Is rheumatoid arthritis a consequence of natural selection for enhanced tuberculosis resistance? A paper in this month's Medical Hypotheses (2004;62: 839-43) says the modern pattern of rheumatoid arthritis is similar to the pattern of tuberculosis 200 years ago. Populations that suffered severe epidemic tuberculosis now have the highest rates of rheumatoid arthritis. One theory is that the genes that increased resistance to tuberculosis infection ended upincreasing the risk of developing rheumatoid arthritis.

A definitive “dictionary of medicines and devices” has been introduced by the NHS (www.dmd.nhs.uk). The idea is that it should enable computer systems to exchange information about specific drugs and devices, thus reducing the chances of error.

A survey looking at some of the reasons why US providers of care don't provide highly active antiretroviral therapy (HAART) to medically eligible HIV infected drug users has identified specific barriers. Resistance to prescribing HAART included being a non-physician, working with populations with a high prevalence of mental illness, injection drug use, alcoholism and homelessness, and where patients had a limited ability to keep appointments. One solution might be to provide on-site drug treatment alongside mental health and social services (AIDS Care 2004;16: 485-500).

Sticking to a gluten-free diet …