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

137 Physician assisted suicide, euthanasia, or withdrawal of treatment
Larry R Churchill, Nancy M P King

139 General practice fundholding and health care costs
Duncan Keeley

140 London's healthcare services - again
Elaine Murphy

141 The changing face of ectopic pregnancy
Lawrence Mascarenhas, John Williamson, Steve Smith

142 Indicators of clinical performance
Martin McKee

143 US clinical research in crisis
Smoking crackdown in UK
Many stillbirths could be avoided
Emergency surgery services need revamp
Goodbye to the "hello nurse" in casualty
"Smart" rationing is possible
Ban on interferon ß is unlawful
Get real on rationing, Mr Dobson
Maternal fever link to cerebal palsy
US doctors lie to help patients
Canada cuts drug evaluation jobs

149 Impact of postmenopausal hormone therapy on cardiovascular events and cancer: pooled data from clinical trials
Elina Hemminki, Klim McPherson

154 Randomised, double blind, multicentre comparison of hydrochlorothiazide, atenolol, nitrendipine, and enalapril in antihypertensive treatment: results of the HANE study
Thomas Philipp, Manfred Anlauf, Armin Distler, Heinrich Holzgreve, Joerg Michaelis, Stefan Wellek on behalf of the HANE Trial Research Group

159 Inpatient deaths from acute myocardial infarction, 1982-92: analysis of data in the Nottingham heart attack register
Nigel Brown, Tracey Young, David Gray, Allan M Skene, John R Hampton

164 Increased brain serotonin function in men with chronic fatigue syndrome
M Sharpe, K Hawton, A Clements, P J Cowen

166 How has fundholding in Northern Ireland affected prescribing patterns? A longitudinal study
Thérèse Rafferty, Keith Wilson-Davis, Hugh McGavock

170 What is to be done about fundholding?
Toby Gosden, David J Torgerson, Alan Maynard

172 Fortnightly review: Plantar fasciitis
Dishan Singh, John Angel, George Bentley, Saul G Trevino

176 ABC of mental health: Disorders of personality
Martin Marlowe, Philip Sugarman

180 How to read a paper: The Medline database
Trisha Greenhalgh

184 Self monitoring of glucose by people with diabetes
N J Crossland; M de Alva and J Jervell; M W J Strachan and others; E Chantelau and S Nowicki; M Gallichan

186 Multiple myeloma
S J Krikler; C S B Galasko

186 Catheters smaller than 24 French gauge can be used for chest drains
P M Taylor

186 Screening for prostate cancer
R H Harwood; W J Catalona

187 Trials of streptokinase in stroke depend on early, accurate diagnosis
K W Muir

187 Tuberculosis treatment is expensive for patients in developing countries
E Bevan

188 Alcohol consumption may influence onset of the menopause
D J Torgerson and others

188 Chronic venous ulcer
R P Cole; A W McEwen and M B Smith; C V Ruckley and others; J J Bergan and N Angle

189 Counselling should be provided before parents are told of presence of ultrasonographic "soft markers" of fetal abnormality
G Mason and C Baillie

190 Harm resulting from screening is likely to be high where prevalence of breast cancer is low
P Adab

190 Minimising factitious hyperkalaemia
P W Masters and A A A Ismail; N J Gourlay and C McArthur

190 HIV positive doctors deserve support
R Drew and G Foster

191 Support and treatment of serious comorbidity also improve survival in breast cancer
H W Nab and J W W Coebergh

191 How widespread is prejudice against sick doctors by self help groups?
N J Stafford

191 Man's fractured sternum was probably due to snake's weight when it fell
B W Davies

192 D W Bain, P N Coleman, C F Coutts-Wood, R K Dutta, L J Glancy, R L Lamming, D S Lewes, J Miller, W B Petana, J N Shephard, G M T Tate, M S Williamson

194 BUPA replies to criticism
Primary care pilots
Doctors and airline's policy
PFI projects
Commons health team

Soundings

195 Professional highs
James Owen Drife

195 The danger of honest admission
Anonymous

196 The traumas of casualty departments
Christopher Bulstrode

197 Understanding Cancer: From Basic Science to Clinical Practice
Malcolm Alison, Catherine Sarraf
Peter Selby

Women and Alcohol: Contemporary and Historical Perspectives
Moira Plant
Alex Paton

198

Editor's choice

BMJ yin issue

The yin issue begins by showing that pooled data from 22 trials do not support the widespread belief that postmenopausal hormone replacement therapy will reduce cardiovascular events (p 149). Yet most doctors seem to believe that it does, and the treatment is becoming common. This is the result of a cultural bias towards doing something. Some feminists also argue that male dominated cultures are drugging women on a massive scale to keep them sexually attractive for as long as possible.

A variant of the bias towards the positive is a bias towards the new. Thus patients with hypertension have increasingly been prescribed angiotensin converting enzyme inhibitors and calcium channel blockers rather than the long established diuretics and ß blockers. But German researchers show from a randomised multicentre trial over 48 weeks that the new drugs are no better in controlling blood pressure (p 154).

A third yin paper - from Nottingham - looks at what happened with inpatient deaths from acute myocardial infarction between 1982 and 1992. Aspirin, ß blockers, and thrombolytic drugs are all being used much more - but age and sex adjusted mortality has not changed (p 159). What's true in clinical trials may not be true in the real world.

Our negative mood extends beyond clinical treatments to policy innovations. Giving general practitioners budgets to cover ancillary staff, some hospital services, and prescribing was one of the central planks of the British government's reforms of the health service. A study from Northern Ireland shows that fundholders managed a one time reduction in prescribing costs but their costs then increased at the same rate as non-fundholders (p 166). An editorial suggests that fundholding hasn't achieved much (p 139), while a paper argues that Britain needs proper evaluation of any future changes in fundholding - using trial methodology (p 170).

Finally, we begin today - in positive mood - a series by Trisha Greenhalgh on how to read scientific papers. This is pitched at a level that should be accessible to all, but even it begins with what some might see as a negative quote: "The extent to which beliefs are based on evidence is," said philosopher Bertrand Russell, "very much less than believers suppose."