For the benefit of a patient who has ovarian cancer and had been taking hormone replacement therapy, I have just been reviewing the HRT risk/benefit equation as we have come to understand it over the last 7 years or so. Back then, we had observational data which suggested that HRT might be the key to preventing osteoporosis and vascular disease in women, against which we needed to balance the somewhat increased risk of breast cancer. The WISDOM of starting a big primary care randomised study did not seem to be in question, until the publication of the Women’s Health Initiative Study in 2002. At that point the WISDOM trial was stopped and only now are its abundant data presented to us – showing a lesser than expected increase in total cancer risk (ovarian is not even mentioned) and a slightly higher than expected increase in thromboembolism and myocardial infarction, especially in older women.
We depend on our practices nurses to tend chronic leg ulcers for as long as necessary, using such materials as their great wisdom and experience dictate. But patients occasionally send us into a panic by turning up outside nurse hours with venous ulcers which they expect us – yes, doctors – to be able to dress. Tipping out the contents of the nurses’ cupboard, we stick on a plausible choice of rectangular wadding with some fancy name and hide it under some sort of tubular bandage which might last the night. Phew. Yes, the nurse will be in tomorrow, goodbye. According to this painstaking systematic review of ulcer dressings, we did right: anything that doesn’t adhere to the ulcer, with some compression on top, is as good as anything else.
Queen Victoria’s chaplain, the Revd Charles Kingsley, once scandalised a dinner party by declaring (with his usual stammer) that he could understand every sexual perversion except celibacy. Alas, this has never been the standard Christian position on the subject, and in the USA the promotion of celibacy is a major tenet of the evangelical right, to the point where abstinence has been seriously promoted – and investigated – as the key to preventing HIV infection. Does it work? Sure it does – most people who don’t have sex don’t get HIV. But do young Americans actually show any sign of having less sex as a result of programmes to promote abstinence? Well, would you believe it, this systematic review shows a complete lack of effect.
The second part of a wise guide to asthma in children from Newcastle upon Tyne. First of all, distinguish asthma from recurrent viral wheeze, for which short-acting bronchodilators are dangerous and usually useless, whereas short courses of oral steroids may help. For true asthma, do not use high dose inhaled steroids, but stick to the lower strengths. Short acting bronchodilators are once again a bad thing, whereas there may be a place – yet to be clearly defined – for long-acting beta-adrenergic drugs provided they are used together with inhaled steroids.