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(1) Silver cars are safest

(Car colour and risk of car crash injury: population
based case control study)
http://bmj.com/cgi/content/full/327/7429/1455

Silver cars are less likely to be involved in a crash
resulting in serious injury than cars of other colours,
finds a study in this week's Christmas issue of the BMJ.

Researchers in New Zealand examined the effect of car
colour on the risk of a serious injury in over 1,000
drivers who took part in the Auckland car crash injury
study between 1998 and 1999.

Factors that could affect the results, such as age and sex
of driver, seat belt use, vehicle age, and road
conditions, were taken into account.

They found a significant reduction (about 50%) in the
risk of serious injury in silver cars compared with white
cars.

There was a significantly increased risk of a serious
injury in brown vehicles and the risks for black and
green cars were also raised. The risk of a serious injury
in yellow, grey, red, and blue cars was not significantly
different from that in white cars.

Some limitations mean that the extent to which these
results are applicable to other settings is open to
question, say the authors. However, increasing the
proportion of silver cars could be an effective strategy
to reduce the burden of injury from car crashes.

Contact:
Sue Furness, Research Fellow, School of
Population Health, University of Auckland, New
Zealand
Email: s.furness{at}auckland.ac.nz

(2) The BMJ guide to wickedness

(Snakes, ladders, and spin)
http://bmj.com/cgi/content/full/327/7429/1436

• Need tips on "sexing up" poor performance data to
meet government targets?
• Want advice to guarantee your dodgy drug sells like
hot cakes?
• Or are you simply after ways to make a dubious but
compelling submission to NICE?

Several articles in this week's Christmas issue of the
BMJ offer a comprehensive guide for the corrupt and
incompetent.

The first study shows how performance targets
encourage gaming and "creative accounting" of data.
The authors describe how to manipulate hospital waiting
times and suggests that position in league tables may
also be improved by various gaming strategies to reduce
hospital death rates.

On a serious note, this review highlights some dilemmas
faced by those under pressure to ensure that healthcare
providers conform to performance targets, say the
authors.

In a second article, researchers decide to cash in their
reputations by setting up a new company, HARLOT
plc, that guarantees to maximise the profits of
manufacturers of dodgy drugs, devices, and useless
screening tests.

They offer to "cook the data" to protect worthless
products and provide "an array of aftercare services"
for keeping the truth from interfering with sales. "If you
faithfully follow our advice, your drug should sell like hot
cakes," they promise.

In the final article, researchers examine some of the
more dubious techniques that can be used by
organisations to make their products seem more
attractive when being assessed by the National Institute
for Clinical Excellence (NICE).

These include selectively reporting the most favourable
evidence and analysing the results in a way that favours
the product. Producers and users of health technology
assessments need to be aware of these potential biases,
they say.

Contacts:
[Performance targets] David Pitches,
Specialist Registrar, University of Birmingham, UK
Email: d.w.pitches{at}bham.ac.uk

[HARLOT plc] via Emma Dickinson, BMJ Press
Officer, London, UK
Email: edickinson{at}bmj.com

[NICE] Amanda Burls, Senior Clinical Lecturer,
University of Birmingham, UK
Email: a.j.Burls{at}bham.ac.uk

(3) Does birth order among siblings decide position in
soccer?

(Football position and atopy: both subject to the birth
order effect?)
http://bmj.com/cgi/content/full/327/7429/1473

Fathers everywhere will be relieved to know that, when
it comes to playing football, the youngest in the family
will not always be nominated the goalkeeper and the
eldest the striker.

In this week's Christmas issue of the BMJ, Michael
Perkin, a child health specialist and father of three young
boys, wrote to all 24 clubs in the Nationwide Division
Three. Fourteen clubs replied, supplying siblings details
of 232 players (23 goalkeepers, 72 defenders, 68
midfielders, and 69 forwards).

Family size varied significantly by football position. The
average number of siblings of a goalkeeper was 1.1,
defender 1.8, midfield 2.4, and forward 2.0. However,
forwards were less likely, not more likely, to be eldest
siblings.

One explanation for goalkeepers being from smaller
families may be that in such families individual children
spend longer in goal, whereas children in bigger families
can rotate through other positions, suggests the author.

Overall, it seems safe to conclude that male siblings
should not be dissuaded from adopting any football
position that appeals to them, he says.

Contact:
Michael Perkin, Clinical Lecturer, Department
of Child Health, St George's Hospital Medical School,
London, UK
Email: m.perkin{at}sghms.ac.uk

(4) Titanic survivors lived no longer than general population

(How long did their hearts go on? A Titanic study)
http://bmj.com/cgi/content/full/327/7429/1457

In the closing song of the 1997 film Titanic, the heroine
tells us that her heart "must go on and on" but a study in
this week's Christmas issue of the BMJ shows that
Titanic survivors lived no longer than the general
population.

Using passenger biographies from the
Encyclopedia-Titanica website, researchers compared
the proportion of survivors alive at each anniversary of
the sinking with two matched groups from the United
States and Sweden.

Of the 500 passengers listed as survivors, 435 could be
traced. The longevity of these passengers was not
remarkably different from that of the two comparison
groups. On average they lived 1.7 years longer than the
general population of the United States and 0.5 years
longer than that of Sweden.

Five women lived past 100, and the three survivors still
alive are now in their 90s. Despite their higher
socioeconomic status, male passengers in first class did
not outlive similar age males in the general populations.

The Titanic survivors did not have shorter lifespans than
the general population. Nor did they substantially outlive
them, conclude the authors.

Contact:
James Hanley, Department of Epidemiology,
Biostatistics, and Occupational Health, McGill
University, Montreal, Canada
Email: james.hanley{at}McGill.ca

(5) Nurses wash their hands more often than doctors

(Audit of soap usage by a primary care team)
http://bmj.com/cgi/content/full/327/7429/1453

Nurses are more conscientious handwashers than
doctors, finds a study in this week's Christmas issue of
the BMJ. Hand washing is a quick, cheap and easy way
of preventing the spread of infection.

Identical soap dispensers were installed next to the
sinks in the consulting room of each member of a
primary care surgery in Cardiff (two nurses and three
doctors).

The soap dispensers were all filled to the same level on
the same day at the start of the study. Over one year,
the amount of soap used and the number of
consultations for each member of the team were
recorded to calculate the ratio of handwashes to
patients seen.

Nursing staff showed greater attention to personal
hygiene than doctors. The best performing nurse
washed her hands at least twice as often (or twice as
thoroughly) as the best performing doctor.

These results will not necessarily reflect handwashing
practices in all teams but form a basis on which others
may conduct similar audits, suggests the author. At the
Christmas party, guess who will be serving the cake ?.

Contact:
Alan Stone, General Practitioner, Canna
Surgery, Cardiff, Wales
Email: alan_stone{at}btinternet.com

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