Bmj Usa: Editor's Choice


BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E87

This article originally appeared in BMJ USA

Life is a series of transitions: from child to adult to senior citizen; from school to work to retirement; from being single to marriage to widowhood or divorce. There is much about transition in this issue of BMJ USA.

Are obese children more likely to remain obese as they move through adulthood? In a prospective study of 1142 children followed from birth in 1947, Wright et al found that overweight teenagers were more likely to be obese as adults (BMJ USA p 85). However, being thin in childhood and adolescence did not protect against obesity in adulthood, and most fat adults were not overweight as children. These findings, the authors conclude, suggest that whole-population interventions aimed at reducing body mass index in childhood may not improve adult health.

As our patients advance into older ages, polypharmacy often occurs, increasing the risk of adverse drug reactions and interactions, and imposing a financial burden on many seniors. In a study of the impact of a pharmacist's review of elderly patients' medications, Zermansky et al found that the review resulted in significant changes in patients' drugs and reductions in drug costs (BMJ USA p 79).

Women go through a hormonal transition during menopause. In an editorial, Dixon reviews the evidence showing that hormone replacement therapy (HRT) reduces the effectiveness of breast screening and increases the risk of breast cancer in women aged 50 and older (BMJ USA p 70). Dixon suggests that it may be time to reassess the value of HRT and to consider other options, such as delivering progestogen directly to the uterus combined with systemic estrogen administration.

In the transition from medical student to practicing physician, we move through that memorable rite of passage known as the residency. The European Working Time Directive will limit the working hours of physicians in training to 58 hours a week beginning in 2004, and to 48 hours by 2009 (BMJ USA p 75). In the US, the Accreditation Council for Graduation Medical Education's limits on resident work hours are poorly enforced, and remedies are now being pursued through legislation and regulation (BMJ USA p 76). As if excessive hours weren't bad enough, residents are often subjected to bullying, as described in a poignant story on page 111.

I am moving through my own transition, after having been elected to the American Medical Association's Board of Trustees in June 2001. Because of a potential conflict between my work for the BMJ and my new role at the AMA (which publishes JAMA), I am resigning as editor of BMJ USA. I'm sad to leave the journal, but I'm delighted that Steven Woolf, MD, MPH, who has been an outstanding associate editor of BMJ USA, has been named as the new editor.—Ron Davis, MD editor, BMJ USA

Wright et al (BMJ USA p 85)

Zermansky (BMJ USA p 79)

Dixon (BMJ USA p 70)

Pickersgill (BMJ USA p 75)

Anonymous (BMJ USA p 111)

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