Minerva

Four fifths of new drugs that come on to the market add little or nothing to existing drugs, says a French pharmacology journal (Prescrire International 2001;10:52-3). An article blames French and European regulatory agencies for uncontrolled increases in “me too” drugs that drive up the nation's drugs bill and add to confusion for patients and prescribers. The problem is particularly evident among drugs for common chronic diseases. Doctors in France can choose from 12 angiotensin converting inhibitors, five low molecular weight heparins, and a wide range of non-steroidal anti inflammatory drugs.

Radiologists often complain that they are rarely acknowledged in Minerva pictures, despite their essential contribution interpreting radiological images. The picture in BMJ of 3 March prompted the latest round of angry correspondence, and Minerva was saved from a severe beating by the editor only by a frantic search through the files and the discovery that a radiologist had reviewed both images and had found them credible. To save her from this kind of stress, please be considerate to radiologists and give them credit where it's due.

In 1349, hundreds of London's plague victims were buried in a plague pit to the north east of the Tower of London. Six hundred and fifty years later, palaeoepidemiologists dug them up again to find out whether their skeletons would be more representative of a medieval population than skeletons from the standard cemetery above the pit (International Journal of Epidemiology 2001;30:104-8). Unfortunately, they couldn't ascribe an age or sex to many of the skeletons. But from severely limited data they concluded that plague pits were no more useful than ordinary cemeteries for studying dead populations.

The Truth and Reconciliation Commission in South Africa had social and political aims, but its final report also mentions a therapeutic function for victims of human rights abuses. Data from a study of 134 victims in the Western Cape do not support this claim (British Journal of Psychiatry 2001;178;373-7). Two thirds of the sample had a recognisable psychiatric illness, and there was no difference between those who had or had not given evidence to the commission. Many could not forgive their abusers, but those who did had better psychiatric health in the end.

Doctors conducting a randomised trial of laparoscopic appendicectomy devised a crafty combination of wound dressings so that patients, nurses, and researchers would be blind to the type of operation carried out (British Journal of Surgery 2001;88:510-14). A few patients guessed that they'd had either open or laparoscopic surgery, but otherwise the blinding worked well. Predictably, children who had laparoscopy got better more quickly, and with less pain, than controls.

Death rates are rising in older people with asthma, possibly because they aren't getting the inhaled steroids known to save lives in younger people. Researchers in Ontario found that only 40% of people over 65 received inhaled steroids after an acute exacerbation and a spell in hospital (Chest 2001;119:720-5). Those least likely to get steroids were over 80, had other illnesses, or were cared for after discharge by a primary care doctor, not a specialist.

The origins of a sweet tooth could lie in a newly identified sweetness receptor called T1R3 (Nature Genetics 2001;28:58-63). The gene for the receptor is located on chromosome 4, which is also the location of genes coding for previously identified bitterness receptors. The discovery is important because the ability to taste the sweetness of food rich in carbohydrate has a critical role in the nutritional health (or lack of health) of human populations. It also paves the way for genetically engineered “designer” sweeteners.

Body shape at birth has some impact on the risk of several adult diseases, including hypertension and diabetes. It also influences the age at which girls start periods, reported a study from the Philippines (www.pediatrics.org/cgi/content/full/107/4/e59). In a cohort of girls from Metro Cebu, a large urban area, girls who were long and thin at birth started their periods six months earlier than those who were short thin babies. Body weight alone had no effect.

For years, accident and emergency doctors in the United Kingdom have been campaigning to lose the “accident” from their title and departments. They are finally making progress, according to a study in Emergency Medicine Journal, a title that lost its “accident” last year (2001;18:79-80). References to emergency medicine are increasing, though probably not in the BMJ, which was caught referring to casualty departments twice in 1999. The NHS dropped the term casualty nearly 40 years ago.

Conflict between doctors and managers is well recorded. But today's competitive healthcare environment has produced a new phenomenon: doctors fighting doctors. Archives of Internal Medicine (2001;161:801-2) likens two doctors pitted against each other to a cockfight: the real players are those on the sidelines rooting for their favourite bird. Winning the contest becomes more important than the state of the birds when it's all over. Birds can, after all, be replaced. And so, presumably, can doctors.

A 68 year old man presented to his accident and emergency department with a history of burning pain across the left side of his face, first noticed after a hot shower. His skin was erythematous, and a diagnosis of superficial burn injury was made. Three days later he returned with multiple crusty eruptions within the distribution of the ophthalmic division of the trigeminal nerve, typical of ophthalmic herpes zoster. He was treated with aciclovir.

I Grant, specialist registrar, A Pandya, specialist registrar, M G Dickson, consultant surgeon, department of plastic surgery, Lister Hospital, Stevenage SG1 4AB

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Doctors from Virginia estimate that blood stream infections acquired in hospital represent the eighth leading cause of death in the United States, causing 20 000 to 70 000 deaths each year (Emerging Infectious Diseases 2001;7:174-7). Two small changes could reduce the death toll substantially, they say: use of central venous catheters impregnated with antibiotics, and rigorous handwashing between patients.

Structured abstracts in original papers are meant to be more informative than traditional unstructured ones, though there's evidence that they may be more inaccurate, at least in medical journals. Inaccuracy is less of a problem in psychology journals, according to a study of papers published in journals of the British Psychological Society (Journal of Information Science 2000;26:278-81). Reviewers found that abstracts were a good summary of the rest of the text, and that structured ones were no better or worse than traditional ones.