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BMJ 1998; 316 doi: (Published 09 May 1998) Cite this as: BMJ 1998;316:1470

Politicians in the United States seem to have given up worrying about the 42 million of their citizens who have no medical insurance (American Journal of Public Health 1998;88:345-6). Opinion polls show that people think the country is losing ground in the provision of health care. The problem seems to be that the government failed to enact any major healthcare reforms in 1993-4 and people were convinced by campaigning that the proposed reforms wouldn't work. No one believes the politicians will come up with an answer, including the politicians themselves.

A woman aged 70 who complained of daytime somnolence and loud snoring at night was found on examination to have signs of masculinisation. Her serum concentration of testosterone was very high (Mayo Clinic Proceedings 1998;73:246-8). An ovarian tumour secreting testosterone was removed, curing the endocrine symptoms and the sleep apnoea. Her sex drive also returned to what she considered normal for her age.

Most patients with sleep apnoea are, however, treated by continuous positive airway pressure through a nose mask. It is not ideal. Many patients complain that the mask leaks, and researchers in Edinburgh have tried the alternative of a face mask. Their study (Thorax 1998;53:290-2) showed that using a face mask reduced complaints of a dry mouth or nose but that 19 out of 20 patients preferred the nose mask …

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