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Jeffrey Aronson: When I use a word . . . Nose-ography

24 Apr, 15 | by BMJ

jeffrey_aronsonWhile editing the forthcoming edition of Meyler’s Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions, I came across a suspected teratogenic effect of high dose oral contraceptives (no longer used)—multiple bony defects with pretibial dimples.

Dimples are mentioned in many entries in Online Mendelian Inheritance in Man (OMIM), a comprehensive source of genetic information, whose print version, Mendelian Inheritance in Man, was the brainchild of Victor McKusick when he was professor of medicine at Johns Hopkins Hospital in Baltimore. There are congenital cheek dimples, postauricular dimples, and dimples on the ear; dimples near joints; sacral dimples; and dimples over the acromial process of the scapula. more…

Maya Annie Elias: Tobacco control in India—more needs to be done to promote smoking cessation in India

24 Apr, 15 | by BMJ

mayaTobacco use is one of the single largest preventable causes of death and a leading risk factor for non-communicable diseases. The burden of tobacco related illnesses prompted the Government of India to initiate various measures for tobacco control. India adapted the WHO Framework Convention of Tobacco Control (FCTC) and passed the “Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce Production, Supply and Distribution)” Act in 2003. The National Tobacco Control Program (NTCP) was launched in 2007-08 and it listed a wide array of regulatory activities for tobacco control, including setting up the National Regulatory Authority (NRA), state and district tobacco control programmes, public awareness campaigns, establishment of tobacco testing laboratories, prohibition of smoking in public places, prohibition of advertisement, sponsorship and promotion of tobacco products, prohibition of sale of tobacco products near educational institutions, and regulation of health warning in tobacco products packs. more…

Carlos Martins: Overuse of medical tests—a new health risk factor?

24 Apr, 15 | by BMJ

Carlos_MartinsA risk factor is, among other things, an aspect of personal behaviour or lifestyle that, on the basis of epidemiologic evidence, is known to be associated with health related conditions considered important to prevent (1).

A new behaviour may be observed in the general population of western countries; a behaviour related to the way patients use medical services with preventive intention and the frequency that they receive medical tests and other screenings. Evidence shows an alarming tendency to overuse preventive health services (2,3). In Portugal, for example, a recent population-based cross-sectional study showed that the majority of Portuguese adults think they should undergo general routine blood and urine tests on an annual basis. Other, even less-recommended screening tests, such as lung X-rays, breast ultrasounds, abdominal ultrasounds, and gynaecological ultrasounds, are deemed necessary by a great proportion of the population (3). more…

The BMJ Today: Cancer drugs, BMJ awards, and challenges for the NHS

24 Apr, 15 | by BMJ

fdaDonald Light and Joel Lexchin write about the easy ride cancer drugs get in the approval process. They point to three weaknesses: trials on cancer drugs are more often unblinded and non-randomised; these drugs are more often approved through accelerated pathways; and, finally, they often use surrogate endpoints. The result is very expensive medicines with little added value: “The 71 drugs approved by the FDA from 2002 to 2014 for solid tumours have resulted in median gains in progression-free and overall survival of only 2.5 and 2.1 months, respectively.” more…

David Payne at WIRED Health 2015

24 Apr, 15 | by BMJ Group

David Payne29.20am: I’m in London at WIRED Health 2015, “exploring the future of healthcare.” Already I’ve bumped into a would-be investor and I’ve just had  a “power shot” of grapefruit juice spiked with chili. Now I’m browsing the exhibitor stands, which includes live demo of the elegant cream leather Tao chair which, according to its inventor and Tao Wellness CEO Viktor Kalvachev and its promotional blurb, is an “invisible gym in your living room” enabling me to work out different muscle groups while I sit at home. more…

David Kerr: Dr Uber

23 Apr, 15 | by BMJ

david_kerr_2015picThe hot topic in the technology world at the moment is the so called “sharing economy.” A great deal of money is being made by companies, such as Uber and Airbnb, where the internet is used to match buyers and sellers without the need for the huge upfront costs of purchasing, for example, cars and properties. The question is whether the concept of a sharing economy could also be of value in healthcare? more…

Jane Morris: Making the glorification of anorexia a crime

23 Apr, 15 | by BMJ

jane_morrisI make a point of telling students that an eating disorder is an illness, not a crime. It’s a more controversial statement these days. Some of my patients continue to argue that anorexia is their lifestyle choice rather than an involuntary illness, and I’ve just learned that the lower house of the French Parliament has approved legislation that would make the “glorification of anorexia” a crime punishable by large fines and even imprisonment.

Olivier Véran, a rather dashing young socialist politician, who is also a neurologist at the University Hospital of Grenoble, has amended health minister Marisol Touraine’s wider health bill to include two key measures on anorexia. more…

Richard Saitz: An EBM challenge—What to do when clear cut evidence doesn’t exist

23 Apr, 15 | by BMJ


This blog is part of a series of blogs linked with BMJ Clinical Evidence, a database of systematic overviews of the best available evidence on the effectiveness of commonly used interventions.

The case of so-called “moderate” drinking

It is “bad” enough when we have randomized trials to guide practice. What I mean is, of course solid consistent evidence from numerous trials should be used to inform practice, but even then it is challenging: do the benefits outweigh the risks? Do the benefits in tightly controlled trials persist in practice? Decisions about primary prevention with aspirin, treatment of stroke with thrombolytics, and the failure of brief counseling for heavy drinking in general practice are among many recent examples of these challenges. The challenges sometimes have to do with close calls, in which the probability of a benefit and a risk are similar and/or are valued differently, and sometimes have to do with limitations in the data or with real issues translating ideal practices to the real world. more…

The BMJ Today: Elders, teens, and tobacco in the modern era

23 Apr, 15 | by BMJ

dragon-final• Jonathan Gornall writes about the tobacco industry’s likely opposition to new UK plain cigarette packaging laws in the powerful feature, “Slaying the dragon: how the tobacco industry refuses to die.” In the article, he provides powerful insight into the industry’s methods for staying alive. These include development of new products, such as e-cigarettes, and working with sympathetic politicians to fight tobacco controls.

smoking_infoHe reminds us of powerful words from the World Health Organization: “It’s important to understand that tobacco products are the only legally available products that can kill up to one half of their regular users if consumed as recommended by the manufacturer.” This feature is accompanied by a series of punchy infographics that highlight just how widespread and costly tobacco use truly is. more…

Owen Bowden-Jones: New drugs, new harms, new clinical guidance

22 Apr, 15 | by BMJ

Owen-Bowden-JonesMindmelt, Annihilation, Black Mamba, and Kronic. Welcome to the world of novel psychoactive substances (NPS), or so called “legal highs.” The past five years has seen an unprecedented increase in the number of these psychoactive drugs. European figures reveal that over 100 new NPS were detected across EU drug markets during 2014 alone. That number has been increasing for the past seven years with no sign of slowing.

Many of the drugs are unregulated and available to buy over the internet or in so called “head shops.” Some clinicians have expressed concern that the legal status of NPS misleads users into believing that they are safer than more established drugs. more…

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