Variations in the use of electroconvulsive therapy in 317 urban areas in the United States show just how far psychiatrists are from reaching consensus on its value. In a third of the areas studied no use of the treatment was reported at all, and in the remainder annual rates varied from 0.4 to 81 per 10000 population (American Journal of Psychiatry 1995;152:869-75). Unsurprisingly, the factors predicting variation in use were related to “provider variables” and state regulations, not the prevalence of depression.

A convincing case for integrating lawyers into medical teams that provide care for patients dying of AIDS is made in the “Hastings Center Report” (1995;25:13-9). Apart from legal problems related to housing, insurance, credit claims, and advance directives, patients may be desperately concerned about the future guardianship of their children and need expert help to sort this out.

A prospective study of 596 patients in (non-traumatic) coma suggests that their prognosis can be assessed very simply (JAMA 1995;273: 1842-8). On day 3 abnormal brain stem function, no withdrawal response to pain, creatinine concentration >132.6 mmol/l, and age over …