BMJ NO 7077 Volume 314 Saturday 1 February 1997

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

Editorials

315 New guidelines on asthma management Duncan Keeley John Rees

316 Managing measles Greg Hussey

317 Reducing vitamin A deficiency Andrew R Potter

319 Surgery, drugs, and the male orgasm William D Dunsmuir Mark Emberton

320 Cardiac sarcoidosis D N Mitchell R M du Bois P J Oldershaw

321 Telling patients they have Alzheimer's disease Barnett S Meyers

News

323 Mammograms not recommended for younger women * p27 protein linked with poor cancer outcome * Chinese government announces fitness programmes * Drug testing kit approved for sale in US * Quebec forced to import surgeons * Dutch euthanasia rules relaxed * Official report criticises French health ministry * Rise in litigation hits British GPs * Oral cholera vaccine raises hopes * Glaucoma gene identified * France may ban casual work on nuclear sites * Medicare hospital fees will be frozen * Mixed sex wards to be phased out in UK * American style HMOs likely in Britain * Sick MPs wheeled in to save UK Government

Papers

329 Immune response to a new hepatitis B vaccine in healthcare workers who had not responded to standard vaccine: randomised double blind dose-response studyJane N Zuckerman, Caroline Sabin, Fiona M Craig, A Williams, Arie J Zuckerman

334 Meta-analysis of trials of prophylactic antibiotics for children with measles: inadequate evidence Frank Shann

337 Commentary: Summary statistics of poor quality studies must be treated cautiously Jesse A Berlin

338 Respiratory morbidity 10 years after the Union Carbide gas leak at Bhopal: a cross sectional survey P Cullinan, S Acquilla, V Ramana Dhara, on behalf of the International Medical Commission on Bhopal

342 Commentary: Industry can damage your health Paul Garner

343 Commentary: Assessing the effects of environmental pollution when people know that they have been exposed R T Mayon-White

343 Follow up policy after treatment for Hodgkin's disease: too many clinic visits and routine tests? A review of hospital records J A Radford, A Eardley, C Woodman, D Crowther

346 Duplication of surgical research presentations I C Cameron, J D Beard, M W R Reed

347 A randomised controlled trial of dictating the clinic letter in front of the patient B W Lloyd

348 Commentary: Interesting idea, but case not proved Mike Pringle

349 Drug points: Acute eosinophilic pneumonia associated with tenidap B M Martinez, P Domingo

349 Potentiation of warfarin anticoagulant activity by miconazole oral gel S Ariyaratnam, N S Thakker, P Sloan

General Practice

350 Duration and recurrence of otitis media with effusion in children from birth to 3 years: prospective study using monthly otoscopy and tympanometry Sarah C Hogan, Kenneth J Stratford, David R Moore

354 Commentary: Reduced confusion over ear effusion? M P Haggard

354 Commentary: Markov models of medical prognosis Andrew Briggs, Mark Sculpher

Clinical review

356 Science, medicine, and the future: The future of the management of ischaemic heart disease David Crossman

360 ABC of clinical haematology: Iron deficiency anaemia Rebecca Frewin, Andrew Henson, Drew Provan

363 Lesson of the week: Cyclosporin treatment for ulcerative colitis complicated by fatal Pneumocystis carinii pneumonia Virginia A Quan, Brian P Saunders, Brendan H Hicks, Gordon E Sladen

Education and debate

365 Regulating the price of the UK's drugs: second thoughts after the government's first report Alan Earl-Slater

Letters

369 Bed shortages P G M Wallace and P G Lawler; J Wardrope

369 Delay in diagnosis of homocystinuria M P Champion and others; I McDowell and D Bradley

370 Future of the NHS will be one of change K Mackay

371 Many claims about passive smoking are inadequately justified P N Lee

371 Congenital anterior abdominal wall defects C Luck and J Scrutton; J Chalmers and others; E Dillon and others; M D Stringer and G Mason

373 Giving influenza vaccination to all elderly people would raise ethical issues D King and R Morgan

373 Helping parents to cope when their preschool children are acutely ill P Impicciatore and others; J Townsend and others

374 Many trusts find labour productivity index useful C Brown

374 The Babinski sign P H W Rayner; T Hughes

374 Associate specialists are included in colleges' scheme for continuing medical education P Toghill

375 Inquiry into homicides by psychiatric patients E Murphy; L Appleby and others

375 Stabilisation of the population is necessary for health for all J Guillebaud

375 Telling the diagnosis to patients with Alzheimer's disease R C Barnes; K Rice and others

376 20% of patients may refuse consent to disclosure of information for Benefits Agency S J Ellis

376 Study about prehospital emergency care was cited incorrectly R Cree and M Weaver

376 Women need to be warned about dangers of hormone replacement therapy E H Price and others

377 Effect of psychogeriatric team on depression in frail elderly people at home R Walters and H Evans; G Pinner and others; S Banerjee and others

378 Plagiarism in the BMJ H Vecht; L Farrell

Obituaries

379 J B Rennie, G W A Neill, B Cashman, R Horn, T G I James, E Kelly, D L Pryer, K Rostron, M Thompson, J C Turner, A P Ward, T M Welsh

Medicopolitical digest

381 Labour attack on NHS * BMA and devolution * Charter for mental health patients * Non-principals' association statutory body

Views & reviews

Personal views

328 Our brilliant careers Trisha Greenhalgh

Managing gastric cancer in Britain: a Japanese experience Takeshi Sano

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Medicine and the media

383 A very public death Naomi Craft

Ethical issues in genetics ignored Pritpal S Tamber

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Medicine and books

385 Impure Science. AIDS, Activism and the Politics of Knowledge Steven Epstein
Roy Porter

A Midwife Through the Dying Process Timothy E Quill
Brendan Kelly

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Minerva

386

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S2 Career Focus

Flexible training in cardiothoracic surgery Anna Merrick

Editors Choice

Editors try to be creative

"Editors simply take in other people's washing," said one great editor. Our job is to wash, sort, and return. But this issue illustrates how editors try to be creative.

Long ago we asked Frank Shann to write an editorial on whether children with measles should be given prophylactic antibiotics. This is an important question. Measles causes more than a million deaths a year, and most of the deaths are from pneumonia. Together we realised that a traditional review could not answer the question confidently. Professor Shann then undertook the systematic review we publish today (p 334). The main conclusion is that the evidence is too poor to give a confident answer. But antibiotics should probably be given if the child has clinical signs of pneumonia or sepsis. An accompanying editorial discusses the World Health Organisation's guidance on managing measles (p 316), while a commentary explores the problems in drawing conclusions from poor quality studies (p 337).

Last year we published a paper showing that most relatives of patients with dementia didn't want the patients told the diagnosis although they would want to know themselves if they were becoming demented. In response we received many letters, two of which we publish today (p 375), showing confusion among doctors about what to do. We thus commissioned an editorial on the subject (p 321). Barnett Meyers says that more research is needed but that "Doctors, patients, and family members who share the responsibility for coping with Alzheimer's disease all require access to diagnostic information."

We were fascinated by the question that paediatrician B W Lloyd asked about whether he should dictate clinic letters to referring general practitioners in front of the family (p 347). The families liked the experience but were no more satisfied than a control group. Dr Lloyd's paper has weaknesses, and we thought that the best way to publish it was together with a commentary discussing the weaknesses and suggesting how the question might be answered better (p 348). We hope that some readers may take up the challenge.

One of the challenges editors are facing is to find better ways of packaging educational material. Our popular ABCs are one response, and a new one begins today - on clinical haematology. We concentrate on common problems, and today's ABC begins with iron deficiency anaemia, the commonest cause worldwide of anaemia (p 360). We have long searched for the best way to excite readers with developments in basic science, and our "Future of series is the answer. Authors describe what is hottest in the science related to a common clinical problem and then speculate on what the science may mean for clinical practice in a few years' time. Today David Crossman describes how basic science will transform the management of ischaemic heart disease (p 356).