Press releases Monday 13 September to Friday 18 September 2010

Please remember to credit the BMJas 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) No support for routine prostate screening, but one-off test at 60 may be beneficial
• (2) Popular supplements to combat joint pain do not work
• (3) Attitudes must change if we are to achieve a good death for all, say experts
• (4) Researchers raise concerns over the increasing commercialisation of science

(1) No support for routine prostate screening, but one-off test at 60 may be beneficial
(Research: Screening for prostate cancer: systematic review and meta-analysis of randomised controlled trials)
http://www.bmj.com/cgi/doi/10.1136/bmj.c4543 (Research: Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study)
http://www.bmj.com/cgi/doi/10.1136/bmj.c4521 (Editorial: Screening for prostate cancer)
http://www.bmj.com/cgi/doi/10.1136/bmj.c4538

Existing evidence from randomised controlled trials does not support routine population screening for prostate cancer, concludes a study published on bmj.com today.

However, a second study also published today suggests that a single test at age 60 could identify men who are most likely to develop and die from prostate cancer. These men could then be monitored more closely, while others could be exempt from further screening.

Prostate cancer is one of the most common cancers among men worldwide. Screening is widely used in many countries, but it remains controversial because experts can�t agree whether the benefits of screening outweigh the potential harms and costs of over-diagnosis and over-treatment of healthy men.

In 2006, a review of two randomised controlled trials concluded that there was not enough evidence to support routine prostate cancer screening. Since then, four new trials have been published.

So Professor Philipp Dahm and colleagues at the University of Florida reviewed all six trials, involving 387,286 participants. They found that screening aids in the diagnosis of prostate cancer at an earlier stage, but does not have a significant impact on mortality, and comes at the risk of over-treatment.

The authors say there is insufficient evidence to support actively inviting all men in certain age groups to attend screening for prostate cancer (as happens with breast cancer screening for women), and they suggest men should be better informed about the uncertainties associated with screening.

In the second study, Professor Hans Lilja and colleagues show that a single prostate-specific antigen (PSA) level test at age 60 strongly predicts a man�s lifetime risk of diagnosis and death from prostate cancer.

They found that 90% of prostate cancer deaths occurred in men with highest PSA levels at age 60, whereas men with average or low PSA levels had negligible rates of prostate cancer or death by age 85. Their results suggest that at least half of men aged 60 and older might be exempted from further prostate cancer screening, which would reduce over-diagnosis and over-treatment.

In an accompanying editorial, Gerald Andriole, Chief of Urologic Surgery at Washington University School of Medicine, suggests that PSA testing should be tailored to individual risk.

He recommends that young men at high risk of prostate cancer, such as those with a strong family history and higher baseline PSA concentrations, should be followed closely, while elderly men and those with a low risk of disease could be tested less often, if at all. �Approaches such as these will hopefully make the next 20 years of PSA based screening better than the first 20,� he says.

Contact:

Study 1: Philipp Dahm, Associate Professor, University of Florida Department of Urology and Prostate Disease Center, College of Medicine, Gainesville, Florida, USA
Email: p.dahm@urology.ufl.edu

Study 2: Professor Hans Lilja, Department of Clinical Laboratories, Surgery and Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
Email: liljah@mskcc.org

Editorial: Gerald Andriole, Chief of Urologic Surgery, Washington University School of Medicine, St Louis, USA
Email: andrioleg@wustl.edu

(2) Popular supplements to combat joint pain do not work
(Research: Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of the hip or knee: network meta-analysis)
http://www.bmj.com/cgi/doi/10.1136/bmj.c4675

Two popular supplements taken by millions of people around the world to combat joint pain, do not work, finds research published on bmj.com today.

The supplements, glucosamine and chondroitin, are either taken on their own or in combination to reduce the pain caused by osteoarthritis in hips and knees.

The researchers, led by Professor Peter J�ni at the University of Bern in Switzerland, argue that given these supplements are not dangerous �we see no harm in having patients continue these preparations as long as they perceive a benefit and cover the cost of treatment themselves.�

However, they add: �Health authorities and health insurers should not cover the costs for these preparations, and new prescriptions to patients who have not received treatment should be discouraged.�

Osteoarthritis of the hip or knee is a chronic condition which is mainly treated with painkillers and anti-inflammatory drugs but these can cause stomach and heart problems, especially if used long-term. Treatments that not only reduce pain but slow the progression of the disease would be desirable, say the authors.

In the last decade, GPs and rheumatologists have increasingly prescribed glucosamine and chondroitin to their patients. And many individuals around the world have purchased them over the counter. In 2008 global sales of glucosamine supplements reached almost $2bn, which represents an increase of about 60% since 2003.

The authors say that results from existing trials about the effectiveness of glucosamine and chondroitin are conflicting. A large scale review of studies was therefore needed to determine whether or not the supplements work.

Professor J�ni and colleagues analysed the results of 10 published trials involving 3,803 patients with knee or hip osteoarthritis. They assessed changes in levels of pain after patients took glucosamine, chondroitin, or their combination with placebo or head to head.

They found no clinically relevant effect of chondroitin, glucosamine, or their combination on perceived joint pain or on joint space narrowing.

Despite this finding, some patients are convinced that these preparations are beneficial, say the authors. They suggest this might be because of the natural course of osteoarthritis or the placebo effect.

�Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should be discouraged from funding glucosamine and chondroitin treatment,� they conclude.

Contact:
Professor Peter J�ni, Head of Division, Institute of Social and Preventive Medicine, University of Bern, Switzerland
Email: juni@ispm.unibe.ch

(3) Attitudes must change if we are to achieve a good death for all, say experts
(Spotlight: Palliative care beyond cancer)
http://www.bmj.com/cgi/doi/10.1136/bmj.c5028

Society�s attitudes towards dying, death and bereavement need to change if we are to achieve a good death for all, say experts in a special series of articles published on bmj.com today in the first BMJ �Spotlight� supplement.

By 2030 the annual number of deaths around the world is expected to rise from 58 million to 74 million, but too many people still die alone, in pain, without dignity, or feeling alienated.

The articles aim to remedy this by exploring how lessons learnt from end of life care for cancer patients can be adapted for those dying from chronic conditions like heart failure and dementia.

�Palliative care beyond cancer� also topped a recent BMJ poll of topics respondents wanted to read more about, suggesting that doctors are keen to be more open about death and deliver better end of life care for their patients.

In the first article, Scott Murray and Kirsty Boyd say that the ability to make an accurate and timely diagnosis of dying is �a core clinical skill that could be done better in all care settings.� They believe that education and training of staff are central to the success of end of life policies in the UK.

The need for mandatory training is supported by Professor John Ellershaw and colleagues who argue that to achieve a good death for all �we need a fundamental shift of emphasis.� They say �we must strive to ensure that a good death is the expectation rather than the exception in all settings.�

In another article about having the difficult conversations about the end of life, GP Stephen Barclay and oncologist Jane Maher believe that clinicians need to create repeated opportunities for patients to talk about their future and end of life care, while respecting the wishes of those who do not want to discuss such matters. �The right conversations with the right people at the right time can enable patients and their loved ones to make the best use of the time that is left and prepare for what lies ahead,� they write.

Talking about dying is also the subject of an article by Professor Jane Seymour and colleagues. They say: �Eradicating ignorance among clinicians, patients, and the public about what can be achieved with modern palliative care and encouraging dialogue about end of life care issues are important means of changing attitudes.�

Finally, Professor Aziz Sheikh and colleagues at the University of Edinburgh explore how the spiritual needs of dying patients can be understood and met in pluralist and secular societies. They believe healthcare workers �need to be aware of their role in listening to patients, their carers and families, and others in the wider healthcare system with knowledge and understanding of the nuances of religious and cultural traditions.�

This special supplement has been supported by the British Heart Foundation and the National Council for Palliative Care.

In spring 2011, the BMJ Group launches a new journal in this field: BMJ Palliative and Supportive Care.

Contacts:

Article 1: Kirsty Boyd, Consultant in Palliative Medicine, Centre for Population Health Sciences, University of Edinburgh, Scotland, UK
Email: kirsty.boyd@luht.scot.nhs.uk

Article 2: Stephen Barclay, General Practitioner and Macmillan Post Doctoral Research Fellow, Institute of Public Health, Cambridge, UK
Email: sigb2@medschl.cam.ac.uk

Article 3: John Ellershaw, Professor of Palliative Medicine, Liverpool Marie Curie Hospice, Liverpool, UK
Email: jellershaw@mariecurie.org.uk

Article 4: Jane Seymour, Sue Ryder Care Professor of Palliative and End of Life Studies, University of Nottingham, UK
Email: jane.seymour@nottingham.ac.uk

Article 5: Aziz Sheikh, Professor of Primary Care Research and Development, Primary Palliative Care Research Group, Centre for Population Health Sciences, University of Edinburgh, UK
Email: aziz.sheikh@ed.ac.uk

(4) Researchers raise concerns over the increasing commercialisation of science
(Personal View: Why are we copyrighting science?)
http://www.bmj.com/cgi/doi/10.1136/bmj.c4738

The increasing commercialisation of science is restricting access to vital scientific knowledge and delaying the progress of science, claim researchers on bmj.com today.

Varuni de Silva and Raveen Hanwella from the University of Colombo in Sri Lanka argue that copyrighting or patenting medical scales, tests, techniques and genetic material, limits the level of public benefit from scientific discovery.

For example, they found that many commonly used rating scales are under copyright and researchers have to pay for their use.

Some genetic tests also carry patents, which prevent other laboratories from doing the test for a lesser cost. Earlier this year, a New York court ruled that patents held by Myriad Genetics for the diagnosis of mutations in the BRCA1 and BRCA2 genes (linked to breast and ovarian cancer) were unconstitutional and invalid.

Extreme commercialisation of science can also lead to patents on medical procedures and techniques, say the authors. However, the American Medical Association recently concluded that it is unethical for physicians to seek, secure or enforce patents on medical procedures.

The scientific community is reacting to the increasing commercialisation of science, they add. For example, all genome sequences generated by the human genome project have been deposited into a public database freely accessible by anyone, while organisations such as the National Institute of Health and Wellcome Trust insist on open access to publication resulting from research funded by them.

The fundamental philosophy of Western science is sharing knowledge and, while patenting is a useful tool for protecting investments in industry, �we need to rethink its role in science,� they write.

They conclude: �Although those who consider science as a commodity are willing to invest in research and development, much medical research is still carried out by non-profit organisations using public money. It is only right that such knowledge is freely shared. This is possible because academic scientists still consider the prestige of discovery more important than monetary reward.�

Contact:

Varuni de Silva, Senior Lecturer in Psychiatry, Faculty of Medicine, University of Colombo, Sri Lanka
Email: varunidesilva2@yahoo.co.uk

FOR ACCREDITED JOURNALISTS

For more information please contact:

Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

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BMA House, Tavistock Square, London WC1H 9JP

and from:

the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)
http://intranet.bmj.com/departments/dept-bmj/bmj-team-resources/web-team-resources/General_blogging_principles.doc