Editor's Choice US editor's choice

The next best thing

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39120.563542.3A (Published 08 February 2007) Cite this as: BMJ 2007;334:0-a
  1. Douglas Kamerow, US editor (dkamerow{at}bmj.com)

    Medicine and public health are always looking ahead. The problem is trying to figure out when something new is better and not just novel.

    With an ageing population comes an increased incidence of macular degeneration, which can cause severe visual impairment. Usha Chakravarthy and Jennifer Lim discuss new, expensive drugs—growth factor inhibitors and monoclonal antibodies—that inhibit the development of macular degeneration. Their editorial (doi: 10.1136/bmj.39100.460671.BE) briefly reviews research that has established that these drugs are better than placebo in slowing neovascularization, but the drugs must be injected into the eye every month to be effective. How much is society willing to pay to keep our elderly population's vision intact?

    Another promising technology riding to the rescue is computed tomography screening for the early detection of lung cancer. The authors of recently published cohort studies claim they have established that smokers benefit from CT scan screening. Pamela McMahon and David Christiani remind us (doi: 10.1136/bmj.39090.662963.80) of similar claims for chest x-ray screening made 30 years ago. Only when randomized controlled trials were performed was it clear that previous observational studies had biases that mistakenly led to conclusions of effectiveness. The authors wisely counsel that we await the results of RCTs now in progress before queueing up at our local radiologists' offices for lung scan screening.

    What drugs will we be able to turn to if and when the next influenza pandemic hits? Sotirios Tsiodras et al (doi: 10.1136/bmj.39105.428981.BE) are concerned that many countries are stockpiling only oseltamivir, which is a newer more expensive antiviral agent. Older drugs, such as amantadine and rimantadine, have fallen from favour because of increasing resistance (and perhaps lower profits?). Wei Shen Lim and colleagues review (doi: 10.1136/bmj.39101.628715.80) current clinical guidelines for treating influenza patients.

    Finally, in a refreshing change from the constant drumbeat of new drugs and technologies, Clare Gillies and associates compare (doi: 10.1136/bmj.39063.689375.55) the effectiveness of lifestyle and pharmacological interventions to prevent or delay the onset of type 2 diabetes in persons at increased risk. Their meta-analyses show that diet and exercise programs are at least equal to (and may be better than) drug treatment in preventing or delaying diabetes.

    Sometimes the next best thing is not new at all.

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