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BMJ 2001; 323 doi: (Published 27 October 2001) Cite this as: BMJ 2001;323:1012

When patients are advised to visit the local genitourinary medicine clinic, it often doesn't go down well. A qualitative study of young women in Glasgow found that attending a genitourinary medicine clinic was a stressful event, but not as bad as they had expected. Family planning clinics were perceived as benign compared with genitourinary medicine clinics, which are still associated with people who hold unacceptable social and moral traits (Sexually Transmitted Infections 2001;77:340-3).

The contraceptive pill hits the headlines again. This time it's being linked with reduced bone density (Canadian Medical Association Journal 2001;165:1023-9). Data taken from a sample of 524 women enrolled in the Canadian multicentre osteoporosis study showed that premenopausal “ever been users” of the oral contraceptive pill have lower bone densities than “never users.” The reduction in bone density could mean increased fracture risks of 20-30%.

Biologists have found another good reason for having sex. Beneficial genetic mutations are passed on in sexual reproduction, leaving behind poor genetic environments. With asexual reproduction, mutations are passed on with all the old genetic baggage still intact, thus effectively holding back the spread of any advantageous mutations. In this particular set of experiments, fruit flies provided the evidence rather than humans (Science 2001;294:555-9).

Biodegradable cardiovascular stents could provide the answer for people who need temporary stenting. German material scientists have constructed a stent from corrodible iron and tested it out in rabbits. The result is a degradable iron stent that maintained patency up to 18 months later without thromboembolic complications or toxic effects. The advantages of such a system may prove particularly helpful in children, who, as they get older, develop a fixed obstruction at implantation sites with conventional stents (Heart 2001;86:563-9).

The damaging consequences of drinking alcohol include injuries. In trying to elucidate whether non-fatal injuries depend on the type of alcohol consumed or simply the amount, epidemiologists conclude that age, sex, and the amount of alcohol are more relevant than what is actually consumed. But injuries are more likely to occur when someone is very drunk, and from this survey it seems that beer drinkers are more likely to achieve such a state than those drinking wine or spirits (Journal of Epidemiology and Community Health 2001;55:789-90).

An examination of 314 randomised controlled drug trials from five general interest medical journals that was published in Family Practice (2001;18:570-3) showed that negative findings were reported in 13% of industry supported trials and 35% of non-industry supported studies (odds ratio 3.5). Although bias towards publication of positive results is well known, Minerva wonders what the connection is between sources of funding and the publication of research outcomes.

Noseclips may become the next “must have” accessory for people with asthma if the results of a small pilot study are confirmed. Aerosol drug delivery leapt up by 113% when 13 volunteers wore noseclips when hooked up to a nebuliser. The authors suggest that the noseclips work by improving the inspiratory versus expiratory ratio. Nasal obstruction, they say, works either by reducing nasal entrainment of air or by increasing the inspiratory drive (Swiss Medical Weekly 2001;131:495-7).

People with major depression apparently can't detect smells very easily. A group of 24 inpatients in the acute phase of a major depressive disorder was compared with a group of healthy subjects (matched for sex, age, and smoking behaviour). Olfactory sensitivity was greatly reduced in those with depression, but these differences virtually disappeared after medical treatment. One explanation for this phenomenon may lie in the close functional connections between the main olfactory bulb and the amygdala (Journal of Psychiatric Research 2001;35:271-7).

The closure of a large breast screening unit in west London has caused anxiety to patients and doctors alike. They may, however, take heart from an analysis in this week's Lancet (2001;358:1340-2). The authors conclude that the two best trials of breast screening failed to find an effect of screening on deaths ascribed to breast cancer after 13 years. Given the apparent lack of evidence for breast screening programmes, Minerva wonders why women are under such pressure to attend.

Women who have radiotherapy for breast cancer are thought to be at risk of developing cancer in neighbouring organs such as the other breast and the thyroid gland. Data from a large retrospective cohort study contradicts the theory, finding that the risk of thyroid cancer associated with radiation was so low as to be undetectable (Cancer 2001;92:1411-8).

A columnist in Health and Ageing (October 2001:52) says that his 13 years in clinical medicine, plus a spell in general practice, is the ideal education for any other occupation. Having moved into the media, he gained an undeserved reputation for being laid back, when all he was actually displaying was a sense of perspective. Once you've looked after a dying child, he says, “the loss of a can of film is but a trivial entry in the catalogue of human woes.”

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Previous reports suggest at least a contributory role for marijuana in formation of lung bullae in West Indian men (Thorax 2000;55:340-2). Two white male habitual marijuana smokers aged 26 (above) and 32 (below) presented with breathlessness, decreased exercise tolerance, and deranged lung function tests. Chest computed tomography showed giant lung bullae and severe upper lobe emphysema. One patient had an upper lobectomy and the second had bullectomy. Some thoracic surgeons are noting increased rates of lung bullae in young men with a history of smoking marijuana. Lung destruction due to smoking marijuana may be more common than was previously recognised.

R Rawlins, C S Carr, K M Brown, registrars, C R Cameron, J E Dussek, consultants, department of thoracic surgery, Guy's Hospital, London SE1 9RT

On 20 January 2002 the BMJ will be publishing a theme issue on war. This will focus on the humanitarian issues and the epidemiology of war. It will also debate how health professionals should respond to it. Submissions for this issue should be sent to papers{at} by 30 November stating that they are submitted for this issue.


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