Diagnostic studies are abundant, but I continue to be amazed that senior researchers often write about things like “specificity” and “sensitivity” as if they are not context-dependent. more…

In the stories of Russia 120 years ago, by Turgenev, Chekhov and Tolstoy, there is a recurring scene: the landowner or his bailiff meets a crowd of discontented peasants and eventually placates them by handing around buckets of vodka. more…

The kidney is really just a sophisticated extension of the cardiovascular system, and in end-stage cardiac disease, measures of renal function provide the strongest prognostic markers (apart from B-type natriuretic peptide). more…

When I first started writing about plants in these reviews, I concentrated on neglected treasures, until a reader complained that he could never find a single plant I described. more…

Folic acid is a vitamin which is particularly necessary for fast-dividing cells – which is why we use folate antagonists to kill bacteria and cancers. But it is still a bit of a shock to think that modest folic acid supplementation (1mg daily) might possibly encourage the development of colon cancer, as this paper suggests. more…

Using traditional British medical metaphors for rarity, you could call this week’s NEJM the Hen’s Dental Journal (or indeed The Rocking Horse’s Lavatory). It had me sweating back on Nightmare Street, as I’ve never seen anything described in the main papers, beginning with renal amyloidosis and proceeding via adrenocortical carcinoma to syphilitic hepatitis, taking in along the way a previously undescribed form of bartonellosis. The correspondence ends with a description of Wiiitis; by which time you can catch the editor hiding a faint Brahmin smile. more…

Nothing illustrates the abasement of primary care in the UK better than the saga of chronic kidney disease and the estimation of glomerular filtration rate. On the flimsiest clinical evidence we were ordered to tell all our patients with an eGFR under 60 that their kidneys might pack up, and collect a few pence for doing it. more…

“Read, mark, learn and inwardly digest” is a phrase the teachers of my youth liked to use (it comes from Cranmer’s Collect for Bible Sunday, in the Book of Common Prayer). That’s what we need to do with articles about diseases we don’t come across often but shouldn’t miss more…

Another negative trial of homocysteine-lowering therapy: this is a substudy of HOPE-2 and shows that oral supplements of folic acid, pyridoxine and cobalamin lower HCy but do not reduce venous thromboembolism. more…

This week’s Annals contain an essay about Montaigne by Alan Wasserstein, entitled “Lessons in Medical Humanism”. Montaigne is generally credited with inventing the literary form called the “essay”, a word which contains a nice ambiguity – an attempt (essaie) to discuss ideas, but also an assay of the reader. more…