News @ a glance
===============

* Barbara Sibbald

*   © 2004 Canadian Medical Association or its licensors

**Smoke alarm in UK:** Despite a call from 18 royal colleges of medicine to ban smoking in public places, the UK government is still reluctant. The government threatened legislation in its 1997 White Paper if the voluntary approach failed, and ASH (Action on Smoking and Health) is considering holding it to that. Only 36 pubs enforce smoking bans. The government faces enormous pressure from the tobacco industry as well as the hospitality sector, both of which have been advocating improved ventilation measures in an attempt to delay legislation. About 80% of Britons are non-smokers, yet 1000 die annually from second-hand smoke related diseases. Prof. Carol Black of the Royal College of Physicians said that if smoking were banned in all workplaces, 300 000 more people would give up smoking. Ireland and Norway recently banned smoking in public places. — *Anne Johnston*, London, UK

![Figure1](http://www.cmaj.ca/)

[Figure1](http://www.cmaj.ca/content/170/8/1218/F1)

Figure. Photo by: Richard Gordon


![Figure2](http://www.cmaj.ca/)

[Figure2](http://www.cmaj.ca/content/170/8/1218/F2)

Figure. Photo by: ASH

**Estrogen study halted:** The US National Institutes of Health halted a large study on the effects of estrogen pills in healthy older women after preliminary data indicated an increased risk of strokes and essentially no lasting benefits. The 11 000 healthy, postmenopausal participants in the Women's Health Initiative (WHI) estrogen-alone study were asked to stop taking the pills in March, a year before the study was slated to stop. The full results will be published in May. “Estrogen alone does not appear to [either increase or decrease] heart disease, a key question of the study,” reported Dr. Barbara Alvin, director of the WHI. “At the same time, estrogen alone appears to increase the risk of stroke and decrease the risk of hip fracture.” In July 2002, another arm of the WHI trial was halted after preliminary data revealed that estrogen plus progestin hormone replacement therapy resulted in statistically significant increases in coronary disease, invasive breast cancer, stroke and pulmonary embolism (*CMAJ* 2002; 167[4]:329).

**Safe injection site criticized:** North America's first safe injection site contravenes international drug treaties and is a “source of grave concern,” states the International Narcotics Control Board. The site opened in Vancouver last September with the capacity to supervise 600 injections daily (*CMAJ* 2004;170[1]:25). The board, an independent, quasi-judicial control agency for monitoring the implementation of the UN drug conventions, states that “such sites are contrary to the fundamental provisions of the international drug control treaties which oblige States/parties to ensure that drugs are used only for medical or scientific purposes.” Board members visited the site in October and urged “the Canadian Government to comply with its obligations under the international drug control conventions.” Vancouver Mayor Larry Campbell discounted the board's criticism, saying “It has no concept of harm reduction.” The UN-funded board, which identifies and predicts dangerous trends, also criticized Ottawa's plan to decriminalize possession of up to 30 grams of cannabis. “The Board is concerned that the revisions could contribute to the mistaken perception that cannabis is a harmless substance,” stated its annual report. 

**Books for Kabul:** University of Manitoba medical students are restocking the shelves of the medical library in Kabul, Afghanistan. “They have 300 books, which are about 30 years out of date,” said Dr. Richard Gordon, a professor of radiology. He started the Kabul Medical Library Project after seeing a CNN news item about the state of the Kabul College libraries. Medical student volunteers from across Canada, including 30 from Manitoba's International Health Group, took on the project and had gathered some 900 texts by early March. Gordon hopes to send the books, via military planes, to Kabul by May. “It looks like this first project will be successful and provide impetus for other projects,” said Gordon. Donations are needed for bookcases and more (800 330-8066).

**GI warning with SSRIs:** Selective serotonin reuptake inhibitors (SSRIs) should be avoided or used with caution in people at risk of gastrointestinal bleeding according to the UK's *Drug and Therapeutics Bulletin*. After examining data from 3 published studies, the article concluded that people taking SSRIs are about 3 times more likely to develop GI bleeding compared with patients not using them. Editor Joe Collier said that while the overall risk of GI bleeding due to the use of SSRIs is small, this risk is “significantly increased” among older patients, those with a history of GI bleeding and those taking aspirin or NSAIDs. “The best course of action, therefore, would be to limit use of these antidepressants in these ‘at risk’ patients.” — *Colin Meek*, Wester Ross, Scotland

**Testing blood for Chagas' disease:** Canadian Blood Services (CBS) hopes to screen donated blood for *Trypanosoma cruzi*, the protozoan that causes Chagas' disease, if a suitable test becomes available, perhaps within 3 years. Later this year, the CBS plans to begin evaluating a screening kit being developed by Janssen- Ortho. *T. cruzi* is found mainly in Latin America; there have been 2 transfusion-related cases in Canada. Infection is lifelong, and 15%–30% of cases have fatal damage to the heart and digestive tract. Some 50 000 die annually of Chagas' disease. The US, which has documented 5 transfusion- related cases, is also planning to introduce screening. — Compiled by *Barbara Sibbald*, CMAJ