With head and heart and hand
  Portraits of 20th century British doctors by Nick Sinclair

BMJ No 7085 Volume 314 Saturday 29 March 1997

This Week in BMJ | Editor's Choice | Press releases | Advertisement details

Editorials

913 The promise of cloning for human medicine Robert Winston

914 Reducing morbidity from chest drains Jonathan Hyde, Timothy Sykes, Timothy Graham

915 Discrimination, informed consent, and the HIV infected clinician Ronald Bayer

916 Removing bias in surgical trials A G Johnson, J Michael Dixon

918 Ultrasonographic "soft markers" of fetal chromosomal defects Martin Whittle

News

919 US firm admits tobacco causes cancer * PVS criteria questioned in court case * Consultant surgeon told to stop operating * Contraception use increasing worldwide * Institute for ethics launched in US * Five apples a day ... * Spanish flu virus identified * Global TB epidemic levelling off * Culture of data privacy is needed * Gulf war records wrongly withheld * GPs criticise review body chairman * Prison sentence brought on anorexia * Relief effort starts in Albania * Ontario attacked over hospital closures * Luisa Brumana, medical student leader, profiled

Papers

925 Cohort study of association of risk of breast cancer with cyst type in women with gross cystic disease of the breast Paolo Bruzzi, Luigi Dogliotti, Carlo Naldoni, Lauro Bucchi, Massimo Costantini, Alessandra Cicognani, Mirella Torta, Gian Franco Buzzi, Alberto Angeli

929 Retirement on grounds of ill health: cross sectional survey in six organisations in United Kingdom C J M Poole

932 A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression Louis Appleby, Rachel Warner, Anna Whitton, Brian Faragher

936 Cross sectional study of contribution of clinical assessment and simple cardiac investigations to diagnosis of left ventricular systolic dysfunction in patients admitted with acute dyspnoea Neil D Gillespie, Graeme McNeill, Terence Pringle, Simon Ogston, Allan D Struthers, Stuart D Pringle

940 Examination of attendance patterns before and after introduction of South Africa's policy of free health care for children aged under 6 years and pregnant women David Wilkinson, Marlene E Sach, Salim S Abdool Karim

941 Commentary: Should mother and child health services in developing countries be free? Anthony Costello

General practice

942 Interpractice audit of diagnosis and management of hypertension in primary care: educational intervention and review of medical records Mahendra Mashru, Ariel Lant

Information in practice

947 Obtaining useful information from expert based sources David C Slawson, Allen F Shaughnessy

950 Information retrieval for patient care Martin Gardner

954 Netlines Mark Pallen

Clinical review

955 Science, medicine, and the future: Non-insulin dependent diabetes mellitus: the gathering storm Stephen O'Rahilly

960 ABC of clinical haematology: Multiple myeloma and related conditions Charles R J Singer

Education and debate

964 Self monitoring of glucose by people with diabetes: evidence based practice Marilyn Gallichan

967 The rationing debate: Central government should have a greater role in rationing decisions: The case for Jo Lenaghan

970 The rationing debate: Central government should have a greater role in rationing decisions: The case against Stephen Harrison

Letters

974 Trends in NHS expenditure M G Dunnigan

974 Poor recruitment to lung cancer trials R T Penson and R M Rudd

975 Fatal methadone overdose E W Benbow and others

975 GP cooperatives J York; J Rawlinson; N Lattey; D A G C Robertson; K McKenna; P Holmes

976 Catching glaucoma F M Chapman and P S Phelan

977 Cyclists should wear helmets B Pless and R Davis

977 Depression and the menopause J Studd; M Hunter

978 Circaseptennial rhythm is an artefact M J Campbell 978 Comorbidity increases benefit of anticoagulation in patients with atrial fibrillation S Morgan

978 Psychological rehabilitation after myocardial infarction C Pither and A C Williams; J M Noon; D A Jones and R West

979 Rehabilitation after heart attack C Bundy

980 A framework for priority setting A Scott and others

980 Internet server with targeted access would cure information deficiency in developing countries R E LaPorte

980 Empowering doctors in the developing world R Macrorie

Obituaries

981 A G Apley, V Bowers, S Brown, J B Cadas, D L Rees, Correction: C H Edwards

Medicopolitical digest

982 Primary care receives royal assent * GPs' Easter campaign * Mental health services * BMA's annual report

Personal views

983 Breakthroughs and wars George Dunea

Education or training: medicine's learning agenda Zo|f5-Jane Playdon and Dan|f5 Goodsman

Medicine and the media

984 Pain, pus, and blood James Drife

Medicine and books

985 When the Air Hits Your Brain. Tales of Neurosurgery Frank Vertosick Jr
M P Powell

Who Has Seen a Blood Sugar? Reflections on Medical Education
Frank Davidoff
Julian Tudor Hart

Minerva

986

S2 Career Focus Classified supplement
On the early career choices of medical graduates Jon Ford

Editor's choice

Exciting challenges: Dolly and POEMS

Over the past few weeks Dolly, the cloned sheep, has provoked ribaldry from satirists, headlines about a master race of humans from tabloid newspapers, and a "knee jerk political reaction" from the president of the United States. As the furore has died down, more measured reactions seem to be setting in - from the House of Commons science and technology committee and from Robert Winston, our editorialist (p 913). Winston shows how complex are the issues that Dolly raises and how potentially useful cloning techniques might prove. The production of Dolly, he says, "should not be seen as a moral threat but rather as an exciting challenge."

A more mundane challenge is thrown down by C J M Poole's study of ill health retirement in six large organisations in the UK (p 929). He finds large variations in the rates of retirement on grounds of ill health. In four organsations the most popular time for opting for ill health retirement coincided with enhancements in benefit, so he suspects that applicants may be motivated more by financial benefits than by ill health.

Financial incentives (or disincentives) are also the subject of a short report, which produces rather a surprising conclusion. David Wilkinson and colleagues looked at attendance patterns at local clinics in a district of South Africa before and after President Nelson Mandela introduced free health care for young children and pregnant and lactating women (p 940). Preventive services for under 6 year olds had always been free and attendances did not change significantly. The greatest increase occurred in attendances for treatment services. The staff, however, complained of being overworked and saw the increased workload as unnecessary and caused by trivial illnesses. The authors suggest that if preventive services are already free then a policy of free care may encourage presentation of self limiting illness and be counterproductive. In his commentary Tony Costello warns against such a simplistic interpretation: in other developing countries the use of preventive services has declined when charges have been introduced.

Finally, this week we introduce a new acronym - POEM - and risk a prediction that you will hear more about it in future. In their paper on obtaining information from expert sources, David Slawson and Allen Shaughnessy argue that useful information can be distinguished from useless on the basis of three questions: Does the information focus on an outcome my patients care about? Is the issue common in my practice? Is the intervention feasible? If the answers are yes then the information is patient orientated information that matters - a POEM.