Editor's Choice

Much about women

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7268.0 (Published 28 October 2000) Cite this as: BMJ 2000;321:0

It's not often that a book reviewer declines to judge a book on the grounds that he or she hasn't been able to do a randomised controlled trial of its impact. But that's more or less what Christopher Cates says in his review of the NHS Direct Healthcare Guide (p 1086). The book is a self help guide for patients, and Cates's point is that it, and the NHS Direct helpline service behind it, is a new healthcare technology and needs evaluating as such. Otherwise, Cates says, arguments about whether NHS Direct is expensive or generates demand are supported by prejudice and anecdote. “And ignorance” John McInerney and colleagues might add. They found that 62% of attenders at their accident and emergency department had never heard of NHS Direct six months after its introduction in their area (p 1077).

Another book review, this time on gender inequalities in health, offers the subversive observation that “Women who gain power become men.” Annette MacKay Rossignol concludes from this that “those of us who have attained a comfortable level of power have an ethical obligation to share power with those who have not” (p 1087). Rhona MacDonald echoes this sentiment in her editorial on rape (p 1034). Worldwide the problem of sexual violence against women is getting worse. Laws continue to discriminate against women, and judicial systems offer them little protection, but MacDonald argues that it is not only governments that need to take action: health professionals should also advocate for women and “brush aside the taboos and talk more openly” about rape. The anonymous writer of this week's personal view clearly knows the effects of such taboos, of keeping private “the shameful secret” of having been raped: “It was as if I had a chronic abscess inside …sapping all my strength and energy” (p 1089).

The writer of the personal view found counselling helpful—albeit five years after the trauma. Yet there is mounting evidence that one particular type of counselling—psychological debriefing delivered shortly after a traumatic event—is not effective and may even be harmful. Justin Kenardy discusses the evidence in his editorial (p 1032), and the study by Rhonda Small and colleagues adds to the doubts about debriefing (p 1043). In their randomised trial of midwife led debriefing after operative childbirth they found that the debriefing had no beneficial effect on depression six months after birth and might have contributed to emotional problems in some women.

Finally, and on a more positive note for women, Valerie Beral has just recruited the millionth woman into the largest ever study of women's health. In a profile of her on p 1042 Geoff Watts describes how she became an epidemiologist to tackle head on the uncertainty she had felt as a clinician.


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