Choice

Something practical, something ethical, something ludicrous

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7266.0/a (Published 14 October 2000) Cite this as: BMJ 2000;321:a

Next time you vaccinate an infant—perhaps five minutes after reading this—use a long needle. Linda Diggle and Jonathan Deeks show in a randomised controlled trial that longer needles produce fewer local reactions (p 931). The authors speculate that the longer needle may ensure that vaccine reaches the thigh muscle. We fast tracked this paper because a simple change in practice can produce quick benefits. We hope that can skip the five year delay that often occurs between new evidence and a change in practice.

We also have high hopes of practical benefits flowing from our new occasional series on 10 minute consultations (p 935). Ten minutes is about the length of a consultation in general practice in Britain, and the series is designed to capture on one page what doctors should ask and do. The first article covers menorrhagia. Further information is given on bmj.com, and readers will be directed to where they can find the evidence that underpins the advice. We thank Ann McPherson, a general practitioner in Oxford, for suggesting the series.

Solid ethical guidance is practical too, and the World Medical Association (WMA) last week revised the Declaration of Helsinki for the fifth time at its meeting in Edinburgh (p 913). It has made clear that research undertaken in the developing world is acceptable only if participants in the study can benefit from the treatment after the study is finished. In other words, researchers cannot exploit the cheap conditions and laxer rules of developing countries to do research that will benefit only those in the rich world. The revised declaration also calls for new treatments to be tested against the current best treatment rather than placebo. These are important developments, and we congratulate the WMA.

Those who offer ethical guidance can never rest. Deborah Josefson describes the case from Colorado of a couple who have used preimplantation genetic screening to produce a child who can provide stem cells for their older daughter, who will otherwise die of Fanconi's anaemia (p 917). Stories have emerged of parents who have already conceived children to donate kidneys or bone marrow to sick siblings. What's new is the use of sophisticated techniques. Meanwhile, a cluster of letters discusses how the World Health Organization and Unicef may have been overinfluenced by manufacturers of breast milk substitutes (p 956). Where does acceptable lobbying end and undue commercial pressure begin?

Finally, don't miss our account of how the BMJ has won an (Ig)Nobel prize for a paper describing couples having sex in an MRI scanner (p 914).

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