BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7109.690 (Published 13 September 1997) Cite this as: BMJ 1997;315:690

The Oregon Health Plan, with its prioritised list of medical treatments, came into operation in 1974 and has since proved politically popular, says a report in the New England Journal of Medicine (1997;337:651-5). The choices have proved acceptable both to patients and to doctors, and 100 000 people have been added to the Medicaid programme. If cuts have to be made in a medical service they may be most acceptable if money is saved by excluding treatments of unproved effectiveness.

Is hepatitis A sometimes transmitted sexually? An outbreak in London reported in the Scandinavian Journal of Infectious Diseases (1997;29:211-2) adds to the evidence that it may be. The infection is more common in homosexual men than in the general population. The link is not too surprising—oral-anal contact might be expected to spread gastrointestinal pathogens.

Metformin, a biguanide drug used in the management of non-insulin dependent diabetes, may cause lactic acidosis in patients with impaired kidney function. The Royal College of Radiologists has recently issued advice to its members and fellows reminding them of the need to ask patients referred for contrast investigations whether they are taking metformin. Anyone taking the drug should stop taking it for 48 hours before and 48 hours after any x ray contrast …

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