Press releases Monday 23 February to Friday 27 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) Being overweight just as risky to health as being a smoker
(2) BMJ reviews the perils of criticising Israel
(3) Head to Head: Should men who’ve ever had sex with men be allowed to give blood? BMJ Online

(1) Being overweight just as risky to health as being a smoker
(Research: Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b496

Obese adolescents have the same risk of premature death in adulthood as people who smoke more than 10 cigarettes a day, while those who are overweight have the same risk as less heavy smokers, according to research published on bmj.com today.

Smoking and obesity are two of the most important behavioural risk factors for premature death in the western world, but it is not known whether smoking and weight have combined effects on the risk of death.

The authors, led by Dr Martin Neovius at Karolinska Institute in Sweden, analysed the cause of death of over 45,000 men who underwent mandatory military conscription tests in Sweden. The participants all had their body mass index (BMI) measured and reported their smoking status at the age of 18 and were followed up for an average of 38 years. In total, the authors assessed 1.7 million person-years of follow-up in relation to the health and mortality of all the participants.

During the follow-up period 2,897 subjects died, the incidence of death was lowest for people with normal weight and highest in obese subjects.

Compared to normal weight adolescents, being overweight at the age of 18 increased the risk of premature death by just over a third, while being obese more than doubled the risk.

Being underweight carried no increased risk, irrespective of smoking status. However, being seriously underweight (a body mass index of less than 17) carried the same risk of premature death as being overweight.

Early death was also linked to the number of cigarettes participants smoked per day. This risk gradually increased the more participants smoked, with heavy smokers at more than double the risk of premature death compared to non-smokers.

But, interestingly, when the effects of weight and smoking were combined, the researchers found no significant change in the results. The combination of obesity and heavy smoking was associated with a large excess risk of early death (almost five times greater than normal weight non-smokers). However, there was no statistically significant interaction between these two factors.

This means that being overweight or obese at the age of 18 increases the risk of premature death, regardless of smoking status, they explain.

The authors note that since the baseline measurements for this study were carried out, the number of adolescent men who are overweight in Sweden has tripled and those who are obese has increased five-fold. However, the number of men who smoke and are underweight in Sweden has halved. Internationally, there have been marked increases in overweight and obesity, but also in adolescent smoking in some countries.

Dr Neovius and his colleagues therefore conclude that "overweight, obesity and smoking among adolescents remain important targets for intensified public health initiatives."

Contact:
Dr Martin Neovius, Department of Medicine, Karolinska University Hospital, Sweden
Email: martin.neovius@ki.sc

In 2004, the BMJ published an article criticising Israel, which provoked hundreds of hostile emails. Today the journal publishes an analysis of those responses and takes a broader look at what journalists and editors face when covering controversial issues.

In the 2004 article, Derek Summerfield expressed his concern at what he saw as systematic violations of the fourth Geneva Convention by the Israeli army in Gaza. The article provoked hundreds of electronic responses to the BMJ's website as well as almost 1000 hostile emails to the editor.

An analysis of these emails concludes that the BMJ was the target of an orchestrated campaign to silence criticism of Israel. Author Karl Sabbagh found that many of the emails were derived from HonestReporting, a website that claims to be "the largest Israel media advocacy group in the world." Yet there was no evidence that any of the authors of these emails had actually read the BMJ article they were criticising.

"There is nothing intrinsically wrong with organising an effective lobby group," writes Sabbagh, "but the ultimate goal of some of the groups that lobby for Israel or against Palestine is apparently the suppression of views they disagree with."

Yet orchestrated campaigns can succeed in closing down debate. For instance, the International Diabetes Foundation recently apologised for an article on the difficulties faced by diabetic Palestinians in Gaza, and the editor of Diabetes Voice (the foundation's quarterly publication) resigned. Sabbagh also describes a similar experience in 1981 when World Medicine, a popular medical magazine, published an article criticising the Israeli prime minister, Menahem Begin. He reveals publicly for the first time that the resulting campaign led to the dismissal of Michael O'Donnell as editor and the closure of the magazine.

"Such campaigns cannot be allowed to succeed - not so much because they are wrong about the issues, but because their ultimate aim is censorship and suppression by means of intimidation," he concludes.

In an accompanying commentary, writer and broadcaster Michael O'Donnell applauds the BMJ for publishing this analysis. "The best way to blunt the effectiveness of this type of bullying is to expose it to public scrutiny," he writes.

He also reminds us that at the same time Summerfield's article was published, "the real world offered a host of sensitive issues: the invasion of Iraq, Guantanamo Bay, allegations of British involvement in CIA "rendition" and torture, to name but three. Yet these issues were freely discussed not just in national media but in medical journals."

But in a second commentary, journalist Jonathan Freedland suggests the BMJ grow a thicker skin. In today's wired world, he says, wading into any topic of controversy triggers a deluge of emails. "It simply comes with the territory."

He describes a coordinated response from several rightwing US websites following an article he wrote in the Guardian during the US election campaign. He also points out that David Attenborough receives hate mail from creationists. "The harsh reality is that what Sabbagh described as a rare, exceptional event is increasingly common - and clearly not confined to the Israel-Palestine conflict," he writes.

In a personal view article, Mark Clarfield, a doctor at Sokora Hospital in Israel, reviews responses to his blog on bmj.com. He will also discuss what it was like as a doctor to experience this conflict in a podcast to be published on bmj.com on Wednesday.

Avoiding topics where medicine and politics collide is not an option for the BMJ, nor is this what our readers want, write BMJ Editors Tony Delamothe and Fiona Godlee in an accompanying editorial. They decide to follow the advice of O'Donnell and Freedland and ignore future orchestrated email campaigns. And they suggest authors, editors, publishers, advertisers, and shareholders do the same.

Contact:
Emma Dickinson, BMJ Press Officer, London, UK
Email: edickinson@bmj.com

(3) Should men who have sex with men be allowed to give blood?
(Head to Head: Should men who’ve ever had sex with men be allowed to give blood?)
Yes http://www.bmj.com/cgi/doi/10.1136/bmj.b318
No http://www.bmj.com/cgi/doi/10.1136/bmj.b311
(Feature: Bad blood: gay men and blood donation)
http://www.bmj.com/cgi/doi/10.1136/bmj.b779

The lifetime ban on blood donations from men who have sex with men was put in place in the 1980s when little was known about HIV. But is this ban still justified? Experts debate the issue on bmj.com today.

Jay Brooks, Professor of Pathology at the University of Texas believes that the ban should remain because the risk of transmission of infection is too great. He argues that the right of recipients to receive safe blood should trump the asserted rights of donors to give blood.

Men who have had sex with men since 1977 have an HIV prevalence 60 times higher than the general population, 800 times higher than first time blood donors, and 8000 times higher than repeat blood donors, he writes. Although testing is better than it has ever been, infections can be transmitted during the window period – the period between infection and its detection.

He also points to evidence from the United Kingdom that moving to a one year deferral policy would increase the risk of HIV in the blood supply by 60%, while dropping the ban entirely would result in a 500% rise.

He concludes: Those who propose a change to policy should provide evidence that there would be no extra risk to transfusion recipients whatsoever.

But Bob Roehr argues that the lifetime ban has no scientific justification, particularly when other high risk groups are not similarly excluded.

A biomedical journalist based in Washington DC, he points to research which estimates that relaxing the criteria to 12 months from when the last sex took place with a new partner would result in only one more unit of HIV positive blood among the 15 million units a year processed in the United States.

He also argues that the ban is unfairly discriminatory as, in the US, people who fall into other categories of risky behaviour – for example, injecting drug users and female sex workers – are allowed to donate blood after a year’s deferral from the last risky activity.

Roehr calls for change in policy in line with Australia, which has had a one year deferral policy for all risk categories since 1992, and a record of one case of probable HIV transmission by transfusion since 1985. He also points out that the American Association of Blood Banks has supported harmonisation to a 12 month deferral for all risk categories since 1997, and the American Red Cross adopted that position in 2006.

An accompanying feature asks why some developed countries now accept blood donations from men who have sex with men, but most do not. It reviews arguments for and against the ban and concludes: “It seems unlikely that lifelong deferral of men who have sex with men is a sustainable policy, but whether a finite period will appease opponents remains to be seen.”

Contacts:
Jay Brooks, Professor of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA. Mobile (please note San Antonio is 6hrs behind UK time): +1 210 705 9778
Email: brooksj@uthscsa.edu

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