BMJ  2004;328:E299 (15 May), doi:10.1136/bmj.328.7449.E299

BMJ USA: Minerva

Minerva

Minerva

Pharmaceutical companies often spend enormous sums to develop thousands of potential names for their products. The companies hope to develop "memorable, positive, and promising" names that are "distinctive enough to avoid confusion and serious medication errors," the Baltimore Sun reports (March 1, 2004). The Food and Drug Administration rejects about 33% of the 200-300 names submitted to it each year.

Might chronic inflammation be a factor in the development of breast cancer? That is one explanation for an association between long term use of antibiotics and breast cancer reported in JAMA ( 2004;291: 827-835)[Abstract/Free Full Text]. A link was found between breast cancer and several different categories of antibiotics, suggesting that treatment for chronic or repeated infections might be the trigger for the cancer. That hypothesis is reinforced by the known anti-cancer effect of non-steroidal anti-inflammatory drugs.

Survivors of meningitis may have impairment of their vestibular apparatus, and this may make swimming dangerous for them. Two case reports in the Journal of the Royal Society of Medicine ( 2004;97: 76-77)[Free Full Text] describe adults who nearly drowned owing to their inability to right themselves in the water. Patients who have become deaf after recovery from meningitis (or after being given an aminoglycoside antibiotic) should have their vestibular function tested.

One explanation of the much publicized epidemic of obesity in the United States is that Americans are eating out more often than in the past. An analysis of data from national health surveys (Preventive Medicine 2004;38: 243-249)[CrossRef][ISI][Medline] showed an increase in meals out, from 2.5 per person per week in 1987 to 2.8 in 1999-2000. Spending on food eaten away from home had doubled between 1960 and 2000. These changes may look small, but the frequency of eating out was shown to be a moderate predictor of the body mass index.

Taking aspirin reduces the risk of colorectal cancer, but anyone wanting the maximum protection from this treatment will need to take a lot of aspirin for a long time. Data from the nurses' study (27 077 participants) have been analyzed at Harvard ( Annals of Internal Medicine 2004;140: 157-166[Abstract/Free Full Text]) and these showed that the greatest protective effect was evident at doses far higher than those recommended to doctors for protection against cardiovascular disease. The conclusion is the old friend—more research is needed.

The estimated number of maternal deaths worldwide in 2000 was 529 000, with fewer than 1% of those in developed countries. An issue of the British Medical Bulletin ( 2003;67: 1-247)[Abstract/Free Full Text] makes chilling reading. Each year 70 000 women die from complications of unsafe abortion, defined as a procedure for terminating unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards.

It's not the cat's whiskers but rats' whiskers that have been helping scientists discover how nerve cell activity controls physical movement. By stimulating single neurons (which cause specific whisker movements) in the rat cortex, they've developed the delicate technique of linking brain activity with movement, which one day may help the development of prosthetic brain-computer interfaces—devices that convert "thoughts" into controlled movement ( Nature 2004;427: 704-710[CrossRef][Medline]).

Minerva thinks it would be great to find a sound way to prevent women who have quit smoking during pregnancy from restarting after they've given birth. One possibility is to encourage them to take bupropion, and there's now convincing evidence that although bupropion and its active metabolites are present in breast milk, the doses that would be ingested by breast-feeding infants are small ( Tobacco Control 2004;13: 52-56[Abstract/Free Full Text]).

Cardiovascular fitness is obviously good for the heart, but now two sets of experiments show that it's good for the brain, and why that might be so (www.pnas.org/cgi/doi/10.1073/pnas.0400266101). Increases in human cardiovascular fitness resulted in better cognitive functioning (especially concentration), illustrating that increased cardiovascular fitness can influence the plasticity of the aging brain.

Minerva goes to the cinema quite often, and she has noticed that smoking has become more frequent in films of all kinds. In the past 50 years smoking on film has first declined, almost to disappear, and has now returned ( American Journal of Public Health 2004;94: 261-263[Abstract/Free Full Text]). So we have the paradox that between 1950 and 1990 smoking in the United States dropped from 44% to 23% but over the same period the number of times per hour that an actor smoked fell to 4.9 per actor per hour. More recently it returned to 10.7 per hour and has now reached 10.9. Does it matter? There is good evidence that smoking on the screen does influence young people.

This patient had been hit in the eye and was found on physical examination to have a blow out fracture. The photograph shows the penetration of air in his conjunctiva from the injury. Subconjunctival emphysema is more commonly associated with injuries that are caused by compressed air. Bina Parmar specialist registrar Mahesh Ramachandani specialist registrar Moorfields Eye Hospital, London EC1V 2PD, UK

If we all walked briskly for 15 minutes each day, would we really keep the obesity epidemic at bay? Simulation of the efficacy of a population-wide campaign shows that 50% of eligible adults would have to perform athletic walking for almost 30 minutes to meet the goal of expending an extra 420 kJ a day across the population. This isn't realistic, say the authors ( American Journal of Public Health 2004;94: 437-440[Abstract/Free Full Text]).

A diagnostic meta-analysis of the value of the CAGE questionnaire in screening for alcohol abuse and alcohol dependence in the general population concludes that it has limited value ( Journal of Clinical Epidemiology 2004;57: 30-39[CrossRef][ISI][Medline]). This is a bit worrying in view of the large number of researchers who based their diagnosis of alcohol problems on CAGE results.

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