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

321 Acute otitis media in children
Azeem Majeed, Tess Harris

322 Kawasaki disease
Nigel Curtis

324 Clinical guidelines
Elizabeth West, John Newton

325 Why Britain's drug czar mustn't wage war on drugs
John Strang, William B Clee, Lawrence Gruer, Duncan Raistrick

326 Educating doctors, to improve patient care
Peter Toon

327 Row over force feeding of dementia patients
For profit medicine in US under scrutiny
Laser treatment for angina rejected by FDA
Mental health problems can be prevented
Nuclear test fallout linked to cancer risk
Drug linked with Churg-Strauss syndrome
Canadians sue over hepatitis C infection
Heart attacks linked to traffic fumes
China clamps down on hospital fees
US budget supports child health
Call for inquiry into CJD cluster
Dr John Chisholm profiled

333 Systematic review of role of polymerase chain reaction in defining infectiousness among people infected with hepatitis C virus
Gregory J Dore, John M Kaldor, Geoffrey W McCaughan

338 Evaluation of validity of British anthropometric reference data for assessing nutritional state of elderly people in Edinburgh: cross sectional study
Elaine Bannerman, J J Reilly, W J MacLennan, T Kirk, F Pender

341 Reduced final height and indications for insulin resistance in 20 year olds born small for gestational age: regional cohort study
Juliane Leger, Claire Levy-Marchal, Juliette Bloch, Agnes Pinet, Didier Chevenne, Dominique Porquet, Dominique Collin, Paul Czernichow

347 Survey of occupancy of paediatric intensive care units by children who are dependent on ventilators
James Fraser, Quen Mok, Robert Tasker

348 Comparison of blood or urine testing by patients with newly diagnosed non-insulin dependent diabetes: patient survey after randomised crossover trial
Pat Miles, Joan Everett, June Murphy, David Kerr

350 Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics P Little, C Gould, I Williamson, G Warner, M Gantley, A L Kinmonth

353 Finance, not learning needs, makes general practitioners attend courses: a database survey
T S Murray, L M Campbell

354 Recent advances: Otorhinolaryngology
Jochen A Werner, Stefan Gottschlich

358 ABC of mental health: Addiction and dependence - II: Alcohol
Mark Ashworth, Claire Gerada

361 The search for evidence of effective health promotion
Viv Speller, Alyson Learmonth, D Harrison

364 How to read a paper: Statistics for the non-statistician. I: Different types of data need different statistical tests
Trisha Greenhalgh

367 Obstructive sleep apnoea
J Shneerson and I Smith;
A I Pack and T Young;
J R Stradling and R J O Davies;
G J Gibson and K Prowse;
S J G Semple and D R London;
H M Engleman and others;
J Wright and T Sheldon

370 Hazards of running a marathon
I A Laing; S Hood

370 Unexpected findings of study of selegiline have not been treated with caution its authors advised
M T Silva and others

370 Drug treatment for benign prostatic hyperplasia
R Mendelsohn and D Thompson; G N Collins; S Taneja

371 Criticism of prophylaxis of gastrointestinal bleeding with H2 receptor antagonists is wrong
T M Cook

372 Treatment of pregnant women with recurrent miscarriage associated with phospholipid antibodies
O B Christiansen; J Kingdom and E Jauniaux; J-C Piette and others; R Rai and L Regan

373 Casualties of Gulf war were higher than most reports suggest
C S Nice

374 H Bound, R Cutler, R P Ellman, A C Gee, J L A Kurowski

Soundings

375 The moment
Liam Farrell

375 Dislocations in the European Union
Anne Savage

Tired all the time
David Memel

377 Managing Family Planning in General Practice
Sam Rowlands
Tim Carney

Clinical Effectiveness and Primary Care
Mark Baker, Neal Masirey, Simon Kirk
Chris Silagy

378

Editor's choice

A battlefield of medicine

Antibiotics have been one of the blessings of medicine and general practice. But research on infectious disease in general practice is showing a much more complicated picture. Azeem Majeed and Tess Harris review a series of papers that the BMJ has been publishing that suggest that antibiotics produce only small benefit in children with acute otitis media (p 321). Meanwhile, a randomised controlled trial of different approaches for prescribing antibiotics to patients with sore throat suggests that the main outcome of immediate prescribing is that you make the patients more likely to come back again (p 350). You don't do much for the sore throat.

How can general practitioners keep up with all these changes? The British government decided in 1990 that it would pay general practitioners to attend continuing education. Now it may be time to scrap the payment and find better ways of educating general practitioners. A study from Scotland suggests that financial considerations rather than learning needs are dictating where doctors go for their education (p 353) - and many end up asleep in lectures funded by pharmaceutical companies rather than interacting in the small groups that educators tell us are most effective. Peter Toon calls for a radical rethink (p 326).

Back in the surgery the age old problems of medicine remain. Continuity of care, says Liam Farrell, general practitioner from Crossmaglen, "is one of the more sensible mantras of academic general practice" (p 375). But he warns of its dark side - the day when the partner/locum/consultant says: "Hey, that guy's a classic case; how did you miss that he is hypothyroid/acromegalic/growing two heads?" It's easy, answers Farrell. "The second head starts as a tiny bump, classically on the right shoulder, where the parrot usually sits; two weeks later it's a wee bit bigger, then slowly over the years it grows until before you know it, like Robert Browning envying you guys waking in England and saying one morning, 'unaware/That the lowest boughs of the brushwood sheaf/Round the elmtree bole are in tiny leaf,' you've got a fully grown second head giving you cheeky backtalk." Farrell describes the difficulty of removing it - you may have to "hack and hack and hack and hack, just like when you butcher a hog."

What can I say? Only, that if you can write like Farrell you can break the rules and write sentences 79 words long - 66 more than the Daily Telegraph allows.