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

199 Preventing perinatal infections G Justus Hofmeyr, James McIntyre

200 Regulating the pharmaceutical industry Alan Maynard, Karen Bloor

201 Misconduct in research: editors respond Richard Smith

202 User fees Andrew Creese

204 When the next influenza pandemic comes R T Mayou White

205 Consultant struck off over research fraud
Number of Welsh trusts set to be cut
Two doctors confess to hastening death
More freedom for doctors to move in EU
Moves to cut junior doctor's hours
Patenting of genes moves step closer
Pain is often misdiagnosed
Half the world in "medieval" squalor
Screening for fragile X is accurate
Ban on fundholders jumping queue
US tobacco firms target Asia
Romania to change healthcare system
Audit shows trusts in financial crisis
Row over charity's stance

211 Contribution of deaths related to alcohol use to socioeconomic variation in mortality: register based follow up study Pia Mäkelä, Tapani Valkonen, Tuija Martelin

216 Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial Taha E Taha, Robert J Biggar, Robin L Broadhead, Laban A R Mtimavalye, Aafke B Justesen, George N Liomba, John D Chiphangwi, Paolo G Miotti

220 Commentary: Sources of bias must be controlled Leila Duley

221 Bone density and risk of hip fracture in men and women: cross sectional analysis Chris E D H De Laet, Ben A van Hout, Huibert Burger, Albert Hofman, Huibert A P Pols

226 Comparison of two methods of screening for genital chlamydial infection in women attending in general practice: cross sectional survey Lucia Grun, Julia Tassano-Smith, Caroline Carder, Anne M Johnson, Angela Robinson, Elizabeth Murray, Judith Stephenson, Andrew Haines, Andrew Copas, Geoffrey Ridgway

231 New connections between medical knowledge and patient care Lawrence L Weed

235 Netlines Mark Pallen

236 Science, medicine, and the future: Treatment of rheumatoid arthritis C D Buckley

239 ABC of mental health: Psychosexual problems J P Watson , Teifion Davies

243 How to read a paper: Getting your bearings (deciding what the paper is about) Trisha Greenhalgh

247 Informed consent
N Pfeffer and P Alderson;
H Campbell and others;
T Cullinan;
S B Squire and others;
M de B Daly;
D Elbourne and others;
K Epstein and B Sloat;
K Mohanna;
T Woodcock and J Norman;
J Sikorski;
R Watson and P Wilson;
A House and P Knapp;
C Williamson;
G C Sutton and others;
A Malin and D Lockwood;
S W P Mhlongo and G V Mdingi;
R Ashcroft and B Toth;
J Mant and others;
D J Stott and others;
D Rutter;
T Brewin;
D Barer

254 French committee will investigate proposed link between activities of nuclear reprocessing plant and leukaemia C Souleau

254 Plans are needed on how to cope with demand for ventilation during pandemic influenza M J Goodman and P B Anderson

255 Scientists should inform public of risks of transgenic experimentation R A Chalmers

255 Public should know of efficacy of early hospital treatment of paracetamol overdose G Wannan and E Fagan

255 Balance in long term follow up between secondary and primary care is necessary P J Watkins

256 H Cantrell, S Coyle, B G Dalton, C M Davis, F C J Fawcett, W S Hart, T M Hennebry, J G Jones, C Langmaid, D C Lillie, J L Patton, J E Tinne, A H Wilson

258 GP pilot schemes
New GMSC chairman
NHS funding
Underage drinking

Soundings

259 Hello sailor
Colin Douglas

259 More money for training? Christopher Bulstrode and John Lourie

A very special day Frédérique Zwart

261 Practical Anaesthesia and Analgesia for Day Surgery
J M Millar, G E Rudkin, M Hitchcock
Maire P Shelly

Prevention and Control of Pain in Children. A Manual for Health Care Professionals
Royal College of Paediatrics and Child Health
Julie McEniery

262

Editor's choice

Unaided minds, science, and euthanasia

Firstly, only a portion of medical knowledge is ever loaded. Secondly, much of it is forgotten. Thirdly, much becomes obsolete - and increasingly quickly. Fourthly, the doctor's unaided mind cannot reliably integrate the knowledge with the infinite variety of patient data. Fifthly, doctors thus fall back on "clinical judgment," a global, intuitive assessment, which cognitive psychology shows to be much poorer than judgments based on thorough analysis of specific data. Sixthly, doctors' education gives them a misplaced faith in relying on their minds: indeed, those who use aids may be scorned. Finally, many people do not have access to the medical knowledge that exists in "expensively educated, highly paid, geographically limited doctors." Weed has answers to these problems. His answers may be less convincing than his analysis of the problem, but the arrival of the information age undoubtedly opens up the possibility of transforming medical practice.

A second great driver of change in medicine is basic science, and C D Buckley looks at how it may advance the management of patients with rheumatoid arthritis (p 236). He argues that management in the past 20 years has been based on a false premise - that its prognosis is generally good. That is why management has begun with symptomatic treatment and advanced to disease modifying drugs. But 90% of patients with aggressive disease will become clinically disabled within 20 years - and the mortality for some patients is equal to that for patients with stage IV Hodgkin's lymphoma. There is thus a need to use disease modifying drugs early; and basic science is opening up a wide range of possibilities. One is a drug that might switch on apoptosis - controlled cell death - in synovial fibroblasts.

Another major change that may come in medicine in the next 20 years is how doctors manage death. The "euthanasia debate" seems to gather greater steam every day (p 206), and on p 260 Frédérique Zwart, a Dutch doctor, describes her grandmother's death from active euthanasia. She found the death very peaceful and was proud of her grandmother.