This week's embargoed articles may not be available until 09:00 (UK time) Thursday.

Press releases Monday 2 February 2009 to Friday 6 February 2009

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://www.bmj.com).

Press releases Monday 2 February to Friday 6 February 2009

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

(1) Resting heart rate can predict heart attacks in women
(2) Patients' attendance at clinics is worse with Choose and Book
(3) What's the ideal relationship between the drug industry, health professionals, and patients?
(4) Fertility drugs do not increase risk of ovarian cancer

(1) Resting heart rate can predict heart attacks in women
(Research: Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b219

A simple measurement of resting pulse predicts coronary events in women independently of physical activity and common risk factors, such as smoking and alcohol consumption, finds a study published on bmj.com today.

Previous studies have shown that resting heart rate predicts coronary events in men. But for women, the relationship between heart rate and coronary events or stroke remains uncertain.

So researchers in the USA assessed resting heart rate in 129,135 postmenopausal women with no history of heart problems. Risk factors that might be expected to affect heart rate, such as high blood pressure, high cholesterol levels, smoking and alcohol intake were taken into account at the start of the study. The women were monitored for an average of 7.8 years, during which time all hospital stays and coronary events were recorded.

During the study period, 2,281 coronary events (heart attacks and coronary deaths) and 1,877 strokes occurred.

Women with the highest resting heart rate (more than 76 beats per minute) were significantly more likely to suffer a coronary event than women with the lowest resting heart rate (62 beats per minute or less).

Further analysis showed that this association was independent of physical activity, did not differ between white and minority women, or those with or without diabetes, but was stronger in women 50-64 years of age than among women 65 years or older.

There was no such relationship between resting heart rate and stroke.

Resting heart rate is a simple, inexpensive measurement that independently predicts heart attacks and coronary deaths, but not stroke, in postmenopausal women, say the authors. Although the strength of this association is less than cigarette smoking or diabetes, it may be large enough to be clinically meaningful, they conclude.

Contact:
Judith Hsia, Senior director clinical research, AstraZeneca, Wilmington, Delaware, USA
Email: judith.hsia@astrazeneca.com

Patients' attendance at clinics is worse with choose and book than with traditional general practitioner referrals, say senior doctors from University Hospital Lewisham in a letter to this week's BMJ.

The electronic "Choose and Book" referral service aims to improve attendance at NHS clinics by giving patients a choice of place, date and time for their first outpatient appointment.

The authors carried out a pilot study at their hospital and found a significant difference in non-attendance (18% with Choose and Book compared to 12% with general practitioner referrals). They also point to a recent study showing that most patients are not experiencing a significant choice in appointment time, date, or hospital.

"Choose and book has failed to achieve its main goal of improving patients' satisfaction and attendance," write the authors. "Moreover, it creates an unnecessary economic burden on the health system and jeopardises the prioritisation process by removing clinicians from the process."

Contact:
Prince Cheriyan Modayil, Specialist Registrar, Department of Ear, Nose, and Throat Surgery, University Hospital Lewisham, London, UK
Email: princemodayil2000@yahoo.co.in

(3) What's the ideal relationship between the drug industry, health professionals, and patients?
(Analysis: Relationships with the drug industry)

The relationship between the drug industry, academia, healthcare professionals, and patients is widely believed to be at an all time low. Five contrasting views, published on bmj.com today, discuss what the ideal relationship should be and what steps need to be taken to achieve it.

Marcia Angell, Senior Lecturer in Social Medicine at Harvard Medical School, believes there should be no relationship between the drug industry and either prescribers or patients.

The purpose of the drug companies' contact with prescribers is nearly always to increase sales, and it usually involves payments of one form or another, she writes. These are often disguised as education, but the real intent is to influence prescribing habits. Likewise, direct to consumer advertising seeks to convince people that they have a chronic treatable medical condition. "We need to stop accepting the fiction that marketing, whether to prescribers or patients, is good education," she concludes.

But others believe that there is a legitimate place for responsible collaboration.

Professors Harlan Krumholz and Joseph Ross propose six standards of conduct to restore public trust. These include dispensing with direct to consumer advertising, foregoing gifts, and stopping industry sponsorship of continuing medical education. "Leading companies and physicians have already taken many of these steps to promote the best care for patients - it's time for the rest to follow," they write.

Richard Tiner, Medical Director at the Association of the British Pharmaceutical Industry, says that the UK industry is committed to a stable and pragmatic partnership with the government and the NHS on medicines - one that enshrines value for money, reward for innovation, and ensures greater availability of new medicines to patients. While Gordon Coutts, Vice President and General Manager at Schering Plough UK, believes that joint working has the potential to create breakthroughs in how the UK tackles major health challenges including cardiovascular disease and teenage pregnancies.

Finally, Scott Gottlieb, a health policy analyst based in Washington DC, suggests that the industry should build trust based on good science rather than marketing related activities. Drug makers need to establish transparent guidelines for interactions with doctors and patients - and focus more squarely on matters of advancing science, monitoring for safety, and improving health education, he writes.

Contacts:
Marcia Angell, Senior Lecturer in Social Medicine at Harvard Medical School, Boston, USA
Email: marcia_angell@hms.harvard.edu

(4) Resting heart rate can predict heart attacks in women
(Research: Use of fertility drugs and risk of ovarian cancer: Danish population based cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b249
(Editorial: Fertility drugs and ovarian cancer)
http://www.bmj.com/cgi/doi/10.1136/bmj.a3075

The use of fertility drugs does not increase a woman’s risk of developing ovarian cancer, finds a large study from Danish researchers published on bmj.com today.

During the past three decades there has been considerable debate as to whether use of fertility drugs increases a woman’s risk of developing ovarian cancer. Previous studies have given conflicting results and concerns remain, particularly for women who undergo several cycles of treatment or who never succeed in becoming pregnant.

So Allan Jensen and colleagues at the Danish Cancer Society examined the effects of fertility drugs on ovarian cancer risk by using data from the largest cohort of infertile women to date.

The study involved 54,362 women with infertility problems referred to all Danish fertility clinics between 1963 and 1998. 156 of these women had ovarian cancer. After adjusting for several risk factors, the researchers assessed the effects of four groups of fertility drugs over an average period of 16 years.

They found no overall increased risk for ovarian cancer after use of any fertility drug. They also found no increased risk among women who had undergone 10 or more cycles of treatment or among those who did not become pregnant.

Although the authors did observe a statistically significant increase in risk of the most common serious type of ovarian cancer among women who had used the drug clomiphene, they stress that this was probably a chance association.

Our results show no convincing association between the overall risk for ovarian cancer and use of fertility drugs, and are generally reassuring, say the authors. However, they do point out that, as many of the study participants have not yet reached the peak age for ovarian cancer, they will continue to monitor the risk.

In a society where there is more and more female infertility and later age at birth of the first child, the unfavourable effects of fertility drugs should be balanced against the physical and psychological benefits of a pregnancy made possible only by the use of these drugs, they conclude.

These data are reassuring and provide further evidence that use of fertility drugs does not increase a woman’s risk of ovarian cancer to any great extent although, small increases in risk cannot be ruled out, warns Penelope Webb of the Queensland Institute of Medical Research, in an accompanying editorial.

Some women who take fertility drugs will inevitably develop ovarian cancer by chance alone, she writes, but the current evidence suggests that women who use these drugs are not increasing their risk of developing this highly fatal cancer.

Contacts:
Research: Allan Jensen, Assistant Professor in Cancer Epidemiology, Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
Email: allan@cancer.dk
or
Susanne Krüger Kjær, Professor in Cancer Epidemiology, Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark / The Juliane Marie Center, Copenhagen University Hospital, Copenhagen, Denmark
Email: susanne@cancer.dk

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and from:

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