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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…

Lavanya Malhotra: India’s lost girls and doctors’ complicity

6 Aug, 14 | by BMJ

Lavanya MalhotraAccording to India’s 2011 census, the sex ratio in India was 943 women for every 1000 men. Yet a recent report by the United Nations reveals that the child sex ratio in India has declined from 927 girls for every 1000 boys in 2001, to 918 in 2011. Behind this statistic, the report points out, are the clinics and medical practitioners “directly mediating sex ratios at birth via sex selection.”

Historically, Indian couples tended to keep on having children until they had produced at least one son or two. In 1974, in an effort to slow down the growth of India’s rapidly booming population, Delhi’s All India Institute of Medical Sciences said that Indian women no longer needed to produce endless children until they bore the right number of sons. Instead, the institute encouraged the determination and elimination of female fetuses. Sex determination followed by abortion would at least dissuade couples from producing extra daughters. This stand might have been conducive to curbing accelerated population growth, but it certainly didn’t help the cause of saving female children. more…

The BMJ Today: What good are doctors?

6 Aug, 14 | by BMJ

Call it an exercise in reflective learning or a sign of deep insecurity, but articles like Richard Smith’s latest blog (“I hate going to the doctor“) always make me (mentally) replay my most recent consultations as a GP. I can’t always be certain that seeing me helped those patients, although I know that many have made an impact on me.

Much of what we do is about connecting with people, and results aren’t always tangible. Brian Secemsky recounts one such encounter, where further followup, rather than an early, quick fix, led to much more than a useful solution for his patient. He concludes, “perhaps outcomes wouldn’t have changed and costly resources wouldn’t have been utilized,” but “the amazing relationship that has evolved . . . would not have come to fruition without going beyond the automated pleasantries of etiquette based medicine.” more…

The BMJ Today: Going beyond the call of duty

5 Aug, 14 | by BMJ

Move over the automation of clinical algorithms and etiquette based checklists, suggests Brian Secemsky, a physician, as he shares a touching account of a patient consultation. Choosing to build a rapport with his patient over several appointments helped unravel the real cause of her suffering, and facilitated appropriate management, which would have otherwise been missed or taken longer. Advocating for a change in physicians’ approach to patients, Secemsky writes: “The medical community should aspire to treat interpersonal communication not as a daily chore to accomplish, but rather as an essential part of becoming a seasoned clinician, as important as excelling in clinical reasoning and resource utilisation.” more…

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