BMJ No 7121 Volume 315 Saturday 6 December 1997 This Week in BMJ | Editor's Choice | Press releases Editorials 1479 Profiting from closure: the private finance initiative and the NHS David Price 1480 Preventing RhD haemolytic disease of the newborn Bob van Dijk 1481 Helicobacter pylori and its interaction with risk factors for chronic disease David J A Jenkins 1482 Pressure to prescribe Trisha Greenhalgh, Paramjit Gill 1483 Evidence based practice in mental health John Geddes, Shirley Reynolds, David Streiner, Peter Szatmari News 1485 Inquiry into organ donor found to have CJD El Niño causes diarrhoea outbreaks HIV epidemic is far worse than thought Researchers' offices raided over AIDS drug UK needs an extra 1,000 doctors Mothers told to breast feed for at least a year EU approves rights over genetic material NHS acts to improve colorectal cancer care Antiretrovirals fail to eliminate HIV entirely US state rules that a fetus is a person Papers 1489 Relation of smoking and alcohol and coffee consumption to active Helicobacter pylori infection: cross sectional study Hermann Brenner, Dietrich Rothenbacher, Günter Bode, Guido Adler 1493 Impact of surgery for stress incontinence on morbidity: cohort study Nick Black, Joanne Griffiths, Catherine Pope, Ann Bowling, Paul Abel 1498 Change in social status and risk of low birth weight in Denmark: population based cohort study Olga Basso, Jørn Olsen, Anne Mette T Johansen, Kaare Christensen 1502 Case-control study of oral contraceptives and risk of thromboembolic stroke: results from international study on oral contraceptives and health of young women Lothar A J Heinemann, Michael A Lewis, Margaret Thorogood, Walter O Spitzer, Irene Guggenmoos-Holzmann, Rudolf Bruppacher, and the Transnational Research Group on Oral Contraceptives and the Health of Young Women 1504 Underreporting of mortality from RhD haemolytic disease in Scotland and its implications: retrospective review Charles R Whitfield, Alaeddin Raafat, Stanislaw J Urbaniak General practice 1506 The influence of patients' hopes of receiving a prescription on doctors' perceptions and the decision to prescribe: a questionnaire survey Nicky Britten, Obioha Ukoumunne 1510 Use of general practitioner computerised records to create a population based twin sample: pilot study based on Parkinson's disease C H Hawkes, A M Macdonald, A H V Schapira Information in practice 1512 Questioning behaviour in general practice: a pragmatic study A Richard Barrie, Alison M Ward 1515 What can PACT tell us about prescribing in general practice? Azeem Majeed, Norman Evans, Paula Head 1519 Netlines Mark Pallen Clinical review 1520 Clinical review: Aetiology, diagnosis, investigation, and management of the cardiomyopathies Celia Oakley 1525 ABC of palliative care: Emergencies Stephen Falk, Marie Fallon 1528 Lesson of the week: Long term sequelae of missed tendon injuries at the ankle N S Thompson, S A Henderson Education and debate 1530 Ethical debate: The dilemma of the incapacitated patient who has previously refused consent for surgery The case history J McFadzean, J P Monson, J D Watson, J H Coakley Consent may not be needed to save life Patrick Hoyte Previous refusal of consent may not be relevant Arthur L Caplan, John Hansen-Flaschen 1533 Meta-analysis: Principles and procedures Matthias Egger, George Davey Smith, Andrew N Phillips Letters 1538 Chlamydia pneumoniae infection and coronary heart disease D Taylor-Robinson; K Numazaki and S Chiba; S M Tauzeeh 1539 Changes in PLAB examination will have implications for overseas doctors A Berlin and others 1539 Chronic disease in institutionalised patients S Moore; A J Sinclair and A J Bayer; D Molyneux; J P Milnes and others 1540 Advice on long term corticosteroid treatment will be clarified P Arlett and M Rawlins 1540 Screening for genital chlamydial infection in women in general practice M Santer; T Stokes and others 1541 Junior doctors need to work more than 48 hours a week A M Hamade and A K AlDabbagh 1541 Screening remand prisoners for drug misuse would be improved by training doctors better R J Wool 1542 Factors influencing relative weights of placenta and newborn infant P Steer; S Evans and others 1542 Exercise is beneficial adjunctive treatment in depression S Beesley and N Mutrie 1543 Postgraduate education for general practitioners J Bahrami; W F Cunningham; J Barbour; P Taylor 1544 Evidence is needed that |gb blockade alone reduces mortality in hypertension L H Opie 1544 Fees for opinions and information are not always justified M J F Davidson and others 1544 BMA remains impartial on professional issues in dispute between two consultants E M Armstrong Obituaries 1545 W R Burkitt, O O Cowpe, A Griffiths, E Houghton, G L Mackay, J S Martin, R G Robinson, R S F Schilling, J K Thomson, F J D Webster, J M Werner Medicopolitical digest 1547 Taxation is fairest way to fund NHS R&D in primary care Go ahead for salaried GPs Representing "part 1" doctors Violent patients BMA council elections Views & reviews Soundings 1548 Fear God and work hard James Owen Drife Personal views 1548 Treating lung cancer in the NHS market Hilary Pickles Are we promoting stress and anxiety? Peter Whelan Men versus women versus animals in drug advertisements Lars Breimer Medicine and books 1552 21st Century Miracle Medicine Alexandra Wyke Bryan Jennett Minerva 1478 S2 Career Focus Classified supplement What do medical students think of flexible training? Aparna Sinha, Alison Cook Editor's choice The hierarchy of organs and political incorrectness Are brains more important than bowels? The hierarchy of medicine suggests so. The pecking order seems to be (in order of the doctors who look after them) brains, hearts, lungs, bowels, and the genitourinary system. The order probably reflects how quickly failure of the organ will kill you. Those who deal with the genitourinary system are clearly low in the hierarchy, but they may be consoled by two papers in this week's journal discussing their territory. Researchers from London followed 442 women having operations for stress incontinence and found that the surgeons were much happier with the result than the women (p 1493). Although almost 90% of women reported an improvement, fewer than a third were continent a year after the operation. Textbooks suggest that as many as 85% should be. The differences may be explained by these researchers asking the women if they were continent while other researchers have asked the surgeons. Urologist Peter Whelan reflects, meanwhile, on what is happening with prostate cancer (p 1549). Why has it changed from being an "almost homely type of disease" into "a major health problem?" The answer, he suggests, is prostate specific antigen. Men over 50 are being urged to be tested, and many will have raised levels of the antigen - but few will have prostate cancer. Because patients are reluctant to be observed the result is an epidemic of possibly useless treatments. Might PSA, asks Whelan, stand for "promoting stress and anxiety"? Flexible working is fashionable, and a survey of medical students in Manchester shows that most approve of flexible training and that three quarters expect to work flexibly in their careers (Career focus). But in the same section Vasantha Kumar launches a politically very incorrect attack on part time working. "Part timers do not," he writes, "bring anything other than uncertainty to medicine - they are the ones who get reduced stress and greater fulfilment as they hide from patient needs ... They are like sophisticated automated telephone answering systems to which we often hang on hoping to hear a human word, ideally from a recognisable voice." Many readers will disagree. Finally, David Haslam tells us of a case he will never forget (p 1505). Thirty years ago he took Stan, his Welsh terrier, to the vet because his behaviour was bizarre - chewing shoes, golf balls, anything. The vet was so sure of the diagnosis that he didn't bother with an examination. "This is typical behaviour that we vets see in dogs who feel unloved ... Show him more affection and his behaviour will improve." Dr Haslam "slunk off" feeling guilty. A few weeks later a locum vet diagnosed acute lymphocytic leukaemia. Stan chewed to ease his sore throat. Home | Current contents | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline