MinervaBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6987.1148 (Published 29 April 1995) Cite this as: BMJ 1995;310:1148
Around half the blindness in children in the developed world is genetically determined (Eye 1995;9:24-8). Advances in molecular genetics have made it possible to offer presymptomatic and prenatal diagnosis for some disorders, but surveys of affected families have shown that substantial numbers of potential parents would not want to terminate the pregnancy if the fetus was shown to be affected. Preimplantation selection seems likely to be more acceptable.
Australia has joined the United States as the second country to allow the patenting of medical methods and techniques (“Medical Journal of Australia” 1995;162:376-80). Fortunately for British doctors (and patients) this step is expressly forbidden by the European Patent Convention of 1973, so we may be spared the need to apply for a licence and pay a fee before learning a new surgical procedure.
Anastomosis of the ileal pouch to the anus has become accepted as the operation of choice for most patients with ulcerative colitis (Diseases of the Colon and Rectum 1995;38:286-9). Questioning of 26 men and 23 women treated by this technique in Copenhagen showed improvement in their quality of life and in particular in their libido and sexual activity. None of the patients reported anal pain, soiling, or faecal leaking during sexual intercourse.
In adults the proportion of the body weight made up of fat depends on both the diet and the amount of exercise. In babies under 12 months (“Journal of Pediatrics” 1995;126:353-7) the composition of the diet seems unimportant: what determines the amount of body fat is the infant's activity. Presumably these are all babies who are on unlimited demand feeds, not undernourished waifs.
A review in Alcohol and Alcoholism (1995;30:13-26) of diagnostic tests for excess alcohol consumption reckons that the best of the newer tests is measurement of the carbohydrate deficient transferrin. This test has a high sensitivity (up to 95%) in detecting people with alcohol dependence and “shows promise” in the identification of non-dependent hazardous drinking.
Scientific papers with huge numbers of authors used to be a feature of physics journals, but the 1990s have seen this fashion spread to other disciplines (“Science” 1995;268:25). Forty papers with more than 100 authors appeared in medical journals in 1994. With large clinical trials becoming ever more common this trend is likely to continue. It is not, of course, seen only in scientific journals: the credits at the end of films are getting longer and longer and are almost self parodies.
An analysis of data from the US Centers for Disease Control and Prevention show that by contrast with Britain (BMJ, 15 April) immigration is a major factor in rising tuberculosis notification rates (New England Journal of Medicine 1955;322:1071-6). From 1986 to 1993, the incidence among those born outside the US rose from 27 to 34 per 100000 compared with a constant 8 in the native population. An accompanying article (pp 1095-9) warns that the reluctance to fund health care for illegal immigrants will deter them from seeking treatment and fuel the rise in notification rates.
The first issue of the “European Journal of General Practice” (PO Box 28091, 3828ZH Hoogland, The Netherlands) made interesting reading. Julian Tudor Hart argues forcefully that doctors and patients should get together to resist corporate interests and demand a service “based on continuing labour intensive care always, as the only cost effective foundation for cures possible only sometimes.” Additional consultation time is the key requirement.
Commercial interests may all too easily conflict with ethical ones. The Journal of Medical Ethics (1995;21:91-6) is worried about transplants from living donors; it draws an analogy with Graham Greene's story The Tenth Man and suggests that ideally no one concerned should have any financial incentive—including the surgeons and the organ procurement agencies.
Mothers of 157 infants recorded the amount they cried as part of a prospective study of growth and development. According to the report in Developmental Medicine and Child Neurology (1995;37:345-53) at 6 weeks one quarter of the babies cried for one hour or more in 24 and 5% cried for more than two hours. Mothers who answered “yes” to the question “Does your baby cry a lot” did have babies who cried more than average. The babies who cried the least were also those who were breast fed longest.
And still on crying babies, infantile colic is often claimed to be the cause of their distress and oral antacids are sometimes recommended. Prolonged treatment with antacids containing aluminium or magnesium may lead, however, to phosphate depletion (“Clinical Pediatrics” 1995;34:73-8). In extreme circumstances this may eventually cause clinical rickets.
The outlook for patients with cystic fibrosis has improved enormously in the past 20 years and is continuing to do so. One recent innovation is daily treatment with an aerosol of recombinant human deoxyribonuclease, which reduces sputum viscosity and improves the forced vital capacity (Thorax 1995;50:321-2). The treatment, however, costs over pounds sterling20 a day, and “given the present NHS funding system it is unclear who should pay for it.”
Clinicians are well aware that viral infections of the ear, nose, and throat are often followed by bacterial infections. A report in “Infection and Immunity” (1995;63:1153-7) describes how intranasal inoculation of influenza A virus promoted colonisation of the oropharynx with pathogenic streptococci and staphylococci: those volunteers who had allergic rhinitis seemed less likely than the others to be colonised by staphylococci. The mechanisms, however, remain obscure.
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