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Long term smoking contributes to cognitive decline

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and launched in Britain by the US company UnitedHealth Group.

Russia

Susan Mayor London

United States India

China

Researchers have found that among people who had their IQ measured at the age of 11, smokers had the greater cognitive decline by the age of 64. Smokers also had lower psychomotor speeds. We conclude that long term smoking does not produce long term cognitive benefits; to the contrary, smoking makes a small but significant contribution to cognitive decline from age 11 to 64. Current smokers and nonsmokers had significantly different mental test scores at age 64. This difference remained after adjustment for childhood IQ, say the authors of a paper in Addictive Behaviors (2005;30:77-88). The authors, from universities at Aberdeen and Edinburgh, who say that some people have claimed that smoking can enhance vigilance, attention, and memory and lower the risk of dementia, set out to investigate whether smoking was a risk factor for relative cognitive decline from age 11 to 64.
Roger Dobson Abergavenny

Case-Managing Long-Term Conditions: What Impact Does it Have on the Treatment of Older People is available at www.kingsfund.org.uk/pdf/ casemanagement.pdf

Signed and ratified, or acceded Signatories signed, but not ratified Non-signatories

Nairobi summit opens with call for action for landmine survivors
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Ashcroft asks Supreme Court to block Oregons assisted suicide law

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US threatens Australia over plan to block extensions to drug patents

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The largest ever gathering of survivors of landmines this week called on states to solidify their commitment to the implementation of the Mine Ban Treaty of 1997 and to work towards greater help for people with disabilities. The 40 survivors, from 33 countries, were attending a landmine survivors meeting, which was part of the Nairobi summit on a minefree world, which opened in Kenya on Sunday. The International Campaign to Ban Landmines estimates that there are currently some 300 000 to 400 000 landmine survivors in the world today, with numbers increasing daily. While a great deal has been accomplished since the Ottawa Convention on the Prohibition of Anti-Personnel Mines was established, the plight of landmine survivors around the world remains a major humanitarian challenge, said Austrias permanent representative to the United Nations in Geneva, Wolfgang Petritsch, president of the Nairobi summit. The 42 countries which have not signed the treaty, as shown on the map above, include: China, Cuba, Egypt, Finland, India, Iran, Iraq, Israel, Kazakhstan, North and South Korea, Kyrgyzstan, Libya, Morocco, Pakistan, Russian Federation, Saudi Arabia, Singapore, Sri Lanka, and the United States.
Peter Moszynski Nairobi

The US government has warned Australia that legislative provisions seeking to ensure generic drugs are not blocked by frivolous patent extensions to branded drugs could trigger a trade dispute between the two countries. In late August, the Australian government reluctantly accepted amendments insisted on by opposition parties in the Senate that seek to prevent evergreening of patents, in which companies get a new patent for minor changes to a drug coming off patent, thereby extending the patents life and frustrating the entry of cheaper generics (BMJ 2004;329:420). The agreement was certified with an exchange of letters
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between the two governments. But the Australian minister for trade, Mark Vaile, has now said that he plans to push through what he describes as minor changes to legislation implementing the Australia-US Free Trade Agreement in the final parliamentary sitting for 2004.
Bob Burton Canberra

Evidence is weak for case management for the elderly

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Limited evidence exists for the effectiveness of case managementa process of planning, coordinating, managing, and reviewing the care of an individual across different servicesfor older people, and the NHS

should proceed with caution before introducing any particular model based on this approach, warned a report published this week. The report found little evidence from available research studies that case management reduced hospital admissions or that it was cost effective. The authors, from the Kings Fund, a charitable foundation doing healthcare policy research, cautioned against the NHS adopting any single approach to case management, which is currently being developed across the service as part of a plan to reduce emergency hospital bed days by 5% by improving the coordination of services for people with severe complex health problems. Several primary care trusts are currently piloting a nurse led model developed by Evercare

Former Attorney General John Ashcroft has asked the US Supreme Court to block Oregons assisted suicide law, known as the Death with Dignity Act. It was Mr Ashcrofts final move before his recent resignation and is the latest move in a three year battle between the state of Oregon and the federal Justice Department (BMJ 2004;328:1337). The act was approved by the state of Oregon in 1994 and reaffirmed in 1997. Oregon is the only state that allows assisted suicide by doctors, by administration of a lethal dose of a federally controlled substance. The act allows terminally ill patients with less than six months to live to request a lethal dose of drugs, and a doctor to administer it, provided that the patients diagnosis is confirmed by two doctors. More than 171 patients have been helped to commit suicide in Oregon since 1998. The Christian Medical Association, the largest religious association of doctors, applauded the federal government. But Oregons governor, Ted Kulongoski, argued that Oregon voters twice approved the right of terminally ill patients to die more quickly. Its past time for this administration to focus on ways to work with Oregon, not against us, he said. Portland lawyer Eli Stutsman, coauthor of the Oregon law, said Mr Ashcrofts appeal to the Supreme Court was politically inspired, and he expressed optimism that the court would not hear the case.
Fred Charatan Florida

BMJ VOLUME 329 4 DECEMBER 2004 bmj.com