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BMJ No 7132 Volume 316 28 February 1998 This Week in BMJ | Editor's Choice | Press releases Receive this page by email each week Editorials 639 The Swiss heroin trials: testing alternative approaches Michael Farrell, Wayne Hall 640 Deaths related to intrapartum asphyxia John A D Spencer 641 Subcutaneous apomorphine in Parkinson's disease K Ray Chaudhuri, C Clough 642 Communication among health professionals John Gosbee 643 New government, same narrow vision Richard Smith 644 Lessons of a hip failure Sarah K Muirhead-Allwood News 645 Short course zidovudine cuts HIV transmission Wisheart gives evidence in GMC case Researchers grow new blood vessels in heart Doctor admits research fraud Tissue trade in Hungary investigated Three glasses of wine a day make you live longer Aggressive marketing of pyschotrophic drugs Polish plagiarism scandal unearthed New obesity mediator is discovered Warning issued over hip implants NHS waiting lists grow under Labour Inquiry ordered into transfer of frail elderly In brief Papers 651 Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study Hans C Siersted, Jesper Boldsen, Henrik S Hansen, Gert Mostgaard, Niels Hyldebrandt 655 Commentary: Risk factors for underdiagnosis of asthma in adolescence P John Rees 656 Commentary: Identifying the correct risks in diagnosis Stephen J W Evans 657 Commentary: Improving the diagnostic rate in asthma: a community issue Hans C Siersted 657 Numbers of deaths related to intrapartum asphyxia and timing of birth in all Wales perinatal survey, 1993-5 Jane H Stewart, Joan Andrews, Patrick H T Cartlidge 660 Effectiveness of screening older people for impaired vision in community setting: systematic review of evidence from randomised controlled trials Liam Smeeth, Steve Iliffe 664 Association of glutamine 27 polymorphism of |gb2 adrenoceptor with reported childhood asthma: population based study E Hopes, C McDougall, G Christie, J Dewar, A Wheatley, I P Hall, P J Helms 665 Parental history of gastric or duodenal ulcer and prevalence of Helicobacter pylori infection in preschool children: population based study Hermann Brenner, Dietrich Rothenbacher, Günter Bode, Guido Adler 666 Relation of aplastic anaemia to use of chloramphenicol eye drops in two international case-control studies Bengt-Erik Wiholm, Judith Parsells Kelly, David Kaufman, Surapol Issaragrisil, Micha Levy, Theresa Anderson, Samuel Shapiro 667 Risk of serious haematological toxicity with use of chloramphenicol eye drops in a British general practice database Tim Lancaster, Ann Marie Swart, Hershel Jick General practice 668 Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland C McCowan, R G Neville, G E Thomas, I K Crombie, R A Clark, I W Ricketts, A Y Cairns, F C Warner, S A Greene, E White Information in practice 673 Communication behaviours in a hospital setting: an observational study Enrico Coiera, Vanessa Tombs 677 Netlines Mark Pallen Clinical review 678 Fortnightly review: Update on male erectile dysfunction G Wagner, I Saenz de Tejada 682 Lesson of the week: Hypopituitarism after coronary artery bypass grafting J S Davies, M F Scanlon 685 Commentary: Hypoadrenalism should also be considered in cases of persistent hyponatraemia P E Belchetz 686 ABC of allergies: Diagnosing allergy Csaba Rusznak, Robert J Davies Education and debate 690 Interpreting treatment effects in randomised trials Gordon H Guyatt, Elizabeth F Juniper, Stephen D Walter, Lauren E Griffith, Roger S Goldstein 693 The new genetics: Psychological responses to genetic testing Theresa M Marteau, Robert T Croyle 697 Continuing medical education: Maintaining standards in British and Canadian medicine: the developing role of the regulatory body Lesley Southgate, Dale Dauphinee Letters 701 Prophylaxis after occupational exposure to HIV V Harindra and J Tobin; J R Willcox; B Evans and D Goldberg; N Mir; P P Walker and M T Reynolds 702 Substitution of another opioid for morphine may be useful for pain control P Murray 703 Studies of drugs in epilepsy cited by author are not evidence based A G Marson and D W Chadwick 703 Search for evidence of effective health promotion A Britton and others; T A Sheldon and others 704 Debate is needed over who provides drug treatment in attention deficit hyperactivity disorder K Sayal 704 Community based heart health promotion project in England J Muir and others; G Davey Smith and S Ebrahim; T Baxter and others 705 Bus shelters in photograph, showing drug adverts, were replaced long ago J Michael 706 Consultants could give patients a letter summarising their consultation C Essex 706 Self regulation is necessary in war on drugs B Trathen 706 Vulval Pain Society provides information on vulval symptoms D Nunns and D Hamdy 707 Weight loss will be much faster in lean than in obese hunger strikers I N Scobie 707 Several factors were not considered in study of increase in hay fever and eczema V McClelland and others 707 Royal colleges need modernisation M Brudenell Obituaries 708 A G S Bailey, A R Bollen, T C Bradford, W F Buchanan, W D Calderwood, R Dharmaindra, S Z Fouad, S L Goodman, A Khunger, L-V Lewis, G B Leyton, D R Mackenzie, N M Mann, L Mitchell, D M P Pullen Medicopolitical digest 710 GMSC will change its name Extra ’60m for GPs must be used flexibly Trusts have more ethnic minority posts Tobacco advertising ban may be challenged Views & reviews Soundings 711 My last car, I promise James Owen Drife Personal view 711 Thomas comes home David Stevens Medicine and the media 712 Smoking on celluloid Douglas Carnall Medicine and books 713 Making Doctors: An Institutional Apprenticeship Simon Sinclair Simon Wessely The Greatest Benefit to Mankind: A Medical History of Humanity From Antiquity to the Present Roy Porter Benjamin Hope Minerva 714 Fillers 689 Always listen to the patient William D Carroll 700 Taking precautions Thurstan Brewin Corrections 656 Systematic overview of co-proxamol to assess analgesic effects of addition of dextropropoxyphene to paracetamol Li Wan Po and Zhang 707 Survival is better indicator than mortality in geographic comparisons of health P A West S2 Career Focus Classified supplement Recent developments in training for general practice Katie Carter Editor's choice The BMJ welcomes careful readers The BMJ welcomes careful readers. We know that some of you never open the packet, flick straight to jobs in neurosurgery, read only Minerva (out loud to your partner in bed), or check the obituaries, as the very old joke has it, to make sure you are not there. That's all right - we are here, believe it or not, to serve not lecture. But we love careful readers: those who doubt everything, add up the figures in tables, check the references, and refuse to accept that Canberra is on the coast of Australia (one of our most celebrated errors). Those careful readers send us 4,000 letters a year, disputing what the BMJ says and feeding the discourse that means that medicine moves on. They are at work in this issue. In 1995 a BMJ editorial argued that it was time to stop using chloramphenicol eye drops because they might cause aplastic anaemia. The argument was based on a series of case reports. Two sets of authors were unconvinced. An international group used two population studies "representing about 185 million person years of observation" to identify 426 cases of aplastic anaemia and 3,118 controls (p 666). None of the cases had taken chloramphenicol eye drops but seven controls had. In a second study the authors used a database from British general practice to identify 442,543 patients who had received 674,148 prescriptions for chloramphenicol eye drops (p 667). From these patients they identified only three who developed severe haematological toxicity. Even if all three cases were related to chloramphenicol, which is unlikely, the risk is very small. Another conclusion is that a lot of work may be needed to "disprove" what seems a sensible conclusion. Some readers may not be impressed by this statistical demolition of a good theory - if Simon Sinclair, a doctor turned anthropologist, is to be believed. He has written a book, reviewed by Simon Wessely, on "making doctors" (p 713). It seems to be a ghastly business in which students learn to despise "bad patients," those with "ambiguous status ... the crock, the fat folder, the somatiser, the overdoser, who seem to be ill but possess none of the tickets of admission, such as an abnormal radiograph." Through transference the students also learn to despise the psychiatrists who look after these patients. Medical students value knowledge ("hard facts"), status, and responsibility. That's why "statistics is above all the subjects most disliked by students" - because it has none of those things. Finally, Minerva may have discovered why in Edward Lear's poem the owl and the pussy cat took a supply of honey with them when they went to sea (p 714). Honey seems to have an antibacterial action against Helicobacter pylori and domestic cats suffer particularly with helicobacter related dyspepsia. 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