Hip fracture risk, smoking and anti-ulcer drugs (PPIs)?

@HealthMed A report in the latest British Medical Journal by Chan and his team from the Gastro-enterology Department at the Massachusetts General Hospital in Boston, USA, suggests a small but potentially important higher risk of hip fracture in current or ex-smokers among post-menopausal women on treatment with the commonly used anti-ulcer drugs - proton pump inhibitors. The risk was small - one extra hip fracture per year for every 2000 women treated -but the risk was greater, the longer the treatment with a PPI. 

The link is biologically plausible as both PPIs and smoking have actions on the body which could increase the risk of hip fracture. The authors were careful to state that the risk did not apply to non-smokers and for those at risk they were unable to attribute this to any specific type of PPI. Of note, there are several reasons why smokers are more at risk of causes of indigestion/dyspepsia which may make them more likely than non-smokers to be on PPI treatment.
 
This report is another example illustrating that drug choice and duration should be based on balancing clinical benefit against potential risk of adverse drug effects.
This was an older study among nurses in the US from data collected from 2000 up to 2008.  
A weakness of the study is that it was not a randomised controlled trial. The report was based on following a cohort of people some of whom happened to be on PPI treatment : that means that the findings may be subject to bias ie there may be reasons unrelated to the PPIs to explain the hip fracture risk, although the authors made clear efforts to control for obvious sources of bias.
Patients who are concerned should consult their GP or pharmacist for advice.

See source reference
Khalili H, Huang ES, Jacobson BC, et al. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. British Medical Journal. Published online January 31 2012

Call for papers for 2012 International Symposium on Poetry and Medicine and Hippocrates Awards

Registration is open for the 3rd International Symposium on Poetry and Medicine to be held on Saturday 12th May 2012  in London at the Wellcome Collection rooms on the Euston Road. The symposium will include poster sessions, lectures, round table discussions and poetry readings (by former President of the Poetry Society Jo Shapcott and 2012 Hippocrates Awards judge Marilyn Hacker) and the 2012 Hippocrates Awards will be announced at the end of the Symposium. 

The programme includes contributors from the UK, USA, Denmark, Greece, Cyprus and France. There are sessions on historical and contemporary themes, illness and poetry, poetry as therapy, poetry in the education of medical students, nurses and doctors, and poetry as an aid to health professionals. The provisional programme of lectures, round table discussions, poetry readings and the Hippocrates Awards Ceremony is now published on the Symposium website.

 Poster abstract submission remains open - deadline 31st March 2012.
 
The Hippocrates initiative was named winner of the Award for Excellence and Innovation in the Arts in the 2011 Times Higher Education awards, announced on 24th November 2011 in London. This award aims to recognise the collaborative and interdisciplinary work that is taking place in universities to promote the arts. 

Entries are now closed for the 2012 Hippocrates Prize for poetry and medicine, which is for unpublished poems in English.  

The Hippocrates poetry and medicine initiative was co-founded by a team from University of Warwick, and has been supported by several external organizations interested in medicine and the arts, including the Fellowship of Postgraduate Medicine, the Wellcome Trust, the Cardiovascular Research Trust and Heads, Teachers and Industry. 

In its first 3 years, the Hippocrates Prize has attracted over 4000 entries from 45 countries, from the Americas to Fiji and Finland to Australasia.

With a 1st prize for the winning poem in each category of £5,000, the Hippocrates prize is one of the highest value poetry awards in the world for a single poem. In each category there is also a 2^nd prize of £1,000, 3^rd  prize of £500, and 20 commendations each of £50.  

BBC broadcaster and journalist Martha Kearney has joined New York poet and critic Marilyn Hacker and medical scientist Professor Rod Flower FRS to complete the judging panel for the 2012 Hippocrates Awards for Poetry and Medicine.

For more on the 2012 Hippocrates Awards and the Hippocrates initiative see my recent update. 

New deadline midnight GMT 3rd February for 2012 Hippocrates entries

Entries are now closed for the 2012 Hippocrates poetry & medicine awards for which there is a £5000 1st prize in each of 2 categories: an Open International Prize and UK NHS-related Prize for an unpublished poem of up to 50 lines written in English. Judging is anonymous.

For the 2012 awards there have been entries from 5 continents, from 32 countries from Argentina to Australia, Brazil to Burma, Italy to India, South Africa to Switzerland, Ghana to Germany, France and Switzerland, and with poems submitted from 36 US states, 5 Indian states, 5 Canadian provinces, and from throughout the UK.

Hippocrates Prize winners will be announced by the judges, Marilyn Hacker, Martha Kearney and Professor Rod Flower, FRS,  at the Awards Symposium in London, Sat 12th May at the end of our 3rd International Symposium on Poetry and Medicine.

A downloadable poster about the 12th May International Symposium on Poetry and Medicine is available.

There is more information about the Hippocrates Initiative in earlier postings on this blog.

The Hippocrates initiative received a 2011 Times Higher Education Award for Excellence and Innovation in the Arts.

For further information, see the Hippocrates initiative website or email the organisers.

Smoking advice in literature

F Scott Fitzgerald

@HealthMed In 'The beautiful and damned', F Scott Fitzgerald's novel of the East Coast 'smart set' during the period just before The Great War and published in 1922, mention of smoking by the superficially charmed young men and women is very frequent, including for Gloria (age '22'). However also striking is Gloria's comment on advice from reformers that '... if you smoke so many cigarettes you'll lose your pretty complexion!'
Further examples welcome of earlier literary offers of advice on risks of smoking, heeded or ignored?

See related previous blog on: Stopping smoking - why and how?

FPM to launch a new journal on Health Policy and Technology

@HealthMed Health Policy and Technology (HPT), the new official journal of the Fellowship of Postgraduate Medicine (FPM), will be launched in March 2012 as a cross-disciplinary journal, which will focus on past, present and future health policy and the role of technology in clinical and non-clinical national and international health environments. HPT will be published by Elsevier, a major international publisher of scientific, technical and medical information

The FPM continues to publish its first international publication, the Postgraduate Medical Journal, launched in 1925. HPT provides a further excellent way for the FPM to continue to make important national and international contributions to development of policy and practice within medicine and related disciplines. The aim of the FPM in establishing this new international journal is to publish relevant, timely and accessible articles and commentaries to support policy-makers, health professionals, health technology providers, patient groups and academia interested in health policy and technology.

Topics covered  by HPT will include
- Health technology, including drug discovery, diagnostics, medicines, devices, therapeutic delivery and eHealth systems
- Cross-national comparisons on health policy using evidence-based approaches
- National studies on health policy to determine the outcomes of technology-driven initiatives
- Cross-border eHealth including health tourism
- The digital divide in mobility, access and affordability of healthcare
- Health technology assessment (HTA) methods and tools for evaluating the effectiveness of clinical and non-clinical health technologies
- Health and eHealth indicators and benchmarks (measure/metrics) for understanding the adoption and diffusion of health technologies
- Health and eHealth models and frameworks to support policy-makers and other stakeholders in decision-making
- Stakeholder engagement with health technologies (clinical and patient/citizen buy-in)
- Regulation and health economics

Professor Wendy Currie will lead the journal as its founding Editor-in-Chief. Her research, consultancy and publications focus on policy-making for large-scale information and communications technology (ICT) projects in health, financial services and government.

The first issue of Health Policy and Technology will focus on Electronic Health Records in the 21st Century, with papers discussing implementation targets for EHRs in healthcare organizations, cross-border policies for EHRs, financial and non-financial costs of introducing EHRs, clinical and patient engagement with EHRs, government policy for EHRs and country comparisons, security and governance practices in relation to EHRs, and the role of EHRs in campaigns to improve citizens' health and reduce health inequalities.

The first issue also includes a paper on the pioneering new Centre for Health Technology Assessment of Devices and Diagnostics within the UK’s National Institute for Health and Clinical Excellence (NICE). There is also the first of a series of interviews with international leaders in the field of health policy and technology, beginning with Sir Michael Rawlins, Chairman of NICE.

The aim of the Fellowship of Postgraduate Medicine (FPM) is to promote international calibre excellence in postgraduate medical education through its publications, clinical and scientific meetings, and other activities.  The FPM is a British medical charity that was founded at the end of World War I, when it pioneered development of post-graduate educational programmes in all branches of medicine.

Its foundation was the result of a merger between the Fellowship of Medicine and the Postgraduate Medical Association, with Sir William Osler the first president of the new organisation. The FPM is supported by Fellows with expertise in the practice of medicine, medical education and publishing, and research in medicine and related disciplines.

HPT website

FPM website

FPM contact email

Commended 2011 Hippocrates entry published in Br J Psychiatry

@HealthMed 'Street-wise' by Wendy French, one of 20 NHS entries commended in the 2011 Hippocrates Prize for Poetry and Medicine, has been published in the December issue of the British Journal of Psychiatry.

 

Entries are closed for the 2012 Hippocrates Awards. With a 1st prize of £5000 for the Open International category and a separate 1st prize of £5000 for the UK National Health Service-related category, this is one of the best funded awards anywhere in the world for a single poem.

Judges for the 2012 Hippocrates Awards are New York poet and critic Marilyn Hacker, medical scientist Professor Rod Flower FRS and BBC broadcaster and journalist Martha Kearney.  

Awards will be presented in London on Saturday May 12th 2012, at the 3rd International Symposium on Poetry and Medicine, to be held at the Wellcome Collection rooms in London. 

During the 2012 Symposium, there will be readings by Jo Shapcott, Past-President of the Poetry Society, and US poet and 2012 Hippocrates awards judge, Marilyn Hacker.  

From eternal fires to venom and personalised medicine

@HealthMed Why should picnics, 'show and tell', and morning break be memorable for a small boy in the Middle East? The road for weekend family visits to the river Zab passed near rocky slopes, above which a heat haze marked scattered low flames. The existence of eternal fires was noted by Greek historian Herodotus, writing in the 5th century BC. A matter-of-fact article in the Pittsburgh Press, 14th May 1965, refers to these as 'seepage of natural gas in the Kirkuk oil field', part of the lands once ruled by Nebuchadnezzar, king of the Neo-Babylonian Empire from ca. 605 BC – 562 BC. The Kirkuk area is now part of northern Iraq. These 'eternal fires', due to natural gas escaping from the rocks, give a possible explanation for the biblical reference to Daniel's three friends, Shadrach, Meshach and Abednego being put to the den of fire. An obvious reason to survive the fires would be, at the right time, heavy rain temporarily extinguishing the flames. Other sites where self-igniting natural gas leaks occur include Central Java.
Primary school play was subject to interruption by sandstorms, and on one occasion spent indoors to avoid a plague of locusts, so dense as to make breathing difficult. Knowing then of locusts from stories of the plagues of Egypt, my memory is of surprise that hedge and tree leaves were largely uneaten. And 'show and tell' was made the more exotic because a friend's father had ready access to formalin - his son regularly bringing in a preserved scorpion or multi-coloured snake. Both may use in their venom sarafatoxin, a primitive form of endothelin, to immobilise pray through causing angina, due to severe coronary artery spasm. This knowledge about toxins arose from the discovery of endothelin by Yanagisawa, reported in 1988
The ancient town of Arapha, near the modern Kirkuk area oil field discovered in 1927, was an important centre in the time of the Babylonian King Hammurabi (fl. 1792 BC to 1750 BC), who provided the early legal Hammurabi Code, including rules for good medical practice, dating back to around 1772 BC. A historical connection to an early example of guidelines for 'personalising medicine'.

-->

© DRJ Singer