Issue 44.
Report suggests that a fifth of
suicides are preventable
The health service is being called on to step up
efforts to protect people with mental health problems from harming
themselves or other people after a report published this week showed
that more than a fifth of suicides among people with mental illness
could have been prevented.
About a quarter of the United Kingdom’s 6500
suicides each year occur among people with mental illness, some 12%
of them while in hospital.
The National Confidential Inquiry into Suicide
and Homicide by People with Mental Illness showed that many people
at risk of suicide are simply slipping through the net. A quarter of
those who committed suicide died within three months of being
discharged from hospital, nearly half of them never making it to
their first follow up appointment.
The report showed that nearly 50% of the suicides
in England and Wales were among people being supervised under the
enhanced “care programme approach”, which requires input from a
multidisciplinary team of mental health specialists. But half of
them were not taking their medication when they died or had missed
their last appointment with community services.
Professor Louis Appleby, director of the inquiry,
said that these latest figures from 1999 suggest that the fall in
the suicide rate among the general population, which has been
observed since the beginning of the 1990s, is continuing. However,
suicides among people with mental illness have remained static.
Mental illness also contributes to about a third
of the 600 murders that occur in the UK each year. Less than 10% of
those accused of homicide in England and Wales, however, had been in
contact with mental health services in the previous year.
Safety First. Five Year Report of the National
Confidential Inquiry into Suicide and Homicide by People with Mental
Illness can be accessed at the Department of Health’s website
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Obesity drug endorsed by NICE
The anti-obesity drug orlistat (Xenical) should
be available throughout England and Wales on the NHS, the
government’s drug advisory body has recommended. The decision by the
National Institute for Clinical Excellence (NICE) should put an end
to “postcode prescribing”, which has led to a 16-fold difference
between the areas where it is most commonly prescribed and the areas
where it is least prescribed.
The institute sets out strict guidelines for prescribing orlistat
as one part of the management of obesity. It should be prescribed
only to adults (aged 18 to 75 years) who either have a body mass
index of ³28 (weight(kg)/(height(m)2))
and also have a serious illness (such as type 2 diabetes or
hypertension) or have a body mass index of
³30 but have no associated
illnesses. Before the drug is prescribed, a patient should have
already
lost at least 2.5kg by dieting and increasing
physical activity.
To continue taking the drug, patients must also
fulfil strict criteria. Treatment should continue for more than
three months only if the patient has lost at least 5% of his or her
body weight from the start of drug treatment; it should continue for
more than six months only if weight loss has been at least 10% of
body weight.
The recommendation will have a significant impact
on the NHS drug budget. The cost of treatment per patient is
estimated to be £537 ($806) a year. The institute estimates that if
the guidance is implemented it will cost around £12m in the first
year-double the current drug costs. This estimate is based on an
extra 11000 people being prescribed orlistat.
Trials have shown that mean weight loss per year
achieved with orlistat is 2.5 kg greater than that achieved with
placebo. This has been accompanied by small but significant
reductions in total cholesterol levels, the ratio of total
cholesterol level to high density lipoprotein level and diastolic
and systolic blood pressure. There is no evidence of the drug’s
efficacy in reducing a person’s weight for periods over 12 months,
and the drug is licensed for use only up to 24 months.
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Poll shows public still has trust
in doctors
Trust in doctors does not seem to have been
dented by the recent poor publicity that they have received over the
Bristol surgery inquiry and the reports about the retention of body
parts at Alder Hey Hospital, Liverpool.
A poll by the independent research agency MORI of
almost 2000 adults, commissioned by the BMA, shows that the public
trusts doctors to tell the truth more than any other group,
including teachers, judges, and clergymen. Eighty nine per cent of
the respondents thought that doctors told the truth, compared with
86% for teachers, 78% for judges and clergymen, 18% for journalists,
and 17% for politicians.
Similarly, satisfaction with doctors remains
high. The same proportion of the public (89%) said they were either
very satisfied (36%) or fairly satisfied (53%) with the way doctors
did their jobs. Only nurses scored more highly, with 95% of
respondents saying that they were either very satisfied (54%) or
fairly satisfied (41%). Dentists and teachers came third and fourth,
with 84% and 82% respectively expressing satisfaction.
The scores compare well with last year’s poll.
Trust in doctors has risen by two percentage points, though the
proportion of those saying they are very satisfied has fallen by
five percentage points.
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Compliance with
unpleasant therapies
Chemotherapy given at home was compared with
outpatient treatment in terms of colorectal cancer patients’ safety,
compliance, use of health services, quality of life, and
satisfaction with treatment. 87 patients receiving adjuvant or
palliative chemotherapy for colorectal cancer were treated with
fluorouracil (with or without folinic acid or levamisole) at
outpatient clinic or at home.
Treatment related toxicity was similar in the two
groups, but there were more voluntary withdrawals from treatment in
the outpatient group than in the home group (14% v 2%, difference
12% (1% to 24%)). There were no differences between groups in terms
of quality of life scores during and after treatment. Levels of
patients’ satisfaction were higher in the home treatment group,
specifically with regard to information received and nursing care.
There were no significant differences in use of health services.
Home chemotherapy seemed an acceptable and safe
alternative to hospital treatment for patients with colorectal
cancer that may improve compliance and satisfaction with treatment.
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