BMJ 14 Jul 2007 Vol 335

Reading research papers is for most doctors an effort of duty rather than love, and although I have tried for nearly ten years to make it sound like fun, even for me the same usually applies. Since its remake, the BMJ has had so little worthwhile research material in some issues that I have been hard put to write about anything. On the other hand, every issue has been fun to read for the rest of its content. In her editorial Fiona Godlee tells us that this is part of a process of changing the focus to papers which will change practice. I hope so. We need much more research from working doctors who are grounded in daily clinical practice and have no desire to build academic careers, but do it purely from the urge to solve real life problems and improve patient care.

A sensible if rather generalised editorial on “The future of the medical profession” (no less) by Roger Jones ends with an awful clanger. “… there are signs that the new political administration may consider better ways of working with medical leaders and the NHS. The importance of doing so cannot be underestimated.” The importance of careful editing, on the other hand, cannot be overestimated. (Note for would-be professors wishing to write orotund editorials: the correct clichés are either “should not be underestimated” or “cannot be overstated”)

Antibiotic-related diarrhoea is certainly an important practical problem in British hospitals, especially when it is caused by Clostridium difficile. There is a plentiful literature about probiotic Lactobacillus preparations but much of it is difficult to apply to real life. Here the researchers gave a commonly available yoghourt drink, Actimel, or a sterile milkshake placebo to 135 elderly patients taking antibiotics in three London hospitals. This reduced the risk of all diarrhoea by two-thirds and none of the treated group got C difficile. Take along a tray of Actimel the next time you go into hospital.

Here is another nice example of well-focussed research: the topic is chronic venous ulceration. No opportunity here for fancy genomics, molecular pathways, and ingeniously crafted monoclonal antibodies. Human beings stand upright and subject the valves of their leg veins to a metre and more of fluid pressure. Blood products leak out through the effect of stasis and the skin breaks down and won’t heal. You can either squeeze the veins or strip them away, or both. This study shows that compression alone heals ulcers as well as compression plus surgery; but surgery helps to prevent further ulceration and so results in more ulcer-free time for patients.

A generally useful systematic review of treatments for painful diabetic neuropathy is marred by a subdivision of anticonvulsants into “traditional” and “newer generation” which is hard to decipher in the main text and in any case has no pharmacological meaning. It would have been better to tabulate the drugs individually. Anyway, it seems that the drugs I use most, like amitriptyline and gabapentin, are good safe bets for starters.

A nice clear guide to that baffling disease we call schizophrenia, which is associated with structural as well as chemical brain abnormalities. We are still left with many more questions than answers, but at least the authors feel justified in ending on an upbeat, pointing out that though most patients do get recurring episodes, most are able to lead nearly normal lives.