BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7418.818 (Published 02 October 2003) Cite this as: BMJ 2003;327:818

Speaking at the 2003 meeting of the American Society of Clinical Oncology in Chicago, which highlighted tobacco control as one of this year's themes, the society's president said “As an American, I am horrified we are exporting this substance of death around the world.” He called on the US government to support all efforts to eliminate this “true weapon of mass destruction” (European Journal of Cancer 2003;39: 1814).

The pool of hearts available for donation might expand if hearts with coronary heart disease were used, which might mean the recipient undergoing bypass surgery at the time of transplantation. When 22 people who received diseased hearts were followed up one and two years later, the results were really pretty good. There had been four early deaths, largely due to the poor health of the recipient, but selective use of donor hearts with blocked arteries can work. In this study, all the hearts had preserved left ventricular function on echocardiography (Journal of Thoracic and Cardiovascular Surgery 2003;126: 821–5).

Analysis of a UK cohort of 1848 patients treated with human pituitary growth hormone from 1959 to 1985 revealed 38 cases of Creutzfeldt-Jakob disease. The risk seems to be higher in people treated between the ages of 8 and 10 years, and in those who received growth hormone extracted by the Wilhelmi method. The risk of showing signs of the disease seems to peak 20 years after first exposure to the hormone (Neurology 2003;61: 783–91).

Legs as well as hearts benefit when statins are taken to reduce cholesterol. A randomised, double blind study of 354 people with intermittent claudication concludes that people with peripheral vascular disease who take statins also enjoy a better lifestyle. The study found that atorvastatin improves the duration of pain-free walking, a benefit that complements the anticipated reduction in cardiovascular events (Circulation 2003;108: 1481–6).

The Caldicott report, published in 1997, was a huge review of patient confidentiality issues. The chief principles for which a “Caldicott guardian” in any healthcare organisation is responsible grows every time a new relevant law is passed, and the role has grown into what is now known as “information governance.” Beware: the Freedom of Information Act 2000 becomes law by 2005 and affects the NHS (Postgraduate Medical Journal 2003;79: 516–8).

The threat of exposure to toxic agents after 11 September 2001 caused widespread panic in the United States. A study that examined the risk factors for belief in exposure to chemicals that could be used by terrorists (such as nerve or mustard gas) found that Gulf War veterans who were older, non-white, and female were more likely to report exposure. The same group was also more likely to report more traumatic events, more physical symptoms during the Gulf War, and poorer current health and was more likely to have a diagnosis of a mental disorder (Journal of Nervous and Mental Disease 2003;191: 431–6).

Why do we sometimes do things for complete strangers when there's nothing in it for ourselves? A psychological study of the enigma of “public good” concludes that having the ability to opt out of something actually fosters cooperation. Although volunteering doesn't produce overwhelming cooperation, it does help prevent mutual defection in many human collective enterprises (Nature 2003;425: 390–3).

Minerva's tendency to be sick in small aircraft makes her an expert in a variety of strategies designed to help avoid the sick bag. She agrees with anecdotal reports from aviators that controlled breathing is an effective countermeasure for motion sickness. Put to the test under proper experimental conditions, where controlled breathing was compared with a counting task, controlled breathing significantly prolonged the time tolerated with nausea and reduced the recovery time after motion stopped (Aviation, Space, and Environmental Medicine 2003;74: 998–1002).

According to a study in Seizure (2003;12: 323–9) women with epilepsy who have taken only one antiepileptic drug are significantly more likely to have polycystic ovaries than women without epilepsy. More importantly, those who take valproate (but not carbamazepine or lamotrigine) and who do not take the oral contraceptive pill are more likely to have biochemical evidence of also having the hormonal imbalance typical of polycystic ovary syndrome than those without epilepsy.

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A previously fit and well 35 year old Nigerian man presented with acute onset right sided hemiplegia. Initial clinical suspicion was of a cerebrovascular accident. Computed tomography and then magnetic resonance imaging showed several discrete lesions, consistent with toxoplasmosis. Subsequent serology was positive for both toxoplasmosis and HIV. This is a reminder that HIV can still present with AIDS defining illnesses and should always be considered in higher risk groups.

Erik K Mayer, house officer, Bernhard Klebe, specialist registrar, renal medicine, Queen Elizabeth Hospital, London SE18 4QH

The idea that medical students might write their own exam questions had Minerva reflecting on how her experience of medical education might have been completely different had she enjoyed the same privilege (Medical Education 2003;37: 734–8). Not surprisingly, the evaluation of this educational project found that students felt more confident in the examination period. The study also indicates that students given this opportunity may increase their learning and reflection in the actual discipline being assessed.

Doctors—and their patients—sometimes feel uneasy about stopping treatment with a proton pump inhibitor after a patient has had a peptic ulcer and been given Helicobacter pylori eradication therapy. But a five year prospective randomised controlled trial concludes that maintenance treatment really isn't necessary (Archives of Internal Medicine 2003;163: 2020–4). Virtually all 82 patients completed the study, and all remained free of H pylori infection with no peptic ulcer recurrence.

Children's rights are failing to be addressed, according to Sir Ian Kennedy. He wants children's services not just to concentrate on needs but to be organised around equal citizenship, with children having the rights to be respected. In the annual Great Ormond Street lecture in September, Kennedy said that food, shelter, safety from preventable hazards, education, and health care “are not extravagant rights.”


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