Published 27 November 2008, doi:10.1136/bmj.a2751
Cite this as: BMJ 2008;337:a2751

Editor's Choice

Where commerce and health collide

The WHO commission on the social determinants of health (the Marmot report) called for an international framework convention on alcohol like the 2005 framework for tobacco control. In this week’s journal, Robin Room and colleagues add their weight and some detail to this call (doi:10.1136/bmj.a2364). "Alcohol is the only strong psychoactive substance in common use that is not controlled internationally," they say in their editorial. A framework convention would put constraints on international trade in alcohol, particularly on cross border trafficking, and would be a call for action, encouraging governments to implement evidence based policies within their own borders.

There’s no shortage of evidence that easy access to cheap alcohol fuels alcohol related diseases. Minerva unearths a new Finnish study published in the American Journal of Epidemiology (doi:10.1136/bmj.a2668). In the two years after a substantial cut in the tax on alcoholic drinks, deaths from alcohol related diseases rose by 16% in men and 31% in women, with the highest impact (as Michael Marmot found in his report) among people who were unemployed and less privileged.

What there may be a shortage of is political will. Earlier this month, a UK parliamentary select committee called for legislation to end cheap alcohol promotions by supermarkets in an effort to reduce crime (doi:10.1136/bmj.a2499). Voluntary codes don’t seem to be working. An international framework convention might give governments the courage they need for effective legislation.

This week we carry several responses to recent guidance on management of osteoporosis. Jon Tobias and colleagues add to a chorus of criticism of the guidelines from the National Institute for Health and Clinical Excellence (NICE), in particular the requirement "that patients identified at risk have to get worse" before being eligible for alternatives to alendronate (doi:10.1136/bmj.a2691). They call instead for the adoption of guidance produced by the National Osteoporosis Society. But to add to an already complex picture, Lennart Veerman and Theo Vos (doi:10.1136/bmj.a2683) remind readers that the society is partly funded by Servier, which is taking NICE to court about its osteoporosis guidance (doi:10.1136/bmj.a2397), as well as by other companies that produce osteoporosis drugs. "Certainly many of NICE’s critics have a financial interest that may lead them to favour generous funding arrangements for osteoporosis drugs," they say in their letter.

Meanwhile the BMJ continues its focus on preventing falls in older people, which must go hand in hand with appropriate prevention and treatment of osteoporosis. The paper by Järvinen and colleagues published earlier this year (doi:10.1136/bmj.39428.470752.AD) is joined by a new study by Fleming and colleagues (doi:10.1136/bmj.a2227), with the finding that a high proportion of elderly people who fell were unable to get up again. A third of them lay on the floor for an hour or longer, greatly increasing their need for hospital admission and long term care. In his linked editorial (doi:10.1136/bmj.a2320), John Campbell lists a range of measures to consider, but concludes that real progress in understanding the needs of this vulnerable group will only come from collaboration between health professionals and the commercial sector.

Cite this as: BMJ 2008;337:a2751

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Relevant Articles

Falls in older people

A John Campbell
BMJ 2008 337: a2320. [Extract] [Full Text]

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Rapid Responses:

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It is customary to ignore what should be done in favour of what pleases us.

BM Hegde
bmj.com, 28 Nov 2008 [Full text]

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