BMJ 25 Nov 2006

As a jobbing clinician, how often do you use a prognostic scoring system? Never, would be the answer for most of us, though we have a vague idea about the prognostic significance of various (mostly cancer-related) terms such as Duke’s C or Gleason 6. When I looked at prognostic scoring systems for heart failure (see Heart Failure and Palliative Care Ch4) I found that there were lots but none that predicted death as well as a single measurement of B-type natriuretic peptide (BNP). Here, GRACE of these investigators, we have a risk score following acute coronary events which is based on nine easily obtained clinical factors, so that in about 15 minutes you could work out whether your patient is likely to die within 6 months. Alternatively, of course, you could just glance at the BNP at 72 hours (or better still, rate of increase of BNP – see Circulation 2004;110:3206).

Here’s a short review of clinically localised prostate cancer which really does tell you all you need to know and manages to be readable despite tight compression of information. Good summary charts. More articles like this please.

The worst thing about the NHS is that there is no mechanism for matching public demand with clinical provision. Clinicians and managers, not politicians, are being left to do the dirty work of deciding which patients’ lives matter most in this land of plenty. So rationer’s moan can be heard throughout the land, and with good reason, especially in relation to trastuzumab (Herceptin).

A professor of oncology attacks the peddlers of “alternative treatments