BMJ No 7114 Volume 315 Saturday 18 October 1997 This Week in BMJ | Editor's Choice | Press releases Editorials 961 Passive smoking: history repeats itself Ronald M Davis 962 High cost, low volume care: the case of haemophilia Christine Lee, Caroline Sabin, Alexander Miners 964 Formula fever: allocating resources in the NHS Trevor A Sheldon 965 Ethics and international research Neal A Halsey, Alfred Sommer, Donald A Henderson, Robert E Black 966 Hastening slowly: Mr Dobson plays a waiting game Rudolf Klein News 967 Surgeons accused of ignoring high death rates Charity takes stand against tobacco industry Flight attendants win passive smoking case Report calls for shake up of public health HRT slightly increases risk of breast cancer Hong Kong acts to prevent medical errors AMA sets up Patient Safety Foundation South Africa's battle over drug costs Extra £300m ($480m) for the NHS this winter European wide drink-drive limit proposed Overseas doctors lose training scheme NHS charter will emphasise patients' duties Professor Stanley Prusiner wins Nobel prize Papers 973 Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence M R Law, J K Morris, N J Wald 980 The accumulated evidence on lung cancer and environmental tobacco smoke A K Hackshaw, M R Law, N J Wald 989 Prevalence of carcinoma in situ of the testis in 207 oligozoospermic men from infertile couples: prospective study of testicular biopsies Aleksander Giwercman, Jørn Kvist Thomsen, Jens Hertz, Jørgen G Berthelsen, Vibeke Jensen, Birgit Meinecke, Lene Thormann, Hans H Storm, Niels E Skakkebæk 991 Comparison of two assays for measuring plasma concentrations of paracetamol C V Egleston, C Browning, I Hamdi, G Campbell-Hewson, S M Robinson 992 Comparison of case fatality in smokers and non-smokers after acute cardiac event Gabe S Sonke, Alistair W Stewart, Robert Beaglehole, Rod Jackson, Harvey D White General practice 994 Sociodemographic and morbidity indicators of need in relation to the use of community health services: observational study Ken Buckingham, Peter R Freeman Clinical review 997 Science, medicine, and the future: Obesity treatment John Wilding 1000 Lesson of the week: Subjective change in ejaculate as symptom of infection with Schistosoma haematobium in travellers Gordon McKenna, Mona Schousboe, Graeme Paltridge 1002 ABC of palliative care: Mouth care, skin care, and lymphoedema Claud Regnard, Sarah Allport, Lydia Stephenson Education and debate 1006 As the health divide widens in Sweden and Britain, what's happening to access to care? Margaret Whitehead, Maria Evandrou, Bengt Haglund, Finn Diderichsen 1009 Personal paper: The conflict in transferring a cystic fibrosis specialist service between two hospitals in Manchester A K Webb, S P Hanley 1011 Correction: Should we screen for gestational diabetes? The case for screening for gestational diabetes - Soares and others Letters 1012 Trends in asthma mortality M J Campbell and others; C A Johnson and others; W T Berrill; P McLoone and D S Morrison; B Kaur and B Butland 1014 Trend in occurrence of asthma among children and young adults G Russell and P J Helms; A B Chang and T P Newson 1015 Helicobacter gastroduodenitis M C Allison and D Williams; D Forman and A Axon 1016 Adding heat probe treatment to adrenaline injection for spurting haemorrhage of peptic ulcers S H Hussaini and M A Hull; S C S Chung and others 1016 "Clearing house" is needed to match available junior doctors to unfilled SHO posts P Leman and others 1017 Debate over mentally ill patient's caesarean section was too emotional W O Goldthorp and G McDade 1017 Insulin dependent diabetes is probably due to environmental effect during childhood R D G Leslie and D A Pyke 1018 Palliative drugs are not for shortening life D Oliver 1018 Frequent consumption of red meat is not risk factor for cancer B D Cox and M J Whichelow 1018 Incidence of early syphilis acquired in former Soviet Union is increasing J Deayton and P French 1019 Stroke prevention in atrial fibrillation F Booth and A Mehta; T Lancaster and J Mant 1019 Elimination of firearms S Chapman; C Rooney 1020 Medical advice is available for ships at sea M Parrish 1021 Defence of cardiologist in misconduct case M Wolfson; M Saunders 1021 Delayed diagnosis for breast disease is mostly due to patients C Nosarti and others 1021 Words matter D J Smart 1021 Correction: The future of healthcare systems Milner and others Obituaries 1022 P Aikman, K W Aron, M D Baber, W G M Bell, D S Chapman, J P Crummie, J B D Evans, A M Flynn, H L Gardner, T C Millar, S S F Munro Medicopolitical digest 1024 Consultants plan crisis survey Private medical insurance BMA gold medal Senior doctors consider retirement BMA notice Views & reviews Soundings 1025 Please help us by completing the questionnaire Trisha Greenhalgh Personal view 1025 Help from unexpected sources Vindra Shenolikar Medicine and the media 1026 Back to the future (again) Sean A Spence Medicine and books 1027 Stopping AIDS: AIDS/HIV Public Education and the Mass Media in Europe Kaye Wellings, Becky Field Television, AIDS and Risk. A Cultural Studies Approach to Health Communication John Tulloch, Deborah Lupton Simon Chapman How to Survive in Anaesthesia P Neville Robinson, George M Hall Simon Scothern, Maire Shelly Minerva 1028 S2 Career Focus Classified supplement Remediation Jamie Bahrami Editor's choice Drama in the BMJ Drama is the common thread in this week's BMJ, and we begin with a tale of possible suppression. "News is what somebody somewhere wants to suppress; all else is advertising," said one newspaper potentate. And bodged suppression can be good for business. Colin Douglas, one of our columnists, was delighted years ago when a letter in the BMJ suggested that one of his books should be banned. He knew that the phrase, "The book the BMJ tried to ban" would boost sales. So what from this week's BMJ might be banned? I feel I must answer my question furtively, looking over my shoulder as I write this in my study on a Monday night. Caution is necessary because the tobacco industry might take out an injunction and try to stop distribution of the paper confirming that being married to a smoker increases the risk of lung cancer by 26% (p 980). The paper also adds to the evidence that exposure to the smoke is definitely the cause. We will abstain from press releasing this paper because of the fear of an injunction. "Why," you might ask, "would the tobacco industry want to stop this paper and not the companion paper that shows that passive smoking increases the risk of heart disease?" (p 973). The answer is to do with the law. A woman who has never smoked, lived with a smoker, and contracted lung cancer may have a case against a tobacco company, whereas it will be much harder for her to prove that her heart disease was a direct effect of environmental tobacco. The next drama is a "whatdunnit?" Imagine, Sherlock, that you see a series of young men complaining of subjective changes in their semen. What is the clinching question to ask? The answer: "Have you swum recently in Lake Malawi?" Gordon McKenna and others from Christchurch, New Zealand, describe seven young men with changes in their semen caused by schistosomiasis (p 1000). All had swum in Lake Malawi. Now, conflict. Two consultant physicians tell how two Manchester hospitals fought for an income generating cystic fibrosis centre (p 1009). The result was "a climate of fear, uncertainty, and demoralisation for the unit, patients, and managers." The many purchasers involved could not agree, and there was no system for arbitrating between opposing groups. This battle was eventually resolved, but many are still being fought - the authors tell us. Finally, a cock up that could have been very dramatic. Last week - unnoticed by us or the media - we published a letter critical of government policy signed by Graham Winyard, the medical director of the NHS. But Dr Winyard was not on a suicide mission. Rather, the authors had copied the letter to him, and we had mistakenly added his name to the list of authors (p 1021). There seem to be so many new ways to muck up. Sorry, Graham. Home | Current contents | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline