US highlights – 27 August 2010

Fiona GodleeFurther on in this blog, columnist Douglas Kamerow focuses on the seeming competition for funding among US health prevention programs (“Smoking versus obesity: must we target only one?”). But individuals can make a contribution too, rather than relying exclusively on politicians and government reforms to support public health measures. Elizabeth Loder, the BMJ’s US based clinical epidemiology editor, blogs about a charity dinner hosted by an organic farm business in an affluent suburb of Boston, which brings its super-crop of luxury tomatoes to less fortunate parts of the population, at drastically reduced prices: “Brookwood Farms, it turns out, is on a mission, in partnership with the Mattapan Food and Fitness Coalition. The aim is to make fresh, organic local produce available and affordable to the residents of Mattapan, an area of Boston that meets many criteria for being a ‘food desert.’ … I’m sure this particular dinner achieved its purpose. I know I will be making a contribution to Brookwood. Who can eat such magnificent food and not be moved to help make its ingredients available to all? The event got me thinking that while homegrown tomatoes are a great thing, so is homegrown charity. Americans are used to giving generously to charitable efforts around the globe, but pockets of great need and deprivation exist right here. Contributing to a local effort such as Brookwood may not seem as glamorous as contributing to global causes espoused by celebrities, but it surely merits more attention than it currently receives. Perhaps, like the best tomatoes, the best sort of charity is also homegrown.” Food for thought?

Best wishes
Fiona Godlee
editor in chief, BMJ

Latest research

Migraine with aura and risk of cardiovascular and all cause mortality in men and women

Individuals who have migraines with aura are at a higher—albeit altogether low—risk of dying from heart disease or stroke than people with no headache. This is the finding of a prospective cohort study reported by Larus Gudmundsson and colleagues. In an accompanying editorial, Klaus Berger and Stefan Evers question whether doctors should inform patients about the risks associated with migraine with aura. They argue that for many people the information will cause an unwarranted amount of anxiety, although others may use the opportunity to modify their lifestyle and risk factors accordingly. According to a second prospective cohort study reported by Tobias Kurth and colleagues, the risk of hemorrhagic stroke is higher for women with active migraine with aura than for women without migraine, whereas women with any history of migraine or with active migraine without aura did not seem to have a higher risk than women without migraine.

Read this research article and others at

Latest from the BMJ
Almost 20 years ago, researchers J M McGinnis and G H Foege found that the actual leading causes of death in the United States were not cardiovascular disease and cancer but smoking and disease related to diet and lack of physical activity. In the intervening decades, antitobacco efforts have been extremely successful, but in the recent past they have been overshadowed by an increasing focus on obesity. Although trends have long been going in the right direction, the downward trend in smoking seems to have stalled, and the tobacco companies are still out there pitching, trying to recruit new smokers to replace those who die or quit, writes Douglas Kamerow. One big test for federal funding will come as the new Patient Protection and Affordable Care Act (healthcare reform) goes into effect. Douglas remains hopeful: “Maybe there will be enough money to go around for both worthy causes. Funding to combat the two leading causes of death in America—whatever their rank order—should not have to be a zero sum game.”

Smoking versus obesity

“Obesity is the prize to pay for our children living very sheltered lives,” writes Luc Bonneux, in a rapid response on Follow this link to send us your own views on the subject.

Quick links—a selection of recent news stories

• US report calls for national strategy to reduce overuse of medical imaging
• Whooping cough outbreak hits several US states
• US doctors report shortage of medical isotopes

Latest pollThis week’s poll asks: “Should egg and sperm donors be paid more to reduce shortages in IVF clinics?”

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Latest podcast

Jill Morrison, a professor of primary care at Glasgow University, talks about how people on long term disability benefit because of mental health problems could be identified by their primary care doctors three years before they stop working. BMJ deputy editor Trish Groves explains more about the journal’s new policy of asking authors of eligible research articles to pay a publication fee. And Richard J Wassersug, professor of anatomy and neurobiology, explains why the modern eunuch remains invisible.

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Latest blogsSiddharta Yadav, a former BMJ Clegg scholar from Nepal, is determined to pursue his further training in internal medicine in the US. He is trying to reconcile his decision to leave his mother country with being fully aware of the implications of the external as well as internal “brain drain” that poor countries are subject to: “For me the single most important reason to take the decision to leave my country for further education was my interest in clinical research. I had to struggle a lot to even get a brief taste of clinical research during my medical training. I do not wish to remain under privileged in that aspect during my further training now. I believe that postgraduate training is the ultimate opportunity to indulge myself into clinical research. Unfortunately, this is not the case with post graduate medical education in Nepal.” And although life as an IMG is fraught with difficulty, he remains determined to last the course and would like to hear what others think about doctors leaving their countries and about IMGs.

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