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BMJ No 7100 Volume 315 Press Releases Saturday 12 July 1997 Embargoed: 00.01 Hrs 11 July 1997 UK time
'Non-lethal' weapons - the doctors' dilemma The development of 'non-lethal' weapons poses a fundamental ethical dilemma for doctors, says an editorial in this week's BMJ. Weapons which do not kill but can blind or 'calm' might look like a cause for rejoicing, says the author, but should advances in knowledge be used for this purpose? How long will the 'disability' induced by these weapons last? "Since the only difference between a poison and a drug is the dose, do military planners really believe that they can control the 'dose' on a battlefield?" he asks. The development of this kind of weapon might precipitate a new arms race; if so, will the focus of research and development really be confined only to the 'non lethal' aspects of the technology? It is the responsibility of doctors, says the author to recommend some kind of controls based on a comparison between the known effects of conventional weapons and the purported effects of the new ones. "The public may be seduced by the term 'non-lethal'. There are reasons why the medical profession should not be", he concludes.
Contact:
Dr Vivienne Nathanson
Tel: 0171 383 6473
Otitis media is a common childhood ear infection which affects three out of every ten children under the age of three in the UK. 97% of these children are given antibiotics for the condition, but there is little evidence that these are helpful, says a paper in this week's BMJ. The authors studied the findings of seven trials comparing antibiotic therapy with placebo in otitis media, and found that there was little evidence to suggest that children given antibiotics had a shorter duration of symptoms, fewer recurrences, or better long term outcomes than those who had received placebo. Antibiotic use in children with otitis media results in the emergence of resistant organisms, both in the children themselves and in the community, they say. Preventive strategies such as the encouragement of breast feeding and avoidance of tobacco smoke should be supported, and otitis media treated with painkillers rather than antibiotics, particularly in cases where the diagnosis is uncertain, they conclude.
Contact: Tel: 001 617 534 4465
Interest in the opinions of different parties, concerned with prioritisation in the health service is high, says a paper in this week's BMJ, but there are substantial differences in the way in which various groups approach the issue of which services should be provided. Six panels, representing patients, GPs, health insurers, university students, specialist doctors, and civil servants not working in the health field, were asked to prioritise services from a range of 10 and given a hypothetical budget which needed to be cut by nearly one third. Although individual panels were able to reach a consensus, substantial differences emerged between the various groups. The main difference between the panels, say the authors, was in the extent to which the parties took the principle of equal access into consideration. Patients and health insurers in particular introduced self-interest as a basis for prioritising. The patients, all suffering from a chronic illness, considered care services to be most important, whereas the choices of health insurers were guided mainly by their concern for the practical feasibility of their chosen strategy. Both panels of healthcare professionals thought most services were necessary, and were the most pessimistic about the possibilities of cutting down public expenditure on health care. "From our results it is not clear that including all the different actors in the decision making process of prioritisation of health services will lead to more equitable or broadly supported outcomes or to better health for the population" conclude the authors. Contact:
Tel: 00 31 20 5664892 Private healthcare leads to rationing in NHS[The real ethics of rationing]Concern about healthcare rationing should focus on how to minimise it in the first place, by eliminating large sources of waste built into the organisation and structure of the NHS, and ending 'parasitic forms of privatisation that allow the privileged to ration ordinary citizens', says a paper in this week's BMJ. There are unlinked themes in the arguments about rationing, says the author. One side of the debate maintains that NHS funding is adequate by ignoring how much rationing already takes place; the other holds that rationing takes place in the NHS and always will. Surely the amount and kind of rationing must affect perception of the adequacy of the funding, he says; but these two central themes of policy are not joined. There are extensive inequalities that lead to rationing; unexplained inequalities in how many resources different doctors use; private insurance that skims off the easy, profitable cases rather than being structured equally; and an arrangement that rewards minimising (i.e. rationing) surgery to NHS patients in order to maximise private surgery. "The shortages in admission beds, theatre nurses and recovery beds, as well as the short hours that NHS surgeons operate, can be partly traced back to the perverse incentives of this open ended (arrangement) to ration services for NHS patients," he says. "If the new government delivers on its deep commitment to equality, most forms of rationing and long waiting times will come to an end," he concludes. Contact:
Tel: 0161 275 7657
A major national conference on Rationing in the NHS will take place on 10/11 July at Kensington Town Hall. It is organised jointly by the BMJ, BMA, the King's Fund and the College of Health. The all day conference today (11/7/97) wil offer both UK and international perspectives on the difficult issues facing Government and health policy makers. Journalists are welcome to attend. There will be a press briefing at 10.45am.
Embargoed: 00.01 HRS 11 July 1997 UK time
For further information, please contact:
Mary Rice on 0171 383 6529
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6.00pm): 0171 383 6254 If you currently receive your British Medical Journal press release by mail and you would like it faxed to you please telephone (00 44) 171 383 6123 (08.30hrs to 18.00 UK hours) or fax (00 44) 171 383 6403 (24 hours). When dialling the UK from abroad, remember to delete the first zero from the local area code, eg, (00 44) 171... BMA on Internet page: http://www.bma.org.uk Please ensure you quote the British Medical Journal when publicising an article
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