British Medical Journal articles from July 2000

British Medical Journal archives from July 2000

Blemished, unsprayed plums.(Editor's Choice)
July 29, 2000... The simplest way to write Editor's Choice is to use the Jack Horner method: you stick in your fingers and pull out plums. A more complex method is to search for, invent, or--if all else fails--imagine themes. I was almost there with...

Adolescent mental health and risky sexual behaviour: young people need health care that covers psychological, sexual, and social areas.(Editorial)
July 29, 2000... Young people need health care that covers psychological, sexual, and social areas Risk taking among adolescents is of great concern to health professionals. Most of the morbidity among young people is related to behaviours that result in...

Thiazolidinediones for type 2 diabetes: new agents reduce insulin resistance but need long term clinical trials.(Editorial)
July 29, 2000... New agents reduce insulin resistance but need long term clinical trials Insulin resistance, or more appropriately the reduced action of insulin, is a prominent defect in type 2 diabetes.[1] It is commonly present in people before...

Training overseas doctors in the United Kingdom: they must be given accurate information about their job prospects.
July 29, 2000... They must be given accurate information about their job prospects The United Kingdom has a long tradition of training overseas doctors--that is, doctors who gained their primary qualification outside the European Economic Area. In this...

Molecular stool screening for colorectal cancer: using DNA markers may be beneficial, but large scale evaluation is needed.(Editorial)
July 29, 2000... Using DNA markers may be beneficial, but large scale evaluation is needed Colorectal cancer is the most common fatal malignancy among non-smokers in North America and Europe. Better tools are needed to improve the accuracy, compliance...

Which clinical studies provide the best evidence?(Editorial)
July 29, 2000... The best RCT still trumps the best observational study A common question in clinical consultations is: "For this person, what are the likely effects of one treatment compared with another?" The central tenet of evidence based medicine is...

MPs call for far reaching reforms to mental health services.(Members of Parliament)(News)
July 29, 2000... MPs have called for far reaching reforms in the provision of mental health services in the NHS in England, including the closure of the three special hospitals for dangerous, mentally ill criminals. In their report, which runs to nearly...

Executives fly the koop.com.(CEO and CFO resign from Dr. C. Everett Koop's website)(News)
July 29, 2000... Two top executives of the health website www.drkoop.com have resigned as the company's financial health has continued to decline. The share price, which was once $35 (23 [pounds sterling]), sank to about $1 earlier this month. The chief...

In brief.(News)
July 29, 2000... US lawsuit seeks contraceptive coverage: Planned Parenthood, a US voluntary family planning organisation, has filed a lawsuit in Seattle against the Bartell Drug Company, a drugstore chain in Washington state, claiming discrimination for...

Gynaecologist struck off the medical register.(Richard Neale)(News)
July 29, 2000... Richard Neale, the gynaecologist who was allowed to practise for 14 years in Britain after losing his licence in Canada, was finally struck off the register in Britain this week. His case raised new doubts about the ability of the General...

Women doctors earn $63 000 less than male counterparts.(News)
July 29, 2000... Researchers at the University of Pittsburgh's Graduate School of Public Health have found a persistent sex bias in doctors' salaries, with women earning on average 14% less than their male counterparts (Annals of Internal Medicine...

UK licence for cisapride suspended.(News)
July 29, 2000... The product licence for cisapride (Prepulsid), a drug used to treat gastric and digestive disorders in adults and children, has been suspended by the Medicines Control Agency after five deaths in the United Kingdom and 125 deaths worldwide...

Cancer drug may cause heart failure.(Herceptin)(News)
July 29, 2000... A team of researchers is calling for long term studies investigating the risk of heart failure among women taking the breast cancer drug trastuzumab (Herceptin) as a result of new evidence that the drug might precipitate heart failure,...

Relatives of Shipman victims win first round in fight for open inquiry.(Harold Shipman, a GP who is serving a life sentence for murdering 15 patients)(News)
July 29, 2000... Relatives of victims of the English GP and serial killer Harold Shipman scored a decisive victory last week in their bid to force the health secretary, Alan Milburn, to hold an open inquiry into how the GP was able to succeed in murdering so...

$1bn drug deal creates debt for "tomorrow's AIDS orphans".(News)
July 29, 2000... The United States has offered sub-Saharan African nations a $1bn (666m [pounds sterling]) loan programme to buy anti-AIDS drugs. The new programme was announced in Washington last week by the congressionally funded US Export-Import Bank. It...

Better screening needed for sickle cell and thalassaemia.(News)
July 29, 2000... Universal antenatal screening for sickle cell disease and thalassaemia may be cost effective in some areas of the United Kingdom, says a report from the Wessex Institute for Health Research and Development. Universal antenatal and...

Lumpectomy good as mastectomy for tumours up to 5 cm.(News)
July 29, 2000... In women with breast cancers up to 5 cm across the rates of long term survival and metastasis-free survival are similar for mastectomy and breast conserving treatment, according to a new study. Previous studies have shown both approaches...

US judge approves distribution of marijuana.(News)
July 29, 2000... A federal judge in Oakland, California, has approved the distribution of marijuana for medicinal purposes from a "medical marijuana" club. The decision marks the first time a federal judge has overturned a federal injunction against marijuana...

Irish blood service sues its former medical consultant.(News)
July 29, 2000... The Republic of Ireland's blood transfusion service, which is currently being investigated for infecting many of the country's haemophilic patients with HIV and the hepatitis C virus, is suing one of its former medical consultants after an...

Concern mounts over female genital mutilation.(News)
July 29, 2000... An ancient cultural rite still blights the lives of millions of women. Judy Jones reports on opposition to a practice that is illegal in Britain but still continues The UK crime writer Ruth Rendell and the consultant gynaecologist Harry...

Psychiatric disorders and risky sexual behaviour in young adulthood: cross sectional study in birth cohort.
July 29, 2000... Abstract Objective To determine if risky sexual intercourse, sexually transmitted diseases, and sexual intercourse at an early age are associated with psychiatric disorder. Design Cross sectional study of a birth cohort at age 21...

Corrections and clarifications.(Correction Notice)
July 29, 2000... Prospective investigation of transfusion transmitted infection in recipients of over 20 000 units of blood In this article by Fiona A M Regan and colleagues (12 February, pp 403-6), the time span of the study was not clear. In the second...

Efficacy and harm of pharmacological prevention of acute mountain sickness: quantitative systematic review.
July 29, 2000... Abstract Objective To quantify efficacy and harm of pharmacological prevention of acute mountain sickness. Data sources Systematic search (Medline, Embase, Cochrane Library, internet, bibliographies, authors) in any language, up to...

To coin a phrase.
July 29, 2000... A few cool days in London in the summer of 1929 are supposed to have given Alexander Fleming the chance to notice penicillin; the former Department of Health and Social Security named its headquarters after him. It stands beside the...

Association of polymorphism of human [Alpha] oestrogen receptor gene with coronary artery disease in men: a necropsy study.
July 29, 2000... The higher oestrogen concentrations in women have been suggested as the reason for their slower development of atherosclerosis compared with men. Oestrogen receptors have been located on macrophages, smooth muscle cells, and endothelial cells...

Early neonatal mortality, asphyxia related deaths, and timing of low risk births in Hesse, Germany, 1990-8: observational study.
July 29, 2000... A higher neonatal mortality related to intrapartum events during the night has been reported in Great Britain.[1 2] We investigated whether the time of birth affects early neonatal mortality or deaths related to asphyxia in low risk births....

Atrial fibrillation associated with sumatriptan.
July 29, 2000... A 34 year old man with a history of migraine presented with palpitations after taking sumatriptan by nasal spray for a severe headache. Examination was unremarkable apart from atrial fibrillation, with a ventricular rate of 130 beats/min. He...

A prescription for improvement? An observational study to identify how general practices vary in their growth in prescribing costs.(includes commentary)
July 29, 2000... Abstract Objective To identify how some general practices have low growth in prescribing costs relative to other practices. Design Observational study. Setting Trent region of England. Participants 162 general practices: 54...

Plague in Glasgow.(One Hundred Years Ago)
July 29, 2000... The outbreak of plague in Glasgow is a calamity which has very wide bearings. The city of Glasgow is not in such direct communication by sea with plague-infected ports or countries as some of our other seaports, and the appearance of the...

Medical ethics.(Clinical Review)
July 29, 2000... Recent advances in medical ethics? This may sound odd if your vision of medical ethics is the application to medicine of the Hippocratic oath. If, however, you believe that the goal of medical ethics is to improve the quality of patient care...

Great Aunt Rose.(leg amputation vs leg conservation)
July 29, 2000... "You know Betty, they should have just taken my leg off. I was a young woman then, I would have coped with it but not now." Great Aunt Rose, my grandfather's oldest sister, was talking to my mother while I was eating my sticky iced...

Horse allergy in children: horse dander may be the "hidden" allergen responsible for a child's asthma.(Lesson of the Week)
July 29, 2000... Horse dander may be the "hidden" allergen responsible for a child's asthma Allergy to pets, such as cats and dogs, causes significant morbidity in children.[1] Apart from immediate symptoms of hypersensitivity, allergens from pets are...

Scientists should die at 60.
July 29, 2000... What a good thing it would be, if every scientific man was to die, when sixty years old, as afterwards he would be sure to oppose all new doctrines. Charles Darwin. Autobiography. N Barlow, ed. London: Collins, 1958:100-1. Submitted...

Improving occlusion and orofacial aesthetics: orthodontics.(ABC of Oral Health)
July 29, 2000... Malocclusion is the abnormal positioning of the teeth or jaws. It is a variation of growth and development and can affect a person's bite (occlusion), ability to clean teeth properly, gingival health, jaw growth, speech development, and...

Greek and Latin Useless for Doctors.(One Hundred Years Ago)
July 29, 2000... What is the value of a knowledge of Greek and Latin to a professor of the art of medicine? I will tell you in the words of a distinguished writer and scholar who has recently passed away: "As to doctors, can we gravely admit that they ought...

Outcomes studies of drug induced ulcer complications: do we need them and how should they be done?(Education and Debate)
July 29, 2000... The hazards of non-steroidal anti-inflammatory drugs are considerable, and they result in the death of up to 2000 patients a year in the United Kingdom.[1 2] Protective strategies that use the prostaglandin analogue misoprostol[3-7] or proton...

Conflict and health: peace building through health initiatives.(Education and Debate)
July 29, 2000... War affects human health through the direct violence of bombs and bullets, the disruption of economic and social systems by which people use to address their health needs, the famine and epidemics that follow such disruptions, and the...

Obituaries.(Obituary)
July 29, 2000... Mary Lois Cartledge (nee Barrett) Psychiatrist and school doctor (b 1923; q Manchester 1947), died from metastatic peritoneal carcinoma on 3 May 2000. Mary worked as a psychiatric resident at Prestwich Hospital, Manchester, and later in...

Don't Tell the Patient: Behind the Drug Safety Net.(Review)
July 29, 2000... Don't Tell the Patient: Behind the Drug Safety Net Bill Inman Highland Park Productions, 17.95 [pounds sterling], pp 304 ISBN 0967581206 Rating: ** Don't Tell the Patient is an autobiographical view of Professor Bill Inman's 30...

Cancer: The Evolutionary Legacy.(Review)
July 29, 2000... Cancer: The Evolutionary Legacy Mel Greaves Oxford University Press, 19.99 [pounds sterling], pp 272 ISBN 0 19 262835 6 Rating: *** Have you ever wondered about the lottery of cancer? I do not mean the much discussed variation in...

The Meat Business: Devouring a Hungry Planet.(Review)
July 29, 2000... The Meat Business: Devouring a Hungry Planet Eds Geoff Tansey, Joyce D'Silva Earthscan Publications, 12.99 [pounds sterling], pp 249 ISBN 185383 603 6 Rating: ** "Why don't you eat your sausages?" I asked a little girl. "I don't...

Accessing ethical information.(Website of the Week)
July 29, 2000... Accessing ethical information This week the BMJ discusses progress in medical ethics. Most of the changes seem to reflect thinking on ethics at a societal level: new guidance for setting priorities, new developments in biotechnology, and new...

NETLINES.
July 29, 2000... * Librarians and "information professionals" in the midwest of the United States have hand picked their best health related sites at http://healthweb. org. It is an excellent selection, neatly classified, with a short and helpful description...

What is the future for training overseas graduates?(Personal Views)
July 29, 2000... The United Kingdom has traditionally accepted many overseas doctors for higher medical training. They receive some structured training and they also fill posts in the NHS. Traditionally, entry was via the PLAB (Professional and Linguistic...

Gourmets.(Soundings)
July 29, 2000... Cooking is an art, they say. What you can learn from books, courses, and teachers is the technical part. After that, it's up to you to develop your own style, the personal touch that makes people talk of X's or Y's soup, not of soups in...

Minerva.
July 29, 2000... Young people from Alabama, Illinois, Minnesota, and California who were recruited into a national cohort in 1985 had put on between seven and 12 kg in weight by 1996 (American Journal of Epidemiology 2000; 151:1172-81). The largest weight...

Hearts and minds and meta-analyses.(Editor's Choice)
July 22, 2000... Big issues dominate this week's BMJ--heart disease, cancer, and the state of our children's health. Two large prospective studies seem to scotch the idea of an association between ischaemic heart disease and infection with Chlamydia...

Heart disease and the inflammatory response.
July 22, 2000... Although it an integral part of the atherosclerotic process we still don't know why Inflammation in the vessel wall plays an essential part not only in the initiation and progression of atherosclerosis but also in the erosion or fissure...

Can heart failure be diagnosed in primary care?(Editorial)
July 22, 2000... Brain natriuretic peptide assays may make it easier Heart failure is an increasingly important problem for primary care physicians in most healthcare systems in developed countries. The condition is almost as common as diabetes mellitus...

Third generation oral contraceptives.
July 22, 2000... Caution is still justified Oral contraception is effective, convenient, and reversible. For most women it is also remarkably safe. Some people involved in family planning go further and imply that the oral contraceptive pill is almost...

Measuring the performance of health systems: Indicators still fail to take socioeconomic factors into account.(Editorial)
July 22, 2000... Indicators still fail to take socioeconomic factors into account It seems that the whole world is suddenly talking about measuring the performance of health systems. Last month the World Health Organization published its findings from a...

Revel in electronic and paper media.
July 22, 2000... BMJ readers and authors should enjoy the strengths of both media Some BMJ readers are proud of not using the world wide web. Others are scornful of paper media, predicting that one day everything will be purely electronic. Both are wrong,...

US court awards $145bn damages against tobacco giants.
July 22, 2000... After a trial lasting two years and hearing 157 witnesses, a six member jury in a Miami court awarded $145bn (97bn [pounds sterling]) in punitive damages against five major US tobacco companies. The class action lawsuit, originally filed...

Mandela restores morale of AIDS conference.
July 22, 2000... Nelson Mandela, South Africa's former president, closed the 13th international AIDS conference in Durban last week saying that poor people in Africa, "who would carry a disproportionate burden of the AIDS epidemic," would wish that "the...

In brief.
July 22, 2000... Dutch to change euthanasia bill: The Dutch cabinet has decided to abandon part of its proposed bill on euthanasia because of concerns expressed by doctors and MPs. The bill will no longer include a clause allowing incurably ill 12-16 year...

Donors reject screening panel for malaria projects.
July 22, 2000... The four founding donors of the "Roll Back Malaria" project, the partnership that is committed to eradicating the disease, have rejected a plan for an independent panel to screen all potential programmes. The rejection came after a...

Gordon Brown announces 43bn [pounds sterling] more for public services.
July 22, 2000... Gordon Brown, chancellor of the exchequer, reiterated this week that spending on the NHS would grow to 58.6bn [pounds sterling] ($88bn) next year, compared with 54.2bn [pounds sterling] in the current financial year (2000-1). Presenting...

US halts University of Oklahoma clinical research.(News)
July 22, 2000... A new federal agency in the United States, established to protect the interests of patients who are the subjects of research, has shut down all government sponsored clinical trials at the University of Oklahoma Health Sciences Center at...

Lung cancer trial has problems in recruitment.
July 22, 2000... Nearly three quarters of patients eligible to take part in a UK trial of chemotherapy in non-small cell lung cancer have declined to take part, according to a study published last week that showed fear of side effects to be a major factor in...

New technique helps to assess vegetative state.
July 22, 2000... Doctors and relatives of patients with brain injury can now determine more accurately whether they have any awareness thanks to a technique developed by staff at the Royal Hospital for Neuro-Disability in London. The sensory modality...

FDA says statin cannot be sold over the counter.
July 22, 2000... An advisory committee to the US Food and Drug Administration rejected a request by the US pharmaceutical company Merck for its cholesterol lowering drug lovastatin to be sold over the counter (without a doctor's prescription). In issuing...

Interleukin 2 increases CD4 T cell counts in people with HIV.(News)
July 22, 2000... Adding interleukin 2 to antiretroviral drugs substantially increases the CD4 T cell count and decreases the viral load of HIV, according to a multicentre trial sponsored by the National Institutes for Health (JAMA 2000;284:183-9). The...

Abortion doctor suffers second attack in six years.
July 22, 2000... A Vancouver gynaecologist, Dr Carson Romalis, who performs abortions and who was shot six years ago as he ate breakfast in his home (BMJ 1994;309:1322), has been stabbed by a young man in the lobby of his office at a medical clinic. ...

NICE issues guidance for heartburn and indigestion.
July 22, 2000... The NHS could save 50m [pounds sterling] ($75m) a year if GPs were more circumspect in their use of proton pump inhibitors, the National Institute for Clinical Excellence said in its guidance to doctors last week. The institute asked...

Ireland's measles outbreak kills two.(News)(Statistical Data Included)
July 22, 2000... The Republic of Ireland is suffering its worst measles outbreak for seven years as a result of the low uptake of the measles, mumps, and rubella (MMR) vaccine. Uptake of the vaccine is less than 80%. The Irish National Disease...

Exercising his passion.
July 22, 2000... Geoff Watts meets Jerry Morris, pioneer of social medicine, who recently celebrated his 90th birthday Jerry Morris is one of those lucky few in whom the ageing process starts normally, then admits defeat and gives up. He moves more slowly...

Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses.
July 22, 2000... Abstract Objective To assess associations between baseline values of four different circulating markers of inflammation and future risk of coronary heart disease, potential triggers of systemic inflammation (such as persistent...

Chlamydia pneumoniae infection and mortality from ischaemic heart disease: large prospective study.
July 22, 2000... Abstract Objective To determine whether there is an independent association between infection with Chlamydia pneumoniae and ischaemic heart disease. Design Prospective study using a nested case-control design. Setting Medical...

The danger of a high C.
July 22, 2000... While about to take blood, I noticed a thin scar running along the left elbow of my elderly patient in exactly the place I would have liked to venesect him. I asked him how he got the scar and was bemused by the reply: "That is from when I...

Chlamydia pneumoniae IgG titres and coronary heart disease: prospective study and meta-analysis.
July 22, 2000... Abstract Objective To examine the association between coronary heart disease and serum markers of chronic Chlamydia pneumoniae infection. Design "Nested" case-control analysis in a prospective cohort study and an updated...

I know him.
July 22, 2000... You kill a man--that is easy... it needs no skill. You can be certain of what you've done, you can judge death, but to save a man--that takes more than six years of training, and in the end you can never be quite sure it was you who saved...

Lord Moran on old age.
July 22, 2000... Lord Moran, Churchill's doctor, who died in 1977 at the age of 94, had this to say about old age and dying: "Old people with slow thoughts pass beyond the doubts and fears and hesitations of their middle years into the silence of great age,...

Effect of improved data collection on breast cancer incidence and survival: reconciliation of a registry with a clinical database.
July 22, 2000... In 1998 a project was undertaken to improve cancer registration in the Trent region by establishing a direct link between Trent Cancer Registry and a breast cancer clinical database for Leicestershire patients at Glenfield Hospital. This...

Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study.
July 22, 2000... Abstract Objectives To characterise the clinical features of patients with suspected heart failure but preserved left ventricular systolic function to determine if they have other potential causes for their symptoms rather than being...

Not such an angel?
July 22, 2000... Easter Monday was a relaxing day, working in the garden and greenhouse after a weekend on duty. All went well until late afternoon when I stopped for a cup of tea. I suddenly realised that my vision was blurred. I closed one eye, then the...

Management of acute coronary syndromes.(Clinical Review)
July 22, 2000... The acute coronary syndromes consist of two groups: unstable angina and non-Q wave myocardial infarction, and ST segment elevation myocardial infarction. This article reviews the management only of patients with unstable angina and non-Q wave...

Rare presentation of maternal primary hyperparathyroidism.
July 22, 2000... Primary hyperparathyroidism is a relatively common condition, being the third most common endocrine disorder after diabetes and thyroid disease. It is most often seen in patients in their 50s and 60s,[1] but it can occur in juveniles,...

Swellings and red, white, and pigmented lesions.
July 22, 2000... Swellings It is not unknown for people to discover and worry about oral lumps, but they usually first notice a lump because it becomes sore. Pathological causes include a range of different lesions, but neoplasms are most important. ...

Who is speaking for children and adolescents and for their health at the policy level?
July 22, 2000... The Bristol inquiry has put children at the heart of the public's agenda on health. This contrasts with the seemingly low position of children on the Westminster government's own health agenda. This status is exemplified by the current...

War and mental health: a brief overview.
July 22, 2000... About 40 violent conflicts are currently active and nearly 1% of the people in the world are refugees or displaced persons. Over 80% of all refugees are in developing countries, although 4 million have claimed asylum in western Europe in the...

What medicine's all about.(A Patient Who Changed My Life Twice)
July 22, 2000... It may have been obvious to her at the time, but somehow I did not quite like to admit to Sylvia that she was my very first--patient, that is. I had just finished my preclinical training at Cambridge and had come down to London to walk the...

Waiting times for patients with cancer.
July 22, 2000... Waiting lists are putting patients' lives in jeopardy EDITOR--Spurgeon et al's findings on waiting times in England for patients with cancer are worrying to say the least.[1] Nevertheless, the authors understate the problem because they...

Prediction of survival for preterm births.
July 22, 2000... EDITOR--We would like to clarify one or two issues raised in the correspondence about our recent paper in the BMJ.[1-4] The data from Trent were presented not as being good or bad but simply to reflect what was actually happening. They...

Sleep apnoea and hypertension.
July 22, 2000... Findings cannot be applied to general public EDITOR--The study by Lavie et al is the first to provide evidence that sleep apnoea is an independent risk factor for hypertension.[1] We think, however, that the clinical implications put...