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Richard Lehman’s journal review—1 September 2014

1 Sep, 14 | by BMJ

richard_lehmanNEJM 21-28 August 2014 Vol 371
711  I have a new little grandson called Timothy. He is lucky being born in August because respiratory syncytial virus generally lies low at this time of the year. Most babies get RSV at some stage of their first year, and the earlier they get it the worse it tends to be, with recurring bronchiolitis every time they get any kind of upper respiratory virus. So I’m hoping Tim won’t get RSV this side of Christmas, and that when he does he will shake it off as a mere cold. There is no effective treatment, although the NEJM seems to believe there may be one in the offing, as they have chosen to give space to a British phase 1 study of GS-5806, a novel oral small molecule that inhibits RSV entry at low nanomolar concentrations by blocking viral-envelope fusion with the host-cell membrane. That sounds like a pretty cunning trick, and in a challenge study in 54 healthy adults, it reduced the viral load and the severity of clinical disease. It also tended to reduce their neutrophil counts and raise their alanine aminotransferase. So not much use for my tiny Tim until it has undergone phase 2 and 3 trials in lots of adults and babies in the community. more…

The BMJ Today: When money and medicine mix

28 Aug, 14 | by BMJ

Anne_GullandEarlier this year, The BMJ published an editorial urging doctors in India to fight back against corruption in medicine. Kickbacks and bribes are a global problem but India, “with rampant corruption at all levels, is prominent in this international field,” the authors wrote.

Since the publication of the editorial in June, the article has been accessed more than 5000 times, but a new feature on by Vidya Krishnan shows how the anticorruption movement is gaining momentum. more…

The BMJ Today: If wishes were sustainable development goals

27 Aug, 14 | by BMJ

kellyFourteen years ago, leaders from across the world came together at the United Nations headquarters in New York to pledge their efforts towards achieving eight targets for global development. Together, these targets became known as the millennium development goals or MDGs (with three of them directly devoted to a health objective).

Since then, The BMJ, along with other publications and organisations, has scrutinised these goals. We’ve analysed the likelihood of achieving these goals—ruminating on the great challenges they present, and the actions that could advance their attainment. Equally, we’ve flagged up the MDGs’ success stories, such as when the goal for access to safe water was achieved five years early.

More recently, we’ve begun thinking about life after 2015, when the time allotted for the MDGs to do their thing runs out. Last year, Charles Kenny from the Center for Global Development examined the lessons we’ve learnt from the MDGs, and suggestions for the post 2015 development agenda. more…

The BMJ Today: Ebola, Edinburgh, edifices

26 Aug, 14 | by BMJ

deputy chair of MJA on stage (1)Ebola and the forthcoming referendum on Scottish independence have, among other things, spared UK national newspaper editors the anxiety of how to fill column inches in the “silly season” month of August. The BMJ can at least drop a print and iPad issue, as it is doing this week, but we and other general medical journals are devoting online space to showcase resources about the Ebola outbreak. Visit to find out more. more…

David Zigmond: Can we always “treat” our tragic paradoxes?

22 Aug, 14 | by BMJ

david_zigmond2Robin Williams’s recent death is a familiar shock: another premature loss of a publicly loved figure. How do we understand and respond to such tragic discrepancy?

On the radio (BBC’s Today programme on Radio 4, 15/8/2014) there were lengthy interviews with two publicly accountable experts: the director of long term conditions for NHS England and the president of the Royal College of Psychiatrists. The interviewer asked whether we could “diagnose” and “treat” psychiatric conditions with greater speed and effectiveness—breast lumps were used as an analogy. All three thought that they could comfort one another and the rest of us with assurances: yes, with better science, systems, and training our interception and outcomes are bound to improve. more…

The BMJ Today: Medicine’s vast horizons

22 Aug, 14 | by BMJ

jose_merinoAt first glance, three articles published this week in The BMJ appear to have limited relevance to medicine. One, written by an economist, discusses the challenges faced by demographers when making predictions about population changes; a second deals with international drug control treaties and the need for policy experiments to evaluate the benefits and risks of drug legalization; and a third discusses whether it is ethical to hire sherpas when climbing Mount Everest. more…

Richard Lehman’s journal review—18 August 2014

18 Aug, 14 | by BMJ

richard_lehmanNEJM 14 August 2014 Vol 371
601  The usual wisdom about sodium chloride is that the more you take, the higher your blood pressure and hence your cardiovascular risk. We’ll begin, like the NEJM, with the PURE study. This was a massive undertaking. They recruited 102 216 adults from 18 countries and measured their 24 hour sodium and potassium excretion, using a single fasting morning urine specimen, and their blood pressure by using an automated device. In an ideal world, they would have carried on doing this every week for a month or two, but hey, this is still better than anyone has managed before now. Using these single point in time measurements, they found that people with elevated blood pressure seemed to be more sensitive to the effects of the cations sodium and potassium. Higher sodium raised their blood pressure more, and higher potassium lowered it more, than in individuals with normal blood pressure. In fact, if sodium is a cation, potassium should be called a dogion. And what I have described as effects are in fact associations: we cannot really know if they are causal. more…

The BMJ Today: When the worst choice is no choice at all

14 Aug, 14 | by BMJ

You would think that any woman raped as an act of war would be given access to a safe abortion by an international organisation providing aid. Sally Howard’s Feature on reveals that, astonishingly, this is often not the case.

I would highly recommend reading this article. It explains that the 1973 Helms Amendment to the United States (US) Foreign Assistance Act has resulted in “an outright ban on US aid funds being used for all abortion related activities, other than post-abortion care.” Although the amendment applies to aid from the US, aid workers have warned that, more broadly, the absence of abortion provision in humanitarian responses to conflict could be “squarely attributed” to US foreign aid policy. If you want to learn a bit more about the number of women who have undergone unsafe abortions there is an informative infographic here. more…

Richard Lehman’s journal review—11 August 2014

11 Aug, 14 | by BMJ

richard_lehmanNEJM 7 August 2014 Vol 371
497  A new gene for breast cancer susceptibility? The PALB2 gene locus has been known about for several years, but this study puts it firmly on the map by intensively investigating 362 members of 154 affected families. The risk for female PALB2 mutation carriers, as compared with the general population, is 35% by the age of 70—about the same as for BRCA2 mutation carriers. The editorial explains why this is so: both genes work in concert to repair double strand breaks in DNA. This is a very fundamental process, and you would have thought that any impairment to it would lead to a whole range of cancer risks, but in the case of PALB2, the risk seems to be mainly of breast cancer (in men as well as women) and Fanconi’s anaemia. Therapeutic efforts for carriers of BRCA and PALB2 mutation carriers are focussed on inhibition of PARP, causing cells that contain broken double stranded DNA to die rather than turn cancerous. more…

The BMJ Today: Boring can be beautiful

7 Aug, 14 | by BMJ

sally_carterMary E Black’s blog on making data beautiful caught my eye this morning. As a technical editor at The BMJ I see a lot of tables, graphs, plots, and charts. I don’t want to put my job at risk, but I’ve got to agree with Mary when she writes that many of these representations of data are boring.

In her blog, she gives us her “top 10 inspirations for glorious data displays.” A world of books, talks, blogs, websites, and hackathons and jams opens up. As Mary writes, “Given that data, and in particular big data, is inevitable, exciting, inspiring, unlocks potential, has fabulous hidden patterns, is a game changer, is a huge business opportunity, can mobilise resources, can change our organisations and our lives forever . . . why does it have to be so BORING?”

And with the importance of data in mind, The BMJ has just published three research papers. more…

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