Intended for healthcare professionals


The old and the new

BMJ 2000; 321 doi: (Published 15 July 2000) Cite this as: BMJ 2000;321:0

Some of the material in this BMJ tells familiar stories, albeit with a new twist, whereas other material has become possible only with the new millennium.

War is as old as humankind, and the second article in our series on conflict and health looks at measuring the effects of war on health (p 169). The authors describe the need to look beyond traditional measures—like infant and maternal mortality and malnutrition—to psychosocial problems, failures in public health, and the health effects of environmental degradation. Another article looks at deaths among humanitarian workers between 1985 and 1998 (p 166). The authors identified almost 400, two thirds of which resulted from intentional violence. The authors suggest ways of reducing deaths, including keeping a database that could guide prevention.

Communicable disease caused few deaths among the humanitarian workers, but catching a patient's infection is an ancient hazard for doctors. A Swiss group gives a new angle by showing that gastro- enterologists were much more likely than controls to develop infection with Helicobacter pylori (p 149). The old, the new, and communicable disease are brought together in the extract from the new Clinical Evidence of what works in preventing malaria in travellers (p 154). Only one intervention—use of insecticide treated nets—is supported by the highest quality evidence, and many familiar measures—like the use of chloroquine—have little evidence to support them.

The most remarkable story of the new is a tale from the internet. General practitioner Di Jelley tells how her heart sank when a mother arrived in her surgery with sheets of internet printouts (p 165). The mother's daughter had “selective mutism,” and the material from the internet included a series of case reports of children who had improved dramatically on fluoxetine. Dr Jelley was very open about her reservations, but a trial of treatment led to a great improvement.

Another millennium phenomenon is the appearance of NHS Direct, a telephone advice line for patients that will soon be available to everybody in Britain. Many doctors are sceptical about resources being diverted into what they see as a public relations exercise, but a debating point is what the effect will be on traditional services. An evaluation of the first year showed no reduction in the demand on immediate services except that there was no increase in demand for general practitioners' out of hours services—as there was in a control area (p 150).

Finally, the obituary of Joze Jancar describes how the ancient (indeed, dead) came in useful: because he did not speak English after escaping from Slovenia, the medical school in Galway interviewed him in Latin (p 180).


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