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Press releases Monday 24 to Friday 28 November 2008

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(1) People wasting billions of pounds on "quack" health food products
(2) A more rational and scientific approach to AIDS is needed, says expert
(3) New screening halves the number of children born with Down's syndrome
(4) Parents of new babies should be considered for a whooping cough booster, say experts

(1) People wasting billions of pounds on "quack" health food products
(Editorial: Trading regulations and health foods)
http://www.bmj.com/cgi/content/extract/337/nov25_2/a2408

Globally every year, obese people waste billions of pounds on food products that "imply" that they aid weight loss, but are totally ineffective, says a nutritional expert on bmj.com today.

Professor Lean from the University of Glasgow, is hopeful that a new European Union (EU) Directive on Unfair Commercial Practices, adopted this year in UK, will finally protect vulnerable consumers who are tricked into to buying useless food products or supplements in attempts to combat their disease.

Unlike medicines, food products that are marketed for health reasons are not subject to the same stringent research trials and control, and consumers are often misled.

It is already illegal for unsubstantiated claims to be made about the composition or nutritional function of food products, eg. that they are low in fat, high in fibre or help lower cholesterol, and it is also illegal to claim that a food can treat or prevent any disease - including obesity. However, many unsubstantiated health claims are still made, or implied. Misleading marketing can be found within brand names and images on packaging, in shelf or shop names, or on websites which suggest that products help weight control, are slimming, or are "Health Foods," when there is no evidence. Lean is concerned that obese people have been fooled into parting with billions of pounds every year on products that cannot help them. In 2000, people in the US spent $35bn (£22bn) on weight loss products, many of them making false and unsubstantiated claims.

The "commercial exploitation of vulnerable patients with quack medicines" will hopefully be brought to an end with the introduction of the new EU directive, say Lean. However, the laws need to be enforced proactively to enable doctors and consumers to move towards managing diseases confidently with evidence based treatment and diet programmes. He points out that, of all the hundreds of products currently on sale to help people lose weight, only energy-restricted diets and exercise, the drugs orlistat and sibutramine, and in some cases bariatric surgery, are safe, effective and cost-effective. The remainder, he says, are either not effective or not safe. The new regulations "may even help with the bigger battle to prevent obesity, by prohibiting advertisements across the EU that encourage children to buy energy dense products or to pester their parents to buy them," he adds.

Contacts:
M E J Lean, Professor of Human Nutrition, Faculty of Medicine, University of Glasgow, Division of Development Medicine, Glasgow, Scotland
Email: lean@clinmed.gla.ac.uk

(2) A more rational and scientific approach to AIDS is needed, says expert
(Feature: AIDS and the irrational)
http://www.bmj.com/cgi/content/extract/337/nov25_2/a2638

The Secretariat of the Joint United Nations Programme on HIV/AIDS (UNAIDS) has lost valuable ground by ignoring for years the contribution of long-term concurrent relationships to Africa's AIDS epidemic, claims an expert ahead of World AIDS Day on bmj.com today.

UNAIDS may be "contributing to the mystification of AIDS in Africa by promoting a needlessly overcomplicated view of the epidemic," says Helen Epstein, an independent consultant on public health in developing countries.

She argues that long term, overlapping, or "concurrent" partnerships provide at least a partial explanation for the staggeringly high infection rates in the general population in some African countries, and calls for UNAIDS to reassess its handling of scientific data.

Epstein speculates that UNAIDS' tendency to emphasize only typical high risk behaviours such as casual sex and prostitution may have hindered prevention, promoted denial and stigma, and contributed to HIV associated domestic violence by implying that people with HIV are necessarily promiscuous.

In fact, African people do not seem to have more sexual partners than people in other countries, but they are more likely to have two or three long term "concurrent" partnerships at a time, and this creates a "virtual superhighway" for HIV.

Condom use is rare on this "superhighway" because long term relationships, even concurrent ones, are seldom perceived as risky. This may explain why reductions in sexual partners have been a crucial factor wherever infection rates have fallen in Africa, she says. For example, in Uganda, a 60% fall in casual partnerships coincided with a 70% fall in HIV prevalence during the 1990s. In addition, declines in HIV prevalence in the US gay community and Thailand were also accompanied by rapid declines in multiple partnerships.

According to Epstein, for years UNAIDS overlooked independent reports about the importance of partner reduction, and until 2006, did not mention long-term concurrency in its reports on sexual behaviour.

Concurrency does not imply a simple solution to the AIDS crisis in Africa, she says, but education about the "superhighway" could help motivate behavioural change, especially partner reduction, and should be integrated into all AIDS education programmes in Africa.

Epstein concludes by calling on the new UNAIDS director and its governing board to re-evaluate the agency's political and scientific roles, and suggests that scientific issues be addressed through a more open process of research and peer review, rather than by one, largely unregulated UN agency.

In a second feature (The invisible epidemic), Bob Roehr examines how institutionalised homophobia and the criminalisation of homosexual activity are aiding the spread of HIV and hindering efforts to provide treatment and prevention among men who have sex with men. According to Dr Peter Piot, director of UNAIDS, homophobia is one of the top five obstacles to stopping the epidemic.

Contacts:
Helen Epstein, Independent consultant on public health in developing countries, New York, USA
Email: helenepstein@yahoo.com 

Bob Roehr, Medical Journalist, Washington DC, USA. Email: bobroehr@aol.com 

A new national screening strategy in Denmark has halved the number of infants born with Down's syndrome and increased the number of infants diagnosed before birth by 30%, according to a study published on bmj.com today.

Many countries, including England, Australia and New Zealand, are trying to introduce national screening strategies for Down's syndrome, but are facing a variety of problems because of a lack of consensus about the screening policy and logistical challenges.

In 2004, the Danish National Board of Health issued new guidelines for prenatal screening and diagnosis. These included the offer of a combined test for Down's syndrome (based on combination of maternal age, plus serum and nuchal screening) in the first trimester. This test gave women a risk assessment for Down's syndrome at an early stage in the pregnancy. Women whose risk was higher than a defined cut off were referred for invasive diagnostic tests (chorionic villus sampling or amniocentesis).

In the previous guidelines screening for Down's syndrome was based on maternal age and a diagnostic test was mainly offered to women above 35 years.

Professor Ann Tabor and colleagues from Denmark, evaluated the impact of the new national screening strategy on the number of infants born with Down's syndrome and the number of referrals for invasive procedures. They analysed data from the 19 Danish departments of gynaecology and obstetrics and the national cytogenetic registry for an average of 65,000 births each year between 2000 and 2007.

Uptake was good, by June 2006 all 15 Danish counties followed the guidelines from 2004 and offered the new screening strategy. In 2006 approximately 84% of pregnant women had a risk assessment for Down's syndrome.

The researchers found that the new strategy was associated with improved earlier detection of Down's syndrome, low false positive rates, and more than a 50% decrease in the number of invasive tests carried out each year.

They report that the number of infants born with Down's syndrome decreased from 55-65 per year during 2000-4, to 31 in 2005 and 32 in 2006. The total number of invasive tests fell sharply from 7524 in 2000 to 3510 in 2006.

The detection rate in the screened population was 86% in 2005 and 93% in 2006. With 3.9% (17) of women receiving a false positive result in 2005 and 3.3% (7) in 2006.

The authors point out that the value of this new screening strategy is that all women can be assessed early in pregnancy (in the first trimester). The national guidelines emphasise that risk assessment should only be done if women choose the test on the basis of informed choice, therefore despite the programme being available to all pregnant in women in Denmark, some will still choose not to be screened.

The authors conclude by emphasising Denmark's success at building a strong national organisation for fetal medicine and a national quality database that allows follow-up of all screened women at a national level and quality control of the new national screening programme.

Contact:
Professor Ann Tabor, Department of Fetal Medicine, Copenhagen University Hospital, Copenhagen, Denmark
Email: ann.tabor@rh.regionh.dk 
Or
Charlotte Ekelund, Department of Fetal Medicine, Copenhagen University Hospital, Copenhagen, Denmark
Tel: 0045 2826 5042

(4) Parents of new babies should be considered for a whooping cough booster, say experts
(Lesson of the week: Rapidly fatal invasive pertussis in babies - how can we change the outcome?)
http://www.bmj.com/cgi/content/short/337/nov27_2/a343

A booster vaccination for parents of new babies and other household members may be the most effective way of preventing the fatal form of whooping cough in young infants, say a group of paediatric intensive care doctors on bmj.com today.

Whooping cough (pertussis) is a distressing infectious disease which affects infants and young children. Vaccination is effective and is usually given to infants at two to four months of age, with a further booster after three years. But evidence is growing that the incidence of pertussis is rising in adolescents and adults.

Infectious adults within a family are the main source of infection for unimmunised infants.

Doctors at the Royal Hospital for Sick Children in Edinburgh report two fatal cases of invasive pertussis in unvaccinated young infants.

In the first case, a one-month old boy presented to hospital with a five-day history of cough, runny nose and difficulty feeding. Both parents, and an elder sibling, reported coughing spells with vomiting in the previous two weeks.

The sibling was fully vaccinated. There was no record of the parents' childhood vaccination status but the mother received a pertussis booster in 1986.

The child was transferred to intensive care, but despite maximum therapy, died within 24 hours.

In the second case, a six-week old girl presented to hospital with a five-day history of cough and breathlessness. Her mother had a persistent cough for more than two weeks. The mother had received all her childhood immunisations including pertussis, there was no record of the father's pertussis immunisation status.

The child died within 30 hours despite maximum therapy. The patient's mother subsequently tested positive for pertussis infection.

This report demonstrates the devastating course of invasive pertussis in young infants, say the authors.

Pre-vaccination infants now account for the majority of pertussis-related complications, hospitalisations and deaths and most infants catch the disease from affected household members, with parents accounting for more than half of the cases.

As a result, several countries, including the USA and Australia, have introduced booster doses for adolescents and adults. France and Germany also recommend a targeted booster for parents and healthcare workers in contact with young children.

Mortality remains high for young infants developing invasive pertussis despite modern paediatric intensive care, say the authors. The best solution is to prevent infection. The introduction of an adult booster or more targeted vaccination of household contacts of young infants should be considered, they conclude.

Contacts:
Ulf Theilen, Consultant, Paediatric Intensive Care Unit, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
Via Stephen Fraser, Press Office, NHS Lothian, Scotland
Email: stephen.fraser@nhs.net 

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