Editor's Choice | This Week in BMJ | Press releases
BMJ No 7101 Volume 315 Press Releases Saturday 19 July 1997 Embargoed: 00.01 Hrs 18 July 1997 UK time
Plea to Dobson to lead the way on health care rationing In an open letter to Frank Dobson, Secretary of State for Health, prominent figures in the medical and academic world have called upon the Government to face up to its responsibilities on health care rationing and take the lead. The letter, published in this week's BMJ, follows a London conference "Rationing in the NHS: Time to Get Real". Delegates at the conference wanted much more openness in health care rationing with equity as one of the main criteria for who gets what. The letter, whose signatories include Dr Sandy Macara, Chairman of BMA, Dr Richard Smith, BMJ Editor, and Dr Robert Maxwell, chief executive of the Kings Fund, says: "Although rationing of health care is inevitable, the problem has become more severe because there seems to be an increasing gap in all health services between what could be offered and what can be afforded. For example, we have a steady stream of new treatments that offer what is often small benefit at very high cost. This is the case with new treatments for patients with motor neurone disease, Alzheimer's disease and multiple sclerosis..... Many patients feel as if the availability of services is determined by a lottery with unknown rules" . Rationing in Britain today is described as inefficient, inequitable, undemocratic and opaque. The Government should be providing leadership and guidance to health workers and decision makers and the general public "One method might be through appointing a national commission that might well include a majority of non-health professionals" says the letter.
Contact: King's Fund
Tel: 0171 307 2585
Dr Sandy Macara c/o Public Affairs Division
Tel: 0171 383 6473
The belief that hormone replacement therapy for postmenopausal women may protect against cardiovascular disease is based on inadequate evidence, says a paper in this week's BMJ. Researchers from Finland and the UK studied the results of 22 trials involving 4124 women, and found no evidence that short term use of HRT protected against heart disease. However, they say, long term effects may be different, both for cardiovascular disease and cancer. Long term effects - because of blood lipida and various general psychological and physiological effects - may take years to make an impact, and the results of long term trials will not be available for some time. There have been hundreds of trials studying the impact of HRT, but adverse effects have not been systematically reported, say the authors.
Contact: London School of Hygiene and Tropical Medicine temporarily at conference, Robinson College, Cambridge
Tel: 01223 339 131 Professor Elina Hemminki
Health Services Research Unit
Tel: 00 358939 672307
GP fundholding has not succeeded in containing the rise in prescribing costs, nor in reducing the use of expensive specialist hospital facilities, says an editorial in this week's BMJ. Neither has it prevented the rise in emergency admissions - indeed the need to reclassify problems as urgent in order to have necessary elective surgery may have been a contributory factor in this. Fundholding should be phased out, says the author. But without better solutions to the problems of the NHS and without a halt to the reduction in the number of hospital beds, 'the service cannot remain comprehensive and we will see falling standards of emergency care and the progressive privatisation of elective surgery". Contact:
The Health Centre Also in this week's BMJ: How has fundholding in Northern Ireland affected prescribing patterns? Heart attack deaths have not fallen despite new treatments[Inpatient deaths from acute myocardial infarction, 1982-92: analysis of data in Nottingham heart attack register]Despite an increase in the use of new treatments, heart attack deaths in Nottingham hospitals did not fall during the period 1982-92, says a paper in this week's BMJ. The authors studied the records of all patients admitted with a confirmed myocardial infarction to two district general hospitals and found that. although a higher proportion were admitted within 6 hours of the onset of symptoms during the period 1989-92 than in 1982-84, 15% were still admitted too late for 'clot-busting' drugs to be used. The average duration of stay in hospital decreased during the period, but admissions were significantly increased, especially among patients aged 75 and over (from 29.1% to 61.2%). Rather than showing an increase in the incidence of heart attacks, say the authors, this is more likely to be due to fewer elderly patients being managed at home and perhaps a greater awareness of the significance of chest pain symptoms. The use of existing treatments needs to be optimised, and new strategies for the management of heart attack introduced, if inpatient deaths from this cause are to be reduced, they conclude. Contact:
Queen's Medical Centre
Tel: 0115 970 9346
Debate on physician-assisted suicide to intensify after supreme court ruling[Physician assisted suicide, euthanasia, or withdrawal of treatment]The debate leading up to the US Supreme Court's decision to return the question of physician-assisted suicide to state governments has engendered an explosion of attention to pain relief and other palliative care for thc dying, says an editorial in this week's BMJ. Whilst the Supreme Court's decision is definitive in confirming the constitutionality of existing laws that prohibit physician-assisted suicide in New York and Washington State, it leaves a great deal unsaid and seems to welcome further developments, say the authors. The idea that states are free to experiment and make physician assistance in suicide legal if they so choose is implicit in the judgement, and attention will now turn to the states as testing grounds on this issue - especially to Oregon, the only state so far to make physician-assisted suicide legal. It remains to be seen whether societal acceptance of physician-assisted suicide will increase, and how it will affect both social support for vulnerable and dying citizens and trust between patients and their doctors, say the authors. Contact: University of North Carolina
Tel:001 919 962 1136
Embargoed: 00.01 HRS 18 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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