Brain gum, CME, and keeping up to date

BMJ 1999; 319 doi: (Published 24 July 1999) Cite this as: BMJ 1999;319:a

Brain gum. Wouldn't we all like a chew on that? The gum features in an editorial on “functional foods,” substances that lie in the hinterland between foods and drugs (p 205). The authors also mention a canned split pea soup that includes St John's Wort “to give your mood a natural lift.” Their message is that marketeers are light years ahead of regulatory authorities, particularly in Britain.

Keeping up to date is the order of the day for doctors, and brain gum might prove much more palatable than continuing medical education, much of which approaches palatability only because of the extravagant meals served up by drug companies to counter the crushing tedium of the lectures. What, for instance, might you diagnose in a 55 year old woman who develops diarrhoea, anaemia, apthous ulcers, sore tongue and mouth, dyspepsia, abdominal pain, fatigue, depression, bone pain, and weakness? Would you think of coeliac disease? You should. Once considered a rarish disease of childhood, it's now recognised to be common and to present in adulthood (p 236).

“How can I stay competent?” is the question asked of the president of the Royal College of Obstetricians and Gynaecologists by an anonymous fellow of the college in our letters pages (p 256). The fellow asks if consultants can be deemed competent when they have only one session (half a day) on the labour ward each week. The president answers that the college recommends that a consultant should be present on the labour ward, without other commitments, for 40 hours a week. He's written to all trust chief executives calling for more consultants. The gap between reality and best practice seems vast. Meanwhile, the Royal College of Surgeons of Edinburgh discloses that there was no consultant present at a quarter of colonic resections in 1996 (p 258). Orthopaedic surgeons are also having to delegate work to unsupervised trainees (p 256).

Training features in an unedifying dog eat dog battle between us and Hospital Doctor, which I might uncharitably describe as a throwaway newspaper that interrupts some spectacular advertising with lowbrow articles along the lines of “Small earthquake in Penge, no doctors involved.” The newspaper reported, as did we (17 July, p 193), on the BMA's annual meeting, but it chose to pick out for editorial comment not the struggles of junior doctors, the opt-out system for organ donation, or any of the most important debates, but rather “black boxing” and the BMJ. Why? Because they compete with us for classified advertising and saw a chance for a fast buck? Did they declare their competing interest? No. (Those who would like to know more about this complex debate should see the explanation on


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