Science, debate, and compassionBMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1795 (Published 31 March 2010) Cite this as: BMJ 2010;340:c1795
- Fiona Godlee, editor, BMJ
Two meta-analyses in this week’s journal evaluate topics of particular interest to surgeons: anaesthesia and wound closure. Natalie Cooper and colleagues ask which is the best form of anaesthesia for women undergoing hysteroscopy as outpatients (doi:10.1136/bmj.c1130). From their meta-analysis of 15 randomised controlled trials, they conclude that neither instilling local anaesthetic into the vaginal cavity nor applying it topically to the cervix does much to reduce pain from the procedure. By comparison, intracervical injection works, but most effective of all is paracervical injection. We can have some confidence in their conclusions since the significant difference was most marked when only a sub-group of the highest quality studies was analysed.
Studies comparing different methods of wound closure in orthopaedic surgery are generally of poorer quality. Toby Smith and colleagues found six studies comparing nylon sutures versus metallic staples in orthopaedic procedures. Only three were randomised controlled trials, and only one of these was appropriately designed and reported (doi:10.1136/bmj.c1199). The authors are suitably circumspect but conclude that sutures carry less risk of wound infection. As B I Singh and C Mcgarvey point out in their editorial (doi:10.1136/bmj.c403), the excess risk was most apparent in patients undergoing non-elective surgery after hip fracture. In these patients at least, the extra few minutes it takes to suture rather than staple the wound seem to be time well spent.
Meanwhile Geoff Scott argues that UK regulators were wrong to allow pharmacies to sell chloramphenicol eye drops without prescription (doi:10.1136/bmj.c1016). The decision five years ago by the Medicines and Healthcare Regulatory Agency has led to a substantial increase in over the counter sales. This doesn’t seem to have contributed greatly to antibiotic resistance, says Scott, but nor has it helped patients or NHS budgets since the treatment is ineffective. This experience should make regulators think twice before adding other antibiotics to the list of drugs that can be sold without prescription.
Last week the journal hung out the flags for US healthcare reform (BMJ 2010;340:c1674, doi:10.1136/bmj.c1674). This week we are in more reflective mode. David Himmelstein and Steffie Woolhandler are members of Physicians for a National Health Service. They see Obama’s bill as conservative, drafted in close consultation with the pharmaceutical and insurance industries (doi:10.1136/bmj.c1778). Its central tenet—that government should force all US citizens to buy coverage from for-profit insurance companies—was first proposed by Richard Nixon in 1972, they say, concluding that, “for now, we will continue to practise under a financing system that obstructs good patient care and squanders vast resources on profit and bureaucracy.”
In case, like me, you find this depressing, there is hope and reconciliation to be found in the personal view from Jim Swire (doi:10.1136/bmj.c1725). He has followed with great personal interest the conviction, illness, and repatriation of the “Lockerbie bomber”—his daughter Flora was killed in the bombing. Now a retired GP, he welcomes the improvement in Al-Megrahi’s health and says we should be proud of the doctors who supported his compassionate release.
Cite this as: BMJ 2010;340:c1795