BMJ NO 7073 Volume 314 Saturday 4 January 1997

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

Editorials

1 Does the world need the BMJ? Richard Smith

2 Hangovers Ian Calder

3 Monitoring blood glucose in gestational diabetes A Bargiota, R J M Corrall

4 Controlling chickenpox in hospitals E M Jones, D S Reeves

5 Polymerase chain reaction D A J Tyrell

News

7 Primary care white paper * Compulsory Caesarean sections * French doctorıs dispute * Gag clauses in US * Widening death rates between rich and poor * Paying for accident victimsı care * Ontario doctors agree deal * UK junior doctorsı hours * Interview with David Kessler * Tackling drugs on EU agenda

Papers

13 Incidence of disorders of spermatogenesis in middle aged Finnish men, 1981-91: two necropsy series Jarkko Pajarinen, Pekka Laippala, Antti Penttila, Pekka J Karhunen

18 Follow up study of moderate alcohol intake and mortality among middle aged men in Shanghai, China Jian-Min Yuan, Ronald K Ross, Yu-Tang Gao, Brian E Henderson, Mimi C Yu

23 Underestimation and undertreatment of pain in HIV disease: multicentre study François Larue, Alain Fontaine, Sophie M Colleau

29 Randomised comparison of diets for maintaining obese subjectsı weight after major weight loss: ad lib, low fat, high carbohydrate diet versus fixed energy intake Søren Toubro, Arne Astrup

34 Longitudinal study of the effect of apolipoprotein e4 allele on the association between education and cognitive decline in elderly men Sandra Kalmijn, Edith J M Feskens, Lenore J Launer, Daan Kromhout

35 Coma induced by abuse of y-hydroxybutyrate (GBH or liquid ecstasy): a case report Gareth Thomas, Stephen Bonner, Alastair Gascoigne

36 Why donıt cancer patients get entered into clinical trials? Experience of the Sheffield Lymphoma Groupıs collaboration in British National Lymphoma Investigation studies B W Hancock, M Aitken, C Radstone, G Vaughan Hudson

General Practice

38 Counting the cost of social disadvantage in primary care: retrospective analysis of patient data Adrian Worrall, J Nicholas Rea, Yoav Ben-Shlomo

Clinical review

43 Science, medicine, and the future: Prospecting for gold in the human genome John Savill

45 The future of asthma Ian P Hall

50 Lesson of the Week: Penetrating intra-oral trauma in children Robert C Law, Claire A Fouque, Angus Waddell, Eleri Cusick

Education and debate

42 BMJ creates an editorial board Richard Smith

58 Funding the NHS: Is the NHS underfunded? Jennifer Dixon, Anthony Harrison, Bill New

62 A difficult case: Childhood onset insulin dependent diabetes presenting with severe hyperlipidaemia Godfrey Nyamugundura, Helen Roper

62-5 Commentaries by Gilbert R Thompson; and P J Manning, W Sutherland, J I Mann

46 Getting published in the BMJ: advice to authors

Letters

69 Cyclists should wear helmets A Davis; T Waterston; D L Robinson; R Keatinge; M Hillman; G H Hall

71 Looking after elderly sick people is core work in general practice D B Goss

71 Midwives can help increase uptake of antenatal screening for HIV S R Killick and others

71 When is referral of Heaf test positive schoolchildren worth while? D Elliman; G E Packe; H Booth and A J Cant

72 Statistical basis of public policy P Brennan; D R Cox and V T Farewell; S Senn; I H Langford; N F Durrant

74 Bowel preparation at home in elderly people M Lewis and others; C D Hanning

74 What is the prior probability of a proposed new treatment being superior to established treatments? I Chalmers

75 Oral contraceptives are drug of choice for menorrhagia in the Netherlands S Zwart and U Meijer

75 Surgery for mental illness has been proved effective R P Snaith

75 Doctors' retainer scheme H F Macleod; J M Chapman

76 Results of American and European studies of thrombolysis in acute stroke are not conflicting A Bruno

76 Charity has published information booklet about clinical trials in cancer M Slevin

76 Assuming that developing countries could not afford xenotransplantation is patronising C R V Tomson

77 BMA asks for 53% pay increase A E A Joseph; S Fordham; E M Armstrong

77 Correction: Should breast reduction surgery be rationed? M Somerville and others

Obituaries

78 I Jones, J R Borg, B S Carter, R F Coggins, I McBride, S R J McNamara

Medicopolitical digest

79 Benefits Agency Medical Services * Consultants criticise underfunding * Consultants' private practice

Views & reviews

80 Personal views
"I need you to sign this, doctor" Trisha Greenhalgh

The caring profession Andrew Gregan

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81 Medicine and the media
Keeping the bad news from journalists Richard Smith

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82 Medicine and books
Nagasaki Symposium: Radiation and Human Health Proposal from Nagasaki Ed Shigenobu Nagataki, Shunichi Yamashita
Keith F Baverstock

The Effects of Atomic Radiation: A Half Century of Studies from Hiroshima and Nagasaki William Schull
Keith F Baverstock

Guide to Postgraduate Medical Education Brian Keighley, Stuart Murray
Jill Thistlethwaite

Health Care Policies and Europe: The Implications for Practice Carol Ludvigsen, Kathleen Roberts
Sallie Nicholas

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84 Minerva

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S2 Career Focus
Non-principal or partner? Naomi Craft

Editors Choice

The BMJ: crisper, cleaner, larger type, and with more science

Welcome to the redesigned BMJ (printed version). We hope you like it. Some of you will, and some of you won't. Anybody who has ever sat in a group discussing a design knows that disagreement is the norm. We thus ran a risk in asking readers what they thought about three proposals for the redesign (in the issue of 27 January 1996). But readers responded generously. We heard from over 350, some sending us five page treatises. Readers were clear that they favoured design A of the three we displayed in the journal. Our readers were wise. We have greatly enjoyed working with Dennis Bailey and Michael Kenny, who produced the design. The messages we got from correspondents and from focus groups we consulted were that you wanted a clean, classical, traditional appearance. You wanted to retain the contents on the cover and to have more "signposting," a larger print size, and a slightly more modern layout. You very much didn't want us to go downmarket The typesize is larger, and the layout has more space and is easier on the eye. One consequence is that there will be still more pressure on space. Signposting is improved, mainly through a line at the top of each page. The popular ABCs in particular have been redesigned, which readers will see when the next one - on haematology - begins in February. The changes are not all about design. We have introduced a new section - called Clinical Review - at the heart of the journal. This educational section will carry clinical reviews, articles on recent advances, ABCs, lessons of the week, and grand rounds. In addition, every month it will carry a new style of article called "The future of... ." These articles will describe important advances in the basic science related to common diseases and then speculate on what the science will mean for clinical practice. We begin with an article on asthma (p 45). Ian Hall thinks that we may see genetic screening for individuals at risk, targeted gene therapy, and immunisation against asthma. We are keen to do a better job with transmitting the excitement of basic science to ordinary doctors. Many doctors left medical school at a time when the new biology was only just beginning, but it is likely -along with information technology - to transform medicine in the next 20 years. John Savill begins a series on what the new biology has to offer medicine (p 43), while David Tyrell explains in an editorial how the polymerase chain reaction can help clinicians (p 5). Other innovations are an editorial board (p 52), a system of scoring books we review (p 82), and more interviews. We begin with David Kessler, who has just resigned as commissioner of the United States Food and Drug Administration (p 11). Let us know of anybody else you'd like us to interview.