BMJ No 7070 Volume 313

This week in BMJ Saturday 7 December 1996

Aspirin should be drug of choice after thrombolysis for myocardial infarction

Controversy remains over whether anticoagulants are appropriate after thrombolysis for myocardial infarction or whether aspirin would be just as effective and safer. On page 1429 Julian et al describe the results of a randomised trial comparing aspirin with intravenous heparin followed by warfarin. The endpoints were cardiac death and reinfarction in 1036 patients treated with anistreplase. Aspirin resulted in a substantially lower risk of bleeding and stroke and no difference in the 30 day rates of cardiac death and reinfarction. The authors conclude that aspirin should be the drug of choice for most patients in this context.

Induced abortion increases risk of suicide

The impact of childbirth on the mother's mental health ranges from the "baby blues" to puerperal psychosis. On p 1431 Gissler et al report on a unique data linkage study of the risk of suicide associated with pregnancy among women of reproductive age (15-49 years). They found that about 5% of all suicides in such women were connected with an ended pregnancy. The mean annual suicide rate was 11.3 per 100 000 for the study period, whereas the rate associated with birth was lower (5.9) and the rates associated with miscarriage (18.1) and induced abortions (34.7) were higher. The risk was increased among teenagers and that associated with abortion was increased in all age groups. Lower social class and being unmarried were risk factors for suicide associated with an ended pregnancy. Increased risk for a suicide after induced abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health.

Cardiovascular risk factors are associated with socioeconomic circumstances in early life

The realisation that cardiovascular disease in adulthood can have its origins in early life raises questions about doctors' attempts to modify risk factors for cardiovascular disease in adults. Blane et al (p 1434) used data from a workplace screening study in the west a Scotland to examine the associations between six such risk factors and working men's social conditions during childhood and adulthood. The risk factors varied in the strength of their associations with childhood and adult conditions. Behavioural risk factors were more strongly associated with adult circumstances. Physiological risk factors were associated to varying degrees with circumstances in both childhood and adulthood. As most of the main risk factors varied with adult social condition the authors argue that they can be modified at this time.

Ankle brachial pressure index helps predict cardiovascular risk

On p 1440 Leng et al report the value of the ankle brachial pressure index, a marker of generalised atherosclerosis, in predicting cardiovascular events. They found that a low value is associated with an increased risk of non-fatal cardiovascular events and death and improves the prediction of future events compared with predictions based only on conventional risk factors. The ankle brachial pressure index is a simple and reliable test which, if included in routine screening for cardiovascular disease, could help to identify those at greatest risk of cardiovascular injury or death.

Nazis had to curb the enthusiasm of zealous doctors

Until comparatively recently the German medical establishment has explained atrocities by colleagues during the Nazi era as the result of a sudden subversion of the profession at some point after Hitler became chancellor-"When the the physicians were able to see clearly . . it was too late to do anything." But the reality is very different. Hanauske-Abel (p 1453) examined documents published in German medical journals largely in 1933 and found that Aryan doctors were enthusiastic participants in Hitler's plans for Jews and other non-Aryans. By 1937 the profession's eager pursuit of enforced eugenic sterilisations so alarmed the Nazi administration that it had to rein in the profession's activities. Hanauske-Abel believes that in 1933 there was a convergence of political, scientific, and economic forces which dramatically changed the relationship between the medical community and the government.

British medical attitude to German human experiments was shaped by self interest

On p 1467 Weindling describes British medical responses to Nazi experiments on humans. The BMJ's correspondent at Nuremberg argued for the scientific -validity of the conduct of some of the medical researchers on trial. His views raised issues of human experiments in wartime and postwar Britain. Clinical ,researchers were concerned that if public reaction to the German atrocities was too critical this could impede -further research. The British supported confidential evaluation of the German medical research by a panel of leading medical researchers. British attitudes were shaped by concerns that the new NHS and state -planning of science could interfere with the autonomy of clinical research. Despite initial condemnations of the German atrocities medical attitudes to human experiments remained in some respects broadly permissive.