Thirty years after the Health Insurance Plan trial showed that mammography reduced mortality from breast cancer most American women still discover their tumours themselves or have them discovered by their doctors (Southern Medical Journal 1995;88:1114-7). Only a quarter of women treated for breast cancer in Atlanta had had their lesions discovered by mammography. The report adds the startling comment that around one physician in eight in the United States believes that mammography is unnecessary in symptomless women.

Global warming seems now to have become accepted as real, with a 2.0°C rise forecast by the year 2100. This will lead to more people being exposed to diseases such as malaria; but as “JAMA” (1996;275:230-3) points out, resistance to antimalarial drugs is emerging and spreading faster than drugs are being discovered and deployed. And for other tropical diseases such as dengue and arbovirus encephalitis, medicine has no effective drugs at all and no vaccines either.

Patients who have acute myocardial infarctions do better if they had angina before the infarct occurred. A study in London (New England Journal of Medicine 1996;334:7-12) has now shown that reperfusion of the ischaemic myocardium is more likely to occur in these patients than in those without angina. …