BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7422.1058 (Published 30 October 2003) Cite this as: BMJ 2003;327:1058

Despite a decade of intensive research focusing on the search for autism genes, none have been found, and the aetiology of the condition remains a mystery. In the United States and elsewhere, autism is emerging as a public health problem. Much of the cost of autism (such as the emotional strain and altered lifestyle of affected families) is impossible to quantify, although a recent economic study conducted in Britain estimated the lifetime costs to society for a person with autism to be in the range of $4m (Public Health Reports 2003;118: 393-9).

A BMJ reader wonders if Minerva is unaware of the biggest hospital specialty and its practice. Quite rightly, he points out that her assertion that cholinesterase inhibitors were, until recently, only used in Alzheimer's disease is somewhat wide of the mark. He says, “I can assure her and her readers that they have formed a significant part of the anaesthetic formulary for quite some time, and will hopefully continue to do so while muscle relaxants remain in use.”

Young women are the UK's biggest boozers and it's going to get worse. A report from an independent market analyst (www.datamonitor.com) predicts that alcohol consumption among the nation's women will rise by 20% by 2007. Those most likely to drink excessively fall in the group aged 18-24. The outlook for Spain is even worse, however, with a rise of almost 60% predicted by 2007.

The thorny issue of personalised pharmaceutical marketing to doctors raises its head in the Archives of Internal Medicine (2003;163: 2213-8). A survey distributed to junior and senior doctors in a single institution presented 18 scenarios that portrayed interactions between doctors and drug companies. Contrary to recent guidelines, most of the marketing activities were not thought to pose major ethical problems and many who took part made a distinction between the ethical appropriateness of gifts on the basis of the monetary value and the type of gift.

Minerva has often wondered why she suddenly remembers her lost thoughts after a good night's sleep. A paper in Nature (2003;425: 614-6) explains that human memory is a dynamic process. In one study, students who had been trained in the morning lost their recall performance by the evening but recovered their performance the next morning.

Statistically significant relationships exist between environmental tobacco smoke and lung disease in children, and lung and heart disease in adult non-smokers. But environmental tobacco smoke is not listed on death certificates. According to the chief medical officer-coroner of Los Angeles, this is because the present state of knowledge, and controversies, don't allow medical examiners to document it as a direct cause of death. Nor is it considered possible to establish to a reasonable degree of certainty the role of environmental tobacco smoke as a contributory cause of death. Is this omission damaging the usefulness of death certification?

Eye perforations commonly follow low speed vehicle crashes, and they are usually caused by the explosive fracturing of toughened glass. After a long fought campaign, legislation was passed in 1986 in the Republic of Ireland making it mandatory to fit safer laminated windscreens in all cars registered there. The impact of this was almost immediate. In 1987 there were 70 eye perforations; in 2001 there were just four (Medicine Weekly 2003 September 24: 49).

A molecule that stops virus particles from being made has been developed as a drug that has been shown to work in humans with hepatitis C. The drug blocks one of the enzymes needed for viral replication, thus greatly reducing viral load. In a pilot study of eight people reported in Nature (advance online publication 26 October 2003, doi: 10.1038/nature02099), virus load dropped by 100-fold to 1000-fold over two days, and no side effects were reported. Longer trials will show whether drug resistance becomes an issue.

Following closely on the heels of the proposed Polypill for people to prevent heart disease, here's another idea. This time it's a combination antihyperglycaemic-statin pill for people with type 2 diabetes. A writer in Clinical Diabetes (2003;4: 148-9) says it's time to rethink what defines cardiovascular risk in diabetic people, and that combination therapy may be the most productive way to reduce the risk, whatever the level of low density lipoprotein when the person starts taking the pill.

An epidemiological study of age related hearing loss conducted between 1993 and 1995 found that 46% of people aged 48-87 had impaired hearing. Further analysis of the follow up data found that the severity of the problem was significantly associated with decreased mental and physical functioning, and quality of life in general—brought about by losing the ability to exchange information with others (Gerontologist 2003:43: 661-8).


This picture illustrates keratoconjunctivitis in the first author, following his participation in the successful resuscitation of a patient with end stage renal failure and a chest infection. During cardiopulmonary resuscitation the author recalls being “showered” with the patient's oral secretions. Subsequently Streptococcus pneumoniae was cultured from both the patient's sputum and the author's conjunctiva. Both patients responded to antibiotics.

M Punekar, senior house officer, Sean Fenwick, specialist registrar, Rasheed Ahmad, consultant, renal unit, Royal Liverpool University Hospital, Liverpool L7 8XP, Michael Briggs, consultant, St Pauls Eye Unit, Royal Liverpool University Hospital

A previous spinal fracture is an important risk factor for subsequent hip fractures in both men and women. The association between a Colles fracture and a hip fracture, however, is significantly stronger among men than among postmenopausal women. A meta-analysis in the Journal of Bone and Joint Surgery (2003;85A: 1936-43) concludes that men who sustain a Colles fracture should be candidates for preventive measures.

There's a perception that people who survive cardiac arrests outside of hospital lead restricted and disabled lives. But the largest ever study of what happens to survivors of out of hospital cardiac arrests reveals that not only do they enjoy a good quality of life, but that bystander initiated resuscitation is strongly and independently associated with better health related quality of life (Circulation 2003;108: 1939-44).

A 39 year old woman who underwent routine gynaecology surgery woke up in the recovery room to find that she'd not only had her tubes tied, but she'd also lost a layer of skin from around her eyes and cheeks. Further questioning revealed that she'd started to use exfoliating agents on her face about three weeks earlier. The agents, which had been bought over the counter, contained 0.05% retinoic acid. The skin loss occurred where the anaesthetist had used adhesive tape to fix the tracheal tube and to close her eyelids (Anesthesia and Analgesia 2003;97: 1310-1).

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