For the full versions of articles in this section see bmj.com UK NEWS Government removes data sharing clause from coroners’ bill, p 618 news World NEWS Target to reduce child mortality is under threat from diarrhoea, p 620 bmj.com Tobacco atlas illustrates shift to low income countries Five academic health science centres are announced in England Zosia Kmietowicz London The health secretary, Alan Johnson, announced on 9 March that five academic health science centres are to be created in England, after peer review of the seven final applicants by an international panel. The successful centres are Cambridge University Health Partners, Imperial Col- lege, King’s Health Partners, Manchester AHSC, and University College London /ap/pa Partners. Bids from Oxford and Birmingham t were unsuccessful.

In July 2007 the junior health minister Ara Talbo Toby Darzi had called for the establishment of aca- Diana Levine lost her livelihood as a musician after her forearm was amputated demic health science centres in England in his strategy for the future of the NHS, High Quality Care for All, to speed up the process The US Supreme Court rules of applying breakthroughs in research to the care of patients. It is hoped that the centres—partnerships on liability for drug labelling between universities and leading NHS Janice Hopkins Tanne The Supreme Court’s ruling forearm amputated after an organisations—will be better able to com- New York means that other people intramuscular injection of pete globally with established centres such The US Supreme Court has who believe they have been promethazine. The drug was as those in the United States, Canada, ruled that the drug company injured by a drug can sue the given by the “IV push” method Singapore, Sweden, and the Netherlands. It was liable for $6.7m manufacturer even where directly into a vein and either is envisaged that the centres of excellence (£4.7m; €5.3m) in damages the drug’s labelling has been penetrated an artery or leaked will be well placed to compete on the world in a lawsuit brought by Diana approved by the FDA. The into surrounding tissue. stage for talent and funding, drawing in eco- Levine, a guitarist from Vermont. number of such suits is likely In her lawsuit Ms Levine nomic benefits for the United Kingdom as Ms Levine’s right forearm to increase and may lead said that the labelling should a whole. was amputated because of companies to strengthen have told doctors to use IV drip Mr Johnson said, “I congratulate the gangrene caused by an injection warnings in their drug labelling. administration instead of the successful candidates, who have demon- of Wyeth’s drug promethazine Ms Levine sued Wyeth in higher risk IV push method. strated their enthusiasm and commitment hydrochloride (Phenergan). She Vermont courts under a product Wyeth said that the decision to the vision of bringing together world said that the drug’s label did not liability law, saying that Wyeth’s was “disappointing, not only class research, teaching, and patient care to sufficiently warn of its risks. labelling of the drug did not for Wyeth, but for patients and improve health in local communities as well Wyeth had argued that sufficiently warn of risks. A jury public health in general. Patients as internationally through their global reach. because the drug’s labelling found in her favour. are best served by a national NHS patients will reap the benefits of the had been approved by the US Wyeth appealed, saying standard for the labelling of work of these new centres. Food and Drug Administration that the FDA had approved prescription medications set “In times of economic uncertainty it is it was protected from lawsuits the drug’s labelling and states by the medical and scientific even more important that we continue to brought in state courts, as could not require stronger experts at the FDA.” support this country’s knowledge industries Ms Levine’s was. Federal law warnings. It said that the label The company also said that it to ensure that we benefit from the competi- usually pre-empts state law. clearly warned of the danger had provided clear instructions tive edge which they provide.” Justice John Paul Stevens, of gangrene and amputation about using the drug, including The centres will retain their academic sta- who wrote the court’s opinion, from inadvertent intra-arterial the risk at issue. tus for five years, after which they will have said that drug makers, not the injection. The Supreme Court’s decision is to reapply. FDA, are primarily responsible Ms Levine developed at www.supremecourtus.gov. Cite this as: BMJ 2009;338:b1005 for their drug labelling. gangrene and had her right Cite this as: BMJ 2009;338:b964 See News, p 623

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Prominent researcher admits fabricating data in 21 articles Jeanne Lenzer New York of Medicine, said that after evaluating the 51 James Eisenach, editor in chief of A well known researcher who promoted the use other articles by Dr Scott the centre “was not able Anesthesiology, said that Dr Reuben’s research of the non-steroidal anti-inflammatory drug to reconstruct the scientific trail” to either prove or was central to the claim that celecoxib reduces celecoxib has admitted fabricating data in 21 of disprove fraud in those articles. pain at six and 12 months after surgery. He said his 72 articles indexed by PubMed. The case is The notice says that “all fabricated data were that the fraud creates a “hole” in pain research “among the biggest which has come to light,” said created under the sole control of Dr Reuben.” and casts doubt on claims about celecoxib. Harvey Marcovitch, chairman of the Committee Dr Reuben, who received research grants Dr Eisenach says in an editorial to on Publication Ethics, an international forum for from , the US manufacturer of celecoxib be published in the May 2009 issue of publishers and editors of peer reviewed journals. (marketed as Celebrex), and served on its Anesthesiology (http://pdfs.journals.lww.com/ Scott S Reuben, chief of the acute pain service speakers’ bureau, pioneered “multimodal anesthesiology/9000/00000/99939.pdf) that at Baystate Medical Center in Springfield, analgesia,” the combination of celecoxib the retracted articles “have been considerably Massachusetts, has admitted the fraud, says with another Pfizer drug, the anticonvulsant cited since 2002” and that mere retraction of a notice issued by the centre. Jane Albert, a pregabalin (Lyrica). The combination, Dr Reuben the articles will not be enough. He says that spokeswoman for the centre, a teaching hospital claimed, was preferable to opioids, and it became the journal will use its peer review system “to that serves as a campus of School a mainstay in . assure that these articles are no longer cited by Obama reverses US federal ban Government removes data sharing clause on funding stem cell research from coroners’ bill Janice Hopkins Tanne New York two are not inconsistent. “As a person Zosia Kmietowicz London President Barack Obama has of faith, I believe we are called to Jack Straw, the UK justice secretary, is to removed the ban introduced care for each other and work to abandon plans that could have allowed by the previous US president, ease human suffering. And many patients’ medical records to be used by third George Bush, on using federal thoughtful and decent people parties without patients’ consent. funds to support embryonic stem are conflicted about, or strongly A spokeswoman for the Ministry of Jus- cell research, in an executive order oppose, this research . . . But tice said that the government still believed issued this week. after much discussion, debate, strongly in data sharing but had accepted Government support will now be and reflection, the proper course the concerns of many critics that clause 152 available for research with many more has become clear. The majority of the Coroners and Justice Bill was not the stem cell lines than previously. These lines of Americans—from across the way forward. are developed from surplus embryos that political spectrum and from of all Although the aims of the clause, which remain after fertility treatment; the backgrounds and beliefs—have come would allow data to be shared among embryos would otherwise have been to a consensus that we should pursue ­government departments so that it was easy stored indefinitely or destroyed. this research, that the potential it offers to identify, for example, children who were President Obama said that human cloning is great, and with proper guidelines and strict ­entitled to free school meals, were good would never be permitted and that research oversight the perils can be avoided.” “there are some justifiable concerns that the would proceed under strict guidelines to In August 2001 President Bush banned powers could have been misused,” she said. be developed by the National Institutes of federal support for research on stem cells Mr Straw would be launching a consulta- Health over the next four months. except for 21 stem cell lines already created. tion on “how data can be shared in a way The order does not provide funding to Scientists found that many of these stem cell that is safe,” she said. “We want a system so ­create new embryonic stem cell lines because lines were contaminated or not useful (BMJ that no one has anything to fear.” of a ban called the Dickey-Wicker amend- 2001;323:357). A BMA spokesperson said, “We think it’s ment. This prevents using federal funds to Private funding of stem cell research was vital for the doctor-patient relationship that create human embryos for research in which permitted. However, scientists had to make this legislation does not go ahead in its cur- they are later destroyed, which occurs when sure that they did not use federally funded rent form. We welcome indications in the stem cells are extracted. The amendment laboratory equipment or supplies. media that the government is listening to the has been renewed annually by Congress for A presidential adviser, the Nobel prize concerns raised by the BMA and a range of more than a decade. winner Harold Varmus, who is head of other bodies, and we look forward to further

s pl In announcing the new policy, President Memorial Sloan-Kettering Cancer Center in discussions with ministers.” Obama said, “In recent years, when it comes New York, said that the new policy was con- Clause 152 attracted strong criticism from to stem cell research, rather than furthering sistent with the president’s intention to use Conservatives and Liberal Democrats when

ner/ chmei ss discovery, our government has forced what I sound scientific practice rather than dogma the bill had its second reading in January believe is a false choice between sound ­science in developing federal policy. (BMJ 2009;338:b412).

Steve G s Steve and moral values. In this case, I believe the Cite this as: BMJ 2009;338:b1011 David Howarth, the Liberal Democrats’

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Prominent celecoxib researcher admits fabricating data in 21 articles Expulsion of relief agencies will our authors.” He also calls for “submission of studies reexamining the questions that seemed devastate Darfur health care to be answered by Reuben in the retracted studies.” John Zarocostas Geneva deliberately deprive such a huge group of Pfizer told the BMJ: “It is very disappointing Sudan’s decision last week to expel 13 civilians of means to survive is a deplorable to learn about Dr Scott Reuben’s alleged major voluntary relief agencies that provide act. “Humanitarian assistance has nothing to actions.” The withdrawal of his research, the humanitarian aid to many of the 4.7 million with the ICC [International Criminal Court] company said, “does not change the risk- people in the Darfur region threatens the proceedings. To punish civilians because of benefit profile of Celebrex. The clinical trials delivery of essential health care, UN officials a decision by the ICC is a grievous derelic- that led to the approval of Celebrex’s six pain and aid experts have warned. tion of the government’s duty to protect its indications, including acute pain . . . did not The decision to expel the agencies from own people.” involve any of Dr Reuben’s research.” Darfur and other areas in Sudan “will have The agencies affected include Médecins The list of retracted articles is at www.aaeditor. immediate important repercussions in the Sans Frontières (MSF), Save the Children, org/HWP/Retraction.Notice.pdf. immediate term, because in several locations Care International, Oxfam, the International Cite this as: BMJ 2009;338:b966 in Darfur they have been the only health pro- Rescue Committee, the Norwegian Refugee viders,” said Fadela Chaib, a spokeswoman Council, Mercy Corps, CHF International, for the World Health Organization. Solidarité, and Action Contre la Faim. justice spokesman and a law academic at “Hundreds of thousands of people [will be] The decision, if implemented, “will cause Cambridge University, described the provi- without access to any health services,” she irrevocable damage to humanitarian opera- sion at the time as “outrageous.” told reporters on 6 March. “We are discuss- tions,” said a spokesperson for Mr Ban. The clause would have amended the Data ing and seeing how we can contain and fill The UN chief said that the confiscation of Protection Act and allowed the government the major gaps.” equipment, money, and other materials “is to order personal data to be shared among WHO has 10 international staff and 100 ­unacceptable and must end immediately.” government departments and outside gov- Sudanese staff in the region. Christophe Fournier, international presi- ernment, provided this supported a policy The United Nations secretary general, Ban dent of MSF, said, “The sudden halt of our objective and struck a fair balance between Ki-moon, and the chiefs of the affected relief medical programmes, including vital surgical, the public interest and the interests of the agencies have urged Sudan’s president, Omar nutrition, and basic healthcare programmes, in individual. al-Bashir, urgently to reconsider his decision. large areas of Darfur will have an immediate The clause was introduced after recom- It was triggered by his indictment by the and devastating impact on the population.” mendations in a review commissioned by International Criminal Court on 4 March for More than 400 000 people were getting the government on data sharing by Rich- war crimes and crimes against humanity. medical care through MSF, said Philipe ard Thomas, the UK information commis- The agencies say they have nothing to do Ribeiro, general director of MSF France. He sioner, and Mark Walport, director of the with the court’s decision and are urging Khar- said that last year MSF treated more than Wellcome Trust, published in July 2008 (BMJ toum to allow them to restart operations. 200 000 people in the region, carried out 2008;337:a777), which called for a fast track Rupert Colville, spokesman for the more than 8000 surgical interventions, and route to data sharing to use medical records UN Commissioner for Human Rights, treated more than 20 000 pregnant women. for research. ­Navanethem Pillay, said, “To knowingly and Cite this as: BMJ 2009;338:b985 But critics were concerned that the gov- ernment took the recommendations of the review too far. In a letter to Mr Straw last week, eight organisations, including the BMA, the Royal College of General Practitioners, the Royal College of Surgeons, and the Royal College of Nursing, expressed “grave ­concerns” about clause 152. They said that the clause seemed to grant the government ­unprecedented powers to access people’s confidential medical records and share them with third parties. The organisations warned that the clause would “undermine the presumption of confidentiality, would corrode trust in the doctor-patient relationship, and could have a disastrous impact on both the health of individuals and the public.” Cite this as: BMJ 2009;338:b1009 zohra ben s emra/reuter s zohra See Observations, p 625 Sudan’s president, Omar Hassan al-Bashir, has expelled aid agencies

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in brief US figures show increasing resistance of flu virus to oseltamivir: Nearly all (98.5%) of influenza A (H1N1) viruses tested in the US from the early 2008-9 flu season were resistant to oseltamivir (JAMA 2009;301:1034- 41). In the previous year 12% of these viruses were found to be resistant to the drug. The viruses were tested as part of ongoing surveillance. Children in poor (See BMJ 2009;338:b995.) countries get diarrhoea on average Alcohol on television affects four times a year; drinking: Men who saw alcohol each episode can be portrayed during an hour of watching life threatening television drank on average 1.5 glasses b is Bothma/epa/cor Nic more of the alcoholic beverages present than men who saw no portrayal. The Target to reduce child mortality is under study “shows a causal link between exposure to drinking models and threat from lack of progress on diarrhoea alcohol commercials on acute alcohol Zosia Kmietowicz London The 15 research questions that achieved consumption,” say the authors (Alcohol and Alcoholism, doi:10.1093/ Two million children die every year from the highest priority score mainly concerned alcalc/agp003). diarrhoea, the World Health Organization better understanding of the effectiveness of says, and more research is urgently needed to available interventions and programmes— Transdermal patches are dangerous determine why mortality remains so high. such as oral rehydration salts and zinc, during MRI: The US Food and Drug Despite the fact that diarrhoea continues exclusive breast feeding, and the integrated Administration has warned that certain transdermal drug patches can cause to cause almost 20% of deaths among chil- management of childhood illness—and of the skin burns during magnetic resonance dren worldwide, the amount of research into barriers to their implementation. imaging. The patches sometimes have the disease has been steadily falling since the However, WHO is concerned that very aluminium backing, which can conduct 1980s. If childhood diarrhoea is not tackled few donor agencies recognise the impor- electricity and overheat. Warnings about urgently, the world will fail to achieve the tance of the areas of health research it has the possibility of burns during MRI are United Nations’ fourth millennium develop- identified. It has convened a meeting of missing from some patch packages. ment goal of reducing the number of child major supporters of child health research Cancer charity changes research deaths by two thirds by 2015, it warns. at the end of March 2009, to share the lists focus: Marie Curie Cancer Care has Although much is already known of research priorities it has determined for said it wants to invest more money about effective treatments for diarrhoea, combating diarrhoea and other “neglected” in research into care at the end of ­knowledge is still lacking on how to ensure childhood diseases. life and place less emphasis on that the children who most need treatment Olivier Fontaine, medical officer with fundamental scientific research. It says that around £400m (€435m; get it. To identify which types of research are WHO’s Department of Child and Adoles- $550m) is spent every year in the UK most needed, WHO, in consultation with cent Health and Development and lead on research into cancer prevention global experts, identified 154 research ques- author of the article, said, “Having seen the and cure, with less than £20m spent tions and then assigned them a priority using devastation that childhood diarrhoea can on end of life research. a method developed by the child health and cause, I hope that we’ll receive the support Smokers’ risk of COPD may be nutrition research initiative of the Global we need to come up with answers to some genetic: Research published in Forum for Health Research (PLoS Medicine of the key questions that remain.” BioMed Central’s open access journal doi:10.1371/journal.pmed.1000041). Cite this as: BMJ 2009;338:b972 Respiratory Research (http://respiratory- research.com) indicates that genetic factors may explain why a quarter of smokers develop chronic obstructive Aid agencies condemn drug seizure by Dutch government pulmonary disease. The study found that Michael Day Milan World Health Organization say Amsterdam, on suspicion that five single nucleotide polymorphisms in a gene linked with asthma were more Aid agencies have condemned that the 50 kg consignment of they might be counterfeit or frequent in the smokers with COPD the Dutch government’s seizure abacavir should be released have breached local intellectual than in smokers without it. “Functional of a shipment of antiretroviral immediately, before the health property rights. studies will be needed to evaluate drugs destined for sub-Saharan of hundreds of Nigerian patients The suggestions were the biologic significance of these Africa, which they say flouts with AIDS or infected with HIV is rebuffed by WHO’s UNITAID polymorphisms in the pathogenesis world trade rules and will put affected. drug purchasing agency. In a of COPD,” wrote Sadeghnejad and patients’ lives at risk. Dutch customs seized the statement it said, “The tablets colleagues. Oxfam International, Health drugs on their way from India in are not counterfeit nor does this Cite this as: BMJ 2009;338:b1010 Action International, and the November at Schiphol airport, shipment infringe other forms

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Inept laboratory work botched cancer results, inquiry finds David Spurgeon Quebec he apologised again on behalf of the provin- Hundreds of patients in Canada’s Newfound- cial government to those affected. The seven land and Labrador province with breast can- month inquiry examined why almost 400 cer were given inaccurate results of oestrogen patients received the wrong results of tests and progesterone receptor hormone testing that were intended to determine the appro- in a wholesale failure of accountability and priate treatment for their breast cancer. The oversight at all levels of the healthcare sys- inquiry heard testimony about inept work tem, an inquiry found this week. at the laboratory that processed the tests In the report Justice Margaret Cameron and poor communication between health

made 60 recommendations to ensure that authorities and the government. Bjor nb erg/spl C hris what went wrong will not happen again, Former employees testified that staff lacked An inquiry has recommended more training to including more training for physicians, man- proper training, handled samples incorrectly, prevent mistakes in breast cancer testing datory continuing education for laboratory allowed poor quality control, and had inade- technologists, and better record keeping. quate supervision. But because the errors are affected eight years after her tests. The health authority at the centre of the thought to have begun in 1997 and were not “It really was a disaster for the health scandal has announced that it has hired a revealed publicly until 2005, says the report, authority here,” said Peter Dawe, regional new chief executive officer, Vickie Kaminski, there must have been “not only deficiencies director of the Canadian Cancer Society. a veteran administrator accustomed to the within the laboratory but also the failure of “They withheld information from individuals, glare of publicity. [the healthcare] management system.” they withheld information from the general Ms Cameron has asked the provincial gov- Even after the problems became public, public, they actually withheld information ernment to report by the end of March 2010 Eastern Health Board continued to fail to from the minister of health at times.” on how her recommendations have been notify affected patients, the inquiry found. Commission of Inquiry on Hormone Receptor implemented. The province’s health minis- One patient told the inquiry on its last day Testing is at www.gov.nl.ca. ter, Ross Wiseman, promised to do so, and of hearings that she had only learnt she was Cite this as: BMJ 2009;338:b952

Spain plans to provide abortion on demand in new legislation María de Lago Madrid parliamentary subcommittee. Under current ­private clinics. The clinics complain, how- Women in Spain will be able to get an abor- Spanish law abortion is permitted: without any ever, that ambiguity in the law leaves them tion on demand up to 12 or possibly 14 time limit, if there is a serious risk to the life subject to different judicial interpretations. weeks of pregnancy for the first time if a or the physical or psychological health of the The parliamentary report recommends proposed law is passed by parliament. woman; up to12 weeks if the pregnancy is a abolishing the need for women aged 16 to 18 And under the proposals this time limit result of a rape; and up to 22 weeks if the fetus years to get a parent’s permission for abortion. will be raised or even removed in cases has serious abnormalities. It also calls for measures to speed up access where the health or life of the woman is at Spain has seen a steady rise in numbers to abortion in public hospitals and to decrimi- high risk or if the fetus has serious physical of abortions over the last two decades, with nalise illegal abortions carried out with con- abnormalities, malformations, or illness. the number increasing by 10% from 2006 sent that fall outside the current regulations, The new criteria for abortion were to 2007. Of the 112 138 abortions registered although these should still be illegal. ­recommended in a report from a cross party in Spain in 2007, 97.5% were carried out in Cite this as: BMJ 2009;338:b922

of intellectual property to our to protect drug firms’ profits The agencies are calling on Aid agencies condemn drug seizure by Dutch government knowledge.” by hindering the international the European Commission to The agencies note too that trade in counterfeit medicines. revise regulation 1383/2003, under rules of the World Trade In February, authorities which they say allows for the Organization, intellectual in the Netherlands, which seizure of medical shipments property rights apply only is a key transit hub, held for on the basis that they might be at a shipment’s origin and several weeks a shipment of infringing intellectual property destination. cardiovascular drugs destined rights or be counterfeit. The organisation says that for Brazil, and in the past year See www.wto.org/english/ n e/alamy Koe o n

T the seizure is the latest example there have been at least 14 theWTO_e/minist_e/min01_e/ Seizure of antiretroviral drugs could risk the of overzealous enforcement of other documented cases (BMJ mindecl_trips_e.htm. health of Nigerian patients, aid agencies warn European regulations that aim 2009;338:b558). Cite this as: BMJ 2009;338:b1002

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National Authority, which has little authority in practice and has been burdened by inef- ficiency, cronyism, [and] corruption, and the inappropriate priorities repeatedly set to sat- isfy the preferences of foreign aid donors.” The problems have been “exacerbated and perpetuated under conditions of mili- tary occupation,” it adds. Aid from outside donors has focused mostly on relief and emergency work rather than long term development. Such aid has had “limited effectiveness, duplicated efforts, and eventually undone previous progress,” says the report. Rita Giacaman of Birzeit University, one of the researchers, said, “It’s like a band aid over an infected wound.” More than $9bn (£6.3bn; €7.1bn) in inter-

Nasser Ishtayeh/ap/pa Nasser national aid has not promoted development, Checkpoint delays have resulted in Palestinian women failing to reach maternity hospitals to give birth she said, “because Palestinians do not have basic security.” More than 1300 Palestinians were killed Palestinian health crisis will end only during the recent 22 days of aerial and ground attacks, and destruction and control of infra- with Israeli withdrawal, concludes study structure have severely restricted fuel supplies and access to water and sanitation, the report Clare Dyer BMJ The report, a series of papers, was peer says. Unemployment and poverty levels have Palestinians in the West Bank and Gaza reviewed during drafting by an editorial risen, and almost half of ­Palestinians depend Strip are enduring a chronic health crisis steering committee that comprised Iain on food aid. that will be fully alleviated only by an end Chalmers of the James Lind Initiative, Harry The former US president Jimmy Carter to the occupation by Israel, a two year, peer Shannon of McMaster University in Canada, says in an editorial accompanying the reviewed study by an international team has Jennifer Leaning of Harvard University, and papers: “The health situation in the occu- concluded. Huda Zurayk from the American Univer- pied Palestinian territory shows the urgency The report, written by a team of health sity of Beirut. They were helped by a team of finding a political solution, as restraints scientists from Birzeit University, near Ram- of international discussants who criticised and insecurities will continue to undermine allah, West Bank—together with colleagues manuscripts and offered advice. The finished the creation of a health infrastructure able from the World Health Organization, papers then underwent external peer review to address the dire public health needs United Nations agencies, and universities after submission to the Lancet. of ­Palestinians. And as long as significant in the United States, the United Kingdom, The report says that attempts since 1994 ­segments of Palestinians are hungry, sick, ­Norway, and France—is described as the to establish an effective healthcare system and without hope of alleviating their plight, ­latest and most comprehensive assessment have failed. It says, “This failure results from a meaningful peace cannot be achieved.” yet produced of the health of Palestinians. arrangements for health care established by Health in the Occupied Palestinian Territory Published by the Lancet, it points to numer- the Israeli military government between is at www.thelancet.com. ous indicators of worsening health among 1967 and 1994, the nature of the Palestinian Cite this as: BMJ 2009;338:b970 the 3.8 million residents of the West Bank and the Gaza Strip, where women of repro- ductive age and children under 5 years old make up roughly 40% of the population. Dreadful visitations Poverty has risen sharply, the report says, Wendy Moore London celebrates the successes in and the Israeli imposed system of check- The trials and triumphs of overcoming such disasters. points and barriers to movement has severely city life are told through a Exhibits include the Bills of restricted access to medical services. collection of rare medical Mortality (shown) recording Hanan Abdul Rahim, the lead author of books in an exhibition the death toll from plague the report’s section on maternal and child opening at the Royal Society in 1665 and John Snow’s health, said that the Palestinian Ministry of of Medicine library this week. map plotting the cholera Health reported 69 cases of women giving Dreadful Visitations and outbreak of 1854. birth at Israeli military checkpoints between Deliverances: The Medical The exhibition runs until 2000 and 2006. Some 10% of women in History of London charts 29 May at the Royal Society labour were delayed for two to four hours the effects on Londoners’ of Medicine, 1 Wimpole on the way to the maternity hospital, when health of plague, cholera, Street, London W1G 0AE. the average time without roadblocks would pollution, and war. It also Cite this as: BMJ 2009;338:b1003 have been 15 to 30 minutes.

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Moving on from bench to bedside to population The new academic health science centres in England defined their role at a conference last week

Geoff WattsL ondon “The moment has been a long time com- ing,” declared Alan Langlands, sometime chief executive of the NHS in England. The moment he was referring to—the imminent emergence of a system of academic health science centres in England—was greeted last week with a conference held at Guy’s Hos- pital in London. Arranged by King’s Health Partners, one of the aspirants to academic health science centre status, the meeting set out to review the hopes embodied in these (mostly) embryonic organisations. The culmination of several decades of fretting over what Sir yce Alan described in his opening address as the health service’s essentially “casual” rela-

tionship with research, the new centres are allar d p i ers intended to close the gap between medical Alan Langlands suggests the new centres will close the gap between medical academia and the NHS academia and the NHS. It was the health minister Ara Darzi who the Institute of Psychiatry, summarised his of community health workers, and by set- in his High Quality Care for All: NHS Next group’s work on the causes of Alzheimer’s ting up programmes devoted to childhood Stage Review first announced the plan to disease. The group’s key finding has been injury, cancer, and other conditions that are foster a group of academic health science that in the brains of Alzheimer’s patients a over-represented in the area. The academic centres. Each, he said, would bring together disproportionately large amount of a neu- healthcare professionals delivering and over- a small number of health and academic bod- ronal protein called tau is phosphorylated. seeing this work mostly do so within the con- ies to encourage world class research. King’s The enzyme predominantly responsible for text of research programmes. The staff get Health Partners, for example, comprises this phosphorylation is glycogen synthase the papers; the people get the care. Guy’s, St Thomas’, and King’s College Hos- kinase-3 (GSK-3). This may prove to be not Another of the aims of health science cen- pitals, King’s College itself, and the South only a useful marker of the disease but a clue tres is to hasten the translation of research London and Maudsley NHS Trust. to treatment. The search is already on for into clinical practice: from bench to bedside, Not that research is the only intended ben- inhibitors of GSK-3. as the slogan has it. The final speaker at the eficiary. The new centres are also supposed This work, he told conference delegates, London meeting was Victor Dzau, president to boost the quality of teaching and care of has occupied 15 years and taken place within of the Duke University Health System in patients. Neither the government nor Lord four different organisations. If carried out Durham, North Carolina. He likes to empha- Darzi himself can grant health science cen- within an academic health science centre it sise the importance of an academic centre’s tre status. This privilege belongs to a com- could surely have been completed more effi- mission to serve the local community by mittee of international experts chaired by ciently and perhaps more speedily. A single adding a third term to the slogan: bench to Ian Kennedy, the Healthcare Commission’s centre would have meant closer collaboration bedside to population. chairman. The committee has been rating all between different basic science departments Imperial College London, together with applicants on their track record and future and between basic and clinical sciences. St Mary’s Hospital and Hammersmith Hos- potential. Their track record will include evi- Recruiting the patients needed for clinical pital, has been describing itself as an aca- dence of international standing in biomedi- studies would also have been quicker. demic health science centre since October cal, clinical, and applied health research, of Less glamorous than research benefits, and 2007. Introducing the new grouping, its chief excellence in teaching, and of the quality of also less straightforward to demonstrate, are executive, Stephen Smith, foreshadowed the their patient care. Criteria for their future the effects of the academic health science government’s own intentions by saying, “We potential include vision, ambition, and likely model on routine care of patients. Michael must be good at discoveries and inventions, benefits to the local community. The con- Klag is dean of the school of public health but then we must be positive and quick at cept itself is not new, and working examples at Johns Hopkins University in Baltimore, introducing these advances into our health- can be found from Harvard University in one of the best known of the US academic care system.” the United States to the Karolinska Institute health science centres. His university, he Lord Darzi has issued a stern warning that in Sweden. pointed out, is located in east Baltimore in groups with “self-designated AHSC status” By way of illustrating the potential ben- the middle of an area of poverty. It fulfils will still be subject to review by his interna- efits of a health science centre, Simon Love- its duty to the local population through its tional panel. stone, professor of old age psychiatry at Urban Health Institute, through a corps Cite this as: BMJ 2009;338:b990

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