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(1) Eating quickly and until full trebles the risk of being overweight (2) Erectile dysfunction gives early warning of a heart attack, warns expert (3) US doctors regularly prescribe real drugs as placebo treatments (4) The HPV vaccine that doctors would recommend
(1) Eating quickly and until full trebles the risk of being overweight (The joint impact of self-reported behaviours of eating quickly and eating until full on overweight: results of a cross sectional survey) http://www.bmj.com/cgi/content/abstract/337/oct21_2/a2002 (Editorial: Eating behaviour and obesity) http://www.bmj.com/cgi/content/short/337/oct21_2/a1926
The combination of eating quickly and eating until full trebles the risk of being overweight, according to a study published today on bmj.com.
Until the last decade or so most adults did not have the opportunity to consume enough energy to enable fat to be stored. However, with the increased availability of inexpensive food in larger portions, fast food, and fewer families eating together and eating while distracted (e.g. while watching TV), eating behaviours are changing, and this may be contributing to the obesity epidemic.
Professor Iso and colleagues recruited over three thousand Japanese men (1,122) and women (2,165) aged 30-69 between 2003 and 2006 to examine whether eating until full and speed of eating are associated with being overweight. Participants were sent a diet history questionnaire about their eating habits including questions about eating until full and their speed of eating.
The researchers report that around half (50.9%) of the men and just over half (58.4%) of the women said they ate until they were full. And just under half (45.6%) of men and 36% of women said they ate quickly.
The group of participants who said they ate "until full and ate quickly" had a higher body mass index (BMI) and total energy intake than those who did not "eat until full and did not eat quickly".
The researchers also found that both men and women in the "eating until full and eating quickly" were three times more likely to be overweight than the participants from the "not eating until full and not eating quickly" group.
The authors conclude that a combination of eating until full and eating quickly has "a supra-additive effect on overweight".
These findings demonstrate how current eating patterns may contribute to the current epidemic of obesity, say Elizabeth Denney-Wilson from University of NSW and Karen Campbell from Deakin University in Australia, in an accompanying editorial.
They call on doctors to work with parents to encourage healthy eating habits in their children like eating slowly, serving appropriate portion sizes, and eating as a family in a non-distracting environment.
Contacts: Hiroyasu Iso, Osaka University, Osaka, Japan Email: fvgh5640@mb.infoweb.ne.jp Elizabeth Denney-Wilson, University of New South Wales, Sydney, Australia Email: e.denney-wilson@unsw.edu.au
(2) Erectile dysfunction gives early warning of a heart attack, warns expert (Letter: Erectile dysfunction is best predictor of cardiovascular risk in men)http://www.bmj.com/cgi/content/short/337/oct21_2/a2166
Erectile dysfunction gives a two to three year early warning of a heart attack, warns an expert on bmj.com today.
But the link between erectile dysfunction and the risk of heart disease is being ignored by doctors, writes Dr Geoffrey Hackett from the Good Hope Hospital in Birmingham.
Over many years Hackett reports regularly seeing patients referred with erectile dysfunction after a heart attack, only to hear that they had developed erectile dysfunction two to three years before - a warning sign ignored by their general practitioners.
It is well known that erectile dysfunction (a symptom of vascular disease in the smaller arteries) doubles the risk of heart disease, a risk equivalent to being a moderate smoker or having an immediate family history of heart disease. Erectile dysfunction in type 2 diabetes has been shown to be a better predictor of the risk of heart disease than high blood pressure or high cholesterol.
But despite this considerable evidence erectile dysfunction is still treated as a recreational or "lifestyle issue" rather than a predictor of a serious health problem, says Hackett.
The UK government has pledged to reduce the death rate from coronary heart disease and stroke and related diseases in people under 75 by at least 40% by 2010, yet there is no screening for erectile dysfunction in patients with diabetes or heart disease, he says.
"Continuing to ignore these issues on the basis that cardiologists feel uncomfortable mentioning the word 'erection' to their patients or that they may have to deal with the management of a positive response, is no longer acceptable and possibly, based on current evidence, clinically negligent", he concludes.
Contact: Gregory Hackett, Good Hope Hospital, Birmingham, UK Email: geoffhackett@fsmail.net geoff.hackett@virgin.net
(3) US doctors regularly prescribe real drugs as placebo treatments (Prescribing "placebo treatments": results of national survey of US internists and rheumatologists ) http://www.bmj.com/cgi/content/abstract/337/oct23_2/a1938
Many rheumatologists and general internal medicine physicians in the US say they regularly prescribe "placebo treatments" including active drugs such as sedatives and antibiotics, but rarely admit they are doing so to their patients, according to a study on bmj.com today.
The use of placebo treatments in clinical practice has been widely criticised because it is claimed that the practice by its very nature is deceptive and therefore violates patients' autonomy. But advocates of placebo treatments argue that they could offer effective treatment for many chronic conditions without necessarily deceiving patients. Despite the controversy, to date there has been little data on doctors' attitudes towards and the use of placebo treatments in the US.
Dr Jon Tilburt and his colleagues from the National Institutes of Health as well as collaborators at Harvard and the University of Chicago examined the attitudes and behaviours to placebo treatments in a national sample of general internal medicine physicians and rheumatologists in the US.
The researchers sent a confidential survey to 1200 randomly selected practising general internal medicine physicians and rheumatologists (a group of doctors who commonly treat patients with debilitating chronic conditions that are notoriously difficult to manage medically).
The authors report that among the 679 physicians (57%) who responded to the survey half of them said they prescribed "placebo treatments" on a regular basis. Most physicians (62%) believed the practice to be ethically acceptable and were happy to recommend or prescribe placebo treatments.
The most commonly used placebo treatments prescribed in the past year were over the counter painkillers (41%) or vitamins (38%). Some of the physicians reported using antibiotics (13%) and sedatives (13%) as placebos, only 3% reported using sugar pills.
Interestingly, among those who prescribe placebo treatments, most doctors (68%) said they typically describe the placebo treatments to patients as "a potentially beneficial medicine or treatment not typically used for their condition", only rarely did they admit to explicitly describing them to patients as "placebos".
Although there was only a moderate response rate to the survey (57%), even if all the non-responders never gave placebos, placebo prescribing is still surprisingly common, say the authors.
The authors say that while the use of placebos has been controversial, the physicians in the study did not believe they were behaving unethically by either using placebos or not being upfront with their patients about doing so.
They point out that understanding the role of placebo treatments in contemporary medicine is complex. They conclude that prescribing harmless treatments like vitamins or over the counter painkillers to promote positive expectations without full disclosure of motivations might not raise alarm bells, but prescribing antibiotics and sedatives when there is no clear medical indication could have serious adverse consequences for both patients and public health.
Contact: Jon Tilburt, Department of Bioethics, National Institutes of Health, Bethesda, USA Email: tilburt.jon@mayo.edu
(4) The HPV vaccine that doctors would recommend (Personal View: (Not) warts and all ) http://www.bmj.com/cgi/content/extract/337/oct23_1/a2186
Despite the government's decision to choose the vaccine Cervarix for the UK human papillomavirus (HPV) vaccination programme, every doctor I have spoken to has chosen Gardisal for their own children, says a doctor on bmj.com today.
Phil Hammond, a general practitioner and broadcaster, shares his consultant colleague's recommendation ("you'd be mad not to protect your daughter against genital warts if you can afford to") and the HPV vaccine choice he made for his children.
The genital warts lobby is largely undercover, he says, "but if it was breast cancer, there would doubtless be an industry supported march on Downing Street…There are no letters to the Times, and warts have never made it to the cover of the Mail."
Both vaccines are equally effective against the strains of HPV that are known to be responsible for seven in ten cases of cervical cancer, but only Gardisal protects against 90% of genital warts.
With 100 000 new cases of genital warts in England each year and condoms only reducing transmission by up to 50%, the far safer option is to vaccinate with Gardisal, argues Hammond.
But, although Gardasil is available privately to parents, at a cost of £350 to £400, most will not be able to afford it.
According to Hammond, with the current cost of treating genital warts estimated to be £23 million, the government's decision may be a false economy. Within three or four years the use of Gardasil would have begun to have a considerable financial payback.
The government's cheap deal for Cervarix only applies to the vaccination programme. The fact is that most doctors would recommend Gardasil because of the extra protection it offers, he writes.
In addition, he argues that there has been a glaring lack of patient choice. Having chosen one vaccine for us the government has failed to provide information on the other vaccine, which is given no mention on the NHS Choices website or on the NHS vaccination site.
He believes that for any licensed treatment, the public should be given quick and easy access to unbiased information on efficacy and safety.
Contact: Phil Hammond, general practitioner, writer, and broadcaster Email: hamm82@msn.com
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