Lancet 4 Aug 2007 Vol 370

A big brain, upright posture, a musical larynx, and the hand – such are the glories of anatomy which set us apart from other primates. So when rheumatoid arthritis sets about destroying the hand it destroys part of our identity as well as the ability to perform many tasks. This is one of many aspects touched on in this useful summary of surgery for the rheumatoid hand: the psychological benefits of restoration can be just as important as the functional.

Nine years have now passed since I first set about writing these little summaries of papers to look out for in the general medical journals, and to me it’s a major disappointment still to be writing about interferon beta as a treatment for multiple sclerosis. Many more promising treatments have appeared during that time – and gone away. So two cheers for this study, which proves that interferon-beta-1b can reduce the progression of relapsing-remitting MS when given early; three cheers to follow when the cause of MS is found; and any number when we really have a cure.

In developed countries we prevent cervical cancer by an enormously labour-intensive programme of patient recall, cervical cell sampling, microscopic examination, further notification, and colposcopy if necessary. Every stage is subject to quality control, and the net effect is a cost per death prevented of about £500k. But what if little of this is available, and none of it is quality-controlled, yet the prevalence of cervical cancer is much higher – as in many parts of the world? This trial from Tamil Nadu in India confirms the result of previous studies, showing that a spot of acetic acid on the cervix followed by a good look and treatment as necessary will prevent a great deal of cervical cancer at minimal cost.