NEJM  30 Dec 2010  Vol 363
2588   A sizeable multinational study seeks to find out whether providing free daily anti-retroviral drugs as well as free condoms might help to reduce the transmission of human immunodeficiency virus in men who have sex with men. The majority of the subjects were recruited in Peru, with smaller groups from Ecuador, Brazil, Thailand, the USA, and South Africa. It’s highly likely that if all at-risk men took the antivirals every day (as offered), they would achieve very high levels of protection; but in this randomised trial, the reduction in infection was only 44%. Blood tests to check for compliance showed detectable antiviral levels in 51% of those who remained seronegative but only 9% of those who became positive for HIV. more…

Carl Heneghan

The last few days has been hectic since the publication of our systematic review in the BMJ on the use of  antivirals in children.  By now, you are probably aware of the findings given the media interest. Basically, our study raised questions about the usefulness of antiviral flu drugs in preventing and treating flu in children, indicating the harmful effects may not be justified by the limited benefits provided. This puts us in direct conflict with the DOH policy of antivirals for all. I think what is important in the present pandemic is to remember how we spent a number of years preventing a similar strategy with the use of antibiotics in sore throat; especially when the published research showed limited benefits in mild disease and the emergence of resistance became a real issue.    more…

Why did the operator at the National Pandemic Flu Service give the child Tamiflu? The cynics will say because the algorithm told him to, but the real answer, according to the UK government, is that it’s the safest thing to do to prevent severe infections. New research in the BMJ questions that policy and looks likely to cause confusion among the public and doctors alike. more…

Human brown fat deposits and the effectiveness of nicotine replacement therapy are just two of the subjects touched on this week by Richard Lehman in his journal review, which also includes a parody of a T S  Eliot poem read by Dylan Thomas. more…

Using maggots to help heal ulcers does not sound like the most modern method but a BMJ paper has found that it can be effective. Researchers studied the effects of maggots and Hydrogel on healing ulcers. They found that there was no difference between using maggots or Hydrogel on the healing time for ulcers, but maggot therapy did reduce the time to debridement. However using maggots did also increase ulcer pain. more…

A BMJ paper has been covered in Computer Weekly this week. The paper reported that a computerised test could be used to calculate whether patients are at risk of Type 2 diabetes and therefore allow doctors to intervene before they develop the disease. The test uses information from patient’s electronic health records and can also be used by the public online (http://www.qdscore.org/). more…

There is some good news this week for men in their fifties who have not exercised much in the past. A BMJ study published last week shows that taking up exercise between 50 to 60 years old is just as effective as exercising frequently by middle age. This means that it is never to late to take up an exercise regime. more…

A friend has written to me asking whom I think might be the “E O Wilson of Medicine,” and I’m stumped. Perhaps some readers of the BMJ have never heard of E O Wilson. For those that haven’t he is a Harvard biologist who has twice won the Pullitzer Prize and who invented “consilience,” the synthesis of knowledge from different areas of human study. In short, he’s the person most biologists would like to read. (I must confess that I’never read him, although I have Consilience on my “to read” list – along with 300 other books.) more…

The BMJ received some praise this week in a blog by Revere, on the Science Blogs forum. Here is an extract:

“Science journals are not just about science. They compete with each other for readership, public recognition and prestige. It used to be that in the UK publishing world The British Medical Journal (BMJ) was the dull, conservative journal and The Lancet was more “out there.”….Now they seemed to have switched places.” more…

Two BMJ studies published last week have been widely cited by the press. The first has found that women’s resting heart rate is a good predictor of coronary events in women. US researchers studied the heart rates of 129,000 postmenopausal women and found that those with the highest heart rates were more likely to have a myocardial infarction or coronary death than those with the lowest heart rates. more…