Showing papers by "Jocalyn Clark published in 2003"

Fear of SARS thwarts medical education in Toronto

Abstract: As the BMJ went to press, the 10th death in Canada from severe acute respiratory syndrome (SARS) was reported in Toronto, and clinical staff and students were being told to continue restricting their presence at the University of Toronto and its teaching hospitals. To contain a possible spread of the syndrome from clinical environments the University of …

Patient centred death.

Abstract: We need better, more innovative research on patients' views on dying A good death has always been important in all cultures. To achieve your chosen afterlife you died either well (euthanatos) or nobly (kalosthanein). But what is a good death in a world that for many is post-religious and medicalised? We know something from research on patients and their families—but not nearly enough. We need much better research that uses innovative and different methods. We don't have good data on how people die (as opposed to what they die of), but there is a strong impression that many die badly.1 People do not die in the places they wish or with the peace they desire. Probably too many die alone, in pain, terrified, mentally unaware, without dignity, or feeling alienated. People who are poor, from ethnic minorities, or marginalised may have even worse deaths. Modern dying involves a struggle for control. Some doctors fear failure when they cannot keep their patients …

BMJ Publishing Group to launch an international campaign to promote academic medicine

Abstract: Please join us Academic medicine is in crisis across the world.1–4 Medicine's capacity to research, think, and teach is collapsing just at the time when science, social trends, and globalisation are offering great opportunities—and threats. The BMJ Publishing Group wants to help revitalise—and reinvent—academic medicine. How can academic medicine best prepare for the 21st century? We don't have an answer, but we propose a great debate. We are not even entirely clear on the diagnosis. Why is academic medicine failing? The increasing pressure to provide …

Intimate partner violence and health: A critique of Canadian prevalence studies

Abstract: OBJECTIVE: The Canadian Public Health Association, along with other professional organizations, has identified intimate partner violence (IPV) as a priority health issue to which the health professions must respond. This study synthesizes Canadian studies on the prevalence of IPV against women, focusing in particular on the stated implications for women's health and health care. METHODS: Medical and social science databases were searched for all articles pertaining to IPV in Canada for 1974 through September 2000. Reference lists of these and other related publications were consulted to supplement the literature review. Data on study characteristics, methods, and results were extracted by two independent reviewers. Discrepancies were resolved by consensus. RESULTS: Sixteen studies were identified in this review, 11 population-based and 5 conducted in clinical settings. Age, ethnicity, and socioeconomic status were not consistently documented, making comparisons and evaluations of generalizability difficult. Annual prevalence of IPV in Canada was found to range from 0.4% to 23%, with severe violence occurring from 2% to 10% annually. Less than two fifths (37.5%) of the studies incorporated a health-related measure. INTERPRETATION: This review reveals a paucity of Canadian prevalence data on IPV, marked by design and methodological issues. Poor quality data may pose a challenge to articulating and establishing a coordinated health care response to eliminating IPV in Canada. Language: en

Freedom from unpleasant symptoms is essential for a good death.

Abstract: Over three quarters of voters in a poll conducted on bmj.com to coincide with this theme issue considered freedom from unpleasant symptoms during dying as the …

Quality improvement forum sets sights on developing countries and on patients

Abstract: Doctors and healthcare researchers last week debated how to import the theories and methods of healthcare quality improvement into the developing world. At the forum on quality improvement in health care in Bergen, Norway, speakers identified inadequate infrastructure, lack of local expertise and leadership, and language as the main barriers preventing the establishment of “first world standards of care” in developing countries. Speakers focused on systems rather than individualised approaches to improving health care and treatment, an idea that is an essential part of the quality improvement movement. “To ask individuals to make change is a bankrupt idea,” said Don Berwick, head of the US Institute for Healthcare Improvement and a plenary speaker at the forum. “This is the case in the North, but even more so in …

A hot flush for Big Pharma

Abstract: So the headlines have dealt another blow to the image of hormone replacement therapy (HRT). Will the drug companies be able to revive the fortunes of one of their most lucrative products? Will the big guns of the pharmaceutical industry be blazing, eager to counteract the latest volley of bad publicity? Or will the industry construct its defences more subtly? Certainly, if the history of HRT promotion is anything to go by, the pharmaceutical public relations machine will be doing all it can to limit the fallout from studies published last week in the New England Journal of Medicine (2003;349: 523-34) [PubMed] and the Lancet (2003;362: 419-27) [PubMed], just as it has been since the first damning results from long term HRT studies were released last year. After all, billions in global sales are at stake. The two latest studies confirm that postmenopausal women taking combined HRT have an increased risk of heart disease and a twofold greater chance of developing breast cancer. These support the negative findings released in July 2002 after the huge US Women's Health Initiative (WHI) study was prematurely halted by its safety monitoring board. But what exactly can the PR machine do in the face of evidence that now says long term HRT use increases women's risk of blood clots, strokes, heart attacks, breast cancer, and dementia, and has no quality of life benefits? Probably what it has always been doing—promoting the idea of HRT both as a cure for a medicalised menopause and an elixir even in the absence of scientific data. HRT has been touted for decades as a panacea not just for the symptoms of menopause (hot flushes, vaginal dryness) but also for heart disease, dementia, osteoporosis, sexual function, mood, and overall vitality. Its tireless promotion by manufacturers is often held up as the ultimate case study in pharmaceutical marketing. Not content to mass market its benefits for the short term relief of menopausal symptoms, the industry set its sights on a bigger goal: the widespread acceptance of HRT as a long term preventive medicine for the massive (and growing) number of postmenopausal women. So far it seems that that strategy has worked. Science journalist Barbara Seaman, who has written extensively about the medicalisation of the menopause, says that American pharmaceuticals giant Wyeth's HRT products have been in the top 50 selling drugs in the US for almost four decades. More than 100 million women worldwide—1.5 million in Britain—took HRT in 2001 and global sales amounted to $3.8bn (£2.4bn; €3.4bn). But after the first wave of publications from the WHI study, Wyeth, which accounts for more than 70% of the global market, saw its share price plummet. The stock, which traded as high as $58.48 (£36.48; €51.66) in May 2002, fell by almost half to a low of $28.25 in July.​July. Figure 1 HRT promotion has depended heavily, although covertly, on industry involvement with scientists. In the 1960s American physician Robert Wilson wrote the influential Forever Feminine, extolling the virtues of HRT as a virtual fountain of youth for the “dull and unattractive” ageing woman. In an article in the New York Times last year (10 July 2002), Wilson's son conceded that Wyeth paid for his father's book and promotion of HRT. In 2002 the powerful New York based Society for Women's Health Research, whose “sole mission is to improve the health of women through research,” held a celebrity gala ostensibly celebrating women's “coming of age.” It was entirely underwritten by Wyeth. In a Washington Monthly article entitled “Hot Flash, Cold Cash,” journalist Alicia Mundy reported that only a few days after the Wyeth themed gala the company donated a quarter of a million dollars to the society. Several weeks later, the WHI study results were made public. Wyeth was in a tailspin. They found support from the society, whose high profile chief executive, Phyllis Greenberger, and her staff went on national radio and television talk shows attacking the findings of the WHI study and its authors. “Instead of taking the side of its constituents,” Mundy observed, “the society seemingly took the side of its donors—and of Wyeth in particular.” As they fervently downplayed the negative findings of the WHI study and urged women not to abandon their HRT, the society's staff failed to disclose their substantial links to Wyeth and other drug companies. Similar activities and non disclosures are under investigation in Australia, after a complaint about the involvement of a well known doctor, Susan Davis, in HRT promotion. HRT industry tactics play out not only in the ivory tower, but also in the corridors of big public relations firms. A group called HRT Aware hired London based PR firm the RED Consultancy to create an initiative that would “secure positive news coverage about HRT, target 45+ women with positive HRT messages, and link HRT to an aspirational life style” (www.pmlive.com/awards). The Choices Campaign, as it was called, launched in February 2000 to wide media coverage. It reached masses of “ordinary” women by touring bingo halls with local celebrities, using a former soap star and female doctor as spokeswomen, and forging relationships with charities such as the Menopause Amarant Trust. What is not so well known is that HRT Aware was an industry group comprised of oestrogen product manufacturers Janssen-Cilag, Wyeth, Solvay, Servier, Organon, and Novo Nordisk.​Nordisk. Figure 2 What will the drug companies do now? HRT Aware also commissioned the Social Issues Research Centre to produce a Jubilee Report (named to coincide with the Queen's Jubilee celebrations), which last month won a Communique award from the magazine Pharmaceutical Marketing in the public relations and medical education category. SIRC's research linked the improved lives of modern day postmenopausal women to HRT. It introduced a new elite group of 50+ women, dubbed the “HRHs” (hormone-rich and happy), who were said to have better careers, relationships, health, wellbeing, and sex lives than those not taking HRT. The Jubilee Report received widespread—and supportive—media coverage in the UK, virtually none of which mentioned that the pharmaceutical industry fashioned the campaign. This year Novo Nordisk hired German PR firm Haas & Health Partner, which sent out to doctors letters downplaying the WHI results. The letters emphasised that the “absolute risk for women is quite minimal” and were signed by Dr Irene Haas (a historian, according to her company's website). A subsequent letter from Dr Haas states “amazingly, a glass of wine per day and obesity have higher breast cancer risks.” That pharmaceutical companies devise clever ways to market their products is hardly surprising. But let us hope that any counter attack that they make to the latest damaging research is subjected to the same kind of scrutiny that HRT itself is now under.

Academic medicine: time for reinvention

Abstract: Editor—We agree with Bell that advocating funding for clinical research needs to become evidence based.1 With colleagues we recently explored the relations between basic research, clinical research, and clinical practice.2,3 In the first report we tried to replicate Comroe and Dripps's seminal study as reported in Science in 1976,4 tracing back from current clinical practice to the knowledge behind the advance.2 Comroe and Dripps concluded that 40% of all research articles judged to be essential for later clinical advance were not clinically oriented at the time of the study and that 62% of key articles reported basic research. Their paper has often been used (albeit at times implicitly) in support of the increased funding for basic biomedical research in the United Kingdom and elsewhere over the past two decades. We found we were unable to repeat the study method, thus confirming earlier doubts about it5 and raising questions about its reliability, validity, and applicability, at least for current circumstances. In recognising the difficulties in tracing backwards from clinical practice, we undertook a preliminary study that tries to work forwards by tracing the impact of a range of research conducted 20 years ago.3 In this study we explored several methods that could help to identify the benefits from previous research and thus potentially be used to develop an evidence base to support funding decisions for research and development. Our work has only begun to scratch the surface of this important but complex issue. Nevertheless, we think that research funding agencies should accept the need for a firm evidence basis for their policies and therefore support researching research, as Smith put it in 1987.5

Threat of war is affecting mental health of Iraqi children

Abstract: The vast majority of Iraq's 13 million children will be affected if the war between Iraq and the West goes ahead, a report released by a Canadian led team of health experts concludes. The report, based on a humanitarian fact finding mission in Iraq that included interviews with 100 families in Baghdad, Karbala, and Basra in January 2003, warns that Iraqi children are at grave risk of starvation, disease, death, and psychological trauma. Casualties are predicted to be in the tens of thousands in the …

Women too busy to exercise.

Abstract: Only a quarter of UK women are exercising enough to reap useful health benefits. This “deeply concerning finding” emerged from a national poll conducted by the charity Cancer Research UK, which also found that women lack the time and motivation to achieve the targets for physical activity promoted by government. Women are advised to undertake brisk activity for 30 minutes a day at least five times a week to reduce their risk of heart disease, stroke, diabetes, …

Threat of war is affecting mental health of Iraqi children, says report

Abstract: The vast majority of Iraq's 13million children will be affected if the war between Iraq and the West goes ahead, a report released by a Canadian led team of health experts concludes. The report, based on a humanitarian fact finding mission in Iraq that included interviews with 100 families in Baghdad, Karbala, and Basra in January 2003, warns that Iraqi children are at grave risk of starvation, disease, death, and psychological trauma. Casualties are predicted to be in the tens of thousands in the …

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice; Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice

Abstract: Eds Gordon Guyatt, Drummond Rennie ![][1] AMA Press, $6295, pp 706, with CD Rom ISBN 1 57947 174 9 ![][2] Eds Gordon Guyatt, Drummond Rennie AMA Press, $3595, pp 442, with CD Rom ISBN 1 57947 191 9 wwwama-assnorg/ama/pub/category/7350html Rating: ![Graphic][3] ![Graphic][4] ![Graphic][5] ![Graphic][6] ; ![Graphic][7] ![Graphic][8] ![Graphic][9] ![Graphic][10] The evidence based medicine philosophy has become so embedded in the activities and motives of the healthcare enterprise that it is hard to believe that it has been only 20 years since the term evidence based medicine (EBM) was first coined Credited with changing the way clinicians practise medicine, EBM has … [1]: /embed/graphic-1gif [2]: /embed/graphic-2gif [3]: /embed/inline-graphic-1gif [4]: /embed/inline-graphic-2gif [5]: /embed/inline-graphic-3gif [6]: /embed/inline-graphic-4gif [7]: /embed/inline-graphic-5gif [8]: /embed/inline-graphic-6gif [9]: /embed/inline-graphic-7gif [10]: /embed/inline-graphic-8gif

Family Violence in Primary Care; Violence Against Women: A Physician's Guide to Identification and Management

Abstract: ![][1] Eds Stephen Amiel, Iona Heath Oxford University Press, £32.50, pp 442 ISBN 0 19 262828 3 Rating: ![Graphic][2] ![Graphic][3] ![Graphic][4] ![][5] Eds Jane M Liebschutz, Susan M Frayne, Glenn N Saxe American College of Physicians, $30, pp 368 ISBN 1 930513 11 www.acponline.org/catalog/books/viol_women.htm Rating: ![Graphic][6] ![Graphic][7] ![Graphic][8] In 1985 US surgeon general C Everett Koop declared domestic violence the biggest public health crisis of the decade. In 1994 the United Nations recognised violence against women as a human rights abuse. In the late 1990s national surveys in Canada and the United States reported that a third of women had been physically assaulted by an intimate partner, putting them at risk of injury, a range of physical and emotional health problems, and death. In 2002 a World Health Organization report on violence and health said that up to 70% of female murder victims were killed by their partners or former partners. Despite this, the healthcare system's role in alleviating violence against women has a short history. Decades of advocacy and … [1]: /embed/graphic-1.gif [2]: /embed/inline-graphic-1.gif [3]: /embed/inline-graphic-2.gif [4]: /embed/inline-graphic-3.gif [5]: /embed/graphic-2.gif [6]: /embed/inline-graphic-4.gif [7]: /embed/inline-graphic-5.gif [8]: /embed/inline-graphic-6.gif

Furore erupts over NIH “hit list”

Abstract: A campaign by a conservative religious coalition has whipped up a controversy about funding by the US National Institutes of Health (NIH) of research on HIV, sexuality, and risk related behaviour, alarming researchers and shedding new light on the business of mixing politics with science. The Traditional Values Coalition, a right wing American church group, generated a list of NIH researchers who they claim are conducting “prurient” health research. The list was made available to members of …

North American style

Abstract: Guidance for medical writers makes much of the distinctions between British and American English. Not surprisingly, the BMJ emphasises the need for British, not American, spelling (bmj.com/advice/stylebook/start.shtml). The Economist seems particularly put off by Americanisms and says so in its excellent style guide (www.economist.com/research/StyleGuide/). International authors …

Canadian task force on preventive health care under threat

Abstract: The Canadian Task Force on Preventive Health Care, an international centre that helps doctors to put research findings into practice, is under threat of closure after 25 years' work. Established in 1976 as an independent scientific panel of experts, the task force enlists volunteer members to review the clinical evidence on topics such as dementia, colorectal cancer, and breast self examination and then publishes recommendations for doctors on the basis of the weight of accumulated evidence. Its set of guidelines is considered the authoritative source for Canadian doctors, and its innovations of systematically classifying research into levels of evidence …

Euro MPs vote on research fund for neglected diseases.

Abstract: Tackling HIV/AIDS, malaria, and tuberculosis in developing countries needs coordinated research funding from the European Union's member states and the private sector, suggests a proposal that was due before the European parliament on Thursday. If the proposal is ratified by MEPs, the parliament will support calls from the European Commission for an EU “neglected diseases” research fund, seen as a companion to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The new fund would establish clinical trials partnerships to produce drugs appropriate to …

GP contract delayed, but negotiations continue

Abstract: The announcement of the new GP contract for primary care doctors in the United Kingdom is to be delayed by at least six weeks, threatening the planned implementation in April 2003. January roadshows set up by the BMA to inform members of the proposed deal will be cancelled and probably not rescheduled until February or March. If a final contract package …