It's an uphill struggle to overcome vaccine scares. Using an unusual combination of game theory and epidemic modelling, two mathematicians conclude that the incentive not to vaccinate children during a scare is greater than the incentive to vaccinate during an educational campaign after a scare. The whooping cough scare in the 1970s bears witness to this, and the MMR debacle looks as though it's going the same way (www.pnas.org/cgi/doi/10.1073/pnas.0403823101).

As a result of the European Working Time Directive limiting the hours of junior doctors, a consultant urologist recently found himself being asked about an apparently urgent clinical problem on the end of a telephone. The caller, from the accident and emergency department, said, “I have a patient here who had a prostatectomy six weeks ago and wants to know if he can have sexual intercourse.” A patient centred approach to medicine is one thing, but Minerva suggests more patient education is required about the appropriate use of emergency services.

Osteoporosis raises the risk of breaking a hip, yet femoral neck fractures in such patients are not always seen on x ray. A team in Hong Kong found that magnetic resonance imaging revealed that half of the patients with unexplained hip pain had occult fractures, and …