The Pharmaceutical Journal
Vol 275 No 7377 p670
26 November 2005

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Pressure on the prescriber more
“The cups that cheer but not inebriate” more
Antidepressants need supportive support more
La Corona: lost city of Guatemala unearthed more

Pressure on the prescriber

An investigation by Nature, described in the 20 October issue, has indicated that more than one third of authors of papers describing drug use have been subject to unwarranted influence from those with a financial interest in the treatment.

Public health experts have also claimed that drug companies distort decisions over the prescribing of new products, and more than one third of the authors concerned have declared a financial interest in the manufacturer. A health policy specialist at Harvard Medical School states that the guidelines published for the information of doctors are often specifically written with the intention of biasing prescribing habits.

In a 2004 survey of more than 200 guidelines current around the world, only 90 were found to contain information on the authors’ conflicts of interest and only 31 of these were free from clear industrial interest. More than a third of panels examined included at least one member who was in the habit of giving seminars on behalf of an interested drug manufacturer. One in 10 had a member who owned stock in the company concerned.

Assessing how many authors have actually declared a conflict of interest and also have links with industry has proved difficult. But the declarations of 685 authors who admit a conflict of interest have been examined and it has been calculated that 35 per cent of them offer evidence of a link.

The influence exerted by industrial money on the choice of prescription drugs is thought to be powerful, though often unconscious. In Britain, some of the experts used by the National Institute for Health and Clinical Excellence have close links with industry, although the institute itself is independent. How to deal with critical authors who are confronted with a conflict of interest in the course of their work is a matter that calls for closer consideration than it has hitherto been afforded.

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“The cups that cheer but not inebriate”

When the East India Company was established in 1600 its mainstay was the import of tea from China. This commodity was sold a little later in a London coffee house, where it entered into competition with coffee as a beverage.

The West in general favoured black tea, whereas in the East green tea was preferred. Both teas came from the same plant, but the method of preparation differed considerably. For green tea the leaves of Camellia sinensis were dried for a short period, then heated to prevent the further fermentation that produces black tea. Yet another beverage material, white tea, was prepared from the earliest buds of the plant, together with leaves, and was allowed only the minimum degree of fermentation.

In the October issue of Chemistry World, Andrew Scott has discussed some aspects of the use of green tea as a cure for minor ills. Green tea, he writes, has been held in high esteem in Chinese and Japanese medicine for thousands of years and regarded as a potent promoter of good health and long life. Cancer is reported to have a lesser incidence in regions where the consumption of green tea is high. The infusion is claimed to prevent a wide range of pathological conditions, including solid cancers, leukaemia, heart disease, arthritis and diabetes.

Tea contains not only caffeine and theobromine but significant quantities of many vitamins — carotene, nicotinic acid, pantothenic acid, folic acid, vitamins C, B₁, B₂ and B₆. Regular consumption of tea also provides manganese and potassium. The polyphenols of tea include flavanols, flavandiols and phenolic acids, together accounting for up to 30 per cent of the dry weight of tea. The most potent are epigallocatechin-3-gallate and epigallocatechin itself. These are antioxidants able to protect cells against free-radical damage. Nevertheless, some toxic effects of green tea are possible, such as neural tube defects in infants if it is consumed to excess during pregnancy.

But, as Chesterton commented, “Tea, although an Oriental, / Is a gentleman at least” — contrasting it with cocoa, which, he said, is “a vulgar beast”.

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Antidepressants need supportive support

A note in the BMJ for 1 October reports the recommendations of a group of psychiatric experts for the clinical guidance of NHS health care workers. It states that when children or other young patients are treated for moderate to severe depression there should be concurrent antidepressant and psychological therapy, and not antidepressants alone. Antidepressant drugs should be carefully monitored for side effects, and should not be used in children suffering from mild depression. Medication is not the first-line treatment for depressed children and should be considered only when psychotherapeutic measures have failed to bring relief.

Once depression has been diagnosed and assessed, children with moderate to severe illness should be offered specific psychological therapy such as cognitive behaviour therapy, interpersonal therapy or family therapy.

The only antidepressant shown in trials to demonstrate benefits that outweigh risks is fluoxetine and, to a lesser degree, sertraline or citalopram.

The guideline cautions against the administration of paroxetine, venlafaxine, tricyclic antidepressants or preparations of St John’s wort to children or young patients.

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La Corona: lost city of Guatemala unearthed

In the issue of Nature for 6 October details of a long-lost Maya city in Guatemala have been revealed. For several decades archaeologists have been puzzled over 30 enigmatic sculptures, mostly carved stone blocks. Although widely distributed, they were believed to come from the same site, which was designated as Site Q. It has recently been claimed that that Site Q is an ancient city known as La Corona, situated in the Peten region.

The possibility that La Corona is Site Q was first brought to the attention of archaeologists in 1997 when researchers from Harvard investigated the place, and found sculptures resembling those of the Site Q stones. A Yale archaeologist came across a trench dug by looters some years before this and discovered an elaborately carved stone block in its original setting. The carvings matched those on the Site Q stones, and hieroglyphs dated it to the year AD 677.

Also discovered were records of key rulers and religious dates and statements that La Corona and another city, Calakmul, were once linked under the Maya. Details of the city of Calakmul have, however, been eroded.

La Corona lies within a national park, and should be protected, but ranchers pose an immediate threat to the site, and fires are encroaching upon the Mayan relics.

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