The BMJ Today: The challenges of foodborne illness, HIV, tuberculosis, and scorpion stings

Tiago_VillanuevaBeing a GP myself, one of the first things I did when I arrived in London last year to work at The BMJ was register with a GP. In London, for a certain catchment area, a resident is free to choose to register in one of a number of NHS GP practices, assuming that they are accepting new patients. Being a foreigner, I have to admit the online ratings and reviews of GP practices at the NHS Choices website were decisive in helping me decide which practice to choose. Moreover, reviews websites often help me decide which airlines, hotels, or restaurants to avoid.

A recent News story in The BMJ reports that reviews posted on the business review website Yelp have helped public health officials in New York City identify foodborne illness outbreaks. With the help of software, they analyzed about 300 000 reviews, and identified 129 that were consistent with a recent foodborne illness, and which met all the criteria for an additional investigation. Reviewers were contacted by email, and about a fifth agreed to be interviewed, thus allowing epidemiologists specialising in foodborne disease to confirm the reports. The researchers also add that the reviews have allowed them to spot outbreaks more easily than analysing emergency room visits, Google searches, or Twitter feeds.

On the other side of the planet, Jane Parry reports from Hong Kong that many young people are failing to identify the high risk they incur of becoming infected with HIV. According to the local Department of Health, 154 new cases were reported from January to March this year. Research by local non-governmental organisation AIDS Concern has found that 40.5% of young people sampled, aged between 14 and 21, did not use a condom during sexual intercourse. Parry attributes this situation to poor sex education in Hong Kong’s schools, which in turn helps perpetuate a low awareness of the risk of HIV infection, as well as stigmatizing social attitudes towards lesbian, gay, bisexual, and transgender people, and people living with HIV.

There’s better news for tuberculosis patients. A new drug combination called PaMZ, which contains PA-824 (an experimental drug), moxifloxacin, and pyrazinamide, could reduce the required time to cure drug resistant tuberculosis from two years to six months, while reducing the cost of treatment to a fraction of its current cost. A recent News story reports that Charity TB Alliance has said that a phase III clinical trial evaluating PaMZ is due to be launched by the end of the year in 50 sites in Africa, Asia, Eastern Europe, and Latin America.

The summer is just around the corner, and many of you will probably be heading to exotic destinations, like India, where doctors have to know how to diagnose and treat patients with scorpion envenomation. In a recent Endgames statistical question, Philip Sedgwick takes us through the intricacies of an open label randomised controlled trial that was carried out in a hospital and research centre in the Indian region of Mahad.

This trial compared the effectiveness of prazosin (a commonly used vasodilator) combined with scorpion antivenom with the control treatment, which was prazosin alone, on the recovery of patients who suffered a scorpion sting. In an open label trial such as this one, patients, researchers, and auxiliary staff were not blinded to treatment allocation after randomisation. This made the trial liable to ascertainment bias, also known as detection bias (or also known as assessor bias or response bias in specific circumstances), where participants and researchers may end up distorting the assessment of outcome measures. Wherever you go this summer, be careful with the food you eat, engage in safe sex, and keep scorpions at bay.

Tiago Villanueva is the editorial registrar, The BMJ.