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Press releases Saturday 27 May 2006
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(1) DRINKING DAILY CUTS HEART DISEASE RISK FOR MEN, BUT NOT FOR WOMEN
(2) RUGBY UNION SHOULD BAN CONTESTED SCRUMS
(3) NICE NEEDS TO BE INSULATED FROM EXTERNAL PRESSURES
(1) DRINKING DAILY CUTS HEART DISEASE RISK FOR MEN,
BUT NOT FOR WOMEN
(Prospective study of alcohol
drinking patterns and coronary heart disease in women and men)
http://bmj.com/cgi/content/full/332/7552/1244
(Editorial: How much and
how often should we drink?)
http://bmj.com/cgi/content/full/332/7552/1224
Men who drink alcohol every day have a lower risk of heart disease than those who drink less frequently, suggests research in this week’s BMJ. But the same is not true for women.
This study raises important questions about drinking patterns and heart health among men and women, but an editorial warns that the results should be interpreted with caution and should not be used to justify potentially harmful drinking behaviour.
It is widely known that moderate drinkers have a lower risk of coronary heart disease than those who abstain, but most research in this field has been done on men and little is known about drinking patterns and risk of heart disease among women.
Researchers in Denmark studied over 50,000 men and women aged 50-65 years who were taking part in a national health study. Details on alcohol intake and drinking frequency over the preceding year were collected, and participants were monitored for an average of 5.7 years.
Coronary heart events were recorded and results were adjusted for known risk factors, such as age, smoking, education, physical activity and diet.
A total of 28,448 women and 25,052 men took part in the study. Women consumed an average of 5.5 alcoholic drinks a week and men consumed 11.3. During the study, 749 women and 1,283 men developed coronary heart disease.
Women who drank alcohol on at least one day a week had a lower risk of coronary heart disease than women who drank alcohol on less than one day a week.
However, risks were similar for drinking on one day a week (36% reduced risk), or seven days a week (35% reduced risk), suggesting that the amount of alcohol consumed is more important than drinking frequency among women.
In contrast, for men, risks were lowest for the most frequent drinkers. For example, men who drank on one day a week had a 7% reduced risk, while men who drank daily had a 41% reduced risk. This suggests that it doesn’t matter how much men drink, as long as they drink every day.
To try to minimise bias, early cases of heart disease were analysed separately, but this did not change the conclusions. However, the authors stress that the benefits of alcohol on coronary heart disease are by far exceeded by the harmful effects of heavy alcohol drinking, and that their findings should be viewed in this context when giving public health advice.
But before the corks start popping, it is worth bearing several caveats in mind, writes Annie Britton, an epidemiology expert, in an accompanying editorial.
For instance, the Danish participants were middle-aged and therefore presumably at a greater risk of heart disease. The low response rate also means that extremes of drinking may not have been captured. Finally, the nature of this report – an observational study – may make it prone to other explanations for the findings.
In the UK, we are drinking well above the optimum level for health, so advice and legislation about keeping consumption safe and healthy are needed, she concludes.
Contacts:
Paper: Professor Morten Grønbæk
or Janne Tolstrup, Centre for Alcohol Research, National Institute for Public
Health, Copenhagen Denmark
Email: mg@niph.dk or jst@niph.dk
Editorial: contact author via Jenny
Gimpel, Media Relations Manager, University College London, UK
Email: j.gimpel@ucl.ac.uk
(2) RUGBY UNION SHOULD BAN CONTESTED SCRUMS
(Personal View: Rugby union
should ban contested scrums)
http://bmj.com/cgi/content/full/332/7552/1281
Rugby union should ban contested scrums* argues a senior doctor in this week’s BMJ.
James Bourke, a consultant general surgeon at Queen’s Medical Centre, Nottingham, has been an honorary medical officer to Nottingham Rugby Football Club for 30 years. In that time, he has experienced seven serious spinal cord injuries, six were related to the contested scrum.
Two of the young players are now wheelchair dependent.
In Australia, no acute spinal cord injuries have occurred in rugby league since contested scrums stopped being allowed in 1996. But injuries continue to occur in rugby union scrums. A recent Australian study found that, between 1997 and 2002, 39% of injured players became permanently dependent on a wheelchair.
The study also looked at the cost of care of a quadriplegic young man over his lifetime and concluded that the laws of scrum engagement in rugby union and the amount of insurance cover for injured players are grossly inadequate.
Rugby union became professional in 1995; players are paid to play and train. Professional rugby union is now often described as an industry. It may be subject to the Health and Safety at Work Act (1974), which requires working practices that are safe and do not put workers at risk. In the under 19 game contested scrums are not allowed.
In Britain, acute spinal cord injuries in rugby union continue to occur, typically associated with scrums at the moment of engagement. Wheelchair dependency among those injured is common, and insurance is inadequate. The rugby football union is known to be concerned about the high level of injury, severity and insurance.
“The incidents involving the two young players who are now wheelchair dependent occurred recently in my experience in rugby union and have caused me to change my opinion on contested scrums,” says the author. “The consequences of injury are so great that the continuing risk of injury cannot be accepted.”
He believes rugby union should follow the example of rugby league in Australia and ban contested scrums. “Rugby union outlawed the “flying wedge” and the “cavalry charge” as they are potentially dangerous. It should now also outlaw the contested scrum,” he concludes.
Contact:
James Bourke, Consultant General
Surgeon, University Hospital, Queen’s Medical Centre, Nottingham, UK
Email: jandabourke20vc@aol.com
* In the contested scrum, each set of forwards tries to shove the opponents off the ball. This is more dangerous than the uncontested scrum, in which the players are not allowed to push their opponents away from the spot where the scrum occurs.
(3) NICE NEEDS TO BE INSULATED FROM EXTERNAL PRESSURES
(Review of NICE’s recommendations,
1999-2005)
http://bmj.com/cgi/content/full/332/7552/1266
(How NICE may be outflanked)
http://bmj.com/cgi/content/full/332/7552/1268
The work of the National Institute for Health and Clinical Excellence (NICE) needs to be insulated from external financial, political, and emotional pressures, say researchers in this week’s BMJ.
NICE was set up as an independent body by the UK government in 1999, charged with getting the best from NHS resources. It examines the value of treatments for the NHS in England and Wales and recommends whether they should be used unreservedly, with restrictions, or not at all.
In its first five years, NICE published 86 guidances covering 117 topics. A review of its guidance found that recommendations were fairly evenly distributed, with NICE deciding no for 22 (19%), yes for 27 (23%), yes with major restrictions for 38 (32%) and yes with minor restrictions for 30 (28%).
The review concludes that, overall, NICE has been fair and consistent in its remit to ensure equity.
But equity is not in everyone’s interests, and NICE has come under increasing pressure from patients, drug companies, and politicians who seek to influence its decisions, write Robin Ferner and Sarah McDowell.
For example, the promotion of trastuzumab (Herceptin) shows how drug companies raise awareness of new drugs. Companies also harness the media to support their views in battles with NICE.
Patients and patient groups also have a strong influence. NICE changed its advice on treatment for Alzheimer’s disease and osteoporosis after vocal campaigns, which have placed trastuzumab at the forefront of public and political consciousness. This has led to the feeling that the licensing and NICE approval of trastuzumab for early stage cancer is a foregone conclusion.
Even politicians seem to undermine NICE by making decisions before guidance is published. Patricia Hewitt, the secretary of state for health, recently stated that primary care trusts “should not refuse to fund Herceptin solely on the grounds of its cost” even before trastuzumab has been licensed for treatment of early breast cancer.
It is easy to see why patients, whose illnesses provide strong motivation to obtain a share of NHS resources, wish their voices to be heard, say the authors. It is also clear that companies, which have to make a profit, will seek what advantage they can. Less easily understood is the way that politicians seem to undermine NICE.
NICE should ensure that the funding available for drugs in the NHS is spent in a way that best serves patients, they write. Appraisal of treatments also needs to be insulated from external pressure.
Contacts:
James Raftery, Professor of Health
Technology Assessment, Wessex Institute of Health Research and Development,
University of Southampton, UK
Email: j.p.raftery@soton.ac.uk
or
Robin Ferner, Director, West Midlands
Centre for Adverse Drug Reaction Reporting, City Hospital, Birmingham, UK
Email: r.e.ferner@bham.ac.uk
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