BMJ  2007;335 (21 July), doi:10.1136/bmj.39281.508345.47

Editor's Choice

US editor's choice

Is everything you know wrong?

With the pace of new research, sometimes I feel like the title of a favorite comedy album of my youth performed by the Firesign Theatre: Everything you know is wrong (still funny, by the way, and available at http://laughstore.stores.yahoo.net/firtheatseze.html). This week's BMJ makes me wonder whether some of my cherished medical beliefs still deserve my fidelity.

Everyone knows that all patients with diabetes should monitor their blood glucose levels, right? Maybe not. Andrew Farmer and colleagues randomized 453 patients with type 2 diabetes well controlled on diet alone or oral agents into three groups (doi: 10.1136/bmj.39247.447431.BE). One group received usual care without blood glucose self monitoring, one performed self monitoring with a less intensive clinical intervention, and the third did self monitoring with more intensive clinical assistance. After 12 months, there were no significant differences in HbA_1c levels among the three groups. In a related editorial, Simon Heller agrees that this trial shows that established patients with good control don't seem to benefit from blood glucose testing (doi: 10.1136/bmj.39276.549109.47). But he also points out that only about 15% of eligible patients enrolled in the trial, and those already testing their blood more than twice a week were not eligible for enrollment. Both of these limit the generalizability of the study.

Everyone knows that the best treatment for depression is a combination of drug and talk therapy, right? Maybe not, despite guidelines supporting combination therapy. Ian Goodyer et al randomized 208 adolescents with moderate or severe major depression to receive specialist clinical care plus either SSRI antidepressants alone or SSRIs plus cognitive behavioral therapy (doi: 10.1136/bmj.39224.494340.55). After 28 weeks there were no significant differences in outcomes in the two groups. Philip Hazell comments (doi: 10.1136/bmj.39265.581042.80) that an increasing amount of research like this now suggests that SSRI monotherapy is a reasonable option for depressed adolescents, but he adds that frequent clinical reviews and monitoring are also necessary.

And, finally, everyone knows that aspirin doesn't help prevent deep vein thrombosis in hospital patients. But in his clinical review of the subject, William Cayley cites a large trial that found a reduction in DVT and fatal pulmonary embolisms in hospitalized patients who took low dose aspirin (doi: 10.1136/bmj.39247.542477.AE). Even though his conclusion is that the place of aspirin in DVT prophylaxis is controversial, some respected guideline developers are now including aspirin in their recommendations.

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Relevant Articles

Self monitoring of blood glucose in type 2 diabetes

Simon R Heller
BMJ 2007 335: 105-106. [Extract] [Full Text] [PDF]

Depression in adolescents

Philip Hazell
BMJ 2007 335: 106-107. [Extract] [Full Text] [PDF]

Preventing deep vein thrombosis in hospital inpatients

William E Cayley, Jr
BMJ 2007 335: 147-151. [Extract] [Full Text] [PDF]

Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial

Ian Goodyer, Bernadka Dubicka, Paul Wilkinson, Raphael Kelvin, Chris Roberts, Sarah Byford, Siobhan Breen, Claire Ford, Barbara Barrett, Alison Leech, Justine Rothwell, Lydia White, and Richard Harrington
BMJ 2007 335: 142. [Abstract] [Full Text] [PDF]

Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial

Andrew Farmer, Alisha Wade, Elizabeth Goyder, Patricia Yudkin, David French, Anthea Craven, Rury Holman, Ann-Louise Kinmonth, and Andrew Neil
BMJ 2007 335: 132. [Abstract] [Full Text] [PDF]

Rapid Responses:

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Unconventional Wisdom in Medicine.

BM Hegde
bmj.com, 30 Jul 2007 [Full text]