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

263 Persistently poor pregnancy outcomes in women with insulin dependent diabetes
David Simmons

264 Refugee doctors in Britain: a wasted resource
Anita Berlin, Paramjit Gill, John Eversley

265 Young adults with arthritic hips
M D Northmore-Ball

266 Fungal infections in critically ill patients
Jeffrey Lipman, Roger Saadia

268 Medicines information - leaving blind people behind?
D K Raynor, N Yerassimou

269 Dearing report to shake up education
Call for a public health agency
Inequality is here to stay
ME specialist admits research errors
Indian research irrelevant to problems
Zambia pushes aid into central fund
Row over Philippines leprosarium
Devolution plans will hit NHS
Jet fuel may cause nerve damage
Crackdown on drug inducements
Pain control treatments reviewed
The plight of refugee doctors
NHS faces economy squeeze

275 Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study
I F Casson, C A Clarke, C V Howard, O McKendrick, S Pennycook, P O D Pharoah, M J Platt, M Stanisstreet, D van Velszen, S Walkinshaw

279 Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994
Gillian Hawthorne, S Robson, E A Ryall, D Sen, S H Roberts, M P Ward Platt on behalf of the Northern Diabetic Pregnancy Audit

281 Long term effect of calcium supplementation during pregnancy on the blood pressure of offspring: follow up of a randomised controlled trial
José M Belizán, José Villar, Eduardo Bergel, Alicia del Pino, Susana Di Fulvio, Silvia V Galliano, Cristina Kattan

286 Epidemiology of suicide pacts in England and Wales, 1988-92
Martin Brown, Brian Barraclough

288 Randomised crossover comparison of skin irritation with two transdermal oestradiol patches
David Ross, Margaret Rees, Val Godfree, Alison Cooper, David Hart, Charles Kingsland, Malcolm Whitehead

289 Analysis of trends in deaths from accidental drug poisoning in teenagers, 1985-95
Ian Roberts, Maggie Barker, Leah Li

226 Effect of fundholding on waiting times: database study Bernard Dowling

293 Fortnightly review: Managing congenital lacrimal obstruction in general practice
James D H Young, Caroline J MacEwen

297 ABC of mental health: Addiction and dependence - I: Illicit drugs
Claire Gerada, Mark Ashworth

301 Controversies in management: Should methionine be added to every paracetamol tablet?

No: The risks are not well enough known
A L Jones, P C Hayes, A T Proudfoot, J A Vale, L F Prescott

Yes: But perhaps only in developing countries
Edward P Krenzelok

305 How to read a paper: Assessing the methodological quality of published papers Trisha Greenhalgh

309 Death rates from leukaemia are higher than expected in areas around nuclear sites in Berkshire and Oxfordshire
C Busby and M Scott Cato

309 MRI scanning to diagnose osteomyelitis in United States and Glasgow
A G Wilkinson; G C Bennet and others

310 Funding is important for randomised trials of surgery
S Bridgman and others

310 Who is responsible for child mental health?
R C Tamhne; S Leff; J Tewson; D Summerfield; A McFadyen and J Roberts; D Sloan

312 Responsibility for services for runaway children must be shared
M MacLeod

313 Reducing morbidity from insertion of chest drains
M Hall and A Jones; G J Peek and R K Firmin

313 Setting target rates for breast feeding would probably be a waste of resources
P Hoddinott

313 Slutsky effect does not seem to explain circaseptennial rhythm in ear growth
P Onghena and others

314 Anaesthetists are younger than other doctors
C McManus

314 Audit of diagnosis and management of hypertension in primary care
K Allan and others; S Barton and M Cranney; M Mashru and A Lant

315 Medical practice is more complicated in remote locations
D Arathoon

315 Correction: Is it time to stop searching for MRSA?
P Wilson and L J Dunn

316 N Browne, L J Christopher, J G G Eglinton, J B Endacott, G R Millar, Correction: W B Petana

Soundings

317 Work experience
Trisha Greenhalgh

317 Helping people to say goodbye
Malcolm Williams

A surfeit of screening
Philip G Griffiths

319 Care in the Community: Illusion or Reality?
Ed Julian Leff
Leila Lessof

Accidents in History
Ed Roger Cooter, Bill Luckin
Leonard Evans

320

Editor's choice

Death and drugs

Williams shares some of his thinking with Michel de Montaigne, the 16th century French writer, whose essay To Philosophise is to Learn How to Die is the best thing that I have read in years. "To begin depriving death of its greatest advantage over us [surprise] ... let us have nothing more often in mind than death. ... We do not know where death awaits us: so let us wait for it everywhere. To practise death is to practise freedom. ... We must always have our boots on, ready to go. ... Death is the origin of another life. ... Living a long life or a short life are made all one by death: long and short do not apply to that which is no more. ... Your death is part of the order of the universe; it is a part of the life of the world. ... Death is one of the attributes you were created with; death is part of you. ... Your life's continual task is to build your death. ... Make way for others as others did for you ... imagine ... how much more painful would be a life which lasts for ever."

Noel Browne, a Dublin psychiatrist, knew death as a child (p 316). He was born in 1915 into a destitute Irish family ravaged by tuberculosis and was an orphan by age 10. (For a startling, funny, and moving account of such a life read Frank McCourt's recently published book Angela's Ashes.) Browne was inspired by the birth of Britain's NHS to try to create something similar in Ireland when he became minister for health. He fought the Roman Catholic church and the medical profession and was ultimately defeated by "the belt of the crosier."

Drugs and death come together in accounts of how teenage deaths from accidental drug poisoning have increased dramatically in the past 10 years (p 289) and of how 124 people killed themselves in suicide pacts in England and Wales between 1988 and 1992 - a quarter used drugs (p 286). Paracetamol is the drug that causes the most deaths from poisoning, and many have argued that the antidote methionine should be added to it routinely. Two articles debate the possibility. The argument for is that it should reduce the number of patients needing liver transplantation. The argument against is that large numbers of people might be exposed to the risks of taking methionine long term (p 301). Finally, an ABC article considers the abuse of illicit drugs and reminds us that a third of people in Britain have used illicit drugs at some time (p 297). About 100,000 people misuse heroin.