Press releases Monday 13 December to Friday 17 December 2010

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) Drinking alcohol during a rich meal slows down digestion, but doesn't increase indigestion
• (2) Submerging your feet in alcohol will not get you drunk
• (3) The key to being attractive (and looking healthy)? A good night's sleep
• (4) Sovereign's head identified after more than four centuries
• (5) BMJ Group Awards 2011: Call for entries

(1) Drinking alcohol during a rich meal slows down digestion, but doesn't increase indigestion

(Research: Effect on gastric function and symptoms of drinking wine, black tea, or schnapps with a Swiss cheese fondue: randomised controlled crossover trial)
http://www.bmj.com/cgi/doi/10.1136/bmj.c6731

People can be reassured that while alcohol may slow down digestion after a rich calorific meal, enjoyed by many during the Christmas season, it will not cause indigestion symptoms such as heartburn, belching and bloating, finds research in the Christmas issue published on bmj.com today.

In order to determine the effects of alcohol on the digestive system when rich meals are consumed, investigators at the University Hospital of Zurich, led by Dr Mark Fox now at the Queens Medical Centre in Nottingham, studied 20 individuals who either drank wine or black tea with cheese fondue followed by cherry liqueur or water as a digestive after the famous Swiss dish.

Fox and colleagues say that while they concentrated on fondue the results of their research "can be generalised to address the wider issue of alcohol's effects on digestion and digestive comfort after any large, rich meal of the kind we all enjoy over the festive season".

Twenty healthy volunteers (14 male and six female) aged between 23 and 58 took part in the study. None of the participants had a history of alcohol misuse or stomach disease. They had an average body mass index (BMI) of 23.6 and none were taking prescription medicine.

The participants were tested on two days at least one week apart. Half of the group drank white wine with their fondue and the other half drank black tea. This was followed by a cherry liqueur digestive (schnapps) or water 90 minutes later.

The research team used established scientific breath tests to assess the effects of alcohol consumption on the digestive system.

The results show that the process of digestion was much slower in the group that drank alcohol with their fondue. However the results also demonstrate that alcohol did not contribute to an increase in indigestion problems such as heartburn, belching and bloating.

The authors conclude that "healthy readers should be reassured that they can continue to enjoy this traditional meal with the beverage of their choice without undue concern about postprandial digestive discomfort".

Contact:
Mark Fox, Associate Professor and Consultant Gastroenterologist, NIHR Biomedical Research Unit, Nottingham Digestive Diseases Centre, Queens Medical Centre, Nottingham, UK and Zurich Integrative Human Physiology Group, University of Zurich, Switzerland
Email: dr.mark.fox@gmail.com

(2) Submerging your feet in alcohol will not get you drunk
(Research: Testing the validity of the Danish urban myth that alcohol can be absorbed through feet: open labelled self experimental study)
http://www.bmj.com/cgi/doi/10.1136/bmj.c6812

Research in the Christmas issue published on bmj.com today explodes the Danish myth that it is possible to get drunk by submerging your feet in alcohol.

The authors, led by Dr Peter Lommer Kristensen from the Hillerød Hospital in Denmark, say it was important that the myth underwent scientific scrutiny to prevent students wasting their time experimenting with this activity.

Three adult volunteers took part in the study. None of them suffered from any chronic skin or liver disease and they were not addicted to alcohol or psychoactive drugs. The participants were not members of any local Alcoholics Anonymous groups and had not been implicated in any serious accidents or socially embarrassing events related to alcohol in the week prior to the study.

The volunteers drank no alcohol for 24 hours before the experiments and they provided a blood sample before submerging their feet in a washing-up bowl containing three bottles of Karloff Vodka. The participants then kept their feet in the vodka for three hours and provided blood samples every half an hour.

The group undertook a self-assessment for signs of drunkenness – they rated themselves on a scale of 0 to 10 on self-confidence, urge to speak and the number of times they desired spontaneous hugs.

The results show that after the three hours there was no increase in the concentration of alcohol in the participants' blood stream.

Kristensen concludes "that the Danish urban myth about being able to get drunk by submerging feet in strong alcoholic beverages is just that; a myth."

He adds that the study has many implications including evidence that driving a vehicle or skippering a boat with boots full of Vodka seems to be safe, and brewery workers cannot become intoxicated by 'falling' into a brewery vat.

Contact:
Peter Lommer Kristensen, Doctor and Research Fellow, Department of Cardiology and Endocrinology, Hillerød Hospital Denmark
Email: pelk@hih.regionh.dk

(3) The key to being attractive (and looking healthy)? A good night's sleep
(Research: Beauty sleep - experimental study on the perceived health and attractiveness of sleep deprived people)
http://www.bmj.com/cgi/doi/10.1136/mj.c6614

If you want to look attractive and healthy, the best thing you can do is get a good night's sleep, finds research in the Christmas issue published on bmj.com today.

For the first time, say the authors, there is scientific backing for the concept of beauty sleep.

The study, led by John Axelsson from the Karolinska Institutet in Sweden, investigated the relationship between sleep and perceptions of attractiveness and health. The authors believe this research is important in today's 24 hour society with the number of people suffering from sleep disorders and disturbed sleep on the rise.

Twenty-three participants between the ages of 18 to 31 took part in the study. They were photographed between 2pm and 3pm on two occasions, once after normal sleep and once after being deprived of sleep. Smokers were excluded from the research and no alcohol was allowed for two days prior to the experiment.

The photographs were taken in a well-lit room and the distance to the camera was fixed. During both photography sessions participants wore no make-up, had their hair loose (combed back if they had long hair) and underwent similar cleaning or shaving procedures. They were asked to have a relaxed, neutral facial expression for both photos.

Sixty-five observers, who were blinded to the sleep status of the subjects, rated the photographs for attractiveness and whether the individuals looked healthy/unhealthy or tired/not tired.

The observers judged the faces of sleep-deprived participants as less healthy, less attractive and more tired.

The authors conclude that the facial signals of sleep deprived people affect facial appearance and judgments of attractiveness, health and tiredness.

Contact:
John Axelsson, Researcher, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Email: john.axelsson@ki.se

(4) Sovereign's head identified after more than four centuries
(Multidisciplinary medical identification of a French king's head (Henri IV))
http://www.bmj.com/cgi/doi/10.1136/mj.c6805

The skeletons of kings and queens lying in mass graves in the Royal Basilica of Saint-Denis in Paris could finally have the solemn funeral ceremonies they deserve, say experts in the Christmas issue published on bmj.com today.

Many of the graves in the Royal Basilica were destroyed by revolutionaries in 1793 and very few remains of the mummified bodies have been preserved and identified.

Dr Philippe Charlier led the scientific breakthrough that has identified the head of the French King, Henri IV.

A team of scientists from different fields of expertise including anthropology, pathology, forensic medicine and genetic studies worked together to make the identification.

Henri IV was known as the "green gallant" because of his attractiveness to women or "good King Henry" because of his popularity amongst his people.

Despite his popularity, Henri IV was assassinated in Paris at the age of 57 on 14 May 1610 by Francois Ravaillac, a fanatical Catholic. Along with the bodies of other French kings and queens, his remains lay in the graves of the Basilica of Saint-Denis, before the graves were desecrated and the corpses mutilated in the wake of the French Revolution.

The authors conclude that "similar methods could be used to identify all the other kings' and queens' skeletons lying in the mass grave of the basilica, so that they can be returned to their original tombs".

Contact:
Philippe Charlier, Forensic Medical Examiner and Osteo-Archaeologist, Department of Forensic Medicine and Pathology, University Hospital R Poincaré, Garches, France
Email: ph_charlier@yahoo.fr

(5) BMJ Group Awards 2011: Call for entries
http://groupawards.bmj.com

BMJ Group is calling on journalists to submit their entry for BMJ Group Awards at http://groupawards.bmj.com. There are thirteen award categories which include health communicator of the year, research paper of the year, sustainable health care, and BMJ Group Award for Lifetime Achievement. The closing date for submissions has just been extended to the 24 January 2011, and entry forms can be found online at http://groupawards.bmj.com. Please nominate in any category and pass this email on to friends and colleagues who also might be interested in entering.

(6) NHS wasting tens of millions each year on expensive insulin contrary to NICE guidance
(Feature: Diabetes - How small changes led to big profits for insulin manufacturers)
http://www.bmj.com/cgi/doi/10.1136/mj.c7139

A drive by the drug industry to promote new, more expensive type of insulins (known as analogue insulins) for people with type 2 diabetes is estimated to have cost the NHS at least £250m extra over the past five years. Yet for most people with type 2 diabetes, the extra cost does not correspond to the equivalent extra benefit.

A joint investigation by the BMJ and Channel 4 News argues that health services and individuals across the world are paying the price for this market drive. Full details will be broadcast on Channel 4 News at 7pm UK time tomorrow (Wednesday 15 December 2010) and published on bmj.com.

Analogue insulin can cost up to five times as much as conventional insulin in some markets, yet the published evidence suggests that the analogues do not improve overall glucose control or safety in type 2 diabetes, although they may have marginal benefits for some patients in terms of convenience, reduced weight gain or less risk of hypoglycaemia.

The National Institute for Clinical Excellence (NICE) recommends human insulin as the treatment of choice for people with diabetes. Furthermore, a recent health technology assessment concluded that, in type 2 diabetes, analogue insulins weren't worth what the NHS was being charged in most cases.

The World Health Organisation has also raised concerns about more expensive analogue insulins taking the place of their cheaper human equivalents while questions remain about their cost effectiveness.

Yet analogues now account for approximately 80% of insulin use in the UK, 70% in the US, and 60% in Europe. Two analogues currently dominate the global market – Novo Nordisk's insulin detemir (Levemir) and Sanofi's insulin glargine (Lantus).

So given the evidence and the costs, why are analogues so popular?

Dr Amanda Adler of NICE suggests that this market share is largely down to clever marketing and says that around 90% of people with type 2 diabetes "would probably do quite well on these human insulins compared with the long acting insulin analogues."

She also points out that the new insulins have much fancier packaging – the "Mont Blanc of insulin devices" – than older human types.

In the push towards analogues, cheaper human insulins are being withdrawn. At the end of December, Mixtard 30, a popular and well tolerated human insulin, will be withdrawn by its manufacturer, Novo Nordisk. Its 90,000 or so users will be forced to seek alternatives, some no doubt moving to analogues.

Several leading specialists and the Insulin Dependent Diabetes Trust have already warned that the move will "adversely affect the wellbeing of many people with diabetes and add millions to NHS costs."

In the UK alone, diabetes is estimated to cost the NHS some £9bn - approximately 10% of its entire budget – and this is set to rise. With healthcare systems across the world under extreme financial pressure, the debate on human versus analogue insulin is a timely and important discussion to have.

In response, the drug companies stress the advantages of analogue insulins citing flexibility and the reduced risk of hypoglycaemia. They said the value to patients is that they offer a much better experience and that in relation to modern insulins it is important to look beyond the cost of the insulin itself.

With regard to Mixtard's withdrawal Novo Nordisk said that whenever new products that provide benefits in efficacy or safety become widely used manufacturers must consider ceasing production of older versions. It says it has taken advice from the Department of Health and others to ensure support for those affected by the withdrawal so that patients are prescribed a suitable alternative insulin and discontinuation is managed effectively.

Contact:
Deborah Cohen, Investigations Editor, BMJ, London, UK
Email: dcohen@bmj.com

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

Press Office telephone : 020 7383 6254 (Weekdays : 0900hrs - 1800hrs)
British Medical Association
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