Commonly used painkillers increase the risk of heart attacks and strokes when taken at high doses or over the long term, according to research.
Experts analysed more than 30 clinical trials on more than 116,000 patients to examine the effects of painkillers on people’s health.

The fears relate to non-steroidal anti-inflammatory drugs as well as newer anti-inflammatory drugs known as Cox-2 inhibitors.

Doctors regularly prescribe such drugs to treat painful conditions, including osteoarthritis.

They are given at much higher doses than those found in over-the-counter remedies, which are used for occasional headaches, aches and pains.

The study, in the British Medical Journal, found that compared with a dummy drug lumiracoxib increased the risk of heart attacks, while ibuprofen was linked to the highest risk of stroke (more than treble the risk).

Diclofenac almost tripled the risk, while etoricoxib and diclofenac were associated with around a fourfold increased risk of suffering death from cardiovascular causes.

The authors, from the University of Bern in Switzerland, said: “Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms.”

In an accompanying editorial, Prof Wayne Ray, from the department of preventive medicine in Nashville, said: “Naproxen seemed least harmful.

“Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.”

Overall, the number of heart attacks and strokes reported was low compared to the number of patients.

In 29 of the trials, there were a total of 554 heart attacks and in 26 trials there were 377 strokes. In 28 trials there were 676 deaths.

From: http://www.guardian.co.uk/high-doses-painkillers-stroke-risk

The first trial among the over 50s in the UK of the “polypill”, a daily tablet combining several low-dose drugs that could protect against heart attacks and strokes, is being launched this month.
The idea was proposed by two British professors in 2003. Prof Sir Nicholas Ward and Prof Malcolm Law, from the Wolfson Institute of Preventive Medicine at Queen Mary, University of London, suggested in a paper in the British Medical Journal that a pill combining low doses of several drugs to bring down cholesterol and blood pressure could save lives.

Ward and Law wrote in their paper: “The polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the western world than any other single intervention.” Richard Smith, then BMJ editor, said it was possibly “more than 50 years since we published something as important as these papers”.

The idea has gained currency and is being explored by more than one team of researchers. While some scientists are investigating a pill they christened the “red heart”, which they hope will cut heart disease deaths among those already known to be at risk in Asia, the Wolfson researchers continue to focus on the original concept.

They hope the trial, which begins this month, will pave the way for a pill which anybody over 50 in the UK will be able to obtain at low cost from a pharmacy within a couple of years.

One of the researchers conducting the trial at the Wolfson Institute, Dr David Wald, said: “The polypill has the potential to be a daily preventive method against heart attacks and strokes, just as the contraceptive pill is a daily preventive method to avoid an unwanted pregnancy. This trial is a step towards making access to the polypill a reality.”

The pill is being made by the Indian generics company Cipla. All components are out of patent and therefore can be copied and are cheap. It contains simvastatin to lower cholesterol and three drugs at half the standard dose to reduce blood pressure – losartan, hydrochlorthiazide and amlodopine.

Unlike the red heart, which is intended for people who have already suffered heart problems, the polypill does not contain aspirin as originally envisaged by Ward and Law in 2003. Aspirin is known to protect against heart attacks and stroke, and trials recently showed there were more than 20% fewer deaths from certain common cancers in people who took a daily low dose of aspirin.

But the Wolfson team want to minimise potential side-effects to make the pill safe for everyone to take, and aspirin has been shown to sometimes cause stomach bleeding.

Wald said: “By offering the polypill on the basis of age alone, prevention is greatly simplified and the population receiving the polypill are not medicalised, because they do not have to become patients to receive it.”

The trial will include 100 people, selected on the basis of age alone, who will take the pill for 12 weeks and a placebo for 12 weeks, without knowing which one is which. They will be monitored for the effects on their blood pressure and cholesterol levels. At the end of the 24 weeks, all will be given the polypill for a further two years to help assess the long-term benefits.

Because the drugs which make up the polypill are all well-known and are often taken together, even if not in a single tablet, there would not have to be the usual long licensing process to get the polypill on the market.

Within 18 months or two years, the researchers hope it may be universally available, although they still envisage that it may be prescribed by a pharmacist, rather than sold over the counter.

From: http://www.guardian.co.uk/heart-attack-stroke-polypill-trial-begins

NHS whistleblowers will be given greater protection under changes being considered in the aftermath of the nursing standards scandal at Mid Staffordshire hospitals.
Andrew Lansley, the Health Secretary, said a “culture of fear” had pervaded Mid Staffordshire NHS Foundation Trust, where between 400 and 1,200 patients died due to poor nursing care between 2005 and 2009, which enabled problems to continue “unchallenged and undetected for so long”.

As a result of the Mid Staffordshire nursing scandal and other problems, Mr Lansley has announced a consultation is to take place over changes to the NHS Constitution, which sets out what staff, patients and the public can expect from the service.

NHS whistleblowers ‘need greater legal protection’ says BMJ

Mr Lansley aims to bring about a cultural shift in the NHS to make it easier for employees to highlight failings.

Specifically, he wants to introduce “an NHS pledge that employers will support all staff in raising such concerns” and “create an expectation that NHS staff will raise concerns about safety, malpractice and wrong doing … as early as possible”.

Reports have repeatedly highlighted how serious problems at hospitals have been allowed to continue because staff have been too afraid to speak up.

An independent report commissioned by the Government last year concluded that patients were “robbed of their dignity” at Stafford Hospital and Cannock Chase Hospital, with some left in soiled bedclothes, while families had to clean lavatories and public areas themselves. Staff were “uncaring” and managers “in denial” about the problems.

The NHS consultation closes on January 11.

From: http://www.telegraph.co.uk/NHSWhistleblowers-charter-for-NHS

Decriminalising drug use could drastically reduce crime and improve health, the outgoing president of the Royal College of Physicians has said.
Sir Ian Gilmore said the laws on misuse of drugs should be reviewed and that their supply should be regulated.

He had formed his view after seeing the problems caused by dirty needles and contaminated drugs, the BBC’s health correspondent Adam Brimelow said.

In a parting e-mail to 25,000 RCP members, which Sir Ian said expressed his own views rather than those of the RCP, he wrote that he felt like finishing his presidency on a “controversial note”.

He endorsed a recent article in the British Medical Journal by Stephen Rolles, from the think tank Transform Drug Policy Foundation, which argued that the policy of prohibition had harmed public health, encouraged organised crime and fuelled corruption.

Sir Ian told the BBC: “Everyone who has looked at this in a serious and sustained way concludes that the present policy of prohibition is not a success.  There are really strong arguments to look again.”

Sir Ian said he had had a longstanding interest in the subject, stemming from his work as a liver specialist.

“Every day in our hospital wards we see drug addicts with infections from dirty needles, we see heroin addicts with complications from contaminated drugs,” he said.

He argued that many of the problems health staff encountered were the consequences not of heroin itself, but of prohibition.

In his e-mail, Sir Ian wrote: “I personally back the chairman of the UK Bar Council, Nicholas Green QC, when he calls for drug laws to be reconsidered with a view to decriminalising illicit drugs use. This could drastically reduce crime and improve health,” he wrote.

In his recent report to the Bar Council, Mr Green said there was growing evidence that decriminalising personal use could free up police resources, reduce crime and improve public health.

Mr Rolles – whose recent BMJ article Sir Ian cited in his e-mail – told BBC Radio 4′s Today programme their arguments were “built on a critique of the failure of the last 40 or 50 years”.

He said the “punitive criminal justice-driven war on drugs” had delivered the opposite of its goals.

“It hasn’t reduced drug use, it hasn’t prevented the availability of drugs, but it has created a whole raft of secondary problems associated with the illegal market, including making drugs more dangerous than they already are and undermining public health and fuelling crime.”

“That is provoking a debate on what the alternative approaches are and the one that we are calling for is legally regulated production supply.”

From:  http://www.bbc.co.uk/news/health-10990921

Three scientists who drew up the key World Health Organisation guidelines advising governments to stockpile drugs in the event of a flu pandemic had previously been paid by drug companies which stood to profit.
An investigation by the British Medical Journal and the Bureau of Investigative Journalism, the not-for-profit reporting unit, shows that WHO guidance issued in 2004 was authored by three scientists who had previously received payment for other work from Roche, which makes Tamiflu, and GlaxoSmithKline (GSK), manufacturer of Relenza.

City analysts say that pharmaceutical companies banked more than $7bn (£4.8bn) as governments stockpiled drugs. The issue of transparency has risen to the forefront of public health debate after dramatic predictions last year about a swine flu pandemic did not come true.

The UK, which warned that 65,000 could die as a result of the virus, spent an estimated £1bn stockpiling drugs and vaccines; officials are now attempting to unpick expensive drug contracts.

The cabinet office has launched an inquiry into the cost to the taxpayer of the panic-buying of drugs.

Although the experts consulted made no secret of industry ties in other settings, declaring them in research papers and at universities, the WHO itself did not publicly disclose any of these in its seminal 2004 guidance. In its note, the WHO advised: “Countries that are considering the use of antivirals as part of their pandemic response will need to stockpile in advance.”

Many nations would adopt this guidance, including Britain. In 2005, the government said it had begun bulk-buying the drug Tamiflu, initially ordering 14.6m doses after bird flu killed 40 in Asia.

The specific guidance on antivirals was written by Professor Fred Hayden. He has confirmed in an email that he was being paid by Roche for lectures and consultancy work at the time the guidance was produced and published. He received payments from GSK for consultancy and lecturing until 2002. He said “[declaration of interest] forms were filled out for the 2002 consultation”.

The previous year Hayden was also one of the main authors of a Roche-sponsored study that asserted what was to become a main Tamiflu selling point – its claim of a 60% reduction in flu hospitalisations.

Dr Arnold Monto was the author of the WHO annex dealing with vaccine usage in pandemics. Between 2000 and 2004, and at the time of writing the annex, Monto had openly declared consultancy fees and research support from Roche and GSK. No conflict of interest statement was included in the annex published by the WHO.

When asked if he had signed a declaration of interest form for WHO, Dr Monto said “conflict of interest forms are requested before participation in any WHO meeting”.

The third scientist, Professor Karl Nicholson, is credited with the WHO’s influential work Pandemic Influenza. According to declarations he made in the BMJ and Lancet in 2003, he had received sponsorship from GSK and Roche.

Even though the previous year these declarations had been openly made, no conflict of interest statement was included in the annex. Nicholson said he last had “financial relations” with Roche in 2001.

When asked if he had signed a declaration of interest form for WHO, he replied: “The WHO does require attendees of meetings, such as those held in 2002 and 2004, to complete declarations of interest.”

A WHO official told the BMJ it had to balance an individual’s privacy with the robustness of guidelines, which were subject to a wide external review process.

From: http://www.guardian.co.uk/business/2010/jun/04/swine-flu-experts-big-pharmaceutical

Women should be tested for chlamydia every time they have a new sexual partner to cut their chances of pelvic disease, UK researchers say.

A study of 2,500 students found that annual screening is not enough to prevent cases of pelvic inflammatory disease, which can cause infertility.

In those who were found to have chlamydia, treatment cut the risk of pelvic disease by 80%.

The National Chlamydia Screening Programme backed the findings.

The researchers from St George’s, University of London, concluded that most cases of pelvic inflammatory disease were in women who did not have chlamydia when they were tested a year earlier.

The findings, published in the British Medical Journal, suggested they may have become infected in the 12 months after screening.

Chlamydia is the most common sexually transmitted disease in the UK and the number of cases is steadily rising.

The researchers recruited sexually active female students between the ages of 16 to 27 from 20 universities and colleges in London.

They were swabbed at the beginning of the study and tested for pelvic inflammatory disease, which as well as infertility can cause chronic pain and increase the risk of ectopic pregnancy, a year later.

The researchers found that most cases of pelvic inflammatory disease occurred in women who tested negative for chlamydia when they were initially tested.

Study leader Professor Pippa Oakeshott, who also works as a GP, said: “The crucial message is that individuals should get tested every time they have a new sexual partner.”

But she added that chlamydia was not the only cause of pelvic inflammatory disease.

“It’s probably several bacteria that cause it, and we should probably be screening for other things, but chlamydia and gonorrhoea is a good start.”

She also said testing needed to be more accessible to young people, with kits being given out in colleges and youth clubs.

A spokesman for the Health Protection Agency said the findings reinforced the testing policy of the National Chlamydia Screening Programme, which was launched in 2003.

“The study, looking at a single annual test, shows the importance of the programme’s approach to testing annually or on change of sexual partner because most cases of pelvic inflammatory disease occurred in women who initially tested negative for chlamydia.”

Last year the National Audit Office criticised the screening programme for duplicating effort and failing to test as many of the under-25 target group in England as it should have.

From: http://news.bbc.co.uk/1/hi/health/8609354.stm