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Paracetamol self-poisoning is a major cause of liver failure and death. Research by Professor Keith Hawton and colleagues in Oxford in the 1990s revealed the extent and characteristics of the problem, and led to UK legislation to restrict pack size in 1998. Hawton and colleagues then showed that this was followed by a substantial reduction, over 30%, in the number of deaths from paracetamol poisoning. Importantly, a 2013 analysis shows that the benefit has been sustained and is not diminishing, with an estimated 374 fewer deaths in the UK since 2008. Registrations for liver transplants due to paracetamol toxicity have also decreased. As a result of these benefits, three other countries have introduced similar restrictions since 2008.
Professor Irving Kirsch has conducted a meta-analysis of both published and unpublished clinical trials of antidepressants (Kirsch et al., 2008). This analysis demonstrates that the effects of antidepressants are mostly placebo effects except with extremely severe depression. The analysis opened an international debate on antidepressant efficacy, influenced NICE guidelines for the treatment of depression (NICE, 2010), and led the scientific committee of the European Medicines Agency to reconsider its own approval of antidepressants (Broich, 2009). It also informed public opinion through widespread media coverage, and produced intentions to change prescribing habits among 44% of surveyed UK doctors. Public awareness of Kirsch's work is such that a class action has been taken against Pfizer, a large pharmaceutical company, and the Vatican has convened an international study meeting (14-15 June, 2013) to produce new recommendations for the treatment of depression.
University of Bristol research has played an important role in shaping local, national and global suicide prevention initiatives. The consequent reductions in suicide rates have been substantial and many hundreds of lives have been saved thanks to this research.
The scope and scale of the impact has ranged from shaping World Health Organisation (WHO) strategy on preventing suicides by pesticide poisoning, informing national legislation on limiting access to the means of suicide in several countries (e.g. analgesics in the UK — 1000 fewer suicides between 2008 and 2013), informing guidelines on the responsible reporting of suicide for the UK media, and developing highly successful prevention measures at the Clifton Suspension Bridge, a suicide site in Bristol (30 fewer suicides between 2008 and 2013).
In 2008-2009 the UK was subject to legal infraction proceedings at the European Court of Justice (ECJ) for allegedly failing to implement the European Union's Urban Waste-water Treatment Directive (UWWTD). Research by the Institute of Estuarine and Coastal Studies, Hull (IECS) for the Environment Agency (EA)/Defra provided evidence to the UK Government for its defence against these allegations. The research consisted of:
- literature/data reviews and collection and analysis of critical evidence from the Humber.
- co-ordinating workshops and convening an expert panel of sufficient authoritative academic opinion to counteract the European Court of Justice allegations.
In December 2009 the European Court of Justice ruled in favour of the UK. Our research therefore helped to save very significant, unnecessary capital investment in nutrient removal technology for sewage treatment nationally and in the Yorkshire and Humber region especially. The UK government thus avoided the possibility of major European Commission fines of up to €703,000 per day, or €256m per annum, for infraction of the Urban Water-water Treatment Directive [1].
Research on the environmental safety and toxicity of nanomaterials in fishes has had a global impact across both government and industry contributing to:
(i) Consensus building on biological effects allowing regulatory agencies/governments to make proper decisions on the hazard of nanomaterials to farmed fish and wildlife.
(ii) Critical evaluation of the internationally agreed process of toxicity testing to determine whether the current legislative test methods are fit for purpose and acceptable to the aquaculture industry.
(iii) Identification of national/international research priorities and policies via work with the OECD and the US Government.
(iv) Influencing government policy to support training and information for industry.
Congenital myasthenic syndromes (CMS) are diseases leading to muscle weakness. They are caused by various gene mutations. However, for many CMS patients with a `limb girdle' pattern of weakness, the gene was unknown, and they were unresponsive to the usual CMS treatments. Research by David Beeson and colleagues has changed this state of affairs. First, they showed that this form of CMS is caused by a mutation in a gene called DOK7. Second, they identified the mechanism by which the mutation causes the disease. Third, they discovered that patients with DOK7 mutations respond to a different class of drug, 03b22 adrenergic receptor agonists. DOK7 mutations are now routinely tested for in clinical practice, and these drugs are standard therapy.