BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7445.964 (Published 15 April 2004) Cite this as: BMJ 2004;328:964

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Gone are the days when cutting the chest wall open is always necessary for cardiac surgery. The rapid evolution of keyhole surgery has seen mitral valve procedures performed without sternotomy, using a left sided posterior mini-thoracotomy approach. A case series of 40 published in the Journal of Thoracic and Cardiovascular Surgery (2004;127: 1026-32) indicates that this type of approach not only offers a valuable option in more complex cases but also has acceptable levels of perioperative morbidity and mortality.

Waiting lists come with the territory of publicly funded health systems. As frustrating as waiting lists are for governments and patients alike, they serve a purpose when they're well managed. Maximised efficiency ensures a steady demand for precious resources such as staff, theatres, and beds, and some clinical problems spontaneously resolve during the waiting time. An editorial in the Journal of the Royal Society of Medicine(2004;97: 159-60) says we should focus more on the number of patients who have been treated, rather than the number still awaiting treatment.

Emergency departments are good places for drug companies to reach as many punters as possible. In the United States, drug companies' marketing expenditure rose by 70% between 1996 and 2000. An …

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