BMJ  2004;329 (20 November), doi:10.1136/bmj.329.7476.0-f

Editor's choice

More research and better behaviour

Last week we had a theme issue on what the rich world could learn from the poor. This week, the cynics will say, it's back to normal: citizens of the rich world only really care about a poor world problem when it might affect them.

An Education and Debate article (p 1231) points out that there's now a sudden interest in organophosphate poisoning in the West because of the fear of chemical attacks by terrorists. Yet organophosphate poisoning has long been a major health problem in many developing countries of the Asia-Pacific region, from poorly controlled pesticides. Actually Nick Buckley and his colleagues aren't that cynical. They argue for better research into organophosphate poisoning because it's in everyone's interest. The standard antidote, atropine, isn't known to be effective, and no new treatments have been developed or tested for the past 30 years. Buckley and his colleagues show that several compounds may be promising—and they suggest that money should be diverted from stockpiling unproved antidotes to researching some new ones.

There's another rich world-poor world conundrum in Rajendra Kale's and Emilio Perucca's editorial about rehabilitating phenobarbital for epilepsy (p 1196). It's much prescribed in developing countries, but has fallen into disrepute in developed ones. The authors argue that phenobarbital is not as bad as it's often painted and might be more often used in the developed world while still being an affordable drug in the developing world. And their conclusion is, of course, that more and better research is needed.

Most weeks, most articles in the BMJ boil down to one of two core messages: we need more research or better behaviour. The better behaviour strand this week is represented in Ros Levenson's personal view about the care of her mother at the end of her life (p 1244). "The story includes extreme kindness and sensitivity from some doctors, nurses, and other health professionals, alongside crass ill judged defensiveness from others." What it also shows is the difficulties of achieving "seamless" care across different disciplines, individuals, and time. To Levenson the care didn't seem to be coordinated: despite an apparent agreement that her mother wouldn't be artificially fed, the doctors, the nurses, and the speech therapists had conflicting ideas on whether or not she should be and acted independently.

Behaviour can't get much worse than rape. This week's Career Focus (http://careerfocus.bmjjournals.com) devotes three articles to the subject: a victim's personal view of the stigma she still feels; a description of the specialty of forensic gynaecology; and an account of the Havens sexual referral centres in London. Open 24 hours a day, they provide both health care for people who have been sexually assaulted and the forensic examinations that the police need—a difficult balance to get right.