BMJ -- Press Releases

Releases Saturday 11 October 2003
No 7419 Volume 327

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(1) TRIAL RESULTS HAVE DRAMATICALLY
REDUCED HRT USE

(2) PEOPLE ARE AVERSE TO TAKING DRUGS

(3) USE EGGS, NOT EMBRYOS, TO DERIVE STEM
CELLS, SAY RESEARCHERS

(1) TRIAL RESULTS HAVE DRAMATICALLY
REDUCED HRT USE

(Changes in use of hormone replacement therapy after the
report from the Women's Health Initiative: cross
sectional survey of users)
http://bmj.com/cgi/content/full/327/7419/845

(Editorial: Taking hormone replacement therapy)
http://bmj.com/cgi/content/full/327/7419/820

More than half (58%) of women stopped taking HRT
after the publication of a large trial in 2002 concluded
that it was not suitable for the prevention of chronic
diseases, finds a study in this week's BMJ.

Six months after the trial results were published,
researchers in New Zealand surveyed 776 women who
were taking HRT.

Of 734 respondents, 423 (58%) had stopped taking
HRT when the results were published, 132 (18%) had
restarted at the time of the survey, and 291 (40%) had
not.

Of the 132 women who restarted, 100 did so because
of the return of symptoms, 16 because they "felt better"
on HRT, and 15 for other reasons.

Most respondents (83%) reported that they had
discussed HRT with a health professional. The authors
also found that older age, use of combined HRT, and
longer duration of HRT were associated with stopping
HRT.

Contact:

Beverley Lawton, Senior Research Fellow, Department
of General Practice, Wellington School of Medicine and
Health Sciences, Wellington, New Zealand
Email: bevlawton{at}wnmeds.ac.nz

(2) PEOPLE ARE AVERSE TO TAKING DRUGS

(Factors involved in deciding to start preventive
treatment: qualitative study of clinicians' and lay people's
attitudes)
http://bmj.com/cgi/content/full/327/7419/841

Many people are averse to taking drugs unless
absolutely necessary and would prefer lifestyle change to
medication, according a study in this week's BMJ.

Researchers in Liverpool interviewed a small group of
family doctors, nurses, and lay people to explore their
views on the minimum benefit they thought would justify
drug treatment to prevent heart attacks.

Participants varied widely in the minimum acceptable
benefits chosen. Many disliked the concept of taking pills
every day and preferred lifestyle change to medication.

Participants wished to consider adverse effects and costs
of treatment. They also wanted to make decisions for
themselves, and clinicians supported this.

There is a danger that increased pressure on general
practitioners to prescribe some drugs may distort
practice and marginalise patients' preferences, say the
authors. They believe that guidelines should reflect the
importance of true dialogue between clinicians and
patients before embarking on lifelong preventive
treatment.

True dialogue between patient and doctor is essential,
and patients' preference and values must be respected,
adds Robert Johnstone in an accompanying
commentary. He recommends that greater emphasis be
placed on listening skills in doctor training and that more
opportunities for "expert patient" training be provided.

Contacts:

Paper: David Lewis, Vauxhall Primary Health Care,
Liverpool, UK
Email: David.Lewis{at}gp-N82115.nhs.uk

Commentary: Robert Johnstone, President, Arthritis and
Rheumatism International, Skelmersdale, UK
Email: robertjohnstone{at}onetel.net.uk

(3) USE EGGS, NOT EMBRYOS, TO DERIVE STEM
CELLS, SAY RESEARCHERS

(Letter: Use eggs, not embryos, to derive stem cells)
http://bmj.com/cgi/content/full/327/7419/872-a

Concerns about the ethics of using embryos created to
treat infertile couples for stem cell research is discussed
by researchers at St Mary's Hospital, Manchester in this
week's BMJ.

Although the Human Fertilisation and Embryology Act
1990 allows the creation of embryos for research in the
United Kingdom, the House of Lords Select Committee
on stem cell research reported in February 2002 that
embryos should not be created unless there is a
demonstrable and exceptional need that cannot be met
by the use of surplus embryos.

However, the authors believe that embryos created to
treat infertile couples are never truly surplus and they
propose an alternative solution.

Most in vitro fertilisation programmes discard hundreds
of healthy human eggs each year because they are
immature or do not fertilise with the partner's sperm, they
write. As such, they suggest that ethically it is far more
preferable to create embryos specifically for this work
from eggs that are currently discarded, rather than ask
infertile couples to provide normal embryos that could be
used in their own treatment.

Contact:

Daniel Brison, Consultant Embryologist, Department of
Reproductive Medicine, St Mary's Hospital,
Manchester, UK
Email: daniel.brison{at}man.ac.uk

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