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Press releases Saturday 15 March 2008

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(1) The NHS is failing people with learning disabilities
(2) Researchers call for better regulation of genetic tests
(3) Medical emergency protocols should be upgraded on all major airlines

(1) The NHS is failing people with learning disabilities /b>
(Editorial: Illness in people with intellectual disabilities is common, underdiagnosed and poorly managed)
http://www.bmj.com/cgi/content/short/336/7644/570

The NHS is failing people with learning difficulties, according to an editorial published in the BMJ today.

The authors say the health needs of this group of patients often go unmet because mental or physical illness is incorrectly attributed to the person's intellectual disability.

According to the authors, doctors are less likely to diagnose psychiatric problems among this group of people, even though in reality they are more likely to suffer from mental illness. They are also more likely to develop chronic disorders such as epilepsy or cerebral palsy.

They point to two significant reports from the Disability Rights Commission (DRC) and MENCAP which both highlighted widespread inequalities encountered by people with learning disabilities and/or mental illness.

They say these reports raise issues about the low priority given to the health needs of this group, the lack of appropriate training given to medical staff, the disregard for the views of carers and the misconceptions among many doctors about the value of the lives of people with learning disabilities.

Hope for improvements in treatment lies with the recently implemented Mental Capacity Act. They argue it should improve the care of vulnerable patients as it sets out a process for ensuring that medical decisions are no longer made in isolation and are made in the ‘best interests' of the patient.

They call for improved communication and liaison between GPs, hospital doctors and intellectual disability services, and joint working between the medical bodies. They conclude: "This may help to reduce morbidity and mortality and improve quality of life."

Contact:
Afia Khanom Ali, Specialist Registrar in psychiatry of intellectual disability, University College Medical School
Email: afia.ali@hackney.gov.uk

(2) Researchers call for better regulation of genetic tests
(Genetic tests for common diseases: new insights, old concern)
http://www.bmj.com/cgi/content/short/336/7644/590
(Editorial: Evaluating laboratory diagnostic tests)
http://www.bmj.com/cgi/content/short/336/7644/569

Better regulation is urgently needed for genetic tests, particularly those marketed directly to the public, argue researchers in this week's BMJ.

In the past 18 months, studies have identified dozens of inherited DNA variations associated with common conditions such as heart attacks, diabetes and asthma, write Professor David Melzer and colleagues.

In many cases, these findings provide insight on the cause of the disease, but clinical applications are still mostly unclear. Much work is now needed to identify and evaluate each potential clinical application. Yet, although the work of translating discovery into evidence based practice is just beginning, several companies have already marketed tests, many directly to the public.

Using tests without proper evaluation, they warn, could trigger erroneous treatment and involve major hazards. For example, direct marketing of the BRCA1 and 2 familial breast cancer tests to women at low risk was criticised for causing unfounded anxiety and unnecessary preventive surgery.

False reassurance from tests for common diseases could also result in effective prevention measures, such as controlling weight and exercising, being ignored. Problems with insurance or implications for other family members may also arise, they add.

So what needs to change to ensure that tests are used appropriately?

The authors call for harmonisation of regulatory standards internationally and for more transparency regarding the clinical evidence base for new tests.

For example, a scientifically independent system for identifying and checking higher risk genetic tests is needed in Europe. Currently, genetic tests in Europe are marketed without pre-market scrutiny by regulators, and companies can keep secret the clinical evidence on their tests. Similarly, few genetic tests developed ‘in-house' by laboratories in the USA are currently reviewed by regulators.

Both consumers and professionals should push for a regulatory system that encourages clinical evaluation and makes the results (or lack of them) easily available to all, write the authors. Professional bodies and health care providers should also remind professionals that using tests in routine practice without evidence of utility is incompatible with good clinical practice.

These improvements in the clinical evaluation of tests may prove as important as the discoveries themselves in realising the promise of genomics to improve health, they conclude.

An accompanying editorial supports these views, saying that international collaboration to set standards and methods is urgently needed.

Contact:
Professor David Melzer, Peninsula Medical School, University of Exeter
Email: david.melzer@pms.ac.uk

(3) Medical emergency protocols should be upgraded on all major airlines
(Personal View: A wing and a prayer: the tale of an in-flight emergency)
http://www.bmj.com/cgi/content/short/336/7643/616
(Feature: Cabin fever)
http://www.bmj.com/cgi/content/short/336/7643/584

Medical emergency protocols should be upgraded and optimised on all major airlines, argues a doctor in this week's BMJ.

Osman Dar, a clinical fellow at Addenbrooke's Hospital in Cambridge shares his experience of treating an elderly man with crushing chest pain on a flight to Africa.

He describes how the medical equipment was limited and how, on landing, the crew did not announce that an ill patient was on board who needed priority evacuation from the plane. And, although the pilot radioed ahead for an ambulance to transfer the passenger to a hospital , the ground staff did not have the means or the facility to arrange one, so when they landed there wasn't one present.

"What I experienced can only be described as a catalogue of failures by a reputable airline," he says.

With the advent of telemedicine and the availability of automated external defibrillators (AEDs), no reason exists now why a suitably trained doctor on the ground cannot at least communicate basic life support management to aircraft crew or even advise the captain to request an emergency landing, he writes.

Although cost implications are an issue for airlines around the world, a proactive policy rather than a reactive one seems sensible, he says. The United States, for example, has mandated AEDs on all airlines since 2004. He also suggests basic minimal standards for medical kits on all planes on all routes and regular audits to improve and individualise them. BMJ looks at how common in-flight medical emergencies are and what doctors are expected to do in such circumstances.

Contacts:
Osman Dar, Clinical Fellow in Diabetes and Endocrinology, Addenbrooke’s Hospital, Cambridge
Email: oadar1@yahoo.com

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