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BMJ No 7129 Volume 316 7 February 1998 This Week in BMJ | Editor's Choice | Press releases Receive this page by email each week Editorials 403 Do silicone breast implants cause connective tissue disease? Cyrus Cooper, Elaine Dennison 404 Neonatal screening for cystic fibrosis Nicholas J Wald, Joan K Morris 405 Missed problems and missed opportunities for addicted doctors John Strang, Michael Wilks, Brian Wells, Jane Marshall 406 Turbulent future for school nursing and health visiting Kate Billingham, David Hall 407 Caring for patients with chronic leg ulcer C V Ruckley 409 Providing primary care in the accident and emergency department I R S Robertson-Steel 410 Rationing health care Albert Weale News 411 Consultation on human cloning launched in UK UK "drink drive" limit may be cut More precise targeting of drugs in pipeline Doctors' strike averted in Hungary UK doctors' pay award phased again Nurses' pay award will not help recruitment Cardiac services to expand in Ireland India approves leprosy vaccine Bill Clinton's State of the Union address France has more early deaths than Britain Health secretary hits back at charges of bias Professor Philip James profiled Papers 417 Risk of connective tissue disease and related disorders among women with breast implants: a nationwide retrospective cohort study in Sweden Olof Nyrén, Li Yin, Staffan Josefsson, Joseph K McLaughlin, William J Blot, Martin Engqvist, Lars Hakelius, John D Boice Jr, Hans-Olov Adami 422 Single dose vitamin A treatment in acute shigellosis in Bangladeshi children: randomised double blind controlled trial Shahadat Hossain, Rabi Biswas, Iqbal Kabir, Shafique Sarker, Michael Dibley, George Fuchs, Dilip Mahalanabis 426 Mortality from overdose among injecting drug users recently released from prison: database linkage study S R Seaman, R P Brettle, S M Gore 429 Evaluation of adjuvant psychological therapy in patients with testicular cancer: randomised controlled trial C Moynihan, J M Bliss, J Davidson, L Burchell, A Horwich 435 Evaluation of reagent strips in detecting asymptomatic bacteriuria in early pregnancy: prospective case series Douglas G Tincello, David H Richmond 437 Is the emergency (999) service being misused? Retrospective analysis Clifford Mann, Henry Guly 438 Raynaud's phenomenon after sympathetic denervation in patients with primary autonomic failure: questionnaire survey Rajeev Mallipeddi, Christopher J Mathias 440 Drug points: Serious interaction between warfarin and oral terbinafine J A Warwick, R J Corrall Parotid swelling and terbinafine J K Torrens, P H McWhinney Nortriptyline intoxication induced by terbinafine P-H M van der Kuy, P M Hooymans; A J B Verkaaik 435 Corrections: Randomised controlled trial to evaluate early discharge scheme for patients with stroke Anthony G Rudd 441 Intranasal chlorhexidine resulting in anaphylactic circulatory arrest Peter Moult General practice 442 Qualitative study of educational interaction between general practitioners and specialists Martin N Marshall Clinical review 446 Science, medicine, and the future: Alzheimer's disease Colin L Masters, Konrad Beyreuther 449 Grand Round: Mycobacterium paratuberculosiscervical lymphadenitis, followed five years later by terminal ileitis similar to Crohn's disease John Hermon-Taylor, Nick Barnes, Chris Clarke, Caroline Finlayson 454 Lesson of the week: Pneumatic compression boots for prophylaxis against deep vein thrombosis: beware occult arterial disease M J Oakley, E F Wheelwright, P J James 456 ABC of palliative care: Bereavement Frances Sheldon Education and debate 459 Ethical dilemma: Should doctors reconstruct the vaginal introitus of adolescent girls to mimic the virginal state? Who wants the procedure and why A Logmans, A Verhoeff, R Bol Raap, F Creighton, M van Lent Commentary: The ethical issue is deceit D D Raphael Commentary: Promiscuity is acceptable only for men Dinesh Bhugra Commentary: Education about the hymen is needed Sara Paterson-Brown Commentary: Cultural complexities should not be ignored Elspeth Webb Commentary: Surgery is not what it seems Lainie Friedman Ross 463 Lay perspectives: advantages for health research Vikki A Entwistle, Mary J Renfrew, Steven Yearley, John Forrester, Tara Lamont 466 Continuing medical education: Learning and change: implications for continuing medical education Robert D Fox, Nancy L Bennett Letters 469 Bias in meta-analysis detected by a simple, graphical test A E Stuck and others; J P Vandenbroucke; L Irwig and others; V Seagroatt and I Stratton; M Egger and others; P Langhorne; F Song and S Gilbody 471 British renal registry is fully electronic D Ansell and others 472 Electronic record linkage to create diabetes registers P J Leslie and others; S Treweek and others; D L Whitford and S H Roberts 473 Under half of senior house officers in Anglia in 1997 were United Kingdom graduates J Biggs 473 UK encourages unrealistic expectations among overseas applicants for training M K Sridhar 473 Adding methionine to every paracetamol tablet S K Saha and R Kale; F N Leach and J M Braganza; N Chada; A E M McLean 474 British trial of transmyocardial revascularisation is continuing N Caine and others 475 Comparison of assays for measuring plasma paracetamo L Jones and others; R FitzPatrick and others 476 Prescription Medicines Code of Practice Authority investigates criticisms of advertisements H Simmonds 476 Psychotropic drug treatment A Lenox-Smith; T Harris and F Smith; C Paton and others 477 Media are too eager to link silicone to disease N Collis and others Obituaries 478 M Critchley, J M England, E C Gambrill, G St J Hallett, J M Hand, W Howel-Evans, J C Lindsay, R Lynn, A F McGlashan, J D Milne, A H W Nias, G H Pearce Medicopolitical digest 480 Doctors who misuse alcohol Management costs in England Patients and research Access to specialist register GPs and merit awards Rationing in general practice Review body report 1998 Research assessment exercise Section 36 payments BMA council elections Views & reviews Soundings 482 None of our business? Trisha Greenhalgh Personal views 482 Living in two worlds Ann Oakley A psychiatrist in the family Kamala-Maria Mueller Medicine and the media 484 To screen or not to screen? Kamran Abbasi Medicine and books 485 Who's Afraid of Human Cloning? Gregory E Pence Udo Schüklenk Western Medicine: An Illustrated History Ed Irvine Loudon Ann Dally Minerva 486 S2 Career Focus Classified supplement When your partner is your partner Wayne Lewis Editor's choice What is happening with Alzheimer's disease? All readers of the BMJare likely to be interested in what will happen with the management of Alzheimer's disease. A fifth of us may well develop it. Colin Masters and Konrad Beyreuther consider the disease in one of our continuing series entitled "Science, Medicine, and the Future" (p 446). The idea behind these articles is to describe what is happening now with the science of the disease and to speculate on what that may mean for clinicians in the future. "An avalanche of knowledge" has confirmed that the generation of Aß amyloid from the amyloid precursor protein is the central pathway in the disease. How the Aß amyloid exerts its toxicity is unclear, but about half the genes that cause Alzheimer's disease have now been identified. The important environmental factors remain undiscovered. Low education, head trauma, smoking, concomitant vascular disease, diabetes, and the menopause all have effects - but they are modest and inconsequential. Might some subtle factor in the Western diet or lifestyle prove to be a major factor? Masters and Beyreuther speculate that by 2008 we might see screening for the genes linked with the disease and possible presymptomatic treatment. There might also be drugs that will act on the amyloidogenic pathway and modify the course of the disease. Currently three drugs are on the market for treating Alzheimer's disease, four await approval, and 16 undergoing early clinical evaluation. Most act on the cholinergic system and are likely to have only a small effect, but drugs that target the amyloidogenic pathway are emerging. Despite the high prevalence, immense cost, and exciting science of Alzheimer's disease many more column inches have probably been devoted by the media to the issue of whether silicone breast implants may cause connective tissue disease (p 403). No good epidemiological evidence has ever suggested that they do, and we publish today a Swedish study comparing connective tissue disease in 7,442 women with implants and 3,353 women who underwent breast reduction (p 417). There was no difference between the groups. Yet on the basis of weak anecdotal evidence American manufacturers have paid out over $4 billion to women with breast implants and the British government has set up an inquiry into the subject. A legal sideline is the probably baseless argument that women with silicone implants may damage their babies through breastfeeding (p 477). Finally, a Paris newspaper attracted the attention of the BMJ100 years ago by proposing to "keep a doctor" in the way a London tailor kept a poet (p 448). The journal was snooty, and a century later we are still suspicious of doctors who peddle their wares in the newspapers (p 484). Home | Current contents | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline