Editor's Choice

Interestingly complex stories

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c978 (Published 18 February 2010) Cite this as: BMJ 2010;340:c978
  1. Jane Smith, deputy editor, BMJ
  1. jsmith{at}bmj.com

    Those who revel in the complexities of primary care should enjoy the four research papers and editorial on managing urinary tract infections in this week’s issue. In a series of studies Paul Little and his colleagues examine the clinical (doi:10.1136/bmj.c199) and cost (doi:10.1136/bmj.c346) effectiveness of different approaches to managing urinary tract infection; the natural course of the infection (doi:10.1136/bmj.b5633); and women’s views about the management and cause of such infections (doi:10.1136/bmj.c279). The message, according to Dee Mangin in her editorial, is that “empirical prescription, delayed empirical prescription, and empirical prescription based on dipstick results (with back up delayed prescription) are all rational options for different reasons” (doi:10.1136/bmj.c657). For her the most interesting finding is that symptoms were less severe and shorter when the doctor took a positive approach to diagnosis and prognosis. “It is not just what is done that matters but how care is provided.”

    Meanwhile conspiracy theorists should read William L Aldis’s letter about the influence of “Big Pharma” in a New York Times article calling into question the safety and effectiveness of generic medicines (doi:10.1136/bmj.c941). “By introducing the subject as a problem of generic v brand products the author plays into the hands of the pharmaceutical industry…The problem is of course one of bioavailability, not generic drugs per se.” Given that the Department of Health has recently opened a consultation on generic substitution (BMJ 2010;340:c135, 8 January 2010), I predict that we will see more articles revisiting the safety and effectiveness of generic drugs—with manufacturers, branded and generic, weighing in on both sides, of course.

    Malcolm O Perry, whose obituary we publish this week, had a bit part in one of the 20th century’s biggest conspiracy theories (doi:10.1136/bmj.c922). He was the Dallas surgeon on duty the day President Kennedy was shot in 1963. His comment to the press that the gunshot wound just below the president’s Adam’s apple could have been an entrance wound helped fan the belief that the assassination was not the act of a lone gunman. Perry later distanced himself from the comments and rarely spoke about the assassination.

    The story behind the withdrawal of the anti-obesity drug sibutramine seems to be more of a cock up than a conspiracy. The European Medicines Agency decided to withdraw the drug after an interim analysis of the SCOUT (sibutramine cardiovascular outcome trial) study found that it increased morbidity from cardiovascular disease. Yet, says Gareth Williams in his editorial, “the odds were always stacked against sibutramine because cardiovascular risk is embedded in its mechanism of action” (doi:10.1136/bmj.c824). “As well as testing sibutramine to destruction the trial has left behind a mess of uninterpretable data” (though apparently no adverse effect on the company’s share price). Williams suggests that sibutramine is no great loss: its fate “reminds us how little anti-obesity drugs have to offer.”

    The clinically curious will enjoy two other things this week: the continuing correspondence about fever as protection against infection—Gavin Barlow and colleagues show that hypothermia on admission to hospital was significantly associated with 30 day mortality in patients with community acquired pneumonia (doi:10.1136/bmj.c905)—and this week’s Minerva picture (doi:10.1136/bmj.c889). The patient is one of several affected by a drug related outbreak of anthrax caused by contaminated heroin; the European Centre for Disease Prevention and Control expects more cases (doi:10.1136/bmj.c937).

    And, finally, those who enjoy websites that allow personalisation should visit the BMJ Publishing Group’s new portal for junior doctors. This brings together relevant content from across the group’s activities and allows you to customise the site by dragging widgets around. Do try it and tell us what you think: http://juniordoctor.bmj.com.


    Cite this as: BMJ 2010;340:c978


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