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EDITORIALS: R McNamee and H Dolk Does exposure to landfill waste harm the fetus? BMJ 2001; 323: 351-352 [Full text]

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Man is not in Great Britain

Malcolm Hannan   (19 August 2001)

Poor handling of news stories by the BMJ

Roger A Fisken   (20 August 2001)

What is measured & new research methods

Mark Metzelaar   (20 August 2001)

Landfill sites and disposable nappies

Michael Casson   (24 August 2001)

Man is not in Great Britain 19 August 2001
Malcolm Hannan, G.P. Peel, Isle of Man Send response to journal: Re: Man is not in Great Britain	Sirs, Your map of landfill sites refers to Great Britain. Great Britain consists of England, Scotland and Wales BUT DOES NOT include THE ISLE OF MAN, which is included in your map. For your information the Isle of Man does have a landfill site but I doubt whether any of our figures are included in your paper. Please be more accurate in future. Malcolm Hannan -- Dr Hannan
Poor handling of news stories by the BMJ 20 August 2001
Roger A Fisken, Consultant Physician Friarage Hospital, Northallerton, North Yorkshire Send response to journal: Re: Poor handling of news stories by the BMJ	Your item "Editor's choice" refers to the difficulty of transmitting medical stories to the general press. Having correctly noted the potential press interest in the article by Elliott et al on birth defects and landfill sites ("The challenge for the media will be to make clear that we do not know whether the association is causal") and having published a thoughtful and balanced editorial by McNamee and Dolk, you then proceed to make a hash of the whole business by printing a note on your "This week in the BMJ" page with the headline: "People living near landfill sites have an increased risk of adverse birth outcomes". The lay press have, of course, not been slow to pick up this headline - see, for example, the front page of the "Guardian" on 18 August. The whole point of McNamee and Dolk's editorial is that we don't know whether living near a landfill site is a risk for birth defects or not - the study by Elliott et al is very important but requires further investigation. What hope is there of curtailing the media's obsession with medical scare stories if even a respected medical journal is prepared to highlight a story by using a sensational headline? Yours sincerely Roger A Fisken
What is measured & new research methods 20 August 2001
Mark Metzelaar, independent research self-employed Send response to journal: Re: What is measured & new research methods	The outcome of the research seems to be small, but if enough subjects are researched, the result is significant. In life probably most causes give a less than 10% result, but it is of uttermost importance to research these. What can be the cause of this? First question is what is measured? Probably not the richest people live near a smoking and smelling waste dump. So only one example for something different that is measured than the effect of waste dumps, can be that less wealthy people have more illnesses. But that whe now already for a long time. For the rest one can say all kinds of stress; physical and mental as well. Smoke-stress is risk factor death cause no.1; so probably environmntal smoke from waste dumps could be the major cause of illnesses. And ofcourse the mental stress that can be related to the unpleasureness of a dirty smell near our homes. That is what whe also now out of research: when people have mental stress; the resistance gets lower or out of balance and illnesses have a much bigger chance. Probable almost everyone is thinking about 'secret' or strange chemical compounds in the waste dumps. Ofcourse, this can be true. But in my opinion, this probably is a quite minor reason; only a small part of the 10%? Further research needs a lot of thinking to give the exact explanation for the results. Creative and several researches are needed to explain these results. But is the medical science willing to do this? Finding maybe 4 different factors that together result in the total of 10%? Maybe some factor allone give even a lesser result, because many times more than one riskfactor strenghten eachother; e.g. a risk factor of 1% and 2% together could give a 6% oucome. Does the medical world want to investigate these small marges and are whe prepared to think about new kinds of research that can find these small data? A standard double blind study is not very suitable for factors under 10%. New methods, logics and a new kind of research has to be created for this.
Landfill sites and disposable nappies 24 August 2001
Michael Casson, General Practitioner 24 The Carriages, Booth Rd. Altrincham, WA14 4AF Send response to journal: Re: Landfill sites and disposable nappies	The recent paper in the BMJ(1) suggesting possible adverse effects of landfill sites may be a further reason,apart from direct health effects on male babies(2) for changing from disposable to re-usable nappies. The former make up to 4.2% of household waste in landfill sites(3) (1)Paul Elliott et al Risk of adverse birth outcomes in populations living near landfill sites. BMJ2001;7309 :363-368(18th August) (2) M A Casson. Testicular cancer and disposable nappies.Electronic Mail BMJ (July 24 2001) (3)Sinead M Saunders Bare Necessities .Oldham NHS TRUST (December 2000) I have a competitive interest. Iam Medical Adviser to Rectella International, Clitheroe, a company developing a cotton based re-usable nappy.