British Medical Journal articles from June 2000

British Medical Journal archives from June 2000

In brief.(News)
June 24, 2000... Two new medical schools planned for UK: Two new medical schools are to be established in England. One will be based at the University of East Anglia in Norwich, and the other will be a joint development between the Universities of Exeter and...

France heads WHO's league table of health systems.(News)
June 24, 2000... If you are going to be ill, the best place to be is France--the country ranked first in an analysis of the world's healthcare systems carried out by the World Health Organization (WHO). Among major countries, France was followed by Italy,...

US Supreme Court bars federal lawsuits against HMOs.(News)
June 24, 2000... The Supreme Court in the United States, in a unanimous decision, ruled that patients could not sue their health maintenance organisation (HMO) in federal court for giving doctors Financial incentives to cut medical costs. Justice David...

NICE approves taxanes for breast cancer.(National Institute for Clinical Excellence)(News)
June 24, 2000... The National Institute for Clinical Excellence (NICE) last week approved the use of taxanes for the treatment of advanced breast cancer for women in England and Wales. A course of treatment will cost around 1500 [pounds sterling] ($2250)...

English NHS to set up new reporting system for errors.(National Health Service)(News)
June 24, 2000... The NHS in England is to set up a new, national system for logging all failures, mistakes, and "near misses" in health care and is to move away from the current "blame culture" to one that can learn from adverse events; these changes follow...

Doctors need more training in delivering breech babies.(News)
June 24, 2000... The single and most avoidable factor in causing stillbirths and deaths among breech babies is suboptimal care given in labour, according to the seventh annual Confidential Enquiry into Still-births and Deaths in Infancy (CESDI). In cases...

Ombudsman slams deputising service.(Healthcall)(News)
June 24, 2000... General practitioners in England have been advised to monitor the deputising service they use more closely after complaints to the health service ombudsman, Michael Buckley, showed that the biggest of the private companies provided a "totally...

Gangrene bug "killed 35 heroin users".(News)
June 24, 2000... The likely cause of an infection that has killed 35 injecting heroin users in Britain and Ireland in recent weeks has been identified as Clostridium novyi type A, a bacterium previously associated only with serious infection during wartime....

US cancer institute funds trial of complementary therapy.(News)
June 24, 2000... The US National Cancer Institute, through its office of Complementary and Alternative Medicine, is funding phase III clinical trials of a controversial treatment for advanced pancreatic cancer. The treatment protocol, the Gonzalez...

Legality of European ban on tobacco advertising questioned.(News)
June 24, 2000... The joy of antismoking campaigners at the prospect of clearer health warnings on cigarette packets was tempered this week by doubts over the legality of a comprehensive ban on tobacco advertising and sponsorship across the European Union. ...

MPs want a tobacco regulatory authority.(members of Parliament)(News)
June 24, 2000... Tougher controls over the tobacco industry, including the creation of a tobacco regulatory authority, were recommended by members of the House of Commons health committee in its second report on the health risks of smoking last week. ...

European Court of Justice likely to annul ban.(antismoking legislation)(News)
June 24, 2000... The European Court of Justice is likely to follow the advocate general's opinion--that the EU antismoking legislation is illegal-and annul the ban. It follows his advice in 80% of cases. But that will not stop the UK government introducing a...

Health and social services "locked in a vicious circle".(News)
June 24, 2000... Two thirds of hospital beds in England and Wales are occupied by people aged over 65, but many of these people could move out of hospital sooner, or need not be there at all, if they had access to more effective rehabilitation services, the...

Access to investigations is needed 7 days a week.(News)
June 24, 2000... More consultants, access to hospital investigations seven days a week, and closer links with intensive care specialists are urged in a report from the Federation of Medical Royal Colleges in the United Kingdom. The report, written by a...

GPs want self regulation to continue.(News)
June 24, 2000... Representatives of the UK's 35000 GPs have overwhelmingly voted for the continuation of self regulation of the medical profession but called on the current General Medical Council to improve its performance. At last week's conference of...

Correction.(Correction Notice)
June 24, 2000... In our picture story describing the new charity being set up to educate the public about facial surgery (17 June, p 1623), we wrongly gave its name as Changing Faces. The correct title of the charity is Saving Faces. We apologise for this...

Management guidelines for women with normal colposcopy after low grade cervical abnormalities: population study.
June 24, 2000... Abstract Objectives To develop an evidence based protocol for the follow up of women with low grade cervical abnormalities for whom treatment is not immediately indicated. Design Population outcome study. Setting Colposcopy...

Amusing the patient.
June 24, 2000... The art of medicine consists in amusing the patient while Nature cures the disease. Voltaire

Effects of treatment for intestinal helminth infection on growth and cognitive performance in children: systematic review of randomised trials.
June 24, 2000... Abstract Objective To summarise the effects of anthelmintic drug treatment on growth and cognitive performance in children. Data sources Electronic databases: Cochrane Infectious Diseases Group controlled trial register, Cochrane...

A book that changed my practice: new insights into mental illness.(The Awakening by F Zuendel)
June 24, 2000... It had all become depressingly familiar: the suicidal teenager with relationship difficulties; a middle-aged office worker who had lost the energy to keep going; a lonely pensioner with insomnia and multiple functional complaints. The answer...

Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department.
June 24, 2000... Abstract Objective To assess the incidence of prognostically important myocardial damage in patients with chest pain discharged from the emergency department. Design Prospective observational study. Setting District general...

Commentary: Time for improved diagnosis and management of patients presenting with acute chest pain.
June 24, 2000... Cardiac troponins T and I are highly sensitive and specific markers for myocardial damage. Troponins are not detectable in normal serum, and modern immunoassays make diagnosis of minor degrees of cardiac damage possible. Cardiac troponins are...

Infant mortality, stomach cancer, stroke, and coronary heart disease: ecological analysis.
June 24, 2000... Mortality from stomach cancer and stroke shows an international correlation, consistent inverse socioeconomic gradients, a particular dependence on socioeconomic circumstances in childhood,[1] and parallel patterns of decline in most...

Role of C282Y mutation in haemochromatosis gene in development of type 2 diabetes in healthy men: prospective cohort study.
June 24, 2000... Type 2 diabetes mellitus is a common complication of iron overload diseases such as hereditary haemochromatosis.[1] A gene mutation (HFE C282Y) has recently been identified that strongly predisposes to haemochromatosis when present in...

A patient who changed my life: "You heard all wrong".
June 24, 2000... "If India's family planning policy has to succeed you all have a part to play." As final year medical students, all unmarried, from conservative backgrounds, even the most macho men in my class were beginning to wish that our project was...

Maternal age and fetal loss: population based register linkage study.
June 24, 2000... Abstract Objective To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history. Design Prospective register linkage study....

To whom it concerns.
June 24, 2000... Smoking kills they say. Maybe they are right. But life kills also. But how come in the cancer hospice, the smoking room is full. Of life. Of laughter. Of craic. At one level the smoking is of no consequence. The non-smoking room is always...

Consumer health informatics.(Recent Advances)
June 24, 2000... Medical informatics has expanded rapidly over the past couple of years. After decades of development of information systems designed primarily for physicians and other healthcare managers and professionals, there is an increasing interest in...

Dental damage, sequelae, and prevention.(ABC of Oral Health)
June 24, 2000... Tooth damage Teeth may be damaged by dental caries, trauma, erosion, attrition, and abrasion or lost through periodontal disease. Disease Caries and inflammatory periodontal disease are the most prevalent oral diseases, both a...

Seeing what you want to see in randomised controlled trials: versions and perversions of UKPDS data.(United Kingdom prospective diabetes study)(Education and Debate)
June 24, 2000... Randomised controlled trials are objective, free of bias, and produce robust conclusions about the benefits and risks of treatment, and clinicians should be trained to rely on them; so says the gospel of evidence based practice. In this...

Modernising the NHS: practical partnerships for health and local authorities.(National Health Service)(Education and Debate)
June 24, 2000... Partnership has become a legal, almost moral, imperative in the health and social care world in recent years. In policy document after policy document the analysis is consistent and welcome. We need to find new ways of working: "The strategic...

A memorable patient: benefits of a cooperative.
June 24, 2000... In common with many parts of the United Kingdom the GPs in the Exeter area have formed a cooperative for out of hours cover. This means that 95 doctors have joined together to provide out of hours medical cover to a large population (over 200...

Obituaries.(Obituary)
June 24, 2000... Peter John Andrew Former general practitioner New Mills, Derbyshire (b Bramhall, Cheshire, 1925; q Cambridge/Manchester 1948; MBE), died from coronary artery disease on 19 February 2000 while out walking. He had intended to pursue a...

Medicopolitical Digest.
June 24, 2000... Local medical committee conference More funds still needed for NHS GPs have welcomed the extra resources committed to the NHS by the government, but at the annual conference of local medial committees last week speaker after speaker...

The BMJ, spin, and the stockmarket.(Scotia stock falls after BMJ publishes report of adverse effect linked to company's drug, Foscan)
June 24, 2000... One of the many anxieties of medical editors is that we have little measurable impact on anything. Systematic reviews have shown that written information is ineffective in changing doctors' practice. "All we do," claimed my predecessor as...

A register of blunders or botchers?
June 24, 2000... One of the classic tactics of "spin"-- telling a story so that listeners hear the message you want to convey--is to preannounce a report and what you are going to do about it a day or two before the report comes out. That way you get your...

Older parents.(Website of the Week)
June 24, 2000... Older parents This week the BMJ carries a paper and an editorial that confirm the fact that older parents are not only less likely to conceive but also more likely to have a bad outcome from their pregnancy (pp 1681, 1708). The human...

Devaluing clinical skills.(Personal Views)
June 24, 2000... Poor clinical performance may be the medical issue of greatest concern to the general public and the press, but most doctors realise that clinical performance and welfare of patients often come second to the interests of institutions and...

Cunegonde's ears, or multiple medical errors.(Soundings)
June 24, 2000... When Miss Cunegonde first arrived from the 18th century, riding on her broomstick, she had hoped to set up her own web page, appear on the Larry King show, and meet Miss Monica Lewinsky. Instead she developed a urinary infection unrelieved by...

Minerva.
June 24, 2000... Low tar cigarettes may entice health conscious smokers (if that's not an oxymoron), but it is doubtful whether they offer any health benefits over their regular counterparts. A review in the Lancet (2000;355:2159-61) points out that the tests...

One in six children live in relative poverty.(News)(Statistical Data Included)
June 17, 2000... One in six of the developed world's children live in relative poverty--that is, below the national poverty line in their country--according to a new report from Unicef. The report looked at both absolute poverty, which was defined as...

Senior doctors split over General Medical Council.(News)
June 17, 2000... The Academy of Medical Royal Colleges, which represents 18 colleges and faculties in the United Kingdom, has suspended its membership of the Joint Consultants Committee (JCC) because of the vote of no confidence in the General Medical...

In brief.(News)
June 17, 2000... NHS to adopt early warning system: Chief Medical Officer Liam Donaldson this week announced a new scheme for England obliging hospital trusts and general practices to report mistakes and untoward incidents to a central register. He said that...

Pallidotomy relieves some symptoms of Parkinson's disease.(News)
June 17, 2000... Posteroventral medial pallidotomy can provide long term relief from many of the debilitating symptoms of Parkinson's disease, but it does not improve others and is not without side effects, according to a study by physicians at the University...

Antibodies can repair damaged myelin in model of MS.(multiple sclerosis)(News)
June 17, 2000... Damaged myelin can be repaired with the use of human monoclonal antibodies. A team of immunologists led by Dr Moses Rodriguez at the Mayo Clinic in Minnesota has discovered two human monoclonal antibodies that seem to promote the repair of...

Gynaecologist banned in Canada appears before GMC.(General Medical Council)(News)
June 17, 2000... A British gynaecologist who was banned from working in two Canadian provinces in 1979 and 1985 but was able to go on practising in Britain until 1999 faced accusations of serious professional misconduct at the General Medical Council this...

Chinese herb may cause cancer.(Aristolochia fangchi)(News)
June 17, 2000... Doctors in Belgium have discovered that a Chinese herb, Aristolochia fangchi, already linked to kidney failure, may cause cancer as well. Patients at a Belgian weight loss clinic were given this herb in error. Staff at the clinic had...

WHO warns of threat of "superbugs".(News)
June 17, 2000... The World Health Organization (WHO) warned this week that the level of resistance to drugs used to treat common infectious diseases is reaching crisis point. If governments around the world do not make greater efforts to control disease...

Clinical Evidence to go to 400 000 US doctors.(doctors receive compendium of best available evidence for effective health care free of charge)(News)
June 17, 2000... Clinical Evidence, the biannual compendium of best available evidence for effective health care, is being sent free of charge to 400 000 American physicians. It is being provided by the UnitedHealth Foundation, a private, not for profit...

Supply of generic drugs still unreliable.(News)
June 17, 2000... Doctors and pharmacists in the NHS are still experiencing interruption in the supply of pharmaceutical drugs, particularly generics, despite the government's decision to tackle the issue last December. "The interruption in supplies is...

Budget cuts may have led to E coli outbreak.(News)
June 17, 2000... Eleven people in the Canadian town of Walkerton, Ontario, have died from municipal drinking water contaminated by the O157:H7 strain of Escherichia coli, while about 1000 of the 5000 inhabitants have become ill. Four different...

Private finance scheme for Worcester "will cut beds".(News)
June 17, 2000... The private finance initiative (PFI) scheme used to finance the building of a new hospital for the Worcester Royal Infirmary will leave Worcestershire with one of the lowest levels of hospital provision in the country, a report published last...

Clinton orders Medicare to cover patients in clinical trials.(News)
June 17, 2000... President Clinton has told the US Department of Health and Human Services to authorise payment for services covered by Medicare for patients in clinical trials. The directive, which does not require congressional approval, follows last...

More doctors criticise the GMC.(General Medical Council)(News)
June 17, 2000... Two more groups of doctors have expressed their frustration with the General Medical Council and passed votes of no confidence in the council "as presently constituted and functioning." The conference of public health and community health...

Claim that events before birth cause cerebral palsy is disputed.(News)
June 17, 2000... The theory that cerebral palsy is caused by events during pregnancy rather than at birth was attacked at a conference last week. Lawyers and doctors at the Action for Victims of Medical Accidents' annual conference in Birmingham claimed that...

Cost effectiveness analysis of screening for sight threatening diabetic eye disease.
June 17, 2000... Abstract Objective To measure the cost effectiveness of systematic photographic screening for sight threatening diabetic eye disease compared with existing practice. Design Cost effectiveness analysis Setting Liverpool. ...

Disability in young people and adults one year after head injury: prospective cohort study.
June 17, 2000... Abstract Objective To determine the frequency of disability in young people and adults admitted to hospital with a bead injury and to estimate the annual incidence in the community. Design Prospective, hospital based cohort study,...

US women's attitudes to false positive mammography results and detection of ductal carcinoma in situ: cross sectional survey.
June 17, 2000... Abstract Objective To determine women's attitudes to and knowledge of both false positive mammography results and the detection of ductal carcinoma in situ after screening mammography. Design Cross sectional survey. Setting...

Views of elderly people on living wills: interview study.
June 17, 2000... Living wills or advance statements record people's healthcare wishes in case they are unable to contribute to a decision concerning their health care in the future, either because of mental incapacity or because physical disability prevents...

Correction.(to 'Burns after photodynamic therapy,' in May 6, 2000 issue)(Correction Notice)
June 17, 2000... Burns after photodynamic therapy An authors' error occurred in this drug point by Shehan Hettiaratchy and others (6 May, p 1245). The last sentence of the second paragraph should have read, "All subjects signed a standard consent form of...

Family medicine: Two case histories.
June 17, 2000... My mother in law has never been a great walker, but at nearly 80 she has kept active and takes a lively interest in the world and her family. She and her husband love Majorca and spend time there every winter. She has put on some weight over...

Effect of anti-inflammatory drugs on overall risk of common cancer: case-control study in general practice research database.
June 17, 2000... Abstract Objective To examine whether anti-inflammatory drug treatment protects against the commoner cancers in the United Kingdom. Design Case-control study using the general practice research database. Setting Practices...

Tribulations of clinical trials: There's more inside the tablet.
June 17, 2000... Several years ago I was invited to be the medical officer for a geological expedition to the Arctic. The attractions of the beauty and grandeur of the high Arctic in summer are somewhat diminished by swarms of mosquitoes, which are notable...

Diagnosis and management of porphyria.(review article)
June 17, 2000... Summary points The porphyrias form a group of inherited disorders of haem biosynthesis of which there are seven main Porphyrias can be classified into acute (neuropsychiatric), cutaneous, and mixed forms Acute forms can be life...

Why did I become a doctor?: A wise headmaster.
June 17, 2000... The acknowledged importance of career advice and guidance has led to a burgeoning cottage industry with the involvement of numerous stakeholders. Starting at school and continuing through the undergraduate and postgraduate phases,...

Oral health and disease.(ABC of Oral Health)
June 17, 2000... A healthy dentition and mouth is important to both quality of life and nutrition, and oral disease may affect systemic health, as discussed in later articles in this series. Development of the dentition Teeth form mainly from...

A message from Holland.(about euthanasia)
June 17, 2000... Eleven years ago a lively 85 year old man came to my surgery. He had been a famous violinist and concert leader for most of his professional life and still enjoyed playing music. He asked me if I would "help" him should he find himself the...

Appropriate feeding methods for infants of HIV infected mothers in sub-Saharan Africa.(Education and Debate)
June 17, 2000... Summary points Concern is increasing over mother to child transmission of HIV in sub-Saharan Africa Decisions about interventions must be based on assessment of risks, costs, and benefits The role of breast feeding in the...

Patient care (empowerment): the view from a national society.(Modernising the NHS)
June 17, 2000... Summary points The NHS needs to work closely with organisations that represent patients and draw on their knowledge and experience Information technologies can help marshall information for patients--and for healthcare professionals...

One hundred years ago: The BMA from a general practitioner's point of view.
June 17, 2000... Dr. Garrett Horder thought that the British Medical Association had not the influence it should possess. The mode of government was defective; the Presidents became Vice-Presidents and ex officio life members of the Council, and there was too...

Patient care (empowerment): a local view.(Modernising the NHS)
June 17, 2000... Summary points Joint working between health and social services needs to supported by real joint funding The NHS should support advocacy services because not all health professionals are able or willing to take patients' views fully...

Obituaries.(Obituary)
June 17, 2000... Julia Mary Beale Recently retired general practitioner Salisbury (b Newport, Gwent, 1935; q Westminster 1958; DCH, DRCOG), died from cancer on 4 April 2000. Married to the former surgeon general, Sir Peter Beale, she worked almost...

Public health conference.(Medicopolitical Digest)
June 17, 2000... Proposals for revalidation attacked Public health doctors believe that the General Medical Council's proposals for revalidation are flawed and unnecessary. And the opposition to the proposals was largely responsible for the overwhelming...

Junior doctors conference.(Medicopolitical Digest)
June 17, 2000... There should be no subconsultant specialist grade Representatives of the United Kingdom's 35 000 junior hospital doctors have unanimously opposed the suggestion of a "subconsultant specialist grade." They called for the resignation of the...

Teaching Made Easy: A Manual for Health Professionals.(Review)
June 17, 2000... Teaching Made Easy: A Manual for Health Professionals Ruth Chambers, David Wall, Radcliffe Medical Press, 18.95 [pounds sterling], pp 216 ISBN 1 85775 373 9 Rating: *** As busy clinician with a healthy commitment to medical education, I...

The Origin of Captured Images.(National Museum of Photography, Bradford)
June 17, 2000... The Origin of Captured Images Specimens and Marvels: The Work of W H F Talbot National Museum of Photography, Bradford, until 9 July William Henry Fox Talbot is widely regarded as the founder of modern photography. He is credited...

Tarring consultants with the Ledward brush.(surgeon Rodney Ledward, who was investigated for possible malpractice)
June 17, 2000... Pity the poor consultants. No sooner do they recover from the battering given to them by the media over their inability to diagnose cancer of the tongue in a 41 year old man (20 May, p 1414) than they receive a new thrashing over the inquiry...

Transplant organs.(Website of the Week)
June 17, 2000... Transplant organs This week a news story highlights a BMA campaign to increase the number of donor organs available for transplantation. In Britain the situation is worsening: 1000 patients each year die on waiting lists, which are increasing...

Priority setting in health care: should we ask the tax payer?(Personal Views)
June 17, 2000... It is popular and politically correct to involve the public in healthcare priority setting. But it may not necessarily be a good thing to involve it in rationing decisions. It is almost an article of faith among many United Kingdom health...

Why seeing a patient after the counsellor is so difficult.(Soundings)
June 17, 2000... "I know now that I haven't resolved my inner conflicts. I have to come to terms with the emotional violence I've suffered and learn to do what I want to do." The "I" is always italicised in the inflection. "My counsellor says that I am far...

Minerva.
June 17, 2000... Research in the United States has shown that congenital heart disease is less common in infants born to mothers who took multivitamins early in pregnancy (American Journal of Epidemiology 2000;151:878-84). No risk reduction was evident when...

Management blamed over consultant's malpractice.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... A government inquiry has blamed poor management within the NHS for allowing the serious malpractice of consultant gynaecologist Rodney Ledward to continue for 16 years. Powerful constraints against "telling tales" and a culture of treating...

Consultants attack "arrogant" GMC.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... Representatives of the United Kingdom's 32 000 senior hospital doctors have overwhelmingly passed a vote of no confidence in the General Medical Council "as currently constituted and functioning." At the annual senior staffs conference last...

In brief.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... Tobacco advertising to be banned in Republic of Ireland: Tobacco advertising and sponsorship will be banned from 1 July in the Republic of Ireland, well in advance of the October 2001 deadline set by the European Union for introducing...