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

757 Optimising the investigation of meningococcal disease
Keith Cartwright, Simon Kroll

758 Climate change - thinking widely, working locally, acting personally
Cathy Read, Robin Stott

759 Peer review: reform or revolution?
Richard Smith

760 Diagnostics in developing countries
Paul Garner, Ayyaz Kiani, Anuwat Supachutikul

761 Determing prognosis after acute myocardial infarction in the thrombolytic era
George A Beller

763 Clinton rejects tobacco deal
French plan to bail out health deficit
Plan to tackle ethnic minority health
Computers are best at interpreting ECGs
Journal attacks unethical HIV trials
Progesterone's role in cardiac protection
Thirty NHS trusts to merge
Blinding peer reviewers gives no benefit
Gender bias exists in research
Citing of research shows national bias

767 Mortality associated with HIV-1 infection over five years in a rural Ugandan population: cohort study
Andrew J Nunn, Daan W Mulder, Anatoli Kamali, Anthony Ruberantwari, Jane-Francis Kengeya-Kayondo, Jimmy Whitworth

772 HIV antibody assay that gave false negative results: multicentre collaborative study
Barry G Evans, John V Parry, Philip P Mortimer on behalf of the Multicentre Collaborative Study Group

774 Epidemiology and clinical management of meningococcal disease in west Gloucestershire: retrospective, population based study
Philip A L Wylie, David Stevens, William Drake III, James Stuart, Keith Cartwright

779 Audit of prenatal diagnosis for haemoglobin disorders in the United Kingdom: the first 20 years
B Modell, M Petrou, M Layton, L Varnavides, C Slater, R H T Ward, C Rodeck, K Nicolaides, S Gibbons, A Fitches, J Old

784 Audit of process of antenatal screening for sickle cell disorders at a north London hospital
Helen Neuenschwander, Bernadette Modell

785 Drug points: Intranasal chlorhexidine resulting in anaphylactic circulatory arrest
D G Chisholm, I Calder, D Peterson, M Powell

786 Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial
Sana M Ceesay, Andrew M Prentice, Timothy J Cole, Frances Foord, Lawrence T Weaver, Elizabeth M E Poskitt, Roger G Whitehead

791 Evaluation of computer support for prescribing (CAPSULE) using simulated cases
R T Walton, C Gierl, P Yudkin, H Mistry, M P Vessey, J Fox

795 Netlines
Mark Pallen

796 Social phobia: epidemiology, recognition, and treatment
J A den Boer

801 ABC of palliative care: Principles of palliative care and pain control
Bill O'Neill, Marie Fallon

805 Global climate change: the potential effects on health
Anthony J McMichael, Andrew Haines

810 Hyperglycaemia after acute stroke
C Counsell and others; A Mitchell and P Kirckpatrick; J Scott and others; C Weir and others

811 More money is needed to care for patients with cancer
R C F Leonard and others

812 Cancer self help groups are underused
E J Watts

812 Case-control study of sudden infant death syndrome in Scotland
P Blair and others; G Draper and W Holland; C Carroll-Pankhurst and E A Mortimer Jr; H Brooke and others

813 Giving thyroid hormones to clinically hypothyroid but biochemically euthyroid patients
G J Beckett and A D Toft; G Williams; C Shepherd

814 Diagnosing pulmonary embolism
A G Fennerty

815 Pneumococcal vaccine campaign based in general practice
N Maskrey and M Parkinson; A N Siriwardena; A Walters and N C Weightman; P McDonald and others; M J Doherty and others

816 Managing eye conditions in general practice
T Manners

817 Medical managers
M Williams; C Bayliss

817 Correction: Impact of postmenopausal hormone therapy on cardiovascular events and cancer
E Hemminki and K McPherson

818 J Cormie, A J P Crowden, D J Davies, B Dennison, H P Ferreira, C A Flynn, C Galvin, M G Gibb, A Jack, J L Stafford, J C Ward, D J Warren

820 NHS white paper in Scotland
GMSC will continue to represent all GPs
Labour wants low pay rise for doctors

Soundings

821 This month's new journals
James Owen Drife

821 The wrong job at the wrong time
Pippa Keech

Ban the bottle
Joanne Nelson

823 Clinical Applications of the Interferons R Stuart-Harris, R Penny
David Isaacs

Culture of Fear: Risk Taking and the Morality of Low Expectation Frank Furedi
Stuart W G Derbyshire

824

Editor's choice

The stories behind the headlines

This week's BMJ provides the detailed stories behind the headlines in two events that received much press attention at the time - a failed HIV test and meningococcal disease in west Gloucestershire.

At Easter last year Abbott Laboratories announced that its HIV antibody assay had allowed a few people to think they did not have HIV infection when in fact they did and should therefore be withdrawn. This aroused concern and prompted the retesting programme described by Evans et al on p 772. Out of almost 21,000 retests performed they found four false negative results, confirming that the test's sensitivity (99.2%) fell below that expected of HIV screening tests (|LX99.9%). They recommend dual screening when HIV infection is clinically suspected.

West Gloucestershire has become known as a place with a high incidence of meningococcal disease, and on p 774 Wylie et al describe changes in the epidemiology and management of the disease in 1982-95, when the incidence was almost three times the national incidence. The early period, 1983-90, was characterised by a prolonged localised outbreak due to a single meningococcal strain. In the second half of the period notifications were close to the national average and no serotype predominated. Another contrast between the two halves of the period was that the use of benzylpenicillin before admission increased from 18% to 40%. In their editorial Cartwright and Kroll re-emphasise the importance of starting treatment with benzylpenicillin immediately (p 757).

Also headline grabbing but rather more complex is global climate change. On p 805 McMichael and Haines outline its likely impact on health, including changes in the range of infectious diseases borne by vector organisms, effects on agriculture, and the consequences of rising sea levels. Over half the world's population lives within 60 km of the sea, and the projected rise in sea level of 40 cm by 2100 would, they argue, have profound effects on food production, economies, and communities. By far the biggest contributor to climate change is the emission of greenhouse gases, and in an editorial Read and Stott show ways in which authorities and individuals can reduce these emissions (p 758).

All these articles reached our pages via some sort of peer review, but many editors have returned from the third international congress on peer review more convinced than ever that peer review as currently practised is deeply flawed. On p 766 Sandy Goldbeck-Wood describes research showing that peer reviewers are not good at detecting flaws in papers and that blinding reviewers to authors' identities doesn't improve their opinions. And on p 759 Richard Smith argues that it's time to experiment with open peer review, at the very least putting authors and reviewers on an equal (unanonymous) footing.