Views And Reviews Minerva


BMJ 1998; 316 doi: (Published 13 June 1998) Cite this as: BMJ 1998;316:1840

Elderly people with chronic illnessses may be missing out on treatment for unrelated conditions (New England Journal of Medicine 1998;338:1516-20). Canadian investigators looked at people over 65 with diabetes, emphysema, and psychosis and found that they were less likely to be taking hormone replacement therapy, lipid lowering drugs, or treatments for arthritis. They suggest two possible explanations: that one chronic disease protects the sufferer against others, or that doctors get distracted by the main complaint and neglect the rest.

Having a brother or sister over 100 years old increases your chances of surviving to that age too (Lancet 1998;351:1560). One hundred and two centenarians and their families were compared with a similar cohort of individuals who had died at 73 and their families. The centenarians' siblings were four times more likely to live beyond 90 years than the others' siblings. The researchers also found, unexpectedly, that centenarians had more siblings—a mean of 4.5 each compared with a mean of 3.2 for individuals dying at 73.

The potential for bias in review articles is well known to most editors and drove the BMJ to introduce a methods section into fortnightly reviews. A study of review articles on passive smoking confirms that conclusions are strongly influenced by the authors' connections (JAMA 1998;279:1566-70). Three quarters of the reviews denying a health risk from passive smoking were written by authors affiliated to the tobacco industry. The investigators looked for other factors that might influence a review's message, such as the quality of the review, the year of publication, and the specific heath risk under review. None were relevant—only the authors' affiliation was statistically associated with a review's conclusions.

There are few diseases as controversial as prostate cancer, but urologists can be sure of one thing: sexual function is critical to quality of life after surgery. Ninety eight of 112 Australians surveyed after radical prostatectomy reported erectile impotence, and 44 of them admitted that it affected their quality of life (Medical Journal of Australia 1998;168:483-6). Impotence was the commonest reported worry, well ahead of fears about cancer and incontinence problems. Unsatisfactory golf club toilets was a more unexpected item on the list.

The jury is still out on the mental development of children conceived by intracytoplasmic sperm injection. A team from Australia found a higher risk of developmental delay, but another team from Belgium did not (Lancet 1998;351:1529-34, 1553). A commentator in the same journal warns that conclusions are premature, but regulation of new reproductive techniques is urgently needed.

An “insertion” allele of the gene coding for angiotensin converting enzyme seems to improve endurance among high altitude mountaineers and UK army recruits lucky enough to have it (Nature 1998;393:221). In this volunteer study recruits homozygous for the insertion allele responded 11 times better to endurance training with bar-bells than did recruits homozygous for the “deletion” allele. Minerva is tempted to have her genotype determined before a forthcoming endurance test at the Wigan triathlon.

Paediatric juniors and nurses may have a part to play in encouraging reading in low income families (Archives of Paediatrics and Adolescent Medicine 1998;152:459-65). In a non-random comparative study parents who were given a couple of books and educational advice at a well child clinic reported reading with their children more often than controls. They also said that they enjoyed it more than control parents did.

Ovarian cancer is familial, but accurate data on risks for various family members are hard to come by. A meta-analysis of 15 cohort and case-control studies gave a relative risk of 3.8 for sisters and 6.0 for daughters of cases (British Journal of Obstetrics and Gynaecology 1998;105:493-9). It's unclear why the relative risk to mothers of cases was only 1.1. The authors speculate that the difference in risk estimates between mothers and daughters may be partly due to the protective effect of having children.

The prize for daft acronym of the week goes to Catch 22 syndrome (British Journal of Psychiatry 1998;172:518-20), which describes a developmental malformation caused by hemizygous deletion of chromosome 22q11—not, as expected, a mental illness brought on by inescapable dilemmas.


A few hours before flying back to London from Hawaii a woman aged 30 had been presented with a lei necklace of mokihana fruit and meile leaves, which she wore for about 20 minutes before removing it to go swimming. During the flight home her neck became painful and blistered. Despite treatment with silver sulphadiazine and flucloxacillin an obvious rash persisted for four days and the skin was still discoloured two months later.

Pauline Bryant, general practice registrar, Hampstead Group Practice, London NW3 4YD

Submissions for this page should include signed consent to publication from the patient.

No one likes to think that disaster lurks around every corner, which is why planning for disasters is generally poor. To find out exactly how often they occur in Britain, researchers from Manchester scrutinised reports from the government, newspapers, the internet, the ambulance service, and Index Medicus. They found only 108 disasters despite going back to 1968, and suggest that this is a serious underestimate (Journal of Epidemiology and Community Health 1998;52:392-8). The government should fund a central register of disasters, they say, so that lessons from the past are not forgotten.

People who have had a heart attack are a captive audience for lifestyle advice, but does it do any good? A qualitative study of 25 people recovering from a heart attack suggests that they are fairly receptive at the start but soon lose faith in the “official” line linking lifestyle to their predicament (Social Science and Medicine 1998;46:1477-86). The problem, say the authors, is that epidemiological evidence rarely translates into personal experience. Advice about dietary fat will fall on deaf ears if the fit octogenarian next door eats deep fried bacon sandwiches for breakfast.

Alternative medicine attracts increasing numbers of new devotees, but we are still unclear what drives people away from more conventional treatments. A detailed questionnaire survey of over 1000 Americans showed that dissatisfaction with conventional doctors has little to do with it (JAMA 1998;279:1548-53). The 40% of respondents who used alternative medicine tended to be better educated and sicker and to have a more holistic approach to health than the rest. They were also more likely to have had a life changing “transformational experience.”

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