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Press releases Saturday 11 November 2006

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(1) A HEALTHY POPULATION IS GOOD FOR THE ECONOMY

(2) GOOGLE CAN HELP DOCTORS DIAGNOSE DIFFICULT CASES

(3) MANY MORE PEOPLE COULD BENEFIT FROM STATINS, SAY EXPERTS

(4) DOCTORS MUST NOT BE LAPDOGS TO DRUG FIRMS

(1) A HEALTHY POPULATION IS GOOD FOR THE ECONOMY

(Investment in health could be good for Europe’s economies)
http://bmj.com/cgi/content/full/333/7576/1017

It’s official. A healthy population is good for a nation’s economy, say researchers in this week’s BMJ.

Although it is now accepted that better health increases economic growth in poor countries, it was less clear that this would also be true in rich countries.

So the researchers examined the link between health and wealth in rich countries and found that healthier people are more productive at work, earn more, and spend more time in the labour force.

Substantial and consistent evidence from rich countries shows that healthier people have higher earnings, say Professor Martin McKee and colleagues. Other studies show that better health increases both the number of hours worked and the probability that an individual will be employed. In contrast, poor health increases the likelihood that someone will retire early.

Although some of these results may be subject to methodological problems, the overwhelming conclusion is that good health has benefits beyond the individual, say the authors.

But how does health affect the national economy?

The current economic wealth of rich countries owes much to previous health gains, they write. For example, about 30% of economic growth in the United Kingdom between 1790 and 1980 can be attributed to better health and dietary intake.

A study in 10 industrialised countries during the century to the mid-1990s also found that better health increased the rate of economic growth by about 30%.

More information is needed to track the contribution of health to economic development, they say. But it seems that better health, measured appropriately, may contribute substantially to economic growth in all countries.

Contact:

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

(2) GOOGLE CAN HELP DOCTORS DIAGNOSE DIFFICULT CASES

Online First
(Googling for a diagnosis – use of Google as a diagnostic aid: internet based study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.39003.640567.AE

Searching with Google may help doctors to diagnose difficult cases, finds a study from Australia published on bmj.com today.

Doctors have been estimated to carry two million facts in their heads to help them diagnose illness, but with medical knowledge expanding rapidly, even this may not be enough. Google is the most popular search engine on the world wide web, giving users quick access to more than three billion medical articles.

So, how good is Google in helping doctors diagnose difficult cases?

Doctors at the Princess Alexandra Hospital in Brisbane identified 26 difficult diagnostic cases published in the New England Journal of Medicine in 2005. They included conditions such as Cushing’s syndrome and Creutzfeldt-Jakob disease.

They selected three to five search terms from each case and did a Google search while blind to the correct diagnoses.

They then selected and recorded the three diagnoses that were ranked most prominently and seemed to fit the symptoms and signs, and compared the results with the correct diagnoses as published in the journal.

Google searches found the correct diagnosis in 15 (58%) of cases.

The authors suggest that Google is likely to be a useful aid for conditions with unique symptoms and signs that can easily be used as search terms.

However, they stress that the efficiency of the search and the usefulness of the retrieved information depend on the searchers’ knowledge base.

Doctors and patients are increasingly using the internet to search for health related information, and useful information on even the rarest medical syndromes can now be found and digested within a matter of minutes, say the authors.

“Our study suggests that in difficult diagnostic cases, it is often useful to google for a diagnosis.”

Contact:

Hangwi Tang, Respiratory and Sleep Physician, Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
Email: hangwitang@yahoo.com

(3) MANY MORE PEOPLE COULD BENEFIT FROM STATINS, SAY EXPERTS

Online First
(Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from randomised trial of 20 536 people)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38993.731725.BE

Cholesterol lowering ‘statin’ drugs are cost effective in far more people than current guidelines recommend and should be considered for a wider range of people, say researchers in a study published online by the BMJ today.

Large trials have shown that lowering blood cholesterol levels with statins greatly reduces major vascular events, such as heart attacks and strokes, in people at high risk.

And research published in 2005 from the largest of those trials (the heart protection study) showed that when cheaper generic versions are used, several years of statin treatment is cost effective for a wide range of people with vascular disease or diabetes.

The heart protection study involved 20,536 men and women presenting at age 40-80 with heart disease or diabetes. They were randomly allocated to receive either 40 mg simvastatin daily or placebo for an average of 5 years.

Using data from this study, the researchers have now estimated the lifetime cost effectiveness of 40 mg simvastatin daily for people in an even wider range of age and underlying vascular risk categories.

The research team found that treatment with generic simvastatin would be cost saving for most of the age and risk categories included in the heart protection study. In other words, the reduced costs of hospital admissions as a result of fewer vascular events outweighed the increased costs of statin treatment in almost all of the categories studied.

In fact, they found that statin treatment was cost effective in people as young as 35 and as old as 85 with an annual risk of a major vascular event as low as 1%. This is well below the risk threshold currently recommended by the National Institute for Health and Clinical Excellence (NICE).

These new analyses indicate that, at current generic prices, lifelong treatment with simvastatin is cost saving or very cost effective for many more people than previously thought, say the authors.

Hence, statin therapy should be considered routinely for people across a wider age range and at lower risk of vascular disease than is currently the case.

Contacts:

The Heart Protection Study Collaborative Group, University of Oxford, UK
Email: hps@ctsu.ox.ac.uk

(4) DOCTORS MUST NOT BE LAPDOGS TO DRUG FIRMS

(Personal View: Doctors must not be lapdogs to drug firms)
http://bmj.com/cgi/content/full/333/7576/1027

Doctors must not be lapdogs to drug firms, argues a leading professor in this week’s BMJ.

Her warning comes after she addressed a conference about the influence of the drug industry on continuing medical education.

Professor Adriane Fugh-Berman’s talk covered the costs of drugs, the costs of promoting drugs to doctors, the salaries of drug representatives, and the funding of continuing medical education. She also covered psychological profiling and monitoring of physicians, including prescription tracking.

Following her talk, several companies withdrew or threatened to withdraw their support for future conferences.

Pharmaceutical firms are not interested in presenting information important to prescribers unless it is also important to the drug industry, she writes. “Drug representatives are paid to be nice to us, as long as we cooperate, sustaining market share of targeted drugs, and limiting our continuing medical education lectures to messages that increase drug sales.”

The drug industry is happy to play the generous and genial uncle until physicians want to discuss subjects that are off-limits, such as the benefits of diet or exercise, or the relationship between medicine and pharmaceutical companies, she adds. Any subject with the potential to reduce drug sales is an anathema.

“If we remain dependent on pharmaceutical companies for sponsoring continuing medical education, then these courses will remain under the control of the drug industry. This control is not contractual, but it is enforced through psychological manipulation.”

She suggests that if corporate sponsorship of medical meetings is deemed indispensable, conference organisers could solicit sponsorship from other companies, such as manufacturers of cars, luggage and travel services. Alternatively, physicians could actually pay for their continuing education, as do lawyers, accountants, and many other business people.

“Medicine must shed its docility and the corporate leash,” she says. “Let us not be a lapdog to the pharmaceutical industry. Rather than sitting contentedly in our master’s lap, let us turn around and bite something tender. Freedom calls.”

Contact:

Adriane Fugh-Berman, Associate Professor, Complementary and Alternative Medicine Master’s Programme, Georgetown University, Washington DC, United States
Email: ajf29@georgetown.edu

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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)