Sun, May 01, 2005 - Page 9 News List

Are the needle's days numbered?

Injections without puncturing the skin, but rather projecting into it, are being mooted as a more effective everyday health procedure

By Natalie Hanman  /  THE GUARDIAN , LONDON

Hugh Pennington, president of the UK's Society for General Microbiology, says: "If we can get rid of needles, that would be a good thing. They can be very painful, especially for kids."

And despite prevention measures, needles still pose a risk. A WHO report says: "Reuse of syringes and needles in the absence of sterilization exposes millions to infection." Unsafe injections are the chief cause of hepatitis C in developing countries, and globally are behind nearly 2 percent of new HIV infections each year.

The problem is exacerbated by a trend for overuse. Patients sometimes prefer jabs because they believe they are best; doctors then overprescribe injections because it is what patients want, and often charge a higher fee for doing so.

"Up to 96 percent of persons [in developing countries] presenting to a primary healthcare provider receive an injection, of which over 70 percent are unnecessary," the report said.

"It's the same in the UK up to a point," Pennington says. "People have the idea that an injection is more powerful." But if this placebo effect gives people confidence, he says, it has to be taken into account. Unless, of course, they are among the estimated 1-3 percent of the population believed to have a phobia of injections.

Sophie Lojez, technical officer for the WHO's Safe Injection Global Network, says more research must be done before a new device is implemented: "We investigated needle-free technologies for mass immunization, but there was doubt whether they were safe. Before any recommendation we need to look at how effective it is."

This involves examining safety, cost, availability, and ease of retraining medical staff. In the meantime, Lojez says, the WHO is using safer devices, such as auto-disposable syringes, which deactivate after a single use.

The UK also accepts the need for better protection from needle-stick injuries, which cause 100,000 accidents every year. The UK's state-funded National Health Service (NHS) reports that sales of safer devices are growing, but traditional needles are cheap and widely used, so the argument for a replacement has to be persuasive.

A specialist at the University of Oxford (UK) pain research unit, who did not want to be named, believes the uptake in needle-free devices has been scotched by manufacturing companies who do not want the competition.

"It is not in their interest to develop this technology," he says. "The companies with the big pennies are not too keen."

Dr. Graham Archard, vice-chairman of the UK's Royal College of General Practitioners, agrees.

"I'm quite sure there were several alternatives that could have been devised by now, but the opposition would be enormous," he says.

Archard doesn't believe there is a large market for needle-free devices, although "young diabetics might find it better than conventional methods."

So perhaps the future lies in a balance: a needle-free option for specialist cases, with sustained safe needle use for the mass market.

As for the MicroJet, Von Muhlen says there's still some way to go.

"Within a year we should have human clinical trials slated," he says.

But is that just the optimism of an eager undergraduate?

"Good for them," says Archard, who encourages young scientists to experiment. "But one has to be guarded -- it is at a very early stage."

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