Ann Intern Med 6 Mar 2007 Vol 146

Population studies in the developed world generally find that about 20-25% of us are anxious and/or depressed, and that is what this US study found when it used a number of assessment tools plus direct patient assessment to detect anxiety disorders in primary care. The GAD-7 scale is pretty simple and reliable, and the first two questions alone (GAD-2: feeling nervous, anxious, or on edge, and not being able to stop or control worrying) pick up pretty well everyone with anxiety. By gad, I can’t stop worrying – about having to give drugs to my patients because I can’t get them cognitive behavioural therapy.If you were or indeed are a postmenopausal woman with low bone mineral density, which would you go for – a daily injection which causes nausea in a quarter of patients, a tablet once a week, or just daily calcium and vitamin D? It’s a bit of a no-brainer, you’d have thought, but the manufacturers of recombinant human parathyroid hormone (teriparatide injection) managed to get this study past a great number of ethics committees and enrolled 2532 women from 168 centres and followed them up for 18 months, by which time a third had dropped out. Sure, teriparatide has an effect: it’s impossible to quantify, thanks to the drop-out rate, and it’s hard to see how the drug can ever compete with bisphosphonates and strontium.

How can you evaluate a diagnostic test when there is no gold standard? That’s the problem with tests for “heart failure