Intended for healthcare professionals

Editor's Choice US editor's choice

Milestones, tombstones, and sex education

BMJ 2007; 334 doi: (Published 18 January 2007) Cite this as: BMJ 2007;334:0-a
  1. Douglas Kamerow, US editor (dkamerow{at}

    Over the past several weeks, the BMJ has been conducting a poll of readers to determine the world's greatest medical milestone since the journal began publishing in 1840. Experts provided 15 candidate advances, ranging from immunizations to birth control pills to x-rays, and more than 11,000 readers voted. In addition to this week's regular journal, we are publishing a supplement with articles about each of the candidates and why they deserved to be the number one milestone (

    But there can only be one winner, and it is—drum roll, please—sanitation (10.1136/bmj.39097.611806.DB)! Doesn't sound too sexy, but as Johan P Mackenbach points out (, crowding and disease actually led to a decrease in life expectancy in Britain in the first half of the 19th century until sewage disposal and clean water systems arrived to reverse it.

    Also in the news section this week is a postmortem (10.1136/bmj.39024.487720.68) by Harlan Krumholz and colleagues on the Vioxx affair, asking what we can learn from that debacle. They conclude that we need better guidelines for industry and independent researchers to work together when evaluating new drugs. Independent safety monitoring boards, greater journal scrutiny of new drug trials, and timelier follow up by journals when they find something amiss would also help.

    Does sex education help prevent unwanted pregnancies? We hope so, but there has been little evidence from randomized trials. Marion Henderson et al publish long term results from the SHARE trial (10.1136/bmj.39014.503692.55) of more than 4000 women. Half took a 20 session sex education course when they were between 13 and 15 years old, and the other half received convention health education that included some sex education. Although the intervention group reported improved knowledge about and quality of sexual activity, there were no differences in their pregnancy or termination rates through age 20. In an accompanying editorial (10.1136/bmj.39087.374653.BE), Trevor Stammers urges careful evaluation of other approaches, including those that more closely involve the family in sex education.

    Now that I have your attention, don't forget to check out the new, redesigned, launched this week. A companion to the new print BMJ, the website is cleaner, clearer, and (we hope) easier to navigate. Comments welcome.

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