BMJ NO 7074 Volume 314 Saturday 11 January 1997

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

Editorials

85 Advising patients with genital herpes Raj Patel, Frances M Cowan, Simon E Barton

86 Setting priorities New Zealand-style Jennifer Dixon, Bill New

87 Hypoplastic left heart syndrome Sean W O'Kelly, Edward L Bove

88 "I've just been bitten by a dog" Fionna Moore

90 Meeting the information needs of health workers in developing countries Neil Pakenham-Walsh, Carol Priestley, Richard Smith

News

91 Research league tables published * "Drive by" mastectomies to be banned * Second Australian euthanasia case * Penalties for doctors prescribing cannabis * Gulf war research under the spotlight * First tobacco legal case in France * China clamps down on blood products * Sunshine - the simple way to purify water * Netherlands tackles waiting lists * HIV trends stable but worries remain * Alternative therapies for the menopause * David Carter, Scotland's CMO profiled

Papers

97 Are short normal children at a disadvantage? The Wessex growth study A Bruce Downie, Jean Mulligan Robert J Stratford, Peter R Betts, Linda D Voss

101 Case-control study of leukaemia among young people near La Hague nuclear reprocessing plant: the environmental hypothesis revisited Dominique Pobel, Jean-Francois Viel

107 Changing prognosis for babies of less than 28 weeksą gestation in the north of England between 1983 and 1994 Win Tin, Unni Wariyar, Edmund Hey for the Northern Neonatal Network

112 Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies Robert Clarke, Chris Frost, Rory Collins, Paul Appleby, Richard Peto

118 Thermographic changes in keyboard operators with chronic forearm pain S D Sharma, E M Smith, B L Hazleman, J R Jenner

119 Validation of a rapid whole blood test for diagnosing Helicobacter pylori infection P Moayyedi, A M Carter, A Catto, R M Heppell, P J Grant, A T R Axon

General Practice

120 Feasibility and effects of nurse run clinics for patients with epilepsy in general practice: randomised controlled trial L Ridsdale, D Robbins, C Cryer, H Williams and the Epilepsy Care Evaluation Group

122 Prevalence of arm movements in patients with coronary heath disease: case-control Study Alan N Rennie

Clinical review

123 Fortnightly review: Prophylaxis of venous thromboembolism M Vestraete

126 Science, medicine, and the future: Molecular genetic approaches to understanding disease John Savill

129 Lesson of the week: Man's best friend: life threatening sepsis after minor dog bite D J Mellor, Sunil Bhandari, K Kerr, A R Bodenham

Education and debate

131 The New Zealand priority criteria project Part 1: Overview David C Hadorn, Andrew C Holmes

135 The New Zealand priority criteria project Part 2: Coronary artery bypass graft surgery David C Hadorn, Andrew C Holmes

139 Funding the NHS: Can the NHS cope in future? Anthony Harrison, Jennifer Dixon, Bill New, Ken Judge

Letters

143 Widow's attempt to use her dead husband's sperm K K Ahuja and others; D Black

143 Serum cholesterol concentration and postpartum depression M Luckas and others; G D Smith

144 Fifth of e antigen negative carriers of hepatitis B virus should not perform exposure prone procedures E H Boxall and A Ballard

144 Resuscitation witnessed by relatives A Goldstein and others; K Stewart and L Bowker

145 Insulin infusion in diabetic patients with acute myocardial infarction B M Fisher; J S Vudkin; G Davey and P McKeigue

146 Disagreements still exist over the chronic fatigue syndrome C Shepherd

146 Treating dysentery with metronidazole in Pakistan T I Bhutta and A Vitry

147 Measurement error J Masse; J M Bland; J R Doyle and J M Doyle

148 Dietary habits and mortality in vegetarians and health conscious people A R Ness and J W Powles; J F Morgan; T J A Key and others

149 Safeguards are needed for new proposals for primary care I Heath and S Amiel

149 Information shared in mentoring must remain confidential R Freeman

Obituaries

150 B G Achong, L G Brock, G J Dixon, R V Harris, H V Jones, A C Marley, W G Millar, G W Milroy, J Pasmore, B B Reiss, K N Sengupta, A C Sheldon

Views & review's

152 Personal View
One born every minute Liam Farrell

Eroding the trust Justine Foster

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153 Medicine and the media
Shine Simon Wessely

154 Medicine and books
Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment Joel Paris
Kwame McKenzie

Developing Primary Care - The Academic Contribution: The Conference of Academic Organizations in General Practice Ed D J Pereira Gray
Chris van Weel

Health and Social Organization - Toward a Health Policy for the 21st Century Ed Blane, Brunner, Wilkinson
George A Kaplan

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156 Minerva

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S2 Career Focus
Locum doctors Dr Philip Morgan

Editors Choice

Learning about cancer from France and rationing from New Zealand

Good communication among countries helps us learn from each other. So, ironically, does poor communication. Thus Britain has for a decade debated whether nuclear installations cause leukaemia. In contrast, France, which is heavily dependent on nuclear power, has had little media attention on the problem. This meant that Dominique Pobel and Jean-Francois Viel could conduct a case-control study of leukaemia among young people near a reprocessing plant in Normandy without having to worry that participants knew the hypotheses being tested (p 101). Consequently, they have contributed greatly to the long running search for why nuclear installations are associated with leukaemia.

The story began in the early 1980s with the identification of a cluster of cases of leukaemia around a British nuclear reprocessing plant. One theory was that the environment was polluted with radiation, but there didn't seem to have been enough radiation released to cause leukaemia A case-control study suggested that occupational exposure to radiation before conception among the fathers of children with leukaemia might be the cause. This hypothesis attracted great scientific curiosity and worldwide attention (although clearly not much in France). A third hypothesis is that population mixing - with probable effects on childhood infection - is the cause. Thus the links between nuclear installations and leukaemia may be nothing to do with radiation but rather with the large influx of workers to rural areas to build the installations.

The French study revives the environmental hypothesis but finds no evidence to support the paternal exposure hypothesis. The authors found links between leukaemia and the affected children and their mothers using local beaches and eating shellfish. The authors suggest that we look for new environmental pathways, particularly in marine ecosystems.

Every country has much to learn from New Zealand because it is one of the few countries to tackle explicitly the rationing of health care. Two papers describe how the New Zealanders have gone about giving priority scores to patients waiting for various surgical procedures (p 131 and 135). Scores are allocated on the basis of clinical severity and various social factors, including ability to work and to care for dependents. In the case of coronary artery bypass grafting the surgeons would have liked to operate on all patients with a score over 25 but accepted that there were funds available only for those with scores over 35. The authors believe that they have taken an "important step towards the goal of a fair, transparent, and evidence based allocation policy Jennifer Dixon and Bill New argue that New Zealand's system based mainly on clinical need makes much more sense than Britain's system, which is often based simply on how long a patient has been waiting (p 86).