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Revisiting old debates

BMJ 1999; 318 doi: (Published 26 June 1999) Cite this as: BMJ 1999;318:0

This week's BMJ revisits old debates—and has at least one new one. Firstly, Nick Freemantle and colleagues revisit the effectiveness of β blockade in secondary prevention after myocardial infarction (p 1730). As they point out, β blockers were once heralded as a major advance, though their use in secondary prevention has declined. Their systematic review shows that β blockers still have benefits as long term treatment after an infarction and compare favourably with other drug treatments.

Another old topic revisited is that of alcohol consumption and mortality—this time with more surprising results. In their 21 year old follow up of drinking and mortality in Scottish men Carole Hart and colleagues fail to confirm the current orthodoxy that moderate drinking is protective (p 1725). They also find no strong relation between alcohol consumption and death from coronary heart disease—but a strong relation with death from stroke.

Baby Check is a checklist of signs and symptoms designed to help parents distinguish between mild and severe illnesses in babies aged under 6 months. It's been well received by parents and professionals but its use has not been properly evaluated. In their randomised trial Hilary Thomson and others show that the use of Baby Check had no effect on service use (p 1740). In an editorial, however, David Jewell says that Baby Check enthusiasts should not be too disappointed (p 1711). Fewer consultations may not be a worthwhile aim, he says: what is needed is better consultations, rather than fewer, and Baby Check has the potential to help with this.

Another old debate rears its head in this week's ethical dilemma—what to do when relatives refuse to accept that a diagnosis of brain stem death means a declaration of death. The authors of the case suggest that the public is often confused about the differences between brain stem death and persistent vegetative state. Indeed, much confusion surrounds persistent vegetative state, and a new BMA report on withdrawing or withholding life prolonging treatment aims to clarify that confusion. In his editorial Steven Luttrell commends the report for trying to fill an ethical vacuum and providing practical guidance for doctors and safeguards for patients (p 1709).

The new debate, engaged in by Julia Neuberger and Raymond Tallis (p1756), is whether we should abandon the word “patient”—with its connotations of passivity and objectification (Neuberger) or of “the vulnerability of the ill person and the often harrowing responsibilities of the doctor or nurse” (Tallis). The one thing both agree on, however, is that there is no obvious word to replace it.


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