MinervaBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6926.484 (Published 12 February 1994) Cite this as: BMJ 1994;308:484
Women who eat a lot of fish and other seafood have heavier (by 200 g) and longer (by 1 cm) babies than those who do not (Journal of Epidemiology and Community Health 1994;47:436-40). The study in the Faeroe Islands that came up with these results was stimulated by the hypothesis that seafood, which is rich in long chain n-3 fatty acids, might prolong the duration of pregnancy by an effect on prostaglandins and might increase fetal growth by improving placental blood flow. More research is planned.
Magnetic resonance imaging allows clinicians to make repeated objective assessments of the progression of the lesions in patients with multiple sclerosis, and some trials of treatment have used this measure as an end point. New treatments such as interferon are opening up encouraging possibilities. Reviews in the “Journal of Neurology, Neurosurgery, and Psychiatry” (1994;57:3-6) and the “Lancet” (1994;343:275-8) are agreed, however, that the gold standard will remain clinical disability - which is what matters to the patient.
Outcome measures are, indeed, being examined more critically in most branches of medicine, and one of the objectives of the new Journal of Medical Screening (1994;1:1-2) is to emphasise the “overriding importance that medical screening is intended to benefit the individuals being screened” and that the early detection of disease should not be an end in itself.
Scientific fraud busters used to be able to rely on inspection of raw data in notebooks and laboratory reports, but this may be far less easy in the current computer era. According to “Science” (1994;263:317-8), digital imaging gives scientists the opportunity to clean up and modify data by using electronic cameras to record everything from histology to electrophoresis. Once in digital format the image can be changed at will - to conform to what the scientist was hoping to achieve.
In 1991 no fewer than 677 adolescents and children living in Los Angeles were shot at by street gangsters cruising past in their cars (New England Journal of Medicine 1994;330:324-7) and 429 of these had gunshot wounds. Thirty six died. Three hundred of the victims were themselves gang members.
Drugs are blamed for much of the violent teenage crime in the United States, but opinions are still widely divided on whether or not to decriminalise at least some drugs. The same issue of the “New England Journal of Medicine” (361-5) includes an article arguing that the war against drugs is being won and that the epidemic is in decline. Use of cannabis is said to be at its lowest level since 1973 and the number of current cocaine users - 1.3 million - is well below the peak of 5.8 million in 1985.
Primary care physicians in the United States are much more likely to ask new adult patients about their smoking habits than about their sexual histories (Morbidity and Mortality Weekly Report 1994;42:988-92). Half the patients were asked if they had ever had a sexually transmitted disease but only a quarter were asked about sexual orientation. Clearly, says the report, health care professionals need more training in risk assessment and risk reduction counselling.
Fifty thousand people die from rabies each year, mostly in Africa, Asia, and South America. A review from Thailand in the “Medical Journal of Australia” (1994;160:83-7) recommends that tourists visiting regions where the disease is endemic should be immunised against it with the human diploid cell rabies vaccine. Boosters should be given every three years to people who need repeated protection.
Patients who have a below knee amputation for ischaemia have only a 59% chance that the stump will have healed at three months. A mammoth prospective study of 713 patients treated in six European countries (British Journal of Surgery 1994;81:33-7) found that at three months 19% of patients had required amputation at a higher level, 11% had died, and 11% had unhealed stumps. The purpose of the trial was to assess the effect of postoperative intravenous infusion of the prostacyclin analogue iloprost: no difference was found in outcome between the treatment and control groups.
Women of childbearing age who need a heart valve replaced are sometimes given biological prostheses so that they will not need to take anticoagulants. A retrospective study of 214 pregnancies in 182 women (British Heart Journal 1994;71:196-201) has suggested that mechanical valves might be better in these circumstances. The 133 women with mechanical valves had no problems with warfarin anticoagulation; 17 of the 49 bioprosthetic valves deteriorated rapidly during pregnancy and needed urgent replacement.
Minerva is fascinated by really long term studies such as the one begun in 1922 by the psychologist Lewis Terman, who followed up a cohort of 788 children who had high scores on intelligence tests. A letter in the “Lancet” (1994;343:296) gives some recent data from the study showing that the unsociable scientists have lived slightly longer than the well adjusted, socially assured businessmen and lawyers. Bang goes the theory that sociability lengthens the life span.
If the bell end of a stethoscope is replaced by a conventional dental probe the sound made by tapping the instrument against the teeth is magnified and gives a reliable guide to whether or not the tooth has been restored (Medicine, Science and the Law 1993;33:51-3). This device may be useful to forensic odontologists when charting the dental records of a corpse.
Tuberculosis could be eliminated worldwide if public health authorities tried hard enough, says a commentary in the “Mayo Clinic Proceedings” (1994;69:85-6). In Western countries the last generation to be heavily infected in childhood was born in the 1940s; in the developing world, treatment programmes are still - despite HIV - effective and no expensive. So let's have a bit of optimism for once and give it a go.