British Medical Journal articles from December 1997

British Medical Journal archives from December 1997

An ethical code for everybody in health care: a code that covered all rather than single groups might be useful.(Editorial)
December 20, 1997... Perhaps there was a time when professional ethics alone gave health care a sufficient moral compass. If so, that time has passed. The fate of patients and the public's health depends now on interactions so complex that no single profession...

Social suffering: relevance for doctors.(Editorial)
December 20, 1997... The term social suffering describes collective and individual human suffering associated with life conditions shaped by powerful social forces.[1] Unlike physical suffering or mental illness, it is largely unrecorded. New measures such as...

Choosing the best research design for each question: it's time to stop squabbling over the 'best' methods.(Editorial)
December 20, 1997... Lots of intellectual and emotional energy, ink, paper, and readers' precious time have been expended comparing, contrasting, attacking, and defending randomised control trials, outcomes research, qualitative research, and related research...

Just what the doctor ordered - more alcohol and sex.(Editorial)
December 20, 1997... So the hedonists were right. At this time of year it is traditional, even in such an open minded journal as the BMJ, to warn with varying degrees of humour or pomposity about the dangers of overindulgence, from the hazards of obesity to the...

Festive cheer for all? (health effects of drinking alcohol may be misunderstood)(Editorial)
December 20, 1997... Christmas and alcohol are inextricably linked. But the evidence based party goer has to weigh up a complex body of research. Like smoking, heavy drinking increases the risk of death from many causes. However, as Sir Richard Doll points out...

New Labour, new NHS? The white paper spells evolution not revolution. (English Labour Party government, National Health Service, white paper published by Labour Party proposing NHS reforms)(Editorial)
December 20, 1997... Since May the new Labour government has repeatedly pledged to abolish the reforms of the NHS carried out by the previous Conservative government in 1991. The internal market, competition, the business ethic, and general practitioner...

Sex and death: are they related? Findings from the Caerphilly cohort study.
December 20, 1997... Introduction Even for a group not especially known for humour, the epidemiologist's standard joke about "being broken down by age and sex" is rather tired. It is also conceptually colourless, for the non-epidemiologist takes more...

The earth may move, but let's keep our feet on the ground. (response to George Davey Smith and others in this issue, p. 1641)
December 20, 1997... Havelock Ellis, the Edwardian Dr Ruth, was concerned with what he called "the problem of sexual abstinence." Abstinence was, he claimed, responsible for neurasthenia, spinal irritation, hysteria, hypochandirasis, myalgia, and anorexia. This led...

Risk factors for winter outbreak of diarrhoea in France: case-control study.
December 20, 1997... Introduction In developed countries acute diarrhoea is a major cause of morbidity and medical expense. Each year in the United States about 99 million people experience acute diarrhoea or vomiting, of whom 8.2 million seek medical help...

Death rates of characters in soap operas on British television: is a government health warning required?
December 20, 1997... Introduction Death is a fact of life in soap opera. It is only natural that producers should exaggerate the danger of real life to make series interesting, but by how much do they do this? What sorts of occupations would be as dangerous...

Reliability of distance estimation by doctors and patients: cross sectional study.
December 20, 1997... The assessment of a patient's walking ability is a simple and practical method of evaluating the state of respiratory, cardiovascular, peripheral vascular, and neurological disease."[1 2] Such assessment correlates well with more sophisticated...

Births at Christmas are different: population based survey of 2 million deliveries.
December 20, 1997... The aim of the present study was to evaluate whether births occurring at Christmas are different from births taking place on other days of the year. We specifically wanted to test whether the pressure on the pregnant woman to have everything...

Do you know your chocolates? Recognition survey among medical staff of various grades.
December 20, 1997... Gifts of chocolates are common on hospital wards. Preregistration house officers have a massive exposure to a wide range and quantity of chocolates--one of the many early and challenging experiences for the new doctor. Chocolate contains...

Increasing handicaps in hospital medicine: two point cross sectional study of golfing activity among doctors.
December 20, 1997... Hospital consultants are often characterised by the media, and sometimes even by apparently well informed government ministers, as neglecting patients for private practice or the golf course. We investigated playing golf as a source of patient...

The colon in medicine: nothing to do with the intestinal tract.
December 20, 1997... Recent work on systematic reviews led us to reflect on the titles of many medical papers and then wonder why there seemed to be more colons about than before. We report our efforts to explore this gut feeling Methods and results We...

So many precious stories: a reflective narrative of patient based medicine in general practice, Christmas 1996.
December 20, 1997... General practice involves the skilful use of relationships[1] above all other resources, including the judicious use of time.[2] The ability to cope with uncertainty, exclude the dangerous, ignore the irrelevant, and decipher almost...

Do overweight people remove their shoes before being weighed by a doctor? Consecutive study of patients in general practice.
December 20, 1997... Casual observation and discussion with colleagues led me to the hypothesis that patients who are overweight tend to remove their shoes before being weighed by their doctor. I thought that this action was probably an attempt to reduce the...

One for the heart. (beneficial effects of alcohol consumption on the heart)
December 20, 1997... "An ounce of whisky, please Sister," or was it half an ounce or two ounces? I cannot remember now, but I know that I prescribed some tentatively after having sought the ward sister's opinion when I was called to my first patient with lobar...

Hip, hip, Hippocrates: extracts from The Hippocratic Doctor.(Medicine As a Profession)
December 20, 1997... What do doctors know of Hippocrates? Many have seen a presumed likeness of "the father of medicine"--a sharp eyed, balding Greek in a toga, often under a tree. Some may remember taking the Hippocratic Oath, which contains the laudable...

Swearing to care: the resurgence in medical oaths.(includes draft revision of Hippocratic Oath)
December 20, 1997... We are witnessing a resurgence of professional interest in medical oaths and codes of conduct. In the United Kingdom the General Medical Council has reissued its professional code and, together with the BMA, the royal colleges, and other...

Professionalism must be taught.
December 20, 1997... The subject of professionalism is often referred to in the medical literature, but the word itself is rarely defined--and it is assumed that physicians understand what it means to be a professional and use this understanding as they make...

Medicine needs its MI5. (British investigational force similar to American FBI)
December 20, 1997... The time is long overdue to add another arm to the policing of medicine. In this article I suggest changes to lever out of the profession the small minority of doctors who would be guilty of serious misconduct, to the benefit of patients and...

The BMJ and the 77 specialties of medicine. (British Medical Journal) (criteria and guidelines for getting information published in the BMJ)
December 20, 1997... "The BMJ never publishes anything useful to leechologists. You haven't got a single leechologist on your editorial board Once in a blue moon you publish a leechology paper, and it's always bloody awful. I don't know who you get to review them....

How to acquire a coat of arms.
December 20, 1997... The Faculty of Accident and Emergency Medicine was inaugurated on 2 November 1993. The new council decided that it would like a logo or badge to signify its identity and to adorn such items as headed notepaper and the president's badge of...

Diagnosis made by hallucinatory voices.
December 20, 1997... A previously healthy woman began to hear hallucinatory voices telling her to have a brain scan for a tumour. The prediction was true; she was operated on and had an uneventful recovery. No previous illnesses Born in continental Europe...

Two hundred years since Malthus.
December 20, 1997... Malthus was by training a mathematician and by profession a teacher of political economy, but his work was greatly influenced by his Christian convictions. In the first edition of his Essay, published in 1798, he put forward the hypothesis that...

Sailors and star-bursts, and the arrival of HIV.
December 20, 1997... Tracking the origins and early history of a newly recognised disease is more than just an academic exercise. To appreciate how a disease began can help medical science to combat it. The classic example is John Snow's investigation of the...

Length - and other strengths.(What Might an Online Scientific Paper Look Like in Five Years' Time?)
December 20, 1997... Scientific journals are centuries old, but the electronic publishing revolution is finally making an impact on them. We asked six people involved in electronic publishing to describe how an online "paper" might look in five years' time. The...

From snapshot to movie.(What Might an Online Scientific Paper Look Like in Five Years' Time?)
December 20, 1997... Within five years most readers and researchers will have understood that the scientific paper, despite its illustrious history, was merely a passing phase. Before the internet, papers were undoubtedly the best way to communicate the results of...

Variation adds value to the author's logic.(What Might an Online Scientific Paper Look Like in Five Years' Time?)
December 20, 1997... A primary research article purports to be an objective record of a discrete piece of work that addresses, in sequence, the introduction of the problem at issue, the approach and methods adopted, the results, and the conclusions to be drawn. One...

Looking to the future: amazon.com and four trends.(What Might an Online Scientific Paper Look Like in Five Years' Time?)
December 20, 1997... Amazon.com is the world's largest bookstore and currency the most successful enterprise on the internet. In amazon.com one can: * Easily find books by browsing; * Find books that are the most read; * Identify books recommended and...

It could fulfil our dreams.(What Might an Online Scientific Paper Look Like in Five Years' Time?)
December 20, 1997... This holiday season I'm dreaming . .. of an online scientific paper that is flexible, accessible, and exceptionally friendly for its diverse users. Like most dreams, this one takes no account of cost, technical feasibility, or any of the other...

"Papers" will still exist.(What Might an Online Scientific Paper Look Like in Five Years' Time?)
December 20, 1997... The very term "paper" is inescapably bound up with the printed word and has no real place in the context of "online." It carries with it clear notions of space limits, formats, and information packaging that have become an integral part of the...

Something for everyone.(What Might an Online Scientific Paper Look Like in Five Years' Time?)
December 20, 1997... Electronic publishing will turn scientific "papers" from dead documents into live ones. Vitek Tracz, founder of Biomednet and one of the contributors above, has called scientific papers "quasilegal documents." They are written not to be read...

Byron's appetites, James Joyce's gut, and Melba's meals and mesalliances. (Illnesses and Creativity)
December 20, 1997... Even for amateurs the retrospective rediagnosis of the famous is one of the lowest forms of medical history, but I hope this three course dinner with its appetiser (Byron), main course (Joyce), and dessert (Melba) will prove worthy of Christmas...

Commentary: ambivalence towards fatness and its origins. (response to article by Jeremy Hugh Baron in this issue, p. 1697)
December 20, 1997... At this distance the diagnoses cannot be absolutely certain, despite the extraordinary details Hugh Baron has so splendidly mustered. Anorexia nervosa is supposed to be a modern disease. I believe it has been around for a long time, probably...

How Renoir coped with rheumatoid arthritis.
December 20, 1997... Few people know that Pierre-Auguste Renoir, who lived from 1841 to 1919, suffered from severe rheumatoid arthritis for the last 25 years of his life. At the 13th European congress of rheumatology in Amsterdam in 1995 Mr Paul Renoir, the...

La salle de garde: bastion of the French lunch hour for junior doctors.
December 20, 1997... The Parisian teaching hospitals are guardians of a number of proud traditions, including (predictably) catering arrangements for internes, or junior doctors, at lunchtime. La salle de garde originally conceived in the mid-19th century to...

The hidden delights of psoriasis. (literary views of the disease)
December 20, 1997... In John Updike's novel The Centaur young Peter Caldwell has psoriasis.[1] He is not sure whether to tell his girlfriend, but he is also aware of the power that the disease can involve, when he wonders: "Should he tell her? Would it, by making...

Gimme five - books, that is.
December 20, 1997... We can probably agree that the best doctors will try to understand how the world looks to their patients. But how can we hope to achieve such understanding? We are prisoners of our own backgrounds (usually privileged), culture and experience...

The session. (humorous description of an Irish music session)
December 20, 1997... One of the joys of Irish culture is our music sessions. You stagger out of the lashing rain into a pub, someone is playing in the corner; you grab a beer, whip out your harpoon or your guitar and get involved More fun than Disneyland more team...

Transmission of Creutzfeld-Jakob disease in corneal grafts.(Editorial)
December 13, 1997... The public and political profile of transmissible spongiform encephalopathies has changed dramatically with the identification of a new variant of Creutzfeldt-Jakob disease[1] and continued uncertainty about the size of the threat this may...

The emerging role of statins in the prevention of coronary heart disease.(Editorial)
December 13, 1997... The Standing Medical Advisory Committee guidelines for the use off statins have ignited considerable debate in Britain, and similar discussions about the use of statins are, or soon will be, occurring in other countries. The crux of the...

Management of head and neck cancer in Britain.(Editorial)
December 13, 1997... Surgical and radiation oncologists will readily disagree over many aspects of cancer management but one point is widely accepted: patients with head and neck cancer probably present the greatest challenge of all. Apart from the obvious...

Hazardous drugs in developing countries: the market may be healthier than the people.(Editorial)
December 13, 1997... The international pharmaceutical market shows substantial regional differences in availability and promotion of drugs.[1] This variation depends on affluence, health requirements, capacity for local manufacture, and the restrictions which...

Developing www.bmj.com: full text current issues available from the world wide web in March.(Editorial)
December 13, 1997... The world wide web looks like becoming the most rapidly adopted communications medium ever. By next year 25% of American households will be connected to the web--just five years after its creation. Telephones took 35 years to achieve similar...

White paper puts GPs in the driving seat of the new NHS. (general practitioners, National Health Service)
December 13, 1997... The British government views its new 10 year plan, outlined this week, as a turning point for the NHS. The white paper The New NHS gives control of most of the NHS budget to GPs and community nurses, The new NHS, foreshadowed the white paper,...

Systematic overview of co-proxamol to assess analgesic effects of addition of dextropropoxyphene to paracetamol.
December 13, 1997... Introduction Analgesic drug combinations are used widely both for self medication and as prescribed medication. In a recent survey of 30 teaching hospitals in the United Kingdom, combination products accounted for 73% of all paracetamol...

Clinical and angiographic predictors of stroke and death from carotid endarterectomy: systematic review.
December 13, 1997... Introduction The absolute benefit derived from carotid endarterectomy is limited by the morbidity and mortality caused by the operation itself. The balance of risk and benefit is particularly fine in patients in whom the risk of stroke...

The west of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin.
December 13, 1997... Introduction Prevention of coronary heart disease, the leading cause of death in the United Kingdom,[1 2] is one of the primary goals of the NHS.[3] The West of Scotland coronary prevention study[4] established that treating...

Epileptic seizures after a first stroke: the Oxfordshire community stroke project.
December 13, 1997... Introduction Cerebrovascular disease is an important cause of epilepsy,[1] particularly in elderly people.[2] When seizures complicate a clinical stroke they have a devastating effect on morale and further impair an already compromised...

Rate of RhD sensitisation before and after implementation of a community based antenatal prophylaxis programme.
December 13, 1997... Despite published guidelines in the United Kingdom for the administration of anti-D immunoglobulin to pregnant women at risk of sensitisation to RhD,[1] maternal sensitisation is still between 1% and 1.5%.[2] RhD sensitisation could be reduced...

Management of cancers of the head and neck in the United Kingdom: questionnaire survey of consultants.
December 13, 1997... Cancers of the upper aerodigestive tract--that is, of the head and neck and excluding lymphomas--present a number of challenges in implementing the changes recommended by the Expert Advisory Group on Cancer Services.[1] As head and neck cancers...

Effect of doctors' ethnicity and country of qualification on prescribing patterns in single handed general practices: linkage of information collected by questionnaire and from routine data.
December 13, 1997... Introduction The issuing of prescriptions by general practitioners is a complex activity that depends on the interplay of many factors, including variables associated with the doctor, the patient, doctor-patient interaction, and...

Vaccines and vaccination. (Science, Medicine, and the Future)
December 13, 1997... Vaccines and vaccination are at a turning point Recent advances in microbial genetics and in immunology have greatly increased our understanding of microbial pathogenesis and of host defence mechanisms. As a result, within the next 10-15 years,...

Lumbar puncture still has an important role in diagnosing subarachnoid haemorrhage. (Lesson of the Week)
December 13, 1997... An early diagnosis of subarachnoid haemorrhage is essential if patients are to undergo appropriate investigation and treatment. It is increasingly common for patients with suspected subarachnoid haemorrhage to initially undergo computed...

Correction. (to 'Obesity treatment: Science, Medicine, and the Future' in the October 18, 1997 issue)(Correction Notice)
December 13, 1997... An author's error occured in this article by John Wilding *18 October, pp 997-1000). In the first paragraph on page 998 it was wrongly stated that no drug is licensed for treating obesity in Britain. In fact, phentermine is still licensed for...

The last 48 hours. (ABC of Palliative Care)
December 13, 1997... During the final 48 hours of life, patients experience increasing weakness and immobility, loss of interest in food and drink, difficulty swallowing, and drowsiness. With an incurable and progressive illness, this phase can usually be...

Gene therapy for cancer - managing expectations.
December 13, 1997... Gene therapy seems to offer new hope in cancer treatment. The new molecular technology can be used to target tumour cells in many ways. These include techniques that correct genes directly--for example, by delivering a nucleic acid sequence...

Your letter failed to win a place ... (proposal that letters criticizing published papers should themselves be subject to peer review)
December 13, 1997... Letters that comment on published work are treated differently from the original article itself. They are rarely subject to peer review, and scientific explanations are not usually given when they are rejected. Professor Shahar argues that this...

Beyond the grand mean? (Meta-analysis, part 3)
December 13, 1997... In the previous two articles[1-2] we outlined the potentials and principles of meta-analysis and the practical steps in performing a meta-analysis. Now we will examine how to use meta-analysis to do more than simply combine the results from all...

What have I achieved? (Personal Views)
December 13, 1997... Although the Psychology of Military Incompetence by Norman Dixon was published 20 years ago the tenet remains true today. I took this book, among others, to a Caribbean island where we celebrated our 40th wedding anniversary. An unwise choice....

The truth is out there. (cognitive behavior therapy for depression)(Personal Views)
December 13, 1997... I discovered the potential of cognitive behaviour therapy (CBT) while suffering from a depressive illness that proved to be resistant to a wide range of physical treatments. My illness was regarded as largely biological in origin but after 18...

Out of the closet. (attitudes about doctors in the pharmaceutical industry)(Personal Views)
December 13, 1997... On the day of my interview for a senior house officer rotation in general medicine, a more senior colleague gave me some unusual advice. "When they ask you about your long term career ambitions, Jackie, you'd better not tell them the...

Community Based Teaching.
December 13, 1997... Ed Susan L Deutsch American College of Physicians, $34, pp 284 ISBN 0 943126 59 2 There is a revolution in undergraduate medical education in Britain at present One proposed change is to move much of the teaching from teaching hospitals into...

Asthma, 2 vols.
December 13, 1997... P J Barnes Lippincott-Raven, 197.50[pounds sterling], pp 2000 (2 volumes) ISBN 0 397 51682 7 In most areas of the world where it has been recorded reliably the prevalence of asthma has been increasing. The rate of increase has been faster...

Profiting from closure: the private finance initiative and the NHS. (National Health Service)(Editorial)
December 6, 1997... Private investment is efficient when it maximises the returns on capital. Public investment is efficient when it maximises returns within the constraints of public policy goals, like meeting the population's healthcare needs. Given these...

Preventing RhD haemolytic disease of the newborn: give anti-rhesus(D) immunoglobulin to all pregnant women who are Rh negative.(Editorial)
December 6, 1997... In 1994 we saw the 25th anniversary year of the worldwide introduction of anti-rhesus (D) immunoglobulin prophylaxis, one of the most successful prophylactic programmes in medical history. In 1977, 110 cases of stillbirth or neonatal death...

Helicobacter pylori and its interaction with risk factors for chronic disease.(Editorial)
December 6, 1997... In this issue Brenner and colleagues document the effects of lifestyle on Helicobacter pylori infection in 447 patients in a German rural practice (p 1489).[1] They found that the H pylori infection rate appeared to be reduced by alcohol...

Pressure to prescribe: involves a complex interplay of factors.(Editorial)
December 6, 1997... Two thirds of consultations with general practitioners end with the issuing of a prescription.[1] The decision to prescribe is influenced by many factors, to do with the doctor, the patient, the doctor-patient interaction, and the wider...

Evidence based practice in mental health: new journal acknowledges an approach whose time has come.(Editorial)
December 6, 1997... Why has it proved so difficult to narrow the gap between research and practice in psychiatry and mental health? The provision of mental health services is determined by many factors, including government policy, public demand, the behaviour...

Relation of smoking and alcohol and coffee consumption to active Helicobacter pylori infection: cross sectional study.
December 6, 1997... Introduction Helicobacter pylori is a major cause of type B gastritis and is strongly associated with duodenal and gastric ulcer disease.[1] Seroprevalence studies have consistently identified socioeconomic conditions in childhood as...

Impact of surgery for stress incontinence on morbidity: cohort study.
December 6, 1997... Introduction Surgery is recommended for women with urinary stress incontinence that has not responded to non-surgical measures and is causing social distress.[1] The surgical procedures used in the United Kingdom are colposuspension,...

Change in social status and risk of low birth weight in Denmark: population based cohort study.
December 6, 1997... Introduction Low birth weight (birth weight [is less than]2500 g) is one of the main risk factors for infant mortality. Low birth weight occurs frequently in industrialised countries--for example in 5.3% of all births in Denmark.[1]...

Case-control study of oral contraceptives and risk of thromboembolic stroke: results from international study on oral contraceptives and health of young women. (Transnational Research Group on Oral Contraceptives and the Health of Young Women)
December 6, 1997... Introduction The transnational case-control study on oral contraceptives and the health of young women was launched in 1991. There were three substudies for cardiovascular events (venous thromboembolism, myocardial infarction, and...

Underreporting of mortality from RhD haemolytic disease in Scotland and its implications: retrospective review.
December 6, 1997... Clarke et al surveyed the decline m RhD haemolytic disease in England and Wales from 1977-92 by reviewing the statistics of the Office of Population Censuses and Surveys; during that time deaths attributable to RhD haemolytic disease had fallen...

The influence of patients' hopes of receiving a prescription on doctors' perceptions and the decision to prescribe: a questionnaire study.
December 6, 1997... Introduction Drugs prescribed by general practitioners account for about one tenth of NHS expenditure and half the total cost of family health services.[1] General practitioners' prescribing behaviour has been the focus of recent...

Use of general practitioner computerised records to create a population based twin sample: pilot study based on Parkinson's disease.
December 6, 1997... Studies of twins are useful in investigating the role of genetics in disease. We describe a population based method of twin ascertainment in Parkinson's disease using doctors' records. Subjects, methods, and results All doctors in...

Questioning behaviour in general practice: a pragmatic study. (Information in Practice)
December 6, 1997... Introduction Evidence based medicine is a style of practice in which doctors manage problems by reference to valid and relevant information. It consists of five steps: formulating answerable questions, tracking down the best evidence to...

What can PACT tell us about prescribing in general practice? (prescribing analyses and cost data)
December 6, 1997... Prescribing is important to general practitioners. Most consultations with a general practitioner result in a prescription being issued, and in 1995 general practitioners in the United Kingdom issued about 550 million prescriptions. The total...

Aetiology, diagnosis, investigation, and management of the cardiomyopathies. (Clinical review)
December 6, 1997... Cardiomyopathies are myocardial disorders that are not secondary to coronary disease or hypertension or to congenital, valvular, or pericardial abnormalities.[1] Classification is based on morphological and functional abnormalities,...

Emergencies. (emergencies in cancer patients)(ABC of Palliative Care)
December 6, 1997... The concept of rapid assessment, evaluation, and management of symptoms due to malignancy is generally accepted. Inherent in this concept is rapid reversal of what is reversible. Some acute events in malignancy have to be treated as an...

Long term sequelae of missed tendon injuries at the ankle. (Lesson of the Week)
December 6, 1997... Lacerations of the hand and wrist may affect underlying tendons.[1] Although lacerations of the ankle are uncommon, injury to underlying structures is still possible. We report on four patients who presented an average of 23 years after injury...

The case history.(The Dilemma of the Incapacitated Patient Who has Previously Refused Consent for Surgery: Ethical Debate)
December 6, 1997... A 72 year old Italian woman who spoke little English was admitted to hospital with a minor haemoptysis. Her medical history was complex. She had asthma, oesophageal varices, and recurrent small pulmonary embolisms, and had undergone partial...