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Press releases Saturday 28 October 2006

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(1) ARE INFLUENZA VACCINES WORTH THE EFFORT?

(2) INDUSTRY TACTICS THREATEN TO DERAIL EUROPEAN ALCOHOL STRATEGY

(3) SOUTH DAKOTA’S ABORTION BAN IS A THREAT TO WOMEN’S HEALTH

(1) ARE INFLUENZA VACCINES WORTH THE EFFORT?

(Influenza vaccination: policy versus evidence)
http://bmj.com/cgi/content/full/333/7574/912

Each year enormous effort goes into producing influenza vaccines and delivering them to appropriate sections of the population. But a review of the evidence in this week’s BMJ suggests that they may not be as effective as we think.

So is this effort justified, asks vaccine expert Tom Jefferson?

Public policy worldwide recommends the use of inactivated influenza vaccines (vaccines that contain dead viruses) to prevent seasonal outbreaks.

But because influenza viruses mutate (change) and the number doing the rounds varies from year to year, it’s difficult for scientists to study the precise effects of vaccines. The most reliable way to judge their effects is to use systematic reviews – impartial summaries of evidence from many different studies.

Evidence from systematic reviews in this field shows that inactivated influenza vaccines have little or no effect on many influenza campaign objectives, such as hospital stay, time off work, or death from influenza and its complications.

Furthermore, most studies are of poor quality (especially in the elderly) and show evidence of bias. And there is surprisingly little evidence on the safety of these vaccines.

The large gap between policy and what the data tell us is surprising, writes Jefferson. Reasons for this are not clear, but may stem from the confusion between influenza and influenza-like illness (the acute respiratory infection which looks like influenza but is not), a lack of accurate and fast surveillance systems, and the fact that vaccines are available.

The optimistic and confident tone of some predictions of viral circulation and of the impact of inactivated vaccines, which are at odds with the evidence, is striking, he says. But given the huge resources involved, a re-evaluation should be urgently undertaken.

"The problem is that the UK has no transparent process for evaluating the effectiveness or cost effectiveness of vaccines," adds BMJ Editor, Fiona Godlee. "NICE would like to take this on. The government should let it."

Contact:

Tom Jefferson, Coordinator, Cochrane Vaccines Field, Rome, Italy
Email: jefferson.tom@gmail.com

(2) INDUSTRY TACTICS THREATEN TO DERAIL EUROPEAN ALCOHOL STRATEGY

(Editorial: A European alcohol strategy)
http://bmj.com/cgi/content/full/333/7574/871

A European strategy to tackle the health impact of alcohol may be the victim of a carefully planned attack by representatives of the alcohol industry, using tactics associated with tobacco manufacturers, warns public health expert, Professor Martin McKee, in this week’s BMJ.

A European Commission report, published earlier this year, showed how alcohol attributable disease, injury, and violence cost the health, welfare, employment, and criminal justice sectors £84bn (€125bn; $157bn) each year, including £40bn in lost production, while the intangible costs of suffering and lost life added a further £182bn each year.

The draft strategy that emerged is now being considered by all the commissioners and a decision on whether to adopt it is expected at the end of October.

Although it is not yet in the public domain, it is expected to include several actions, such as monitoring drinking habits among young people and ensuring that alcohol related harm is taken into account in areas such as cross border advertising, road safety, and consumer information. It also envisages support for comparative research and data collection across Europe.

Given the magnitude of the threat to health posed by hazardous drinking, some may argue that the strategy should go much further. Yet, even these modest proposals may now fail, warns McKee.

Emerging evidence indicates that some elements of the alcohol industry have been engaged in a massive and highly effective exercise to derail them.

For example, a report commissioned by the trade organisation, The Brewers of Europe, argues that there is no need for Europe wide action. It was written by the Weinberg Group, an American company previously involved in the tobacco industry’s campaign to undermine evidence on the harmful effects of passive smoking.

Its content is remarkably similar to the tobacco industry reports that contended there was insufficient evidence that its products caused any harm or that preventive measures would be effective.

Now that the methods used by the tobacco industry have been exposed, few serious commentators believe what they say, writes McKee. Unfortunately, the alcohol industry seems to be going down the same path. European commissioners will miss a valuable opportunity to improve the health of their fellow citizens if they are taken in by the alcohol industry’s arguments, he concludes.

Contact:

Martin McKee, Professor of European public health, London School of Hygiene and Tropical Medicine, London, UK
Email: martin.mckee@lshtm.ac.uk

(3) SOUTH DAKOTA’S ABORTION BAN IS A THREAT TO WOMEN’S HEALTH

(Personal View: Abortion ban in South Dakota)
http://bmj.com/cgi/content/full/333/7574/925

In this week’s BMJ, a senior doctor raises serious concerns over abortion law in the US state of South Dakota.

Earlier this year, South Dakota passed a bill which bans virtually all abortions in the state except for circumstances in which the procedure is necessary to “prevent the death of the mother.” Under this new legislation, doctors face prosecution for the termination of any pregnancy in which maternal death is not clearly averted by its performance.

This law does great harm to women with complicated pregnancies and must be opposed, argues, Dr Marvin Buehner, an obstetrician and gynaecologist who has practiced in South Dakota since 1993.

Even then elective abortions were performed only in a single clinic in this state, which was picketed for years, giving rise to the notion that providing abortion services would be professional suicide for any private practitioner, he writes.

“The environment of intimidation here is still so pervasive that neither I, nor my colleagues, nor our state medical association spoke in objection when the legislature proposed a sweeping abortion ban, vetoed in 2004, or when it was reintroduced this year.”

But despite the difficulties, he is determined to continue to provide termination options for women with serious medical complications.

He has publicly testified that the law does great harm to women with complicated pregnancies and has worked with the South Dakota State Medical Association and the American College of Obstetricians and Gynaecologists to oppose the law for its “horrific medical consequences.”

As a result, he faces “a daily parade of protesters” outside his office, even though neither he nor any of his partners perform abortions at their clinic.

Polling data show that 70% of physicians in the state oppose the law, and that the public is poised to reverse this draconian bill in a November referendum, primarily because there are no exceptions for victims of rape or incest, he says.

If the law is overturned, the battle over abortion will continue to rage on in the United States. But perhaps the defeat will allow more reasonable voices to be heard over the harsh rhetoric of extremists, he concludes.

Contact:

Marvin Buehner, Obstetrician and Gynaecologist, Black Hills Obstetrics and Gynaecology, Rapid City, South Dakota, USA
Email: meb@blackhillsobgyn.com

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)