Overdiagnosis and over-treatment of malaria is a major problem in South and central Asia, where malaria is a minority cause of febrile illness, and primary health centres often rely on clinical symptoms for a diagnosis. Researchers from London and Afghanistan conducted a patient randomised study in a primary care setting in two areas where malaria is endemic. They found that rapid diagnostic tests for malaria reduced inappropriate use of antimalarial drugs compared with clinical diagnosis.
The tests also improved the detection and treatment of rare cases of P falciparum malaria compared with microscopy. The authors conclude that the introduction of such tests should be considered, to improve clinical care, reduce the overuse of antimalarials, and improve disease surveillance. The accompanying Editorial fundamentally agrees, but points out that rapid diagnostic tests are not necessarily a substitute for good microscopy.
Meanwhile, back in the First World, US researchers investigated if the widely publicised warnings in 2003, from the US Food and Drug Administration, about a possible increased risk of suicidality with antidepressant use in young people were associated with changes in antidepressant use, suicide attempts, and completed suicides among young people. They found that safety warnings about antidepressants and widespread media coverage decreased antidepressant use, and that suicide attempts in young people increased simultaneously. The authors caution that it is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting.
In an accompanying Editorial, three UK researchers argue that a better understanding is needed of how patients, doctors, and others respond to warnings to ensure that attempts to reduce drug related harm do not inadvertently achieve the opposite. “One approach would be to use the rich data in individual electronic health records to conduct extensive and powerful observational evaluations of the effects of treatments in the real world,” they say.
Will digital technologies facilitate a greater understanding of health issues around the world? The BMJ’s patient partnership editor, Tessa Richards, blogged from a conference in Paris (Health 2.0—new technologies and e-patients). According to its own website, Doctors 2.0 & You is “the only international congress devoted to the understanding of how physicians use new technologies, Web 2.0 tools, [and] social media to communicate with other healthcare professionals, patients, payers, pharmaceutical companies, [and] public agencies.” Let’s hope they will play a major part in providing access to good healthcare for all.
Birte Twisselmann is web editor and obituaries editor, The BMJ.