Intended for healthcare professionals

Editor's Choice

Intelligent analysis

BMJ 2006; 332 doi: (Published 01 June 2006) Cite this as: BMJ 2006;332:0-f
  1. Jane Smith (jsmith{at}, deputy editor

    The BMJ's shortcuts (p 1327) are our look at the research papers in the other big general journals. From this week on we are offering another view through Richard Lehman's blog on ( Richard Lehman is an Oxfordshire general practitioner who started writing a weekly review of JAMA, the Lancet, New England Journal of Medicine, and the BMJ for a few friends; the circulation then grew to the primary care department at Oxford University and beyond. We've been enjoying his review in the BMJ's office for some time, and we thought our readers might too.

    Richard puts in as many “tempters” for journal papers as he can manage on two sides of A4: “I regard them more as an illustration of my view of the medical humanities than evidence based medicine.” And he tries to find space for a filler, often on plants, but he promises proverbs, poems, and recipes.

    When he comes to review this week's BMJ Richard will probably include the papers on the effectiveness of prehospital parenteral antibiotics for suspected meningitis. The first, a case-control study by Anthony Harnden and colleagues (p 1295), showed that administration of parenteral penicillin by general practitioners was associated with an increased odds ratio for death; the second, a systematic review of observational studies by Susan Hahné and colleagues (p 1299), showed that the association between parenteral antibiotics and outcome was inconsistent. All authors conclude that confounding by severity is the most likely explanation for these counterintuitive results. The strength of the first study, says editorialist Duncan Keeley (p 1283), is that it restricts the analysis to children in whom the diagnosis was made by the GP (the study's statistician explains what a difference that makes on p 1297). Keeley concludes that GPs probably shouldn't change their practice with respect to prehospital parenteral penicillin, but he speculates that detecting and doing something about hypovolaemic shock while getting the child to hospital fast may be more important for improving survival.

    We might look back in 10 years' time and wonder what the fuss about COX 2 inhibitors was all about. The meta-analysis of randomised trials of COX 2 inhibitors and NSAIDs by Patricia Kearney and colleagues (p 1302) confirms that selective COX 2 inhibitors are associated with a moderately increased risk of vascular events (mainly due to myocardial infarction), as are high dose regimens of diclofenac and ibuprofen but not high dose naproxen. In their editorial on life without COX 2 inhibitors Shaughnessy and Gordon (p 1287) conclude that we probably haven't “lost a truly superior option.”

    Elsewhere in this week's issue is evidence that cardiologists provide the best care for patients with myocardial infarction, though for less ill patients (p 1306), and that commercial weight loss programmes do work (p 1309). And readers who are stung by the accusation of Darwinist Richard Dawkins that they “are a bit undereducated in Darwinism” (p 1294) might learn something from Paul Brown's lighthearted letter on unintelligent design (p 1341).

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