Powerful forces at work

BMJ 2000; 321 doi: (Published 19 August 2000) Cite this as: BMJ 2000;321:a

Powerful forces surge through this week's BMJ (reproduction, scepticism, talking about illness, and making mistakes)—which is perhaps as well because, being a double issue, it will have to serve for two.

The conventional wisdom is that failure to seek contraceptive advice is one factor behind Britain's high teenage pregnancy rate. But Dick Churchill and colleagues show on p 486 that nearly all of the 240 pregnant teenagers they studied had consulted their general practitioner in the year before pregnancy, and most of them had sought contraceptive advice. Basil Donovan observes in an editorial that simply having access to contraception may not be enough to contain “our relentless drive to reproduce” (p 461).

Three previous trials have shown an effect of homoeopathy versus placeobo in atopic allergies. In a fourth, on p 471, the same authors further challenged the hypothesis that homoeopathy is simply acting as a placebo by including an objective measure. They found that in 51 patients with allergic rhinitis the homoeopathic treatment significantly improved nasal airflow. They conclude that homoeopathic dilutions do differ from placebo, though Tim Lancaster and Andrew Vickers comment that they need to do the large trials “that really could change thinking” (p 476).

For a person with cancer telling anybody about it is difficult. How much more difficult it is for a parent talking to her child is explored by Josephine Barnes and colleagues (p 479). They asked 32 women with breast cancer whether they had delayed telling their children and why. Mothers avoided discussion to prevent their children's questions, to prevent them from being distressed, and because they thought their children would not understand. Those mothers who had discussed their illness from an early stage did so because they wanted to keep their children's trust and also to help alleviate their distress. In his editorial Duncan Keeley argues that health professionals mustn't let a perceived lack of expertise inhibit them from doing their best to assist patients in helping their children to understand painful truths (p 462). He quotes Tisseron—it is better to talk badly about such things than not to talk about them at all.

Our theme issue on medical error in March has produced many responses (p 505). Among them is an anonymous writer's rather bitter observation that blaming individuals is more emotionally satisfying than targeting institutions (p 507).

The reason for our double issue is not because most people in Western Europe seem to be on their holidays but simply because this year has 53 Saturdays. Nevertheless, for those who are on holiday now is a good time to think up a sketch for our Christmas review (p 466).


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