into public views and suggest strong support for the confidential use of identifiable data on cancer for public health purposes and for statutory cancer registration,± they conclude.

Contact:
Lucy Fielden/Victoria Lefroy, Fuse PR, London, UK lucy@fusepr.com / victoria@fusepr.com

BMJ Online First
(2) Blood clots may hold key to treating dementia
(Cerebral emboli as a potential cause of Alzheimer±s disease and vascular dementia: case-control study)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38814.696493.AE

Spontaneous blood clots or debris from arterial disease in the brain (known as cerebral emboli) may hold the key to preventing or treating dementia, say researchers from the University of Manchester in this week±s BMJ.

Alzheimer±s disease and vascular dementia account for 80% of all dementias but the cause was unknown.

They monitored the occurrence of spontaneous cerebral emboli in 170 patients with dementia (85 with Alzheimer±s disease, 85 with vascular dementia) and 150 controls of the same sex and age.

They detected cerebral emboli in 32 (40%) of patients with Alzheimer±s disease and 31 (37%) of those with vascular dementia in only one hour of monitoring, compared with just 12 each (15% and 14%) of their controls. This suggests that both types of dementia have more in common than we've thought before, say the authors.

This study is the first of this type and more research is needed, but the authors conclude that spontaneous cerebral emboli are significantly associated with both Alzheimer±s disease and vascular dementia and may represent a potentially preventable or treatable cause of both types of dementia.

Contact:
Charles McCollum, Professor of Surgery, Academic Surgery Unit, University of Manchester, UK Email: cnmcc@man.ac.uk

(3) Early diagnosis key to melanoma cure
(Editorial: Cure of cutaneous melanoma)
http://bmj.com/cgi/content/full/332/7548/987

A combined strategy of public education and early diagnosis currently offers the only hope of cure for people with melanoma, warn senior doctors in this week±s BMJ.

Melanoma is a deadly but potentially curable type of skin cancer, largely thought to be caused by excessive and intense intermittent exposure to sunlight. The incidence of melanoma is rising faster than any other cancer and is approximately doubling every decade.

Yet, surprisingly, no surgical procedure or therapy has been shown to improve overall survival.

However, there is recent encouraging evidence that a combined strategy of public education and early diagnosis may be effective, write J Meirion Thomas and Victoria Giblin.

Public health campaigns that highlight the danger of excessive sun exposure and the importance of spotting unusual skin lesions early seem to be having an effect.

Although the overall incidence of melanoma continues to rise, there is evidence that the rate of increase of in-situ melanoma is falling, they say. There is also evidence that incidence of invasive melanoma is stabilising in individuals of 35-45 years, and younger, and that the incidence of thick melanomas (greater than 3mm) has stabilised or declined in the same age groups.

Deaths from melanoma may also be falling. Data from Australia, USA and UK suggest that, in females, melanoma deaths may have reached a plateau but continue to rise in males.

In conclusion, early diagnosis of melanoma currently offers the only hope of reducing mortality and efforts must be intensified in this regard, say the authors. Primary prevention is relevant in order to stress the importance of lifestyle (avoiding the midday sun), protective clothing and sunscreens.

Above all, the risk of sunburning in childhood and adolescence should be stressed at every opportunity, they conclude.

Contact:
J Meirion Thomas, Consultant Surgeon, Royal Marsden Hospital, London, UK Email: meirion@roseway.demon.co.uk

(4) Should we screen people for depression?
(Should we screen for depression?)
http://bmj.com/cgi/content/full/332/7548/1027

(Editorial: Depression needs to be managed like a chronic disease)
http://bmj.com/cgi/content/full/332/7548/985

Screening for depression is unlikely to be an effective way to improve the mental wellbeing of the population, say researchers in this week±s BMJ.

Nevertheless, it may soon become health policy in England and Wales as primary care doctors are rewarded for screening under their new contract.

Using UK National Screening Committee criteria, the research team scrutinised the rationale and evidence to support such screening.

They found that, although depression qualifies as a major public health problem, criteria regarding test performance, acceptability, and treatment benefits were not met.

Other key criteria are unlikely to be achieved, say the authors. For example, that the benefit from screening should outweigh the harm and that the screening programme should be cost effective.

Opportunistic screening and population level screening for depression do not fulfil the criteria of the National Screening Committee, say the authors. However, the assumption has been made that screening for depression should be recommended.

Screening should only be considered as part of a package of enhanced care. Without this, moves to implement screening will be associated with increased costs and no benefit, they conclude.

An accompanying editorial argues that it is time we treated depression as the chronic disease that it is.

Contact:
Simon Gilbody, Senior Lecturer in Mental Health Services Research, Department of Health Sciences, University of York, York, UK Email: sg519@york.ac.uk

(5) Britain must embrace psychological therapy for mental health problems
(The case for psychological treatment centres)
http://bmj.com/cgi/content/full/332/7548/1030

(Editorial: Depression needs to be managed like a chronic disease)
http://bmj.com/cgi/content/full/332/7548/985

Britain must embrace psychological therapies on a large scale if we are to tackle our mental health problems effectively, argues a leading economist in this week±s BMJ.

Depression and anxiety disorders cost the UK around ±17bn in lost output. New drug treatments are now available to all, but psychological therapies are not. Yet the National Institute for Health and Clinical Excellence (NICE) recommends psychological therapy as a cost effective treatment.

So should the Treasury support psychological therapy?

Professor Richard Layard of the London School of Economics believes it should. He shows that the benefits of psychological therapy exceed the cost. ±There is no net cost to the government because of savings on incapacity benefits and other NHS costs,± he writes.

So, what scale of expansion is needed and how should it be organised?

To implement the NICE guidelines requires 10,000 more therapists, says Layard. The extra therapists should work in teams based in centres, but much of the therapy should be delivered to people near their homes, in general practices, job centres and workplaces.

He believes that training this number of therapists is feasible over a seven year period, and recommends that 250 of these psychological treatment centres should be set up over the next seven years.

±If this is well done, it could transform the lives of millions, at no net cost to the Exchequer,± he concludes. An accompanying editorial argues that it is time we treated depression as the chronic disease that it is.

Contact:
Professor Lord (Richard) Layard, Centre for Economic Performance, London School of Economics, London, UK Email: R.Layard@lse.ac.uk

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