CrazinessBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7230.0/a (Published 29 January 2000) Cite this as: BMJ 2000;320:a
Every country seems to have something it's crazy about. In the United States it's guns. In Germany it's speed. And in Britain it's beating children. The British become upset about attempts to limit their right to beat their children.
The European Court of Human Rights ruled that British law inadequately protects children, and the government agreed to amend it (p 261). Yet a Department of Health consultation document issued this month says: “parents may consider it appropriate to discipline a child through physical punishment … it would be unacceptable to outlaw all physical punishment of a child by a parent.” An alliance of over 220 organisations, including five royal colleges, believes that the law should offer the same protection to children as adults—meaning they could not be assaulted. An editorial reminds us that physical punishment works no better than other methods of child discipline and has serious side effects, not least teaching that physical violence is a way to solve problems.
Some might consider that a certain amount of craziness has surrounded the fetal origins hypothesis of adult cardiovascular disease. The greatest enthusiasts for the hypothesis are sometimes heard to argue that so long as your birth weight and placenta were all right you can smoke all you want. The body of evidence in support of the theory is now impressive, but what's not been clear—until today—is the size of the effect.
A Newcastle group have data on the carotid intima-media thickness (a measure of preclinical atherosclerosis and a predictor of coronary heart disease and stroke) in people born in 1947, and followed since then (p 273). Adult socioeconomic position and lifestyle was much more important than birth weight and early life factors in explaining variation in carotid intima-media thickness. The authors recommend that those wanting to prevent heart disease and stroke continue to concentrate on adult factors.
Authors from Oxford have used some clever pharmacoepidemiology to expose what may be a new kind of craziness (p 291). They were investigating the management of menorrhagia in primary care and noticed continued prescribing of 5 mg tablets of norethisterone despite unclear indications.
The authors found high prescribing of 5 mg tablets in the summer of five years with a smaller peak at Christmas and New Year. They speculate that the drugs may be prescribed to delay menstruation during holidays. They conclude: “Whether this lifestyle or convenience prescribing is appropriate for the NHS is open to debate.”
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