Minerva September 2003

Fears about biological terrorism in the United States have led to health workers currently being offered vaccination against smallpox. The main hazard is eczema vaccinatum, a possibly life threatening reaction to the vaccine in people with a history of atopic dermatitis or eczema. Self reporting has led to only a third of the expected numbers giving a history of skin disease, but the good news is that not a single case of eczema vaccinatum has occurred in the first 31 000 health workers who have been vaccinated (Annals of Internal Medicine 2003;139:1-7).

If and when the whole population is urged to be vaccinated, some sort of compact should be offered, says Clinical Infectious Diseases (2003;36:1547-51). This agreement between the citizens and their government would say that vaccination could be done without informed consent but that the government would underwrite claims for damage from adverse reactions.

Nurse practitioners have become competent lower gastrointestinal endoscopists, but only recently have they been shown to carry out upper endoscopies without any problems. A prospective study at King's College Hospital, London, found that few differences emerged in the diagnoses of or the discomfort or satisfaction reported by the patients who had had endoscopy by a nurse and those investigated by a doctor (Gut 2003;52:1090-4).

Since 1983 the American Cancer Society has recommended that mammographic screening for breast cancer …