Intended for healthcare professionals

Choice

The BMJ loves surgeons: true

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7119.0 (Published 22 November 1997) Cite this as: BMJ 1997;315:0

The Royal College of Surgeons estimated 10 years ago that about a third of patients who died of major trauma who were admitted to accident and emergency departments could have been saved. It recommended the creation of major trauma centres. The Department of Health set up such a centre in the North West Midlands, and today we publish the results of an independent “before and after” study (p 1349). The authors conclude that such centres could at best produce only a small saving in deaths. These results are disappointing, particularly as trauma centres do seem to have reduced deaths in the United States and Germany, but David Yates insists in an editorial that this paper cannot be the end of the story (p 1321).

Our other surgical trial, one that is randomised and controlled, produces positive results. It shows that patients with bleeding varices do better when their varices are injected if they are also given octreotide, a synthetic analogue of somatostatin (p 1338). The drug works by causing splanchnic arteriolar constriction and reducing the release of peptides that contribute to the hyperdynamic circulatory syndrome of portal hypertension.

Surgeons may also be interested in the letters about a suggestion—from surgeons—that, instead of giving patients with cancer 10 year survival rates, doctors might tell them what fraction of normal life expectancy remains to them (p 1375). A research registrar who had breast cancer two years ago when aged 33 approves of the method.

Those who have less interest in surgery should not be left feeling neglected by this week's journal. We start a new series on meta-analyses, a statistical technique that evokes great passion among doctors (p 1371). The first paper points out that the number of meta-analyses published each year in journals indexed on Medline has grown steadily from under 50 in 1987 to 800 in 1996. Meanwhile, Kamran Abbasi investigates a company that promises prospective parents near 100% accuracy in choosing the sex of their baby by using a method that the fertility expert Lord Winston calls “complete nonsense” (p 1386). Yet the company achieved extensive media coverage and has had 1300 inquiries.

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