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Editor's Choice

Reasons for optimism

BMJ 2007; 335 doi: (Published 13 December 2007) Cite this as: BMJ 2007;335:0
  1. Rajendra Kale, senior clinical editor, BMJ
  1. rkale{at}

    Why would we publish a clinical review of a condition that affects only about 7000 people in the United Kingdom? We reject many articles because the condition described is “too rare for the BMJ.” Why is cystic fibrosis (p 1225; doi: 10.1136/bmj.39391.713229.AD) an exception? Much has changed for patients with the condition. They live longer—the predicted survival for babies born in the 21st century is now more than 50 years; the standard treatment is changing; and the focus is now on screening newborns. Therefore non-specialists are more likely to encounter patients with cystic fibrosis than they did in the past. All of which is good news.

    This week’s BMJ provides solutions for several clinically important problems. A systematic review (p 1248; doi: 10.1136/bmj.39398.682500.25) finds that antithrombin III should not be given to critically ill patients. This is good news because not using this expensive drug could save money, and it might save lives too because the drug increases the risk of bleeding. A randomised controlled trial (p 1251; doi: 10.1136/bmj.39399.456551.25) finds that the solution to treating a displaced intracapsular fracture of the femoral neck is arthroplasty, not internal fixation. The treatment of this “unsolved fracture,” as Martyn Parker calls it in his editorial (p 1220; doi: 10.1136/bmj.39392.353090.80), has been controversial for 50 years, so it is good to have an answer. And a feasibility study (p 1244; doi: 10.1136/bmj.39405.472975.80) finds that a population screening programme for coeliac disease run by nurses detects patients who were not picked up during routine clinical care.

    Elsewhere, too, the news is good. WHO has launched a campaign—“Make medicines child size”—to make drugs safer for children (p 1227; doi: 10.1136/bmj.39423.581042.DB). This will hopefully reduce the use of unlicensed drugs in children and make more drugs available to them. The UK government is to spend £105m on improving stroke services, which is aimed at preventing 1600 strokes and cutting 6800 deaths and disabilities a year (p 1231; doi: 10.1136/bmj.39423.703993.DB). And £520m is to be ring fenced for a reform that will provide older people and those with disabilities with individual budgets and more control over their social care budget (p 1231; doi: 10.1136/bmj.39426.592176.DB). All this has put me in a positive frame of mind and made me optimistic even about modernising medical careers, and I find myself convinced by Martin Marshall, who says that the MTAS cloud has a silver lining and the Tooke report is a window of opportunity (p 1222; doi: 10.1136/bmj.39421.672523.BE).

    But in case you thought that all is well even with the NHS, you should read what Gerry Robinson says about it in a documentary (p 1268; doi: 10.1136/bmj.39426.643449.0F). Robinson, a management guru, was charged with reviving Rotherham General Hospital in South Yorkshire and met with some success. But he said on his return, “I just despair of this stuff . . . It reminds me of Russia, 800 million light bulbs but no shirts. You have the central dogma driving it but no logic.”

    Finally, the story I enjoyed most (p 1233; doi: 10.1136/bmj.39423.603391.DB) told who lived longer—old master sculptors or old master painters? Sculptors it is, and a possible reason is the greater amount of physical work involved in their art. Clearly the sensible thing to do this Christmas is to bin the watercolour paint and brushes and buy a hammer and chisel.

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