Archive for the ‘Editor’ Category

BMJ 2008;336:2-3 (5 January).
Proton pump inhibitors have been a tremendous therapeutic advance and have transformed the lives of patients with previously intractable symptoms, say editorialists Ian Forgacs and Aathavan Loganayagam. But the drugs are being overused, and side effects – although rare – should not be overlooked.

Rapid Response by Dr Raymond C Seidler, GP, NSW, Australia:

  • “Perhaps it would be salutary to consider how rare it is now to see patients with perforated ulcers or even serious gastric or duodenal ulceration.
  • These were commonplace in my early days of general practice 25 years ago. The proton pump inhibitors as a class are effective.”

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BMJ  2007;335:786 (20 October).

Two papers have recently been published on bmj.com on the treatment of osteoarthritis of the knee.

Acupuncture has no additional benefit in people taking a course of exercise.

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Editorials, BMJ  2007;335:897 (3 November).

The possible influence of diet on the risk of cancer is constantly topical. The subject is important because people can change their diets, and even a moderate effect on risk could prevent several thousand cancers each year in a country the size of the United Kingdom. However, apart from the confirmed adverse effects of alcohol and obesity on the risk for some types of cancer, progress in understanding has been slow and the evidence remains confusing.

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Rapid response to Professor Gareth William’s editorial on the use of weight loss aid, orlistat, correctly concludes that it is no substitute for a healthy lifestyle;

by: Howard Marsh MRCP MRCGP
Medical Director
GlaxoSmithKline Consumer Healthcare, 1500 Littleton Rd, Parsipanny, New Jersey 07054, USA

GSK launched a non-prescription version of orlistat (brand name alli) in the US in June this year, the first FDA-approved weight loss medicine to be available over-the-counter (OTC).

The weight loss that can be achieved with OTC orlistat requires commitment to adopt a low-fat, reduced calorie diet.

Indeed all our communication, including television advertising, websites, in-store communications as well as materials provided to pharmacists stresses this requirement. These materials specifically state that “alli is not a magic pill” and provide candid information about the consequences of eating too much fat.

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Physician assisted death in vulnerable populations; Claims of increased risk in these groups are not supported by evidence.

BY: Timothy E Quill, professor of medicine, psychiatry and medical humanities; BMJ 2007;335:625-626 (29 September).

Physician assisted death (both voluntary active euthanasia and physician assisted suicide) has been openly practised in the Netherlands for more than 25 years and formally legalised since 2002. The practice has been analysed in four major national studies between 1990 and 2007. A more restricted form of physician assisted death (physician assisted suicide only) was legalised in Oregon in 1997.

In Oregon, one in 50 dying patients talk to their doctors about assisted death and one in six talk to family members. There seems to be much conversation about end of life options, therefore, but relatively few cases of assisted death.

The Dutch practices of physician assisted death have also remained stable over the duration of four studies.

A study by Battin and colleagues published in this week’s Journal of Medical Ethics that analyses existing databases from Oregon and the Netherlands dispels many of these concerns. They found no increased incidence of physician assisted death in elderly people, women, people with low socioeconomic status, minors, people in racial and ethnic minorities, and people with physical disabilities or mental illness. The one exception was people with AIDS.

These findings call into question the claim that the risks associated with legalisation will fall most heavily on potentially vulnerable populations.

It raises the possibility that legalisation and regulation with safeguards may protect rather than facilitate the practice.

The most controversial cases in the Netherlands are the life ending acts that have no explicit requests (known as LAWER cases, doesn’t say why I’m afraid)(about 1000 cases each year). Most, but not all, of these patients were suffering greatly and had lost the ability to make decisions for themselves, and many had previously given consent for physician assisted death under such circumstances.

A recent study of six Western European countries—using the same format and questions as the Dutch studies—showed that four of the six countries where assisted death is illegal had a much higher incidence of LAWER cases than is seen in the Netherlands.

In fact, such cases were more common than cases of assisted death where voluntary consent was given.

If you want to find out more WHY THERE IS MORE EUTHANASIA in countries were it is NOT legalised, just CLICK HERE.

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BY: Mike Clancy, ER consultant, BMJ 2007;335:623-624 (29 September)

Acute chest pain is responsible for one in four emergency medical admissions in the United Kingdom observation and investigation is not easy, especially when the consequences of misdiagnosis include infarction, arrhythmia, and death.

The strategy of evaluating such patients in a chest pain unit based within or near the emergency department is used in 30% of emergency departments in the United States.

In theory, a chest pain unit should improve outcomes—but does it?

The ESCAPE trial by Goodacre and colleagues tried to answer this question.

The introduction of a chest pain unit had no significant effect on the proportion of people attending the emergency department with chest pain, the proportion of people with chest pain who were admitted, or the number of people admitted over the next 30 days.

Setting up a chest pain unit led to more patients being tested, but no reduction in the proportion of patients admitted.

The trial showed no benefits of chest pain units.

If you want to find out more about the effectiveness of chest pain units, just CLICK HERE.

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Academic boycott of Israel: follow-up to the BMJ‘s debate

BMJ  2007;335:234-235 (4 August).

Why just Israel? As a Palestinian I know at first hand the damage done by calling to boycott Israel, academically or economically. Not only does it validate everything the Palestinians are saying, including support for suicide bombing, it is hurting any chance of peace and is taking away any chance for help from Israel. Maybe if the world wants to help they should have the courage to boycott the Arab countries until they give the Palestinians living there citizenship status and maybe some rights.

BY: Saleem Abdallah, political analyst, West Bank, Palestine

Boycott proposers often state that boycotting South Africa worked, so why not Israel? The glaring difference is that whereas supporters of the apartheid regime supported the ideology, Israelis as a whole have voted in at least the last three elections against the occupation and in favour of a two state solution. I also feel there is no substitute for meeting the “enemy” directly—for example, at academic meetings, as happens regularly in Israel and elsewhere, and breaking down stereotyping, something which Tom Hickey seems determined to restrict.

BY: Andrew Fink, consultant ophthalmologist, Ra’anana, Israel  

The motion’s scope needs to be widened: what about Palestinian academia, which has consistently failed to condemn state sponsored acts of terror and violence against unarmed citizens both inIsrael and Palestinian territories? If you really care about the fate of these two states, you should apply the same measureto both sides. 

BY: Ehud Emanuel, citizen, Israel

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